News Scan for Dec 12, 2016

Ebola in breastmilk, semen
Colistin-resistant Klebsiella
Anthrax vaccine funds
Low chikungunya numbers
Creutzfeldt-Jakob test

Breastmilk, semen carry Ebola virus for extended periods

An international group reporting in Clinical Infectious Diseases said a 9-month-old who died of Ebola in Guinea after her parents showed no signs of the illness likely contracted the virus through her mother's breastmilk. Both the mother's milk and the father's semen tested positive for Ebola virus.

The child represented the first case of Ebola in the area where she was living in 42 days, and no known epidemiologic contacts could be found. Genetic testing revealed that both parents carried the virus but reported being asymptomatic.

The authors note that, though rare, transmission of Ebola from asymptomatic mothers to children is possible via breastmilk.
Dec 10 Clin Infect Dis abstract

In related study published today in The Lancet Global Health, researchers studied 26 male Ebola survivors to measure how long Ebola stayed in their reproductive tracts post-infection.

They found Ebola virus RNA in semen samples up to 407 days after disease onset (median, 158 days). Using statistical analysis, they predicted that 90% of men will clear Ebola virus from their semen within 294 days of disease onset.

The men supplied seminal fluids every 3 to 6 weeks, with a median follow-up of 255 days. The authors said that the time to clearance of Ebola virus RNA from seminal fluid varied greatly. Previous studies showed Ebola virus RNA in semen for up to 9 months post-infection.
January Lancet Glob Health study


Study describes colistin resistance in Carbapenem-resistant Klebsiella

A new study from an ongoing investigation into patients with carbapenem-resistant Klebsiella pneumoniae (CRKp) has found resistance to colistin in 13% of patients.

The study, published in Clinical Infectious Diseases, looked at a cohort of 246 patients nested within the Consortium on Resistance Against Carbapenems in Klebsiella pneumoniae (CRACKLE), a prospective, multicenter observational study of patient hospitalized with CRKp. The study included patients who were tested for colistin susceptibility as part of routine clinical care from December 2011 to October 2014.

Colistin resistance is considered a grave threat in patients with severe CRKp infections because it is one of the last lines of defense against multidrug-resistant bacteria. With growing use of the drug over the past two decades, cases of colistin-resistant CRKp strains are being reported globally.

Of the 246 patients, colistin resistance was confirmed by a central research laboratory in isolates for 31 (13%), and patients with colistin-resistant CRKp were associated with a more than triple hazard for 30-day in-hospital mortality (aHR 3.48, P < 0.001). Polymerase chain reaction testing indicated a number of different strain types, a finding the authors say argues against a single clonal outbreak. None of the patients in the colistin-resistant CRKp group received colistin in the 14 days preceding the first positive culture.

The authors also say the colistin resistance observed in the isolates appears to be chromosomally mediated; analysis of the isolates did not indicate the presence of the MCR-1 or MCR-2 genes, which are carried on plasmids and can readily transfer colistin resistance to different types of bacteria.
Dec 10 Clin Infect Dis study

HHS awards $1 billion contract for anthrax preparedness through 2021

The Department of Health and Human Services (HHS) announced it was giving $1 billion to Emergent BioSolutions to supply the Strategic National Stockpile (SNS) with 29 million doses of BioThrax, an anthrax vaccine, through September of 2021. 

BioThrax is the only Food and Drug Administration–approved anthrax vaccine that's licensed for use both pre- and post-exposure to Bacillus anthracis, which causes anthrax and can be used as a biological weapon. Emergent also announced today that the Biomedical Advanced Research and Development Authority (BARDA) issued a notice of intent to deliver $100 million worth of BioThrax to the SNS within the first half of 2017.

"Emergent believes these actions reflect the U.S. government's continued assessment of anthrax as a high-priority threat and its firm commitment to protect the nation against bioterrorism," said Daniel J. Abdun-Nabi, president and chief executive officer of Emergent BioSolutions, in a press release. "We are pleased to be able to make meaningful contributions to helping the government execute its strategy to achieve its preparedness goals."
Dec 12 Emergent press release


PAHO reports only 256 new chikungunya cases

For the third update in a row, the Pan American Health Organization (PAHO) late last week reported low chikungunya numbers, with only 256 new cases.

The previous two updates noted only 231 and 305 new cases, respectively. Countries and territories in the Americas this year have now reported 441,867 suspected, confirmed, and imported cases, according to PAHO's Dec 9 report.

Guatemala reported the most new cases, with 133. It now has 5,169 cases for the year. Bolivia was next with 31 new cases and 20,804 for the year.

Many nations, however, are behind in their reporting to PAHO on the disease. Brazil, for example, which has logged about 80% of the cases so far in 2016 and noted more than 100,000 new cases in a catch-up report in early November, has not reported on the latest 3 months' of data.

The outbreak started in late 2013 on the Caribbean island of St. Martin, and has now sickened 2,320,307 people.
Dec 9 PAHO update


Diagnostic algorithms developed for Creutzfeldt-Jakob disease

A new study in JAMA Neurology showed that a diagnostic algorithm could diagnose Creutzfeldt-Jakob disease (CJD) with 100% specificity and sensitivity by using cerebral-spinal fluid (CSF) samples and nasal swabs.

In the case-control study, 86 Italian patients with sporadic CJD were followed from suspected diagnosis to death. Using modified nasal brushing to collect olfactory mucosal (OM) samples and by combining those results with CSF samples, the researchers were able to achieve 100% sensitivity, whereas traditional OM-only tests have 73% sensitivity. OM sampling is suggested if CSF results are negative. Gentle nasal swabs, or brushes, worked as well as cytobrushes for OM collection, the study found.

The authors concluded that early and accurate diagnosis of Creutzfeldt-Jakob disease is imperative. While there's no known cure for the neurodegenerative disease, early treatments can help alleviate some symptoms.
Dec 12 JAMA Neurol study
Dec 12 OIE Finland report
Dec 12 Avian Flu Diary post

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