News Scan for Dec 19, 2016

H7N9 in Hong Kong
Bacteriophage study
Chikungunya update

Hong Kong reports first imported H7N9 case of the new season

Hong Kong's Centre for Health Protection (CHP) today announced its first imported H7N9 avian influenza case of the new season, in a 75-year-old man who started having symptoms in Guangdong province in southern China, according to a statement.

The man has underlying health conditions and was seen at a hospital in Dongguan for chest discomfort on December 8. When he returned to Hong Kong the next day he was admitted to a hospital, and initial tests were negative. On Dec 17 he developed a fever and was diagnosed with pneumonia. Tests on a nasopharyngeal aspirate sample was positive for H7N9. The patient is in serious condition and has been in isolation.

According to the report, the man denied any poultry or live market exposure. The man's contacts haven't showed any symptoms and further tracing of his contacts in Hong Kong is underway.

Hong Kong has now reported 17 imported H7N9 cases. The latest case is part of a fifth wave of H7N9 activity since the virus was first detected in humans in 2013. The mainland has reported eight infections over the past several weeks.
Dec 19 CHP statement


Aerosolized bacteriophages help reduce drug-resistant Acinetobacter

A new study by researchers in Taiwan has found that bacteriophages show promise as an environmental biocontrol agent against drug-resistant infections.

In a paper published Dec 16 in PLoS One, the researchers describe a two-phase prospective intervention study in which they added aerosol with active bacteriophage to the standard cleaning procedures in the intensive care units at a public teaching hospital in Taiwan. Bacteriophages, also known as phages, are viruses that infect bacteria and have been shown to have some activity against drug-resistant bacteria. The purpose of the study was to investigate whether aerosolized phages could affect nosocomial incidence of carbapenem-resistant Acinetobacter baumannii (CRAB), a problematic pathogen in ICUs that can survive for long periods of time on inanimate surfaces.

In the study, the researchers measured the incidence density of CRAB, along with carbapenem resistance rates and antimicrobial drug consumption amounts, in the ICUs over two periods: January 2012 to February 2013 (the baseline period), and March 2013 to December 2013 (the intervention period). During the baseline period, routine environmental decontamination procedures were followed. In the intervention period, a phage aerosol was used after routine cleaning.

During the study, a total of 264 new acquisitions of CRAB were identified in the ICUs—191 in the baseline period and 73 in the intervention period. The rates of new acquisitions of CRAB decreased from 8.57 per 1,000 patient-days in the baseline period to 5.11 per 1,000 patient-days in the intervention period. In addition, the percentage of carbapenem-resistant isolates with A baumannii decreased from 87.76% to 46.07%. There was also a significant reduction in the consumption of three antimicrobials used against CRAB (tigecycline, meropenem, and colistin methanosulfonate). Consumption of imipenem decreased as well, but less dramatically.

"In conclusion, this is the first study to use a phage as an environmental biocontrol agent to decontaminate CRAB colonization in ICUs," the authors write. "Phage can significantly reduce the incidence of CRAB and provides adjuvant activity for the control of CRAB infection in healthcare settings."
Dec 16 PLoS One study


PAHO's annual chikungunya total grows by 33

Continuing a string of a small stream of new chikungunya cases, the Pan American Health Organization (PAHO) last week reported 33 new infections, even fewer than the 256 and 231 cases reported in the previous two weeks.

Countries in the Americas have now reported 441,900 suspected, confirmed, and imported cases, according to a Dec 16 report from PAHO. Nations reporting new cases include Mexico, Colombia, and the United States. All of the US infections are imported, with 154 such cases reported so far this year.

Several countries have not reported new totals for several weeks. Sometimes nations report several weeks of new data at one time to bring their totals up to speed.

The outbreak started in late 2013 on the Caribbean island of St. Martin, and has now sickened 2,320,340 people.
Dec 16 PAHO update

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