News Scan for Dec 29, 2016

Saudi MERS cases
H7N9 in China, Hong Kong
Salmonella Oslo outbreak
Antibiotic-free chicken
Cholera in Yemen

Saudi officials report MERS in 2 healthcare workers

Saudi Arabia's Ministry of Health (MOH) today announced two new MERS-CoV illnesses, both of them involving expat women working as healthcare workers in Aseer, located in the southwestern corner of the country.

Their ages are 30 and 41, and both are asymptomatic after contracting Middle East respiratory syndrome coronavirus (MERS-CoV) in the healthcare setting. The country's most recent case from Aseer, announced by the MOH on Dec 8, involved a 60-year-old Saudi man who had direct contact with camels and died from his infection.

The pair of new infections raise Saudi Arabia's MERS-CoV total to 1,519. Twelve people are still in treatment or monitoring.
Dec 29 Saudi MOH statement


H7N9 avian flu infects 2 more in China, 1 in Hong Kong

Two more H7N9 avian influenza cases have been reported in China, one in Shanghai and the other in Hunan province, according to government statements translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

The illness in Shanghai is the second recent case to be reported from the city for the current flu season. The first, announced Dec 21, involved a man from Jiangsu province. A statement today from the city's health department said the new case-patient is a 34-year-old man who is being treated for his infection. It's not clear where the man was infected, as the report seems to suggest he has a connection to Sichuan province.

Meanwhile, officials from Hunan province in a statement yesterday announced an H7N9 infection in a 53-year-old woman who had direct contact with poultry and is receiving treatment.

China is experiencing a fifth wave of H7N9 activity, and so far 19 cases have been reported during this season.
Dec 29 AFD post on Shanghai case
Dec 29 AFD post on Hunan case

In a related development, Hong Kong's Centre for Health Protection (CHP) today reported its second H7N9 case of the season today, a 70-year-old man with underlying health problems who had traveled to the mainland Guangdong province cities of Shenzhen and Zhongshan, where he came across mobile stalls selling live poultry. After he returned to Hong Kong he bought chilled chicken from a shop near a live-poultry market, but no live poultry were sold in the shop.

The man's symptoms began on Dec 26, about 10 days after he returned from the mainland. He sought care the following day and was admitted to the hospital isolation ward yesterday where he is in stable condition.

The new cases from China and Hong Kong boost the global H7N9 total since the virus emerged in humans in 2013 to 827, according to a case list maintained by FluTrackers, an infectious disease news message board.
Dec 30 CHP statement
FluTrackers H7N9 case list


CDC: 14 Salmonella Oslo infections linked to cucumbers

A total of 14 patients in eight states have been sickened in an outbreak of Salmonella enterica serotype Oslo linked to Persian cucumbers, the Centers for Disease Control and Prevention (CDC) reported today. The outbreak was first identified in April.

According to today's Morbidity and Mortality Weekly Report (MMWR), illness-onset dates ranged from Mar 21 to Apr 9, and ages of the patients range from 3 years to 68. Nine of the 13 patients were female. Three of the patients were hospitalized, but no deaths were reported.

Michigan reported 3 of the cases, Minnesota, Massachusetts, Illinois, and Ohio reported 2 each, and Wisconsin, Nebraska, and Kentucky reported 1 apiece.

After the outbreak was detected by PulseNet, the CDC, along with the Food and Drug Administration (FDA) and state and local health and agricultural departments, conducted epidemiologic, trace-back, and laboratory investigations to identify the source. Evidence indicated that Persian cucumbers bought at a single grocery chain were the source of the outbreak, although none of the cucumber samples collected yielded any Salmonella.

This is the fourth Salmonella outbreak associated with cucumbers since 2013, with more than 1,200 illnesses and 260 hospitalizations in the previous three outbreaks, the CDC said. Because of these outbreaks, the FDA has selected cucumbers for an enhanced microbiologic surveillance sampling program in fiscal year 2016 that will assess common factors associated with Salmonella contamination.

The CDC advises consumers to thoroughly wash and scrub cucumbers and refrigerate them as soon as possible to prevent multiplication of bacteria.     
Dec 30 MMWR report

Burger King, Tim Hortons to stop serving chicken raised on antibiotics

The company that owns fast-food chains Burger King and Tim Hortons announced yesterday its intention to switch to chickens raised without medically important antibiotics, Reuters reports.

Restaurant Brands International Inc said it plans to make the switch in US stores in 2017 and in Canadian stores in 2018.

The company becomes the latest major restaurant chain to stop serving chickens raised on antibiotics that are also used in human medicine. McDonalds made the move earlier this year, and Wendy's Co announced that its chicken would be antibiotic-free by 2017. Chik-fil-A says it will stop serving chicken raised with medically important antibiotics by the end of 2019.

"We believe that it is important to reduce the use of antibiotics important for human medicine in order to preserve the effectiveness of antibiotics in both veterinary and human medicine," the company told Reuters.

But a representative of the group As You Sow, which promotes corporate responsibility through shareholder activism, told Reuters that Restaurant Brands International isn't going quite as far as the other companies. Under the plan, the company will eliminate only those antibiotics that are "the most critical in human medicine," from their supply chain, Reuters reports.

Public health officials are concerned that the use of medically important antibiotics in food-producing animals is contributing to the emergence of antibiotic resistant infections, and have called on the agriculture industry to reduce their use. Approximately 70% of all medically important antibiotics sold in the United States are used in farm animals.

Last week, the FDA reported that the sales and distribution of medically important antibiotics for use in food animals rose by 2% from 2014 to 2015.
Dec 28 Reuters story
Dec 22 CIDRAP News story "FDA: Antibiotic use in food animals continues to rise"


Suspected cholera cases in Yemen approach 13,000

Yemen in the past week has recorded 1,089 new suspected cholera cases, including a fatality, raising its outbreak total to 12,733 suspected cases, the World Health Organization (WHO) said today in its weekly update.

The new cholera-related death brings that total to 97, for a case-fatality rate of 0.76%, the agency reported. To date, 163 stool samples have tested positive for Vibrio cholerae 01.

The affected areas include 135 districts in 10 governorates and the national capital of Sana'a. Almost 60% of cases and deaths have been in the governorates of Aden, Ibb, Taizz, and Al Hudaydah.
Dec 29 WHO update

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