News Scan for Feb 16, 2017

H5N8 in Israel, Europe
Vaccine safety
Imported-food outbreaks
C diff cluster
Leptospirosis in NYC

H5N8 avian flu outbreaks expand in Israel, Europe

Israel and four European countries reported more highly pathogenic H5N8 outbreaks, according to the latest updates from the World Organization for Animal Health (OIE). Israel reported six new outbreaks in the central part of the country, with start dates ranging from Jan 23 to Feb 12, five of them at farms (turkeys, ducks, and laying hens) and one involving three barn owls found dead at a nature park. Of the poultry outbreaks, the virus killed 6,515 of 99,260 susceptible birds.

In Europe, Croatia reported four more H5N8 outbreaks, all of them in backyard poultry at neighboring premises near the city of Tordinci in the far eastern part of the country. Czech Republic officials also reported four more outbreaks involving backyard poultry, which together killed 39 of 303 birds across three different regions.

Italy reported one more H5N8 outbreak, which began on Feb 14 at a turkey farm in Lombardy region in the north and led to 100 poultry deaths among more than 14,000 birds. Also, Poland reported two more events involving backyard poultry, affecting Silesia province in the south and Lower Silesia province in the southwest.
Feb 16 OIE report on H5N8 in Israel
Feb 16 OIE report on H5N8 in Croatia
Feb 16 OIE report on H5N8 in the Czech Republic
Feb 16 OIE report on H5N8 in Italy
Feb 16 OIE report on H5N8 in Poland


Anti-vaxxers offer $100,000 for proof of thimerosal safety in vaccines

With no mention of the deep scientific literature that has already shown that thimerosal in vaccines does not cause autism, two prominent voices of the anti-vaccine movement yesterday announced a $100,000 "challenge" to anyone who can demonstrate the safety of vaccines that contain the preservative, multiple media reports noted yesterday.

Robert F. Kennedy, Jr., son of the former US attorney general, via his World Mercury Project, offered the money to anyone "who can find a peer-reviewed scientific study demonstrating that thimerosal is safe in the amounts contained in vaccines currently being administered to American children and pregnant women," the New York Daily News reported. He appeared at a press conference with actor Robert De Niro to challenge vaccine safety. Kennedy may head a vaccine safety commission under President Donald Trump, who has also made anti-vaccine comments.

Paul A. Offit, MD, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, told Buzzfeed, "There are seven studies, published from 2000 to 2007, showing that children who received thimerosal-containing vaccines were at no greater risk of getting autism as compared to those who contained the same vaccines that didn't contain thimerosal."

Since 1999, no vaccine except most seasonal flu vaccines has contained thimerosal, an ethylmercury. The removal of the preservative from childhood vaccines has not been associated with a resultant decline in autism.

Kennedy said the Trump administration still plans to convene a vaccine safety commission to explore potential links between vaccines and multiple disorders, including autism, Medscape reported today. Earlier this month more than 350 medical organizations wrote to Trump to express "unequivocal support for the safety of vaccines."
Feb 15 New York Daily News story
Feb 15 BuzzFeed report
Feb 16 Medscape article


US reports says disease outbreaks tied to imported foods rising

The incidence of US disease outbreaks related to imported food, though a small proportion of all such outbreaks, has increased in recent years, with fish and produce most commonly implicated, federal scientists said yesterday in Emerging Infectious Diseases.

Experts from the Centers for Disease Control and Prevention and the Food and Drug Administration highlighted national outbreak data from 1996 to 2014. They noted 195 outbreaks related to imported food from 1996 to 2014, which resulted in 10,685 illnesses, 1,017 hospitalizations, and 19 deaths. As well, the percentage of outbreaks related to imported food compared with all outbreaks climbed from 1% in 1996 through 2000 to 5% in 2009 through 2014, and the average annual number increased from 3 in the earlier period to 18 in the latter.

Most illnesses were associated with Salmonella and Cyclospora, and the most common agents reported were scombroid toxin and Salmonella. Fish and seafood were responsible for 55% of the outbreaks and 11% of illnesses, and produce was responsible for 33% of outbreaks and 84% of illnesses. Outbreaks attributed to produce had a median of 40 illnesses, compared with a median of 3 in outbreaks attributed to fish and seafood.

Food imported from Latin America and the Caribbean was most commonly implicated, followed by Asia.
Feb 15 Emerg Infect Dis study


Study: Stewardship helps reduce C diff incidence in German hospital

A study yesterday in Antimicrobial Resistance and Infection Control describes a cluster of hospital-acquired Clostridium difficile infections (CDIs) in 26 patients with osteoarticular (bone and joint) infections.

The study was initiated after an increase in CDI incidence was observed in early 2015 in patients on the septic ward of a German hospital who experienced mostly implant-associated osteoarticular infections. Retrospective analysis showed that the rise in incidence on the ward had begun in 2014. The aim of the study was to define the source of the infections and evaluate the impact of measures taken by the hospital after the increase in CDIs.

From June 2014 through December 2015, 63 patients with gastrointestinal disorders were tested for C difficile, and CDI was confirmed by polymerase chain reaction testing in 26 patients. Multilocus sequence typing showed that 15 of the CDIs (58%) were caused by C difficile ribotype RT027. But molecular epidemiologic analysis, environmental sampling, and analysis of inpatient contacts could not identify a common source of the RT027 isolates. The only shared risk factor among the patients with RT027 was their stay on the septic ward.

Evaluation of the infection control and antibiotic stewardship measures undertaken by the hospital in response indicated that the incidence of CDI was reduced only after implementation of an intensified antibiotic stewardship program that lowered the use of three high-risk antibiotics on the septic ward: fluoroquinolones, third-generation cephalosporins, and clindamycin. Use of those antibiotics on the septic ward was double to triple the use of unaffected orthopedic wards. The intervention shifted antibiotic therapy toward the use of narrow-spectrum penicillins, linezolid, and rifampicin.

"The successful reduction of the CDI incidence demonstrates the importance of antibiotic stewardship programs focused on patients treated for osteoarticular infections," the authors conclude.
Feb 15 Antimicrob Resist Infect Control study        


Small cluster of leptospirosis reported in New York City

Three people in a one-block area of the Bronx have been diagnosed as having leptospirosis, a rare bacterial disease spread by rats.

According to NYC Health, the city’s department of health and mental hygiene, all three cases occurred in the past 2 months. This is the first time a cluster of cases has been identified in the city.

Leptospirosis does not transmit person to person; instead it's transmitted when humans come into contact with the infected urine of rats or with water or soil that's been contaminated. According to NYC Health, there were 26 cases of leptospirosis reported in New York City from 2006 to 2016, or 1 to 3 cases per year.

If not treated with antibiotics, leptospirosis can cause acute renal failure, liver failure, and even death. Symptoms are wide-rangin, and can include fever, jaundice, and a rash.

"Given the non-specific presentation of leptospirosis, providers are reminded to consider leptospirosis in any patient presenting with evidence of acute renal and hepatic failure, or … a history of exposure to rats or environments contaminated by rat excreta," a press release from NYC Health said.
Feb 14 NYC Health press release

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