News Scan for May 05, 2017

Minnesota measles
Liberia illness cluster grows
Adult vaccine uptake
Drug resistance in hospitals

Measles outbreak in Minnesota, fueled by anti-vaxxers, grows to 44 cases

A Minneapolis-area measles outbreak that has been fueled by low vaccination rates in Somali-Americans grew by 3 cases today, to 44, the Minnesota Department of Health (MDH) reported today.

Anti-vaccine advocates have encouraged residents to avoid the measles-mumps-rubella (MMR) vaccine over baseless claims of a link to autism, the Washington Post reported today. The activists include Andrew Wakefield, an anti-vaccine leader, who visited the Somali community several times in 2010 and 2011, after which MMR vaccine rates plummeted.

Wakefield defends his role: "The Somalis had decided themselves that they were particularly concerned. I was responding to that."

He says of the measles outbreak, "I don't feel responsible at all."

But local Somali-American clinician Siman Nuurali countered, "It's remarkable to come in and talk to a population that's vulnerable and marginalized and . . . to take advantage of that. It's abhorrent."

Yesterday Kris Ehresmann, RN, MPH, infectious disease director for the MDH, said state officials are considering imposing mandatory isolation and quarantine orders on some people to help contain the outbreak, according to the Minneapolis Star Tribune. "We have some people who have not followed what we asked, and they have been blatant in exposing other people. They have potentially spread the disease in other locations," she said.

As part of a large immunization response, the MDH has widened its MMR recommendations, the department said in a news release yesterday. In addition to the usual guidelines—in which kids receive a shot around 1 year old then from 4 to 6 years old—officials said children living in affected counties and Somali-American children statewide should get the second MMR vaccine dose on an accelerated basis. That means they should receive it if they had the first dose at least 28 days previously.

"We would not be surprised if we saw additional cases in other parts of the state where there are clusters of unvaccinated people before this is over," Ehresmann said in the release.
May 5 MDH update
May 5 Washington Post story
May 4 Star Tribune article
Mar 4 MDH news release
May 4 MDH guidance for healthcare workers


Seven more cases reported in Liberia's unexplained illness cluster

Seven more cases have been reported in an unexplained illness cluster in Liberia in people who attended the funeral of a religious leader in Sinoe County, raising the total so far to 28, the African Press Agency (APA) News reported yesterday.

Francis Kateh, MD, Liberia's deputy health minister and chief medical officer, told reporters in Monrovia yesterday that the seven additional cases are from Greenville, the epicenter of the outbreak and where the funeral took place, according to the APA report.

He reiterated that tests have ruled out Ebola and Lassa fever, and he added that two pathologists are expected in Liberia today to conducts autopsies. So far, 12 deaths have been reported, and the two most recent ones were a man from Monrovia who had traveled to the funeral and his fiancé, who apparently had not. Kateh said the health ministry is searching for 60 people from Monrovia who attended the Greenville funeral to observe and isolate them.

Meanwhile, a World Health Organization (WHO) spokesman said at a press briefing in Geneva today that results of tests at labs in Europe and the United States are still pending, but so far the investigation suggests a point-source of infection, with the leading theory as food, drink, or water poisoning, Agence France-Presse (AFP) reported today. Tarik Jasarevic said the overall risk of spread is thought to be low.
May 4 APA story
May 5 AFP story


CDC says US adult vaccine coverage up but still wanting

The use of several key adult vaccines increased slightly in 2015—the year for which the most current data are available—but are still low, the US Centers for Disease Control and Prevention (CDC) reported today.

CDC researchers evaluated self-reported immunization statistics from the National Health Interview Survey for recommended adult vaccinations in 2015, and for flu vaccine during the 2014-15 flu season, according to the latest figures in Morbidity and Mortality Weekly Report (MMWR).

They noted that pneumococcal vaccine uptake increased by 2.8 percentage points over the previous year (to 23.0%), tetanus and diphtheria with acellular pertussis (Tdap) vaccine uptake was up 3.1 percentage points (to 23.1%), herpes zoster vaccine among adults aged 60 years and older increased 2.7 percentage points (to 30.6%), and hepatitis B vaccine use among healthcare workers rose by 4.1 percentage points (to 64.7%). Flu vaccine coverage improved by 1.6 percentage points, to 44.8%.

Increases of Tdap and herpes zoster vaccines were similar to those seen in 2014. Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30% or higher.

The authors concluded, "Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage."
May 5 MMWR report
Feb 5, 2016, CIDRAP News scan on 2014 numbers


Study finds multidrug resistance rates similar in small, large US hospitals

A study yesterday in Clinical Infectious Diseases reports no systematic differences in rates of antimicrobial resistance between large tertiary care hospitals and small community hospitals.

Using antibiotic susceptibility data obtained from The Surveillance Network Database-USA, which includes a network of clinical laboratories that serve approximately 300 hospitals across the United States, investigators compared multidrug-resistance (MDR) rates at large tertiary care hospitals (TCHs) and small community hospitals (SCHs) for five organisms: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Facilities were considered SCHs if they had fewer than 300 beds. Investigators identified 38 TCHs and 68 SCHs.

When the investigators compared MDR rates for inpatient and outpatient locations at both types of hospital for the entire study period, they found that the MDR rates were higher at SCHs for four of the organisms: E coli (26.1% vs. 24.9%), S aureus (52.7% vs. 45%), K pneumoniae (25.5% vs. 17.8%), and A baumanni (59.9% vs. 41.1%). Resistance rates in P aeruginosa were higher at TCHs (17.2% vs. 15.3%).

An examination of yearly MDR rates from 1999 to 2012, after adjustments were made for time and variability between hospitals, showed that MDR was higher in A baumannii only at small community hospitals in both patient locations, while E coli showed higher resistance at TCH inpatient locations, and S aureus was higher in SCH outpatient locations. No significant differences in resistance were found for other organisms between the two types of hospital.

The authors say they were surprised by the findings, since they hypothesized that TCHs would have higher MDR rates because they see more complex cases. But that might be balanced out by the fact they are also more likely to have antimicrobial stewardship and infection control programs than SCHs. Finding that MDR is no less of a problem at small community hospitals, they say, emphasizes the importance of ensuring those facilities have those programs as well.
May 4 Clin Infect Dis study

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