News Scan for May 15, 2017

Saudi MERS cases
Syria paralysis cluster probe
H5N1, H5N8 outbreaks
Chikungunya spike
Access to older antibiotics

Three hospital-related MERS cases in Saudi Arabia

Over the weekend and through today, Saudi Arabia's Ministry of Health (MOH) reported four more MERS-CoV cases, including two linked to possible healthcare exposures.

On Saturday, a 54-year-old Saudi man from Bisha was listed in critical condition after being infected during a hospital stay, indicating a possible hospital outbreak. The man was symptomatic. Last week, Saudi Arabia reported that a 71-year-old man from Bisha was in critical condition with Middle East respiratory syndrome coronavirus (MERS-CoV).

Yesterday, a 55-year-old Saudi man from Riyadh was also diagnosed as having MERS. He was symptomatic and in critical condition. He was listed as a primary exposure, meaning he did not contract the disease from another person.

Today, two expatriate healthcare workers from Riyadh were also diagnosed, a 33-year-old man and a 30-year-old woman. They were both asymptomatic and in stable conditions. Their cases seem to suggest a second hospital outbreak, as Bisha and Riyadh are roughly a 5-hour drive apart.

The latest cases raise Saudi Arabia's number of MERS cases since the disease was first detected in humans in 2012 to 1,608, which now includes 665 deaths. Five people are still being treated for their infections.
May 13 MOH update
May 14 MOH update
May 15 MOH update


Investigators probe acute flaccid paralysis cluster in Syria

Health officials are investigating a cluster of 23 acute flaccid paralysis cases in Syria, and test results on one of the samples suggests potential vaccine-derived poliovirus (VDPV), ProMED Mail reported on May 12, based on a submission from an anonymous source that it says is known and reliable.

Samples were apparently sent to the US Centers for Disease Control and Prevention (CDC) for further testing. Authorities are worried that the virus is a circulating VDPV (cVDPV) type 2. The case cluster is located in the Miadin district of Deir ez-Zor governorate in eastern Syria.

ProMED said the submission is the first validation of media reports describing a suspected polio case cluster, adding that there is instability in the area, which experienced a wild poliovirus outbreak in 2013 that at the time prompted vaccination campaigns. ProMED said lower routine vaccine coverage heightens the prospect of cVDPV in inadequately vaccinated people.

So far this year, only five wild poliovirus cases have been reported—three in Afghanistan and two in Pakistan. No cVDPV cases have been recorded so far, compared with three at this time last year, according to the latest information from the Global Polio Eradication Initiative (GPEI).
May 12 ProMED Mail post
GPEI polio case update


H5N1 strikes more backyard birds in Vietnam

In the latest avian flu developments, Vietnam reported more highly pathogenic H5N1 outbreaks, and Russia and South Korea reported new H5N8 detections in poultry farms that affected 2.5 million birds, according to notifications from the World Organization for Animal Health (OIE).

Vietnam reported three more H5N1 outbreaks in backyard poultry in Dak Lak and Dak Nong provinces in the south. The events began from Apr 29 to May 4, killing 550 of 4,007 susceptible birds in total. Authorities culled the surviving birds as part of the response measures, which in Vietnam also includes vaccination.

The latest H5N8 outbreak in Russia, which has reported several recent events, occurred at a large farm in Tatarstan Republic in the west. The outbreak began on May 3, and of 447,800 susceptible birds, the virus killed 5,202.

South Korea reported 40 more H5N8 outbreaks that occurred from Feb to and Apr 4. All involved poultry farms, mostly those that raised ducks, but also chicken breeder, broiler, and layer facilities. The outbreaks occurred in three provinces: North Jeolla, South Jeolla, and South Chungcheong. The virus killed 1,323 of 2,058,869 birds on the farms.
May 15 OIE report on H5N1 in Vietnam

PAHO reports 16,000 new chikungunya cases, mostly in Brazil

Countries in the Americas reported 16,436 new chikungunya infections, led almost entirely by new cases in Brazil, the Pan American Health Organization (PAHO) reported late last week.

The case count for 2017 has now reached 48,009, according to PAHO's May 12 update. The agency reported 825 and 907 cases the 2 previous weeks.

Brazil accounted for 16,156 of the new cases and has now tallied 43,010 this year, or 90% of the total. Panama had the next-highest increase, with 97 new cases and 716 for the year, but Peru wasn't far behind, with 96 new cases and 751 so far in 2017.

Brazil has still not reported on its most recent month of data. And many nations have not reported on their chikungunya situation for even longer stretches of time, with more than half not reporting at all in 2017. PAHO reported two new deaths last week, raising that number to nine, all in Brazil.

The chikungunya outbreak began in late 2013 on the Caribbean island of St. Martin and has now sickened at least 2,435,036 people.
May 12 PAHO update


Market forces limiting access to older antibiotics, experts say

Older antibiotics that are still effective are not widely marketed or universally available because they are not seen as profitable, according to a new commentary by European infectious disease experts in Clinical Microbiology and Infection, and the authors say limited access to these drugs is a threat to antibiotic stewardship.

According to the article, recent research has shown that 22 of 33 old but still useful antibiotics—including drugs like penicillin, nitrofurantoin, and fosfomycin—were marketed in fewer than 20 countries in 2011 mainly because of economics, with high registration costs and small market size leading to a perceived lack of return on investment for pharmaceutical companies. Meanwhile, another study showed that, in the United States, 148 antibiotics were in short supply from 2001 to 2013, with 22% of drugs experiencing multiple shortages.

The authors note that child-friendly formulations of old antibiotics also have limited availability. Some suspension liquids—considered superior in terms of absorption to crushed-up tablets—have been withdrawn from the market, while some parenterally administered antibiotics are not appropriately sized for administration of neonatal doses.

The result of this limited access to older antibiotics, the authors argue, is that physicians may be forced to use less optimal, broad-spectrum antibiotics that can produce negative patient outcomes because they are less effective or more toxic. In addition, use of broader-spectrum agents may encourage the emergence of resistance.

To rectify the situation, the authors call on international groups like the World Health Organization (WHO) and the European Commission to take the lead in developing a strategy to ensure the sustainable production, registration, and availability of older antibiotics. Suggested steps include defining a group of antibiotics for which there should be universal access and establishing a mechanism to monitor global availability and shortages.

"Significantly improved global access to key older antibiotics in their optimal formulation, quality and cost could result from a coordinated set of actions that several countries and WHO might be willing to support or engage in," the authors write.
May 14 Clin Microbiol Infect article

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