News Scan for Jun 02, 2017

Saudi MERS case
Zimbabwe H5N8 outbreak
Diarrheal disease
South Sudan vaccine deaths
Allergy test for stewardship

New MERS case detected in Saudi Arabia  

The Saudi Arabian Ministry of Health (MOH) reported a new case of MERS yesterday in a man from Riyadh.

The 47-year-old expatriate is in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). The man is not a healthcare worker, nor did he have contact with camels. The source of his infection is listed as primary, which means it's unlike he contracted it from anyone else.

The latest case pushes Saudi Arabia's total number of MERS-CoV illnesses since the virus was detected for the first time in humans in 2012 to 1,619, which includes 668 deaths. Four people are still being treated for their infections.
Jun 1 MOH


Zimbabwe reports first H5N8 outbreak

Animal health officials in Zimbabwe yesterday reported the country's first highly pathogenic H5N8 avian influenza outbreak, which affected a large commercial farm, signaling another expansion of the virus in Africa.

In a report on the event to the World Organization for Animal Health (OIE), coming just 2 days after the Democratic Republic of Congo (DRC) reported its first highly pathogenic H5 outbreak, authorities said the event began on May 17 at a farm in the country's Mashonaland East region. The farm has eight separate sites located 1 km apart, and outbreak initially struck a parent breeding facility housing about 83,000 broilers. More than 3,000 chickens died the first week.

Of 2 million susceptible poultry, the virus killed more than 7,800, and about 75,000 were culled.

The first site is near a dam that's a gathering site for migratory birds, which are suspected to be the outbreak source.

If the DRC outbreak is confirmed as H5N8, it and the Zimbabwe event would push the number of African nations reporting the virus to seven. The others are Cameroon, Niger, Nigeria, Tunisia, and Uganda.

In other African avian flu developments, Nigeria today reported two more H5N1 outbreaks, both involving layer farms, according to a separate report to the OIE. One began May 28 in Kaduna state and the other started on May 29 in Kano state. Between the two locations, the virus killed 1,200 of 14,200 birds. Officials said both events have been designated as resolved.
Jun 1 OIE report on H5N8 in Zimbabwe
Jun 2 OIE report on H5N1 in Nigeria


Report: Global burden of diarrheal disease decreased in past 25 years

A new report from the Global Burden of Disease (GBD) Diarrheal Diseases Collaborators said that while there is still significant room for improvement, there have been substantial gains in reducing the burden of diarrhea in the last 25 years. The report was published yesterday in The Lancet Infectious Diseases.

In 2015, there were 1.3 million diarrheal deaths worldwide, making it the ninth leading cause of death globally and the fourth leading cause of death among children under the age of 5. There were an estimated 499,000 deaths due to diarrhea in children under 5 in 2015. Because it especially affects children, diarrheal disease is a leading contributor to disability-adjusted life-years (DALYs).

Between 2005 and 2015, the collaborators found that deaths due to diarrhea decreased by an estimated 20.8%. Rotavirus was the leading cause of diarrhea deaths (199,000 deaths in 2015), followed by Shigella (164,300) and Salmonella (90,300).

Thirty-eight percent of diarrheal deaths occur in children, as noted in the accompanying commentary published alongside the study. And while the commentary authors applaud the efforts of the GBD, they point out that because the work relies on models and statistics not uniformly kept by countries, it may not provide the most accurate picture of disease burden.

"The central challenge to the GBD project is that the source data for their model-generated estimates are often sparse, out of date, or entirely absent in exactly the same places where diarrhoeal disease exacts its greatest toll. In short, the absence of robust country-level surveillance statistics might itself be a symptom of a frail or failing public health system in those countries," the commentators concluded.
Jun 1 Lancet Infect Dis study
Jun 1 Lancet Infect Dis


15 South Sudanese children dead after measles campaign

The World Health Organization (WHO) confirmed yesterday that 15 South Sudanese children died after receiving contaminated measles vaccines. The children all died from sepsis in early May. At least 32 other children suffered from fever and diarrhea after vaccination but recovered.

The children lived in Nachodokopele village, Kauto County, a remote area of South Sudan. According to the WHO, the deaths were preventable and largely due to untrained and unqualified staff administering the vaccines. The vaccines were also handled improperly and not refrigerated.

The Associated Press (AP) today said children as young as 12 were administering the vaccine, adding, "One syringe was used for all the children during the four-day campaign, and the vaccine was stored without refrigeration the entire time."

All of the children who died were under the age of 5 and were targeted in a measles campaign that aims to inoculate 2 million children in South Sudan. Measles is endemic in South Sudan, with 665 cases so far this year. In 2016, the country reported 2,294 cases and 28 deaths attributed to the virus.
Jun 1 WHO statement
Jun 2 AP


Beta-lactam allergy test shown to improve antibiotic stewardship

The use of beta-lactam allergy skin testing (BLAST) at the point of care in hospital antimicrobial stewardship programs (ASPs) resulted in greater use of preferred beta-lactam therapy without increasing the risk of adverse drug reactions, according to a study yesterday in Clinical Infectious Diseases.

Researchers in Toronto conducted a prospective study on the use of point-of-care BLAST as part of ASPs in three hospitals. Of 827 patients with reported beta-lactam allergy over the 15-month study period, beta-lactam therapy was preferred in 632 (76%).

The investigators reported that 50% (124/246) received preferred beta-lactam therapy based on history at baseline, but the percent rose to 60% (232/386) during the intervention period and to 81% (313/386) once BLAST was instituted, without any increase in adverse events. After adjusting for multiple patient variables, the researchers determined that BLAST was associated with 4.5-fold greater odds of receiving preferred beta-lactam therapy.

The authors note, "Longer term studies are needed to better assess the safety and clinical impact of this ASP intervention."
Jun 1 Clin Infect Dis study

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