News Scan for Jun 22, 2017

Proof for vaccine events
NDM-1 at Mexican hospital
Yemen cholera outbreak

Highest EU court says no proof needed when ruling on vaccine side effects

Even in the absence of scientific pro, the highest court of the European Union (EU) said yesterday that courts can decide whether a vaccination led to someone developing an illness without definitive scientific proof, the New York Times reported.

The decision was based on a French case that involved a man who was immunized against hepatitis B in the late 1990s and later developed multiple sclerosis. The man sued the vaccine manufacturer, Sanofi Pasteur, in 2006 for damages.

France's Court of Appeal dismissed the case based on a lack of causal evidence between hepatitis B vaccine administration and multiple sclerosis.

But the EU's top court said that if there was "specific and consistent evidence" between vaccine administration and illness onset, a vaccine could be considered defective. The court said some factors could lead a national court to conclude that "the administering of the vaccine is the most plausible explanation" for the disease and that "the vaccine therefore does not offer the safety that one is entitled to expect.”

According to the story, the court did rule specifically on the French case.
Jun 21 New York Times story


NDM-1 gene identified in CRE isolates at Mexican hospital

Researchers have identified four Enterobacteriaceae species harboring the carbapenem-resistance gene NDM-1 among isolates collected at a tertiary care hospital in Mexico, according to a study yesterday in PLoS One.

Of the more than 3,000 isolates collected at the hospital from September 2014 to July 2015 following detection of an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), 86 (2.83%) were found to be carbapenem resistant and carbapenemase producers, and 52 isolates (one per patient) were selected for further study. Carbapenemase-producing species included Klebsiella pneumoniae (46 isolates), Enterobacter cloacae (3), Escherichia coli (1), Providencia rettgeri (1), and Citrobacter freundii (1). Fifty-one of the 52 isolates were classified as multidrug-resistant.

The NDM-1 gene was detected in 46 K pneumoniae isolates, 3 E cloacae isolates, 1 E coli isolate, and 1 P rettgeri isolate, for a total of 51. Other carbapenemase genes detected included VIM, IMP, and KPC. The transfer of plasmids harboring the NDM-1 gene was obtained in eight transconjugants.

Analysis of clonal diversity revealed that 60% of the K pneumoniae isolates belonged to clone A, corresponding to the ST392 strain. The ST307, ST309, ST846, ST2399, and ST2400 strains were also detected in K pneumoniae. The E coli isolate corresponded to ST10, and the E cloacae isolate corresponded to ST182.

"The results obtained in this study indicate that blaNDM-1 was disseminated horizontally among different species in a tertiary care hospital in Mexico, also with proof of strain spread predominantly of K. pneumoniae ST392," the authors write. "We have provided evidence of plasmid transfer but, given the variation in plasmid sizes, complex rearrangements must also be occurring."

The authors note that while the detection of more than one CRE species and multiple carbapenemase genes in the same hospital in the same period has previously been reported, it's been in countries distant from Mexico (China and Kuwait). "Because of this, our report underscores the importance of active surveillance in all enterobacterial species," they write.
Jun 21 PLoS One study


Suspected cholera cases in Yemen top 185,000

In an update today on a large cholera outbreak in Yemen that has been under way since October 2016, the World Health Organization (WHO) Eastern Mediterranean regional office (WHO EMRO) said today that 37,079 more suspected cases were reported last week, along with 196 related deaths.

As of yesterday, the outbreak total stands at 185,301 suspected cases and 1,233 deaths, the WHO said. It added that the overall case-fatality rate is 0.7%, though the percentage is higher in people older than 60. The WHO and its partners have established 18 diarrhea treatment facilities and 28 oral rehydration centers in response to the outbreak.

Though the disease is endemic in Yemen, the country has seen a surge in cholera cases since late April. The cholera outbreak has struck 268 districts in 20 of 21 Yemeni governorates.
Jun 22 WHO update

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