News Scan for Oct 11, 2017

News brief

Saudi Arabia reports new MERS case in Riyadh

The Saudi Arabian Ministry of Health (MOH) reported a new case of MERS-CoV in Riyadh today.

A 58-year-old Saudi man was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms. He is in critical condition and is not a healthcare worker. The source of the man's infection is listed as "primary," meaning it is unlikely he contracted the virus from another person.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,729, including 701 deaths. Two patients are still being treated, according to the MOH.
Oct 11 MOH update

Indonesia reports fatal H5N1 case, China mild H9N2 infection

In its latest regular update on flu spread between animals and people, the World Health Organization (WHO) said it received notifications of two new avian flu cases between Jul 25 and Sep 27, a fatal H5N1 infection in an Indonesian child and a mild H9N2 illness in a Chinese toddler.

The H5N1 case in Indonesia is its first known illness in about 2 years. The child's symptoms began on Sep 5, and he was hospitalized on Sep 5. The patient died on Sep 10, the same day tests on a sample revealed the H5N1 infection. The investigation found the boy had been exposed to poultry at his house, and tests confirmed H5N1 in birds in the area. Testing of the child's contacts turned up no other H5N1 illnesses.

The WHO said the case lifts the global H5N1 totals to 860 lab-confirmed cases and 454 deaths.

Meanwhile, China reported another H9N2 case, apparently its fourth of the year. The child got sick on Sep 18, had a mild illness, and received outpatient care. The investigation found no history of exposure to live poultry.

H9N2 is endemic in Chinese poultry. Infections are more common in children than in adults. Earlier cases this year involved an 11-month-old boy from Gansu province, a 32-year-old man from Beijing, and a 2-month-old baby girl from Guangdong province.

The WHO's flu report also acknowledged seven previously reported H7N9 cases in China, as well as two variant H1N2 (H1N2v) and 19 variant H3N2 (H3N2v) cases reported earlier by the United States.
Sep 27 WHO flu at human-animal interface report
Aug 9 CIDRAP News scan "Baby from China infected with H9N2"

Antibiotics before minor surgery not shown to lead to resistant bacteria

Surgical patients who receive prophylactic (preventive) antibiotics before certain low-risk operations are not at an increased risk for antibiotic-resistant infections immediately after the procedure, New York City researchers reported yesterday in the Journal of the American College of Surgeons.

The investigators looked at simple surgeries such as some general surgical procedures, simple or diagnostic laparoscopy, or elective orthopedic, gynecologic, and urologic procedures for which no guidelines have been published for the use of prophylactic antibiotics to prevent surgical site infection. (Guidelines do exist for most major operations.) The scientists reviewed all 22,138 adult patients at Columbia University Medical Center who had one of these operations from 2008 to 2016. The team then focused on patients who developed an infection within 30 days of the operation.

A total of 689 patients (3.1%) developed an infection in that time frame, 550 of them (80%) had received antibiotic prophylaxis, and 338 (49%) had an infection resistant to antibiotics. Patients, though, had the same risk for developing an antibiotic-resistant infection whether they had received prophylactic antibiotics or not: 47% of patients with a resistant infection had no antibiotic prophylaxis and 49% had received antibiotics.

The only factor associated with a higher risk for a postoperative antibiotic-resistant infection was a previous antibiotic-resistant infection.

"The results of this study should be reassuring for those surgeons who choose to use antibiotic prophylaxis believing that antibiotics decrease the overall risk for infection following surgery," said principal author Daniel Freedberg, MD, of Columbia University, in an American College of Surgeons (ACS) news release.
Oct 10 J Am Coll Surg study
Oct 10 ACS news release

Eric Hargan named acting secretary of HHS

Eric Hargan, a Chicago attorney who worked for the Department of Health and Human Services (HHS) during the George W. Bush administration, was named acting HHS secretary yesterday.

Hargan takes on the role left vacant by Tom Price. Price offered his resignation to President Donald Trump last month after reports surfaced that he misused government planes and travel funds. Politico broke the story in September, revealing that Price and his wife billed the government at least $400,000 in private charter planes.

Hargan was sworn in yesterday.

"Eric Hargan brings a wealth of knowledge, expertise, and leadership experience to HHS. His commitment to public service and vast experience in the healthcare field will help guide the department as we advance President Trump's agenda on behalf of the American people," said HHS's acting secretary Don Wright, MD, in an HHS statement.
Oct 5 HHS statement
Oct 11 Politico story

Very long-term study of malaria in Africa finds decreasing prevalence

Malaria caused by the Plasmodium falciparum parasite has steadily declined in sub-Saharan Africa since 1900 overall but little change has been observed in the high-transmission belt that covers large parts of West and Central Africa, according to a study today in Nature.

Researchers from Kenya, the United Kingdom, and South Africa analyzed data from 50,424 surveys at 36,966 geocoded locations that cover 115 years of malaria history. They determined that malaria prevalence dropped from 40% in 1900 through 1929 to 24% in 2010 through 2015. The trend, however, has been interrupted by periods of rapid increases or decreases, and "the cycles and trend over the past 115 years are inconsistent with explanations in terms of climate or deliberate intervention alone."

They also note that the prevalence in the high-transmission belt in the midsection of the continent has changed little. They conclude, "Although caution is required in predicting a complex future, if past trends remain consistent we would expect further reductions in the range and intensity of malaria transmission in Africa, punctuated with resurgences."
Oct 11 Nature study

Bioterror Scan for Oct 11, 2017

News brief

Anthrax treatment shipped to US stockpile

The first shipment of Anthim (obiltoxaximab) injection, a novel treatment for the inhalation of Bacillus anthracis, which causes anthrax, has arrived in the US Strategic National Stockpile (SNS) according to a press release yesterday from Elusys Therapeutics, Inc. Elusys manufactures Anthim and has received more than $240 million from the US government to develop the drug over the past 15 years.

"Our first delivery of Anthim to the SNS marks a major commercial milestone for Elusys and it is a significant achievement for the U.S. Government," said Elizabeth Posillico, PhD, president and CEO of Elusys. "Anthim can now be provided by CDC [Centers for Disease Control and Prevention] to treat U.S. citizens, first responders and military personnel in an anthrax emergency."

Anthim is a monoclonal antibody that neutralizes toxins released by B anthracis. The Food and Drug Administration approved Anthim last year based on the results of animal studies. Anthim does not have direct antibacterial activity and should be used in combination with appropriate antibacterial drugs, the news release said.

Anthim can be used in both children and adults after B anthracis inhalation and can be used prophylactically if no other antibacterial agents are available, the company said.
Oct 10 Elusys press release

Seychelles reports imported plague in Madagascar traveler

The Seychelles Ministry of Health (MOH) yesterday reported an imported plague case in a 34-year-old man who had travelled to Madagascar and had been under passive surveillance since he arrived, according to a statement posted on the MOH Facebook page.

He had been under passive surveillance in Seychelles since Oct 6 and sought care for symptoms on Oct 9, which resulted in immediate isolation. Jude Gedeon, MD, the country's public health commissioner, said several tests yielded normal findings, but a rapid plague test was weakly positive. Testing at the Pasteur Institute in France confirmed the positive plague findings.

The man was given antibiotics, and all 42 of his direct contacts are under active surveillance, including his partner, who has symptoms, though an infection has not been confirmed. Close contacts also include a child who lives with the couple. Fifteen of the close contacts have been placed on antibiotic prophylaxis.

Air Seychelles has cancelled all flights to and from Madagascar, and members of a basketball team who were under surveillance at a center have been discharged after none of them came down with symptoms. The MOH said the imported case is separate from the basketball group.

Madagascar is battling a plague outbreak since August, so far totaling 387 cases, 45 of them fatal. Most of the illnesses are the pneumonic form if the disease. Though plague is endemic to parts of Madagascar, with outbreaks typically reported this time of year, the current outbreak is unusual due to its high case count, widespread geographic area, large percentage of pneumonic cases, and involvement of large urban areas.
Oct 10 Seychelles MOH Facebook post