News Scan for Nov 06, 2017

Strep burden, resistance threat
Salmonella probe ends
Ebola susceptibility
MDR-TB in Minnesota

Supplement details group B Streptococcus, resistance risks

Group B Streptococcus (GBS) bacteria cause at least 147,000 stillbirths and infant deaths worldwide each year, but providing effective treatment brings up antibiotic resistance and stewardship issues, according to a supplement to Clinical Infectious Diseases published today.

Led by the London School of Hygiene & Tropical Medicine (LSHTM) and involving more than 100 researchers from around the world, the series of 11 research papers estimates that about 18% of women globally harbor GBS. The researchers also conservatively estimate that, out of 410,000 GBS cases every year, at least 147,000 stillbirths and infant deaths occur around the globe annually. Africa had the highest burden, with 54% of estimated cases and 65% of stillbirths and infant deaths, despite housing only 13% of the world's population.

According to the new research, funded by the Bill & Melinda Gates Foundation, the top five countries by numbers of pregnant women colonized with GBS were India (2,466,500), China (1,934,900), Nigeria (1,060,000), the United States (942,800), and Indonesia (799,100).

GBS prevention focuses on prescribing antibiotics to women in labor, aiming to reduce disease in infants, given that no vaccine is available, according to an LSHTM news release. At least 60 countries have a policy for antibiotic use in pregnancy to prevent newborn GBS disease, but implementation of policies varies.

Joy Lawn, MB BS, PhD, an LSHTM professor, said in the release, "Antibiotics currently prevent an estimated 29,000 cases of early-onset group B Streptococcal disease per year, almost all in high-income settings. However, this approach may be difficult in low-income settings where many births take place at home, and laboratory capacity for screening for GBS is limited. In addition, giving antibiotics to 21.7 million women may contribute to antimicrobial resistance—a major global health crisis."
Nov 6 Clin Infect Dis supplement
Nov 6 LSHTM news release


CDC announces end to papaya-linked Salmonella outbreak investigations

The Centers for Disease Control and Prevention (CDC) late last week announced the end of official investigations into a Salmonella outbreak linked to Maradol papayas imported from Mexico. The CDC said the outbreaks appear to be over.

A total of 251 people were sickened in 25 states, in four separate outbreaks, each linked to a different papaya grower in Mexico. Two people died, and 79 were hospitalized. Since the CDC's last updates on Sep 13, officials have confirmed 16 new cases.

The largest outbreak occurred with fruit grown on the Carica de Campeche farm in Tenabo, Campeche. In that outbreak, the first to be identified by the CDC, 220 people in 23 states were infected, including 1 death in New York City, and 68 hospitalizations. Patients reported illness onset dates from May 17 to Oct 4. Of 145 people interviewed by the CDC during this outbreak, 79 (54%) reported eating papayas.

The outbreaks led to recalls from Grande Produce and Bravo Produce, among other distributors of Mexican papayas.
Nov 3 CDC
update on largest outbreak
Nov 3 CDC update on Urbana outbreak
Nov 3 CDC
update on Infantis outbreak
Nov 3 CDC
update on Anatum outbreak


New study to investigate genetic susceptibility to Ebola

The US National Institute of Allergy and Infectious Diseases (NIAID) launched a new prospective study to examine the role genes may play in Ebola virus. The study is based in Liberia, and will enroll 8,000 children and adults, including people who got sick and survived during the 2013-2016 outbreak, people wo had close contact with a patient but didn't get sick, and people with no known Ebola exposure.

In addition, researchers will use blood samples from 500 patients who died from Ebola virus. The blood samples of enrollees will be analyzed by teams of researchers in the United States and Liberia, who will use special equipment to read each patient's DNA in an effort to determine if certain genes are more likely to confer Ebola virus disease or certain symptoms.

"Why some infections are asymptomatic while others are fatal, or why some people rapidly clear the infection while others remain in treatment for weeks or have lingering traces of virus months or years after infection, remains unclear," the NIAID said in a press release. "Investigators predict that by studying people's DNA, they might uncover genetic differences that influence these outcomes."
press release  


Minnesota officials report deadly 17-case outbreak of MDR-TB

Ramsey County, Minnesota, home to St. Paul, is combatting the nation's largest outbreak of multidrug-resistant tuberculosis (MDR-TB), which has grown to 17 cases and 6 deaths, the Minneapolis Star Tribune reported today.

The outbreak has primarily affected elderly residents of the county's Hmong community, with 10 cases linked to a senior care center, where the first case was detected last year. Four other Ramsey County Hmong residents also contracted MDR-TB.

Of the 6 deaths, 3 were a direct result of the disease, health officials said. State officials are monitoring more than 350 people who may have been exposed. Testing on 125 people has revealed 58 latent TB cases, which means people who have no symptoms but can pass the disease to others. The report did not say whether those cases involved resistant strains. People with latent TB are being urged to take second-tier antibiotics—the same as MDR-TB patients—but the treatment can last up to 2 years and cost $134,000. (First-line treatment lasts at least 6 months and costs $17,000, the story said.)

"In the case of these individuals, if there wasn't evidence that they had been exposed to multi-drug resistant tuberculosis, then they would have just been recommended to get the normal course of treatment," said Kris Ehresmann, RN, MPH, infectious disease director at the Minnesota Health Department. "But the [second-tier] treatment is arduous and has many side effects."

The outbreak represents another costly challenge for Minnesota health officials, who had to deal with a 79-case measles outbreak earlier this year. The state has tapped almost $225,000 in emerging fund to combat the MDR-TB outbreak.

Minnesota has the second-largest US Hmong population, after California.
Nov 6 Star Tribune story

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