News Scan for Apr 06, 2018

California measles cluster
Polio in Afghanistan, Pakistan
Ebola household spread
UK antibiotic Rx letter

San Francisco officials report measles cluster, plus related case in Nevada

The San Francisco Department of Public Health (SFDPH) yesterday issued a health advisory about six confirmed measles cases, plus another from Nevada linked to the cluster. The Bay-area cases are from Santa Clara (5) and Alameda (1) counties and involve unvaccinated people.

All seven cases are linked to an unvaccinated traveler who was exposed in Europe and began having symptoms after returning to the Bay area.

Local health departments are conducting contact investigations, and the SFDPH is urging clinicians to suspect measles in patients with a rash and fever, regardless of travel history. Also, the department advised clinicians to prepare their facility for the possibility of measles cases and to ask patients to call ahead if they have fever and rash.

The patient in Nevada appears to be a student at the University of Nevada, Reno, according to an Apr 4 statement from the Washoe County Health District (WCHD). It said the patient doesn't pose an ongoing risk to the public, but was at several locations in the area during the infectious period, and health officials are working to notify potential contacts. Many of the locations were at the university, but they also include Squaw Valley Ski Resort, medical clinics, and retail locations.
Apr 5 SFDPH health advisory
Apr 4 WCHD announcement

New polio cases recorded in Afghanistan, Pakistan 

Pakistan confirmed its first case of wild poliovirus type 1 (WPV1) in 2018, according to the most recent update published by the Global Polio Eradication Initiative (GPEI).

The case occurred in Dukki district, Balochistan province, with the patient experiencing an onset of paralysis on Mar 8. In 2017, Pakistan recorded eight polio cases.

Afghanistan also recorded a new case of WPV1, in Ghaziabad district, Kunar province. This is Afghanistan's seventh case this year. The patient experienced onset of paralysis on Mar 3.

On Apr 9, health officials in both Pakistan and Afghanistan will begin a coordinated immunization campaign with bivalent (two-strain) oral polio vaccine to interrupt transmission the virus.
Apr 3 GPEI


Ebola household study identifies risk factors for transmission

A study to tease out factors associated with the spread of Ebola in households found the deaths of the index case and more days with wet symptoms (vomiting, diarrhea, and bleeding) were among risk factors for transmission. Researchers from Sierra Leone, the US Centers for Disease Control and Prevention, and the World Health Organization (WHO) reported their findings today in an early online edition of the Journal of Infectious Diseases.

For their analysis, the investigators enrolled all confirmed case-patients who were the first to be sick in their households in Freetown, Sierra Leone, from December 2014 to April 2015, about 6 months after the country's outbreak began. The team interviewed patients and followed their contacts through the 21-day incubation period and tested secondary cases.

Among 150 index cases, 83 household contacts (9.9%) got sick with Ebola during the incubation period. Besides index patient death and presence of wet symptoms, risk factors also included Ebola symptoms in the absence of fever, being younger than 20 years old, and caring for infected people. Care providers had a three times higher rate of contracting Ebola, and few reported using any form of barrier protection such as gloves or plastic bags over their hands.

Researchers also found some factors were associated with lower transmission rates, such as avoiding the index patient after illness onset and having a piped-in drinking water source.

The findings are useful for planning public health strategies for future outbreaks, the group wrote. For example, they noted that the risk profile found in the study can be used to identify higher-risk households and ways to modify risk. "Consideration should be given to more intensive monitoring of high risk contacts to promote rapid diagnosis of secondary cases and to minimize further transmission within the household," they wrote.
Apr 6 J Infect Dis abstract


English health officials issue written warning about antibiotic prescribing

England's chief medical officer has sent letters to more than 8,000 general practitioners (GPs) telling them that they're overprescribing antibiotics, according to a report today in Pulse, a UK medical publication.

The letters were targeted to all GPs in the top 20% of antibiotic prescribing, as well as GPs in practices where prescribing rates have increased every year by more than 4%. Public Health England (PHE) has sent letters to practices in the top 20% of prescribing in previous years, as part of a campaign to reduce inappropriate antibiotic prescribing.

"These annual letters are designed to support and encourage practice-based stewardship, as we know antimicrobial resistance is an issue of serious concern," a PHE spokesperson told Pulse. "We hope that the letters will respectfully support GPs to improve their antibiotic stewardship."

Recent PHE research found that at least 20% of all antibiotics prescribed in English primary care could be classified as inappropriate. The British government has called for cutting the amount of inappropriate prescribing by GPs in half by 2020.
Apr 6 Pulse story
Feb 28 CIDRAP News story "UK study deems 20% of primary care antibiotics inappropriate"

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