News Scan for Jun 08, 2018

Salmonella from backyard poultry
Melon-linked Salmonella
Polio in Pakistan
Nipah research priorities
Malaria treatment safety

Salmonella outbreaks tied to backyard poultry cause 124 cases in 26 states

The Centers for Disease Control and Prevent (CDC) today said it is investigating several Salmonella outbreaks totaling 124 cases in 36 states linked to contact with backyard poultry flocks.

Outbreak strains are Salmonella Seftenberg, Montevideo, Infantis, Enteritidis, Indiana, and Litchfield. Twenty-one people have required hospitalization, but no deaths have been reported, the CDC said. Illness-onset dates range from Feb 2 to May 14.

The patients tilt young, with 31% of them preschool-aged. Of 74 case-patients interviewed, 55 (74%) reported contact with chicks or ducklings in the week before they fell ill. People reported obtaining the baby poultry from several sources, including feed supply stores, websites, and hatcheries.

"Mail-order hatcheries should provide health-related information to owners and potential purchasers before they buy any birds," the CDC said. "This should include information about preventing Salmonella infections from contact with live poultry." The agency said stores should buy only from suppliers who have adopted best practices from the US Department of Agriculture.

Among advice to consumers, the CDC said poultry owners and handlers should always wash their hands after touching live poultry or anything in the birds' environment. The agency said 70 Salmonella outbreaks have been tied to backyard poultry since 2000.
Jun 8 CDC statement
CDC advice on keeping backyard poultry


CDC says pre-cut melon is likely source of 60 Salmonella cases in 5 states

Consumers in five Midwestern states should not eat pre-cut melon bought from several national retail chains because it is the likely source of 60 Salmonella infections in those states, the CDC announced today.

Cases have been reported in Illinois (6), Indiana (11), Michigan (32), Missouri (10), and Ohio (1), the agency said in an email to journalists. Thirty-one people have been hospitalized, but no deaths have been reported.

Sick people have reported eating pre-cut cantaloupe, watermelon, or a fruit salad mix with melon, according to the alert. Most people bought pre-cut melon at Walmart or Kroger stores in the Midwest. Yesterday Walmart and Kroger removed pre-cut melon linked to the outbreak from all Walmart, Kroger, Jay C, and Payless stores in the affected states.

The CDC said consumers should discard pre-cut melon bought from Walmart stores in any of the five states or from Kroger, Jay C, or Payless stores in Indiana and Michigan. The warning includes fruit salad mixes with pre-cut melon but does not include whole melons.

The Food and Drug Administration is working to identify a supplier of pre-cut melon to stores where sick people shopped, officials said. The CDC may expand its advice to consumers to include other stores where contaminated pre-cut melon was sold. State health officials are working with the two federal agencies on the investigation.
Jun 8 CDC notice


Pakistan announces second polio case of 2018

Health officials in Pakistan reported a new case of wild poliovirus in Balochistan. This is the second polio case in Pakistan in 2018; last year, the country recorded eight cases of the paralyzing disease.

According to the Global Polio Eradication Initiative (GPEI) weekly report, the new case-patient in Pakistan experienced symptom onset on Apr 15. GPEI said vaccinators using the bivalent oral polio vaccine reached more than 20 million Pakistani children during May.

The Pakistani newspaper The Express Tribune, meanwhile, said today that a third case was recorded in Balochistan's Dakki district, when an 18-month-old toddler tested positive for the virus.

Pakistan, Nigeria, and Afghanistan are the reaming countries in the world with active, endemic wild poliovirus transmission. Afghanistan reported a new environmental sample of wild poliovirus in Kunar province, collected on Apr 24, GPEI noted. Afghanistan has had eight polio cases this year.
Jun 8 GPEI report
Jun 8 Express Tribune


Lancet editors underscore need for more Nipah research

In light of the Nipah virus outbreak in Kerala, India, which has left 16 dead, the editors of The Lancet penned an editorial calling for more research on the emerging virus.

Like Ebola, the experts say, Nipah has pandemic potential, and the recent human-to-human transmission seen among healthcare workers and family members of patients in India provides more evidence that the virus is highly infective and often deadly. Some estimates show Nipah as having a 75% case-fatality rate.

The World Health Organization (WHO) has issued a roadmap for Nipah, the editors note, after the agency included the virus in the 2018 list of priority epidemic threats. And the Coalition for Epidemic Preparedness Innovations, announced on May 21 a $25 million investment in two US biotechnology firms working on a Nipah vaccine.

"However, for true countermeasures and preparedness, a broader and more comprehensive approach and investment are urgently needed. In addition to diagnostics, therapeutics, and vaccines, surveillance infrastructure must be improved to rapidly identify and verify cases, conduct detailed contact tracing, investigate spillovers, and better understand the ecology of bats and Nipah virus infection, especially outside of outbreak scenarios," the editors warn.

According to the WHO, there have been 600 human cases of Nipah from 1998 to 2015, all in South and East Asia. The virus's natural host is the fruit bat, but outbreaks have also infected livestock. The first human outbreak occurred in the late 1990s in pigs in Malaysia and Singapore and moved to humans, killing 106 people.
Jun 8 Lancet editorial
WHO Nipah R&D blueprint and roadmap


Combination drug treatment for malaria found not cardiotoxic

The effective and well-tolerated drug combination of dihydroartemisinin and piperaquine, which has faced concern over possible cardiotoxicity because of its proarrhythmic potential, carries a risk of sudden cardiac death no higher than baseline levels, found a study published yesterday in The Lancet.

The authors, from Thailand, Spain, and England, carried out a careful review and Bayesian meta-analysis of 94 human studies comprising 197,867 patients (501,156 courses of treatment; 1,396,494 doses) who had received the combination therapy for at least one 3-day regimen in mass drug administration programs, as a preventive treatment, or in case management of uncomplicated malaria. Patient follow-up in all studies was a minimum of 3 days.

Only one patient, a 16-year-old girl in Mozambique who had heart palpitations after a second dose of dihydroartemisinin-piperaquine and died en route to the hospital, was identified as having a potentially drug-related sudden death. Median pooled risk estimate of sudden unexplained death after the combination treatment was calculated at 1 in 757,950 (95% confidence interval, 1 in 2,854,490 to 1 in 209,114), not higher than the baseline rate of sudden cardiac death (1 in 1,714,280 to 1 in 100,835 over a 30-day risk period), according to the authors.

The apparently misplaced concern over potential cardiotoxicity of the combination drug rests of the fact that piperaquine can prolong cardiac ventricular repolarization duration and the electrocardiographic QT interval.

"Concerns about repolarisation-related cardiotoxicity need not limit its [dihydroartemisin-piperaquine] current use for the prevention and treatment of malaria," the authors write. An accompanying commentary further states that the combination "should be shed of its cardiotoxic reputation, so that malaria-endemic areas can benefit from its full potential and to decrease the toll that malaria still imposes globally."
Jun 7 Lancet article
Jun 7 Lancet commentary

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