News Scan for May 16, 2019

Antibiotics in school beef
MERS hospital outbreak analysis
Monkeypox in Singapore

School procurement policy calls for beef raised on fewer antibiotics

Using a first-of-its-kind procurement policy aimed at combating antibiotic resistance, four school districts in upstate New York today awarded contracts to Slate Foods, a beef supplier that buys cattle from farms that have agreed to use practices that reduce the use of on-farm antibiotics.

The procurement policy, which was developed by four Tompkins County school districts in conjunction with the Center for Agricultural Development and Entrepreneurship (CADE) and the Cornell Cooperative Extension, specifies that vendors that bid on the school districts' beef contracts must source the beef from farmers who employ on-farm management practices that lower the risk of infection in animals. In addition, those farmers must only use antibiotics in individual animals that are sick or at high-risk of infection.

The policy is a response to concerns about routine, blanket use of antibiotics in cattle to prevent infection, a practice that is widely seen as contributing to antibiotic resistance. CADE believes the policy, if it's adopted by other school districts, could be a tool to incentivize farmers to adopt more stringent antibiotic stewardship measures than are currently required by the US Department of Agriculture and the Food and Drug Administration.

"We'd like to see school districts throughout New York State—and potentially across the nation—replicate the same food buying policy," CADE executive director Phoebe Schreiner said in a press release. "It will not only have important public health implications for our communities, it will also reward beef producers who use improved antibiotic practices. For those who don't, it offers a carrot to move in that direction."
May 16 CADE beef procurement policy

Study of healthcare-linked MERS outbreaks finds variation, useful lessons

An analysis of 11 MERS-CoV hospital outbreaks from 2015 to 2017 found substantial differences among them, highlighting complex factors that lead to case clusters. Researchers from France, Saudi Arabia, South Korea, and the World Health Organization (WHO) reported their findings May 14 in Scientific Reports.

The 11 outbreaks included 423 lab-confirmed MERS-CoV (Middle East respiratory syndrome coronavirus) cases. Ten outbreaks occurred in Saudi Arabia and one in South Korea, an event triggered by a traveler returning from the Middle East that sickened 186 people. The investigators defined a healthcare outbreak as one that had five or more lab-confirmed, epidemiologically linked cases documented in a single facility with no more than 14 days between patients' symptom onsets.

The researchers found that the length and epidemic profiles of the outbreaks varied, some starting with a sharp rise in cases, with others beginning more slowly with isolated cases detected for a few weeks before a cluster emerged. Also, their analysis revealed that some outbreaks had a sharp decline in cases, though others had a long tail lasting several weeks after the peak.

The reproduction number (R0) early in the outbreak was as high as 5.7 in South Korea, which the team notes probably reflects multiple superspreading events at two hospitals.

A key public health lesson is how long it took to bring the outbreaks under control, the group wrote. All of the events reached an R0 value below 1 within 2 to 6 weeks after the first cases were identified, highlighting the timeframe in which hospital and health ministry officials can put control measures in place to stop hospital-related outbreaks.

The authors said the differences in outbreak size and duration might reflect variations in how quickly cases were suspected and the timing of interventions. Also, the factors were affected by superspreading events early in some outbreaks. Also, the study confirmed earlier findings that age and underlying health conditions relate to increased risk of death. Investigators also found that being a healthcare worker was protective, which they said might be explained by younger age, fewer chronic health conditions, and earlier illness identification.
May 14 Sci Rep abstract


WHO details Singapore’s first monkeypox case

A Nigerian national became Singapore's first monkeypox case-patient a week ago. According to an update today from the World Health Organization (WHO), he is currently in stable condition.

The 38-year-old man arrived in Singapore on Apr 28 and attended a workshop at a hotel on the 29 and 30. On Apr 30 he developed symptoms of monkeypox, including rash, fever, chills, and muscle aches. He stayed in his hotel room from May 1 through the 7, and was then taken to a public hospital by ambulance. Monkeypox was confirmed the next day.

The WHO said the man worked in the Delta region in Nigeria and attended a wedding on Apr 21 in Ebonyi state. Nigeria has been battling a multistate monkeypox outbreak since September 2017.

Health authorities have identified 23 close contacts, including 18 workshop attendees. Close contacts were offered post-exposure prophylaxis with smallpox vaccination, and, as of yesterday, 14 people have been vaccinated. Close contacts have also been quarantined for 21 days.

"Given that authorities in Singapore have promptly initiated appropriate public health measures, including isolation of the primary case, contact tracing and quarantine, surveillance and risk communication, the risk of onward spread in the country is low," the WHO said.

Monkeypox is a self-limiting disease, with most symptoms resolving within 3 weeks. Though human-to-human transmission is possible, most patients contract the disease from eating tainted meat. There is no treatment for the viral disease.
May 16 WHO update

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