News Scan for May 28, 2019

Flour E coli outbreak
Prospective audit and feedback outcomes
Southern Hemisphere flu rise
Yellow fever in Uganda
Polio in Central African Republic

Flour-linked E coli outbreak sickens 17 in 8 states

Federal health officials and their state partners are investigating an Escherichia coli O126 outbreak linked to flour sold at Aldi stores in 11 states in the eastern part of the country. So far, 17 illnesses have been reported in eight states, the US Centers for Disease Control and Prevention (CDC) said in a May 24 outbreak announcement.

A day earlier, Aldi and ADM Milling Co. recalled 5-pound bags of Bakers Corner All Purpose Flour, the US Food and Drug Adiministration (FDA) noted. The flour was processed at an ADM Milling facility in Buffalo, New York, and was distributed in the following states: Connecticut, Delaware, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, and West Virginia.

The CDC said illness-onset dates range from Dec 11, 2018, to Apr 18 and that health officials are using PulseNet, the national subtyping system, to identify illnesses that are part of the outbreak. Whole-genome sequencing on samples from sick people suggest the E coli strains are closely related, hinting at a common source of infection.

Patient ages range from 7 to 86 years old, and three have been hospitalized. No deaths have been reported. States reporting sick patients include New York (5), Ohio (5), Pennsylvania (2), California (1), Connecticut (1), Missouri (1), New Jersey (1), and Rhode Island (1).

Of seven people who were interviewed, four reported eating, licking, or tasting raw homemade dough or batter. Two with detailed information reported eating raw food made with flour or baking mixes from Aldi.

Investigators with the Rhode Island Department of Health collected records and flour samples from a bakery where a sick person ate raw dough, and the probe found that the bakery had used Bakers Corner flour from Aldi, and the team isolated the outbreak strain from an unopened bag of flour collected from the bakery. Genetic sequencing suggests that the strain in the flour is closely related to the E coli O126 strain found in sick people.
May 24 CDC outbreak announcement
May 23 FDA recall notice


Acceptance of audit and feedback suggestions linked to better outcomes

A single-center study conducted at a hospital in Canada has found positive benefits associated with exposure to prospective audit and feedback (PAF), Canadian researchers report in Antimicrobial Resistance and Infection Control.

The retrospective matched cohort study analyzed patients who were assessed during the first year of the hospital's PAF service, in which pharmacists with infectious disease experience review antimicrobial therapy in patients newly admitted to the hospitalist unit. While previous research has shown a reduction in antimicrobial use in the unit after the service was implemented, the researchers wanted to evaluate the impact on clinical outcomes. To do that, they compared 30-day hospital mortality, 30-day post-discharge mortality, and 30-day hospital re-admission rates in those patients compared with a control group of patients admitted prior to initiation of the PAF service.

A total of 348 patients were assessed and received PAF suggestions during the first year of the service, and they were matched with 827 control patients. Of 707 PAF recommendations made, 66% were recorded as fully accepted and 15.8% as partially accepted; 23% of the recommendations were to stop antimicrobial therapy. Unadjusted analysis showed that the composite end point was significantly less likely to occur in the exposed (20.7%) versus the unexposed cohort (28.2%).

In the adjusted analysis, patients in the exposed cohort were 29% less likely to be associated with the composite end point than the control patients (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.52 to 0.97). This observation persisted when only patients with PAF recommendations that were fully or partially accepted were considered (OR, 0.61; 95% CI, 0.43 to 0.87), but not when patients with declined recommendations were analyzed (OR, 1.26; 95% CI, 0.66 to 2.40).

"The positive findings from the current study support the use of PAF which will aid in encouraging hospitalist physicians to apply best practices for optimizing antimicrobial care in their outpatient settings and support outpatient AS [antimicrobial stewardship] systems," the authors of the study write.
May 24 Antimicrob Resist Infect Control study


WHO: Flu on the rise in Southern Hemisphere

Across most of the temperate zone of the Southern Hemisphere influenza detections are rising, according to the latest global flu update from the World Health Organization (WHO).

Australia, New Zealand, and South Africa saw an increase in influenza A (H3N2) activity, while South America has seen mostly H1N1. Overall, Oceania and Australia reported more influenza-like illness (ILI) detections than this time last year, a trend also seen in some countries in South America.

Flu activity continues to decrease throughout much of the Northern Hemisphere, including North America and most of Asia.

Globally, 57% of all lab-confirmed flu specimens tested in recent weeks were typed as influenza A, and 43% as influenza B. Of the subtyped influenza A viruses, the WHO said, 30.9% were H1N1 and 69.1% H3N2.
May 27 WHO


Uganda confirms yellow fever outbreak in 2 locations

Uganda has confirmed a yellow fever outbreak in two districts—Koboko and Masaka—located in the northern and central regions of the country, according to a bulletin from the WHO's African regional office.

Officials identified two cases of yellow fever in March, when routine surveillance showed the virus in an 80-year-old woman and a 10-year-old girl, neither of whom had been vaccinated against yellow fever.

Rapid response teams were sent to the villages of both patients and found an additional seven cases of yellow fever, and a "substantial population of unvaccinated individuals due to immigration and missing the yellow fever reactive vaccination campaign, which was conducted in 2016."

Uganda has not yet introduced the yellow fever vaccine into routine immunizations, and one of the cases in Koboko district is near the Ugandan–Democratic Republic of Congo (DRC) border, where an Ebola outbreak is ongoing. Cross-border surveillance has been heightened, the WHO said.
May 26 WHO African regional office bulletin


Two vaccine-derived polio cases detected in Central African Republic

Two cases of vaccine-derived polio were detected in the Central African Republic, Reuters reported today—the eleventh and twelfth cases reported in Africa in 2019.

Despite this outbreak, Africa could be declared free of endemic polio as soon as 2020 if there are no more wild poliovirus detections. The declaration would come 3 years after Nigeria recorded its last wild poliovirus case.

Vaccine-derived polio cases are caused by the oral polio vaccine (OPV), widely used because it is cheap and effective. OPV can be risky in places with poor sanitation and low immunity to polio, because vaccinated people can excrete the virus, exposing others via sewage and contaminated water.

Nigeria, along with Afghanistan and Pakistan, is one of three remaining countries in the world with endemic wild poliovirus transmission.
May 28 Reuters article

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