News Scan for Feb 07, 2020

Measles outbreak in LA
Polio in five countries
Sewage-based AMR surveillance

Measles outbreak reported in Los Angeles

The Los Angeles County Department of Public Health this week confirmed a local outbreak of measles among five people—four of them county residents who were exposed to an unimmunized international visitor who was infectious with measles.

In a press release, department officials listed public places in Los Angeles and Santa Monica visited by the confirmed case-patient from Jan 26 to Feb 1, and warned that unimmunized people, or those with unknown immunization status, who were at these sites at the same time could be at risk for developing measles. They're urging people who were in those locations during the time period to review their immunization records and monitor themselves for illness.

As of Jan 31, according to an update this week from the US Centers for Disease Control and Prevention (CDC), there have been 5 confirmed measles cases in 5 states in 2020. A total of 1,282 cases were confirmed in 31 states in 2019—the greatest number of measles cases reported in the United States since 1992. Most were among people who had not been vaccinated.
Feb 5 LA County Department of Public Health press release
Feb 3 CDC measles update


Five countries report more polio cases

In its latest weekly update, the Global Polio Eradication Initiative (GPEI) said five countries have reported new cases: Pakistan, the Democratic Republic of Congo (DRC), Somalia, Angola, and Burkina Faso.

Pakistan reported 8 wild polio virus type 1 (WPV1) cases, including 2 from Punjab province, 4 from Sindh province, and 1 each from Khyber Pakhtunkhwa and Balochistan. Some patients had illness onset in 2019, bringing the annual total for 2019 to 144. The number of cases for 2020 rose to 7.

In the DRC, 5 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported, 1 each from Kwilu, Kongo Central, and Kinshasa provinces and 2 from Sankuru. GPEI says none of the newly-confirmed cases are new emergencies, but the fact that the virus has been detected in the mega-city of Kinshasa is of major concern. The total number of cases for 2019 rose to 82.

Elsewhere in Africa, Angola reported 8 cases of cVDPV2, including 4 from Brie province, 2 from Luanda, and 1 each from Malanje and Cuanza Norte provinces, raising the total for 2019 to 111. Burkina Faso reported 1 case of cVDPV2 from Centre-Est, with illness onset beginning in 2019. Somalia reported 1 cVDPV2-positive environmental sample from Banadir.
Feb 5 GPEI report


Paper touts benefits of global sewage-based AMR surveillance

Implementation of a global sewage-based antimicrobial resistance (AMR) surveillance system based on metagenomics sequencing could yield substantial and rapid benefits and be implemented quickly and at minimal expense, according to a paper today in Science.

The paper, written by AMR experts at the Technical University of Denmark and the University of Edinburgh, argues that because current international AMR surveillance systems such as GLASS (the Global Antimicrobial Surveillance System) focus on surveillance of clinical isolates from hospitalized patients and resistance to last-resort antibiotics, they capture only one slice of the global AMR picture. Furthermore, this type of surveillance is based on small samples and is hard to implement in resource-poor settings. 

"This emphasis on clinical settings makes it difficult to determine the global spread of resistance to first-line drugs in the wider community, a large part of the global AMR burden," the authors write.

But global sewage-based surveillance using metagenomics sequencing, which can detect all known resistance genes, could complement clinical surveillance by generating pooled data from a large, non-hospital population that is not routinely assessed by conventional surveillance, the authors suggest. In addition, sewage-based surveillance is easy to implement, can be conducted in low-income settings using inexpensive equipment, and is not restricted to a limited set of bug-drug combinations.

"We therefore consider sewage-based surveillance to be a potentially valuable addition to current options for global AMR surveillance and monitoring," they write. "Though not a substitute for other surveillance methods, it can provide data that is otherwise hard to obtain and may sometimes be the easiest route to providing any information at all, especially in resource-poor settings."

The authors suggest an immediate working model could involve annual collection of sewage samples from across the globe and shipment to a central facility responsible for sequencing, bioinformatics, and reporting.
Feb 7 Science abstract

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