News Scan for Jun 29, 2020

More DRC Ebola
Cyclospora outbreak grows
Delayed antibiotics for respiratory infections
Dengue in Florida Keys

Ebola infects 4 more in DRC's Equateur province outbreak

Officials have reported 4 more confirmed cases in the Democratic Republic of the Congo (DRC) Equateur province Ebola outbreak, raising the total to 28, the World Health Organization (WHO) African regional office said today on Twitter.

So far, no details on the latest cases in the DRC's 11th Ebola outbreak are noted. Of the 28 cases, 25 are lab-confirmed and 3 are listed as probable. The number of deaths held steady at 13.

On Jun 25 the country declared an end to its 10th outbreak, which was centered around North Kivu and Ituri provinces and was by far the country's biggest and longest. The current outbreak is occurring in the same area of northwestern DRC where a small outbreak—the DRC's ninth—was reported in 2018.
Jun 29 WHO African regional office tweet


Cyclospora cases top 200 in bagged salad outbreak

With 84 new cases and one newly affected state, now 206 people in eight states have been sickened with Cyclospora in an outbreak tied to bagged garden salads sold at Aldi, Hy-Vee, Jewel-Osco, and—named for the first time—Walmart stores in the Midwest.

All four retailers have issued recalls for the affected products, the Centers for Disease Control and Prevention (CDC) said in an outbreak update posted late on Jun 26. The recall affects bagged salads sold in Arkansas, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wisconsin.

So far 23 people have been hospitalized for their infections, but none have died. Illness-onset dates range from May 11 to Jun 17. Six people have been infected in North Dakota, the latest state to report cases. According to the CDC, all six ill people reported eating a salad purchased from a single restaurant location in North Dakota.

"There are typically multiple clusters of Cyclospora infections that occur each summer. CDC is working to determine if other recent cases of Cyclospora infection are linked to contaminated ingredients in these bagged salad mixes," the CDC said.
Jun 26 CDC
Jun 23
CIDRAP News scan on previous update


Delayed URTI antibiotics tied to higher risk of hospitalization

Waiting to treat upper respiratory tract infections (URTIs) with antibiotics was associated with an increased risk of hospital admission in a large population-based study examining the safety of delayed antibiotic prescribing in URTI patients, researchers from the University of Manchester reported today in Clinical Infectious Diseases.

Using two large databases of electronic health records from primary care practices linked to hospital admission records in the United Kingdom and Wales, the researchers looked specifically at patients with a URTI diagnosis and a prescription for amoxicillin, clarithromycin, doxycycline, erythromycin, or phenoxymethylpenicillin. Antibiotic prescribing among patients was classified as either immediate or delayed, with immediate defined as a prescription on the same day as diagnosis and delayed defined as a URTI diagnosis 1 to 30 days before the prescription. The primary outcome was hospital admission for infection-related complications in the 30 days after the prescription.

Between the two databases, 1.82 million with a URTI and an antibiotic prescription were identified, with 91.7% receiving an immediate antibiotic and 8.3% receiving a delayed antibiotic. When the results of both data sets were combined, delayed antibiotic prescribing was associated with 52% increased risk of infection-related hospital admission (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.43 to 1.62). The effects of delayed prescribing were lowest in children (adjusted HR, 1.36; 95% CI, 1.25 to 1.47) and highest in adults aged 18 to 59 years (adjusted HR, 1.61; 95% CI, 1.42 to 1.84). The probability of delayed antibiotic prescribing was unrelated to the predicted risks of hospital admission.

Analyses of Numbers Needed to Harm (NNH) showed considerable variability across different patient groups. The median NNH with delays in prescribing was 1,357, 2.5% percentile 295 and 97.5% percentile 3,366.

The findings are noteworthy because UK treatment guidelines recommend no antibiotic or a delayed antibiotic in URTIs except in more severe cases.

"There is an important need to better target delayed antibiotic prescribing to URTI patients with moderate risks of complications and immediate antibiotic to those with higher risks," the authors of the study concluded. "Further research on the cost effectiveness of the most optimal threshold is needed to establish the treatment thresholds."
Jun 29 Clin Infect Dis abstract


Florida Keys dengue total rises to 10

The Florida Department of Health on Jun 26 issued a mosquito-borne illness alert following the detection of eight more locally acquired dengue fever cases in Monroe County, the jurisdiction that includes the Florida Keys.

The cases bring the county's 2020 dengue total to 10, and the health department said it and the Florida Keys Mosquito Control District are working on surveillance and prevention efforts and that control activities have been stepped up in the Key Largo area. Epidemiologic investigations are under way to determine the source and extent of the infections.

The US Centers for Diseases Control and Prevention (CDC) said in its latest update on Jun 5 that, as of Jun 3, only one locally acquired dengue case had been reported in the United States, which was in Florida. In 2019, the CDC reported 20 local cases in the United States, including 16 in Florida.
Jun 26 Florida Department of Health alert
Jun 5 CDC
dengue total for 2020
dengue total for 2019

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