News Scan for Feb 19, 2021

More DRC Ebola cases
Hospital wastewater impact on resistance
Polio cases in 7 countries

Two more cases lift DRC Ebola total to 6

Provincial health officials in the Democratic Republic of the Congo's (DRC's) North Kivu province yesterday reported two more Ebola cases, one of them more than 90 miles from Butembo, the main epicenter, according to Reuters.

The new cases raise the outbreak total to six, with the number of deaths remaining at two. One of the new patients is from Katwa, about 6 miles from Butembo. The other is from Manguredjipa, about 93 miles away.

Provincial Health Minister Eugene Nzanzu Salita said one of the patients is a known contact of an earlier confirmed case, and an investigation is underway into how the other new patient contracted the virus.

The DRC first reported the new flare-up on Feb 7; the outbreak is occurring in the same area where the country's 10th outbreak took place. That outbreak was declared over in June 2020, and further genetic sequencing is underway to determine the source of the virus. The index patient in the new cluster was married to an Ebola survivor, and in rare instances, the virus can persist in immune protected body sites—such as the eyes or testes—of those who survive their infections.
Feb 19 Reuters story


Swedish study finds hospital wastewater selects for multidrug-resistance

A new study conducted in Sweden provides evidence that hospital wastewater selects for multidrug-resistant strains of bacteria while killing antibiotic-sensitive bacteria.

In the study, published late last week in Environment International, a team led by researchers from Sweden's University of Gothenburg conducted a series of laboratory experiments to test whether filtered wastewater from a major Swedish hospital, as well as treated and untreated municipal wastewater, select for antibiotic resistance. Compared with the municipal wastewater, the hospital wastewater had the highest concentrations of antibiotics (including cefadroxil, ciprofloxacin, linezolid, and amoxicillin).

When the researchers exposed a sample of 149 Escherichia coli isolates to the different wastewater samples, they found that the hospital effluent significantly increased resistance to several antibiotics (cefadroxil, ceftazidime, and tobramycin) and the proportion of multidrug-resistant isolates. Further experiments with these isolates and E coli isolates with less resistance showed that exposure to hospital wastewater inhibited the growth of susceptible isolates, while multidrug-resistant isolates continued to grow.

The researchers then reproduced these findings in water samples containing many different types of bacteria, finding that exposure to hospital wastewater significantly increased the abundance of antibiotic-resistant E coli, while killing off more susceptible strains. In comparison, untreated municipal wastewater had a very small effect, and treated wastewater had no effect.

"The results were very clear," lead study author Joakim Larsson, PhD, who directs the Centre for Antibiotic Resistance Research at the University of Gothenburg, said in a university press release. "In all assays, we could see that antibiotic-sensitive bacteria were rapidly killed by the hospital wastewater, while the multi-resistant ones continued to grow."

Larsson and his colleagues say more research is needed to determine which antibiotics are contributing to antibiotic resistance, but add that the results point to the need to evaluate ways to reduce the risks associated with hospital wastewater.
Feb 13 Environ Int study
Feb 16 University of Gothenburg press release


Seven nations report more vaccine-derived polio, WHO extends health emergency

Seven countries—one in the Middle East, five in Africa, and one in Central Asia—reported more polio cases this week, all involving circulating vaccine-derived poliovirus type 2 (cVDPV2), according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

In the Middle East, Afghanistan reported one case from Khost province. The case is included in its total for 2020, which is now at 304.

In Africa, Ivory Coast reported one more case, involving a patient from Kabadougou, lifting its 2020 total to 72. The Democratic Republic of Congo (DRC) has two more cases, both from Sud-Ubangi province, increasing last year's total to 78. Ethiopia has three more cases, two from Oramiya region and one from Amhara region, bringing its total for last year to 24. Mali reported one more case, in a patient from Gao region, putting its total for 2020 at 36. And Sudan added one more to its total for 2020, involving a patient from South Sudan whose illness lifts the total to 57.

In central Asia, Tajikistan, which reported its first case last week, reported one more this week. The latest case involves a patient from Khatlon province, marking the first for 2021. The earlier case was counted in the country's 2020 total.
Feb 18 GPEI update

In other polio developments, the World Health Organization (WHO) said today that its polio emergency committee met earlier this month to review the latest trends and to assess if the global situation still warrants a public health emergency of international concern (PHEIC). They unanimously agreed that the risk of international spread still warrants a PHEIC and recommended that temporary recommendations be extended another 3 months.

They said the risk of wild poliovirus type 1 (WPV1) in Pakistan and Afghanistan remains high, with Pakistan's small decrease not yet sustained and Afghanistan's case numbers doubling. The group was also swayed by an increasing cases and environmental detections of cVDPV2 in new and earlier affected countries.
Feb 19 WHO statement

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