News Scan for Sep 27, 2018

Multidrug-resistant fungus
Final cereal Salmonella count
Congo yellow fever vaccine steps

CDC reports multidrug-resistant fungus linked to fungicide exposure

A case report today from the Centers for Disease Control and Prevention (CDC) details the detection of a multidrug-resistant fungus in patients from three states.

The cases, described in today's Morbidity and Mortality Weekly Report, involve patients in Pennsylvania, Virginia, and California who were infected or colonized with Aspergillus fumigatus, an environmental mold that's the primary cause of invasive aspergillosis—an invasive infection that typically affects immunocompromised patients. Resistance to triazole antifungals in A fumigatus is associated with treatment failure and increased mortality. Increasingly common reports of triazole-resistant A fumigatus in Europe prompted the CDC to initiate passive laboratory monitoring for triazole-resistant A fumigatus isolates in 2011.

The monitoring identified a total of seven isolates (out of 2,300) collected from 2010 through 2017 that were carrying the resistance marker TR34/L98H. This resistance marker confers resistance to all triazoles and has been associated with triazole fungicide use in agriculture rather than previous patient exposure to triazole antifungals. Four of the seven patients identified had no known exposure to antifungal medications before culture of the resistant isolate, supporting environmentally acquired resistance. Three of the patients died from their infection.

The authors of the report note that A fumigatus spores are known to be carried long distances in the air, which can put patients at risk for infections with resistant strains, even when those patients live in areas without known agricultural fungicide use.

"Given that A. fumigatus can undergo selection for antifungal resistance during triazole fungicide exposure in the environment, and spores of resistant strains might be transmitted through the air and inhaled, further exploration of triazole fungicide use and presence of triazole-resistant A. fumigatus in these areas is warranted," the CDC researchers write.
Sep 27 CDC MMWR report


CDC: 135 Salmonella cases linked to Honey Smacks; outbreak probe over

In a final report on a Salmonella outbreak tied to Honey Smacks cereal, the Centers for Disease Control and Prevention (CDC) confirmed 135 cases in 36 states. The new total represents an increase of 5 cases since the previous CDC update on Aug 31.

There were no deaths reported in this outbreak, but 34 people were hospitalized. New York, Pennsylvania, and California reported the most cases, with 16, 12, and 11 cases, respectively. "As of September 26, 2018, this outbreak investigation is over," the CDC said.

Patients reported illness onset from Mar 3 to Aug 29, and patients ranged in age from less than 1 year to 95 years old. The median age was 57, and 69% of patients were female. Whole-genome sequencing from isolates collected from eight food samples and 91 patients did not show antibiotic resistance.

Lab testing showed the outbreak strain wasSalmonella Mbandaka, which was identified in a sample of unopened Kellogg's Honey Smacks cereal collected from a retail location in California and in samples of leftover Honey Smacks collected from the homes of sickened patients in Montana, New York, and Utah.

On Jun 14, Kellogg Company recalled Honey Smacks cereal, and the CDC said that consumers should not eat Kellogg's Honey Smacks cereal with a "best if used by" date of Jun 14, 2019, or earlier. Honey Smacks has a shelf life of 1 year.
Sep 26 CDC report


Republic of Congo to vaccinate more than 1 million against yellow fever

Yesterday the Republic of Congo launched a 6-day yellow fever vaccination campaign targeting 1 million people in the port city of Pointe-Noire and surrounding areas, the World Health Organization (WHO) said in a press release yesterday.

The campaign was launched in response to an outbreak that began in late August, when yellow fever was confirmed in a 20-year-old man at a health center in the city, which has a population of 1.2 million.

"Since then, no other case has been confirmed in the country, but more than 200 suspected cases have been reported since the beginning of the year, with most of these notified by the health authority in Pointe Noire," the WHO said in the release. "It's possible that there are also undetected cases as a large proportion of the Pointe Noire population seeks care in the private system and the national surveillance system may not be receiving notification."

The population of Pointe-Noire has suboptimal yellow fever vaccine coverage and high-density  Aedes aegypti populations, which could fuel urban transmission of the mosquito-borne virus.

According to the WHO, the campaign uses vaccines from the global emergency yellow fever vaccine stockpile managed by the International Coordination Group on Vaccine Provision and funded by Gavi, the Vaccine Alliance.
Sep 26 WHO press release 

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