Cucumber-linked Salmonella outbreak total climbs to 341

The US Centers for Disease Control and Prevention (CDC) said today that 56 more illnesses have been reported in a multistate Salmonella Poona outbreak linked to cucumbers imported from Mexico, raising the total so far to 341 cases.

Three more states (Hawaii, Kentucky, and Pennsylvania) have reported cases, lifting the number of affected states to 30. One more person has died from their illness, a patient from Texas, putting the fatality count at two. Meanwhile, the number of people who have been hospitalized for their infections has climbed from 53 to 70, or 33% of cases with available information.

The CDC announced the outbreak linked to cucumbers distributed by Andrew & Williamson Fresh Produce, based in San Diego, on Sep 4. On the same day the Food and Drug Administration posted a recall notice, which noted that the products had been distributed to at least 22 different states, and perhaps others.

PulseNet, the CDC's subtyping network, has suggested that the outbreak involves three different Salmonella Poona strains.

In its update today, the CDC said a handful of states have made progress with testing the cucumbers for Salmonella. Nevada's health department has isolated one of the outbreak strains on samples from retail cucumbers, and Arizona and Montana have isolated Salmonella from similar samples, with DNA fingerprinting under way to determine the subtype. Tests on Salmonella isolated by San Diego health officials on cucumbers from the company's produce facility are still under way.

The US outbreak has triggered recalls of the cucumbers by two grocery chains in Canada, though so far no illnesses have been reported there, according to Sep 6 and Sep 8 announcements from the Canadian Food Inspection Agency (CFIA). The recalls were from Safeway and Overwaitea Food Group and apply to these stores: Save On Foods, PriceSmart Foods, Coopers Foods, Overwaitea, and Freson Brothers.
Sep 9 CDC outbreak update
Sep 8 CIDRAP News scan "Cucumber-linked Salmonella outbreak sickens 285 in 27 states"
Sep 6 CFIA recall notice
Sep 8 CFIA recall notice

Study finds high-dose flu vaccine cost effective in elderly

A cost analysis of efficacy data for the high-dose flu vaccine showed a 93% chance that it will save money compared with standard-dose flu vaccines in seniors, a study yesterday in The Lancet Infectious Diseases noted.

Canadian and US researchers, including two from Sanofi Pasteur, which makes the Fluzone High-Dose vaccine and funded the study, analyzed data from a large efficacy study published last year. That study involved about 32,000 people 65 years and older and found the high-dose vaccine to be 24% more effective than a standard trivalent (three-strain) vaccine in preventing lab-confirmed flu. It appeared in the New England Journal of Medicine.

In the current study, the investigators determined that the high-dose vaccine was more cost effective even though it costs more than twice as much as the standard vaccine ($31.82 vs $12.04 per dose). They found that medical costs were $1,377 for each high-dose recipient and $1,493 for each standard-dose recipient. Mean "societal costs" were $1,506 and $1,635, respectively.

Hospital admissions for influenza accounted for 95% of the total healthcare costs and 87% of the total societal costs. A probabilistic sensitivity analysis showed that the high-dose vaccine is 93% likely to be cost saving, the authors wrote.

In an accompanying commentary, Mark Jit, PhD, MPH, of Public Health England, noted that, using the study's finding, savings could reach $150 million a year if all standard-dose vaccine was replaced with its high-dose counterpart in those 65 and older.

He wrote, however, that immunization against flu is not merely a choice between two vaccine and adds, "High-dose influenza vaccines are an undoubtedly important addition to the medical armamentarium for combating influenza; however, vaccination of older adults is just one component of a comprehensive influenza control strategy."
Sep 8 Lancet Infect Dis study
Sep 8 Lancet Infect Dis commentary
Aug 14, 2014, N Engl J Med study
Oct 24, 2013, CIDRAP News story "Early results in large trial affirm high-dose flu vaccine for seniors"

Flu activity still increasing in Australia, WHO says

Influenza activity in the Southern Hemisphere continues, with an increase in Australia and a drop in South Africa, the World Health Organization (WHO) said in its latest global flu update.

In Australia, flu activity seems to be still increasing, the WHO said, with influenza B predominant, followed by H3N2. In New Zealand, however, flu activity may have peaked in the second week of August, with H3N2 and B strains predominating.

Southern and Southeast Asia reported low flu activity overall, but India reported a minor increase in activity, predominantly 2009 H1N1. Activity was also high in southern China, much of it caused by H3N2.

Activity was also low in tropical regions of the Americas and the Caribbean, except Cuba, which is reporting high levels of flulike illness. Flu activity was also low in temperate South America, except for Chile, which is reporting high levels of respiratory virus infection.

Flu activity decreased in South Africa, with flu B predominating in recent weeks. Flu levels are also low elsewhere in Africa. Flu is at interseasonal levels in the Northern Hemisphere as expected at this time of year, the agency reported.

Globally, recent circulating strains comprised 76% influenza A and 24% flu B. Of the subtyped A viruses, 88% were H3N2 and the rest 2009 H1N1.
Sep 7 WHO update