Texas data reveal 8% rate of Zika-linked birth defects

Data on infants born to women suspected of having a Zika virus infection in Texas show higher-than-average rates of birth defects and suboptimal levels of testing, according to a report today in Morbidity and Mortality Weekly Report (MMWR).

Scientists with the US Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services detailed findings from 219 pregnant Texas women with laboratory evidence of possible recent Zika virus infection, including 49 (22%) with lab-confirmed Zika, from Jan 1, 2016, through Jul 31, 2017. Pregnancy outcomes were recorded for 185 (84%), including 182 live-born infants and 3 pregnancy losses.

Zika virus testing was completed for 80 (43%) of the 185 infants or fetuses, and Zika-linked birth defects were recorded in 15 pregnancies (8%; 14 live-born infants and 1 miscarriage), including 6 (17%) of the 36 infants or fetal losses delivered by women with lab-confirmed Zika. The 8% birth defect incidence compares with 5.5% for the country as a whole and 4.4% in US territories, according to the most recent CDC data.

Ten infants or fetuses had microcephaly, five of whom had additional birth defects, including holoprosencephaly, hydranencephaly, craniosynostosis, and clubfeet. Zika-related birth defects in the other three infants included holoprosencephaly, cataracts, and ventral pons hypoplasia.

Zika virus testing was not completed for 105 infants or fetuses (57%), including 3 pregnancy losses and 10 live-born infants for whom only a placental or cord blood specimen was tested.

The authors concluded, "The occurrence of travel-related Zika virus infections, combined with the threat of local transmission in Texas, indicates a need for continued surveillance for birth defects associated with Zika virus infection. . . . Efforts to increase the frequency of collecting and testing of specimens from infants born to mothers with laboratory evidence of possible recent Zika virus infection are needed."
Aug 11 MMWR report


Saudi Arabia confirms 2 more healthcare workers infected with MERS-CoV

The Saudi Arabian Ministry of Health (MOH) today reported that two more healthcare workers have contracted MERS-CoV in Dumah Al Jandal, the site of a growing hospital-based outbreak.

The healthcare workers are both female expatriates, ages 38 and 42. Neither presented with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus), and both are in stable condition. The MOH said both infections are healthcare acquired. In the past 10 days, the MOH has reported at least 11 cases connected to a hospital in Dumah Al Jandal, which is located in northwestern Saudi Arabia.

The MOH also noted the death of two previously reported patients. The two men were from Khamis Mushait in southern Saudi Arabia and Hail in the north central part of the country. As of today, Saudi Arabia's MERS-CoV cases since 2012 total 1,694, including 688 deaths. Eleven people are still being treated for their infections.

In other Saudi Arabian news, the European Centre for Disease Prevention and Control (ECDC) today said the relative risk for illness during the annual Hajj in Mecca is low. Millions of Muslims will make a pilgrimage to the holy city from Aug 30 to Sep 4. Foodborne illnesses and respiratory viruses are the biggest public health concerns, according to the ECDC's assessment.
Aug 10 MOH
Aug 10 ECDC


Researchers develop a rapid test for antibiotic susceptibility

A team of researchers in Sweden have developed a test that can determine antibiotic susceptibility in less than 30 minutes, according to a new study in Proceedings of the National Academy of Sciences.

The "fASTest" method, developed by researchers at Uppsala University, uses a microfluidic chip that captures bacterial cells in 2,000 parallel cell traps. Growth media containing antibiotics is loaded into the chip, and the growth rate of the individual bacterial cells in response to the antibiotic is monitored using microscopy and compared to the growth rate of cells exposed to growth media without antibiotics. The total time for testing, from loading of the bacterial sample to diagnostic readout, is less 30 minutes—fast enough to be used at the point of care.

For the study, the researchers tested urinary tract infections (UTIs) caused by Escherichia coli, the primary cause of infection in 85% of UTIs diagnosed in primary care. First, they determined the antibiotic response time of E coli to nine different antibiotics used to treat UTIs, and found that it was possible to detect changes in the growth rate of the bacteria within 3 to 11 minutes. In a test of 49 clinical uropathogenic E coli isolates in response to ciprofloxacin, all isolates were correctly classified as susceptible or resistant in less than 10 minutes, with similar sensitivity and specificity as traditional methods of antibiotic susceptibility tests.

Although the test is years away from clinical use, the findings are significant because traditional antibiotic susceptibility tests, which measure bacterial growth with and without antibiotics in liquid cultures or solid agar plates, typically take 1 to 2 days to produce results. As a result, clinicians often have to prescribe a broad-spectrum antibiotic in the early stages of an infection, or risk prescribing the incorrect antibiotic. A susceptibility test that could provide results in 30 minutes would enable clinicians to provide proper treatment more quickly.

"The hope is that, in the future, the method could be used in hospitals and health centers to quickly provide correct treatment and reduce unnecessary use of antibiotics," study co-author Dan Andersson, PhD, said in an Uppsala University news release.
Aug 8 Proc Natl Acad Sci study
Aug 8 Uppsala University news release


Avian flu outbreaks hit farms in Italy and Taiwan

Italy today reported two more highly pathogenic H5N8 avian flu outbreaks in commercial poultry, both in Lombardy region where other outbreaks were recently reported, according to a notification from the World Organization for Animal Health (OIE).

One of the events began Aug 3 at a goose farm in the city of Pavia, killing 2,100 of 3,065 birds. The other started on Aug 8 at a turkey farm housing 7,680 birds in the city of Mantova. The surviving birds were slated for culling, and as control steps authorities have placed protective and surveillance zones around the affected farms.

Several European countries were hit hard by H5N8 outbreaks over the winter and spring, and some, including Italy, continue to report a smaller stream of ongoing outbreaks or sporadic detections.

The UK Department for Environment, Food, and Rural Affairs (DEFRA) on Aug 8 issued an updated risk assessment on ongoing H5N8 activity in the United Kingdom and other European countries. It said recent positive findings in a mute swan found dead in Norfolk county confirms that the virus continues, as expected, to circulate in resident waterfowl at very low levels. Italy's outbreaks are located in the same area and might reflect common contact, DEFRA said, noting that the overall risk for the UK is still considered low.
Aug 10 OIE report on H5N8 in Italy
Aug 8 DEFRA report

Meanwhile, Taiwan yesterday reported two more highly pathogenic H5N2 outbreaks, both at duck farms, according to a report from the OIE. The events began on Jul 24 in the same city of Changhua County on the west side of the island. Between the two locations, authorities culled 1,498 birds to control the spread of the virus.
Aug 9 OIE report on H5N2 in Taiwan


Nigerian healthcare workers test positive for Lassa fever

Three Nigerian healthcare workers at the country's largest university hospital have tested positive for Lassa fever, according to a post on Avian Flu Diary, an infectious disease blog.

Though Lassa is endemic in Nigeria, the cases are concerning to health officials because the healthcare workers possibly contracted the virus at the Lagos University Teaching Hospital. Now, 150 potentially exposed staff are being monitored for signs of the hemorrhagic fever.

This year has seen about half as many Lassa fever infections as 2016, according to Nigeria's most recent epidemiologic update. Between the first of the year and Jul 23, officials noted 344 suspected cases of Lassa, compared with 746 cases during the same period in 2016.

Nigerian media reported several Lass fever cases in Lagos in recent weeks.
Aug 10 Avian Flu Diary post


Study: Rotavirus vaccine cuts healthcare costs in US children

The rotavirus vaccine led to dramatic cuts in costs associated with hospitalization and care for pediatric cases of acute gastroenteritis (AGE), according to a study today in the Journal of the Pediatric Infectious Diseases Society.

The rotavirus vaccine was introduced in 2006, and the researchers compared cases of AGE from 2000 to 2006 with those from 2008 to 2013 in preschool-aged children, using data from hospitals in 26 states. They estimated that, from 2008 to 2013, AGE-related hospitalizations were reduced by 382,000, resulting in a $1.2 billion reduction in direct medical costs.

From 2008 to 2013, diarrhea hospitalizations decreased by 31% to 55%, with fewer hospitalizations toward the end of the study period. By 2015, 75% of US children between the ages of 1 and 3 had been vaccinated against rotavirus. That's lower than the 95% uptake seen for other childhood vaccines, including the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine.
Aug 10 J Pediatr Infect Dis Soc study

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