Saudi Arabia reports two more MERS cases

Saudi Arabia's health ministry today announced two more Middle East respiratory syndrome coronavirus (MERS-CoV) infections, one of which appears to be in a health worker with an asymptomatic infection who had contact with a confirmed case, according to a machine-translation of a statement posted on the ministry's Web site.

The health worker is a 26-year-old working in Riyadh, and the second case is in a 51-year-old resident of the Jawf region who has underlying medical conditions and is hospitalized in an intensive care unit in Riyadh. The relationship between the case-patients isn't clear from the translation, nor are their genders.

The new cases raise Saudi Arabia's MERS-CoV count to 132 cases with 55 deaths.
Dec 5 Saudi health ministry statement

IDSA offers guidelines on vaccines for immunocompromised patients

New guidelines from the Infectious Diseases Society of America (IDSA) are designed to fill an information gap by offering comprehensive recommendations on immunizations for people who have compromised immune systems, such as those with cancer, HIV, or Crohn's disease, the IDSA announced today.

Vaccination rates tend to be lower in immunocompromised patients, in part because their physicians may be concerned about vaccine safety and effectiveness, the IDSA said in a press release. The group said most such patients should receive the influenza vaccine and other immunizations.

The recommendations were published today in Clinical Infectious Diseases. They are intended for both primary care physicians and specialists who treat immunocompromised patients, and they include recommendations for vaccinations for those who live with such patients.

"The guideline provides 'one-stop shopping' for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for all vaccinations, from influenza to chicken pox," said Lorry G. Rubin, MD, lead author of the guideline. "Previously, the recommendations were difficult to retrieve because in most cases information had to be accessed individually by vaccine rather than by the category of patient disease."

The 122 specific recommendations in the guideline cover patients with all types of immunocompromising conditions, the IDSA said.

The guidance says that inactivated influenza vaccine is recommended for immunocompromised patients aged 6 months and older, except those who are very unlikely to respond, such as those receiving intensive chemotherapy or those who have received anti–B-cell antibodies within the past 6 months. It says the live attenuated flu vaccine should not be used in immunocompromised persons.
Dec 5 IDSA press release
IDSA guidelines in Clin Infect Dis

Raw-burger holiday tradition led to Wisconsin outbreak last year

A 17-case outbreak of Escherichia coli infections last holiday season in Wisconsin was linked to consuming raw ground beef as "tiger meat" or "cannibal sandwiches" as part of a winter holiday tradition, health officials reported today in Morbidity and Mortality Weekly Report (MMWR).

The outbreak came to light Jan 8 this year when Wisconsin's state lab notified the Wisconsin Division of Public Health of two patients with identical E coli O157:H7 clinical isolates. The two had bought raw ground beef at the same Watertown, Wis., market and served it raw with onions on rye bread or crackers as part of a holiday specialty.

Health professionals identified 17 outbreak patients, 4 with confirmed illness and 13 listed as probable cases. The patients ranged in age from 1 to 82 years, with a median of 46. Thirteen of them were female. Eight had received outpatient care, but none died or required hospitalization.

Fourteen patients reported eating raw ground beef as tiger meat or cannibal sandwiches during the holidays, and three were exposed via cross-contamination.

The investigators also interviewed 58 people who bought raw ground beef from the meat market from Dec 22, 2012, through Jan 4, 2013, or their household contacts or people in the area who reported gastrointestinal illness. The list included outbreak patients. All but 1 of 56 who answered the question said they consumed raw ground beef only on special occasions.

Fifty-three of the 58 (91%) knew that eating raw ground beef could cause illness, but only 17 of 42 (41%) thought that sickness could be severe. Six of 15 patients (40%) and 28 of 40 other respondents (70%) said they planned to continue eating raw burger.

The meat market voluntarily recalled 2,532 pounds of raw ground beef because of the outbreak, the authors said. The MMWR report does not name the market, but a Jan 15 US Department of Agriculture (USDA) recall notice specified that it was Glenn's Market and Catering of Watertown.

This same region of Wisconsin saw outbreaks of more than 50 cases linked to eating raw ground beef in 1972, 1978, and 1994, the MMWR report says. It adds that the sandwiches are a tradition in some Upper Midwest regions.
Dec 6 MMWR report
Jan 15 USDA recall notice

Lawlessness, violence in Pakistan spur 2013 polio increase

Of the three countries in the world in which polio is still endemic, Pakistan ranks first in the number of cases so far in 2013, with 72, and is the only one with an increase in cases over last year, according to a story from Agence France-Presse (AFP). World Health Organization (WHO) officials count opposition to the vaccination campaigns by militant groups and violence against vaccination workers as the reasons behind these dubious honors.

Of this year's cases in Pakistan, the large majority (50) have been in the lawless northwest tribal areas bordering Afghanistan. Pakistani Taliban groups banned polio vaccinations in Waziristan last year, claiming the campaigns were covers for espionage, says the story. Vaccination workers have been attacked and in many cases killed while trying to reach children with vaccine in the northwest as well as other areas of the country.

Elias Durry, emergency coordinator of the WHO Polio Eradication Pakistan Program, said 33 million children were vaccinated in the recent campaign but that 2.3 million had been missed, mainly because of violence and security threats.

The two countries in addition to Pakistan where polio remains endemic are Nigeria, with 50 cases this year, and Afghanistan, with 6. Last year Nigeria had 110 cases, Pakistan 58, and Afghanistan 31.
Dec 4 AFP story
Most recent (Dec 2) CIDRAP News scan addressing violence in Pakistan