News Scan for Mar 19, 2019

News brief

New CIDRAP program targets chronic wasting disease threat

The University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) today announced the launch of the Chronic Wasting Disease Response, Research, and Policy Program (CWD Program) to address the wildlife disease crisis and the potential for zoonotic spread and human-to-human transmission. CIDRAP is the publisher of CIDRAP News.

CWD is a prion disease that affects several cervid species and has been found in at least 26 US states and 3 Canadian provinces. Though no human CWD cases have been detected, many health groups advise against eating meat from animals that have tested positive for CWD.

Michael Osterholm, PhD, MPH, CIDRAP's director and professor in the School of Public Health, said in a University of Minnesota press release that some experts believe human CWD cases linked to contaminated meat may be documented in the years. "There is an immediate and critical need for national leadership on addressing CWD, and the CWD Program establishes the University of Minnesota as both the national and international center for CWD response, research, education and policy," he said.

The program, with support from the university's office of Vice President for Research and office of Vice President for Academic Clinical Affairs, will focus on coordinated and proactive leadership with government agencies and other groups, public education (hunters, healthcare groups, wildlife groups, and policymakers), promotion of rapid testing in cervids, and conduction of primary prevention research.
Mar 19 University of Minnesota press release

FDA requests money to fund food safety technology

In a statement today, Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, said the agency has requested funding from President Trump's 2020 budget to fully implement the Food Safety Modernization Act (FSMA).

"We must invest to prevent problems from happening by solidifying the agency's tools under FSMA. We must also embrace new innovations to improve our ability to secure the food supply chain and engage in more effective tracking and tracing of food from farm to fork," Gottlieb said in a statement co-signed by Deputy Commissioner Frank Yiannas, MPH.

The use of whole-genome sequencing (WGS) to identify culprits in foodborne illness outbreaks has greatly increased the number of outbreak investigations in the past few years, Gottlieb said. The FDA investigates approximately 120 potential human food safety outbreak incidents per year and needs increased funds to complete those investigations, he said.

In addition to WGS, the FDA has used more and more blockchain technology to monitor and secure the food supply chain, which also requires additional funding.

"We believe that the additional resources requested from Congress will help our program better protect our nation's food supply and lay the foundation for efforts to create a new era of smarter food safety in which new technologies can provide innovative products, help us better detect outbreaks, and better track and trace foods in the supply chain to prevent contaminated foods from reaching consumers," Gottlieb said.
Mar 19 FDA statement

Anthrax triage checklist designed to help quickly diagnose cases

A study today in the Annals of Internal Medicine used anthrax patient case reports from 1880 through 2013 to develop an initial triage checklist that would help quickly identify the illness in patients during a bioterrorism attack that used Bacillus anthracis, the bacterium that causes anthrax.

Experts from the US Centers for Disease Control and Prevention used medical records from 408 patients who had inhalation, ingestion, or cutaneous anthrax or primary anthrax meningitis, and 657 control patients to establish a checklist that correctly classified 95% of anthrax patients (95% confidence interval [CI], 93% to 97%) without diagnostic testing. The checklist accurately identified controls 76% of the time (CI, 73% to 79%). With the checklist in place, only 5% of anthrax patients required further testing to confirm the bacterial infection.

The progressive checklist contains 12 points, including heart rate, respiratory rate, presence of rash, and headache.

"The screening checklist combines easily collected vital sign data with brief questions on mental function and symptoms; the only physical examination components (required for just 40% of patients in our data set) are observation of cutaneous lesions, auscultation of the lungs, and evaluation for ascites," the authors said.

They concluded that the checklist could be used by both medical and non-medical professionals in a mass casualty setting with confidence.
Mar 19 Ann Intern Med study

Flu Scan for Mar 19, 2019

News brief

More than half of hospital trainees report to work with flulike illness

More than half of postgraduate hospital trainees self-reported that they come to work while experiencing influenza-like illness (ILI) symptoms, despite also saying that doing so poses a risk to patients, according to a study yesterday in the American Journal of Infection Control.

The study is the latest evidence of healthcare worker presenteeism—reporting for work while ill—and was based on an anonymous online survey given to trainees at the Albert Einstein College of Medicine in the Bronx, New York, in the spring of 2018.

Fifty-four percent of 197 trainee participants said they went to work while experiencing ILI in the previous year, even though 93% of participants said doing say was dangerous to patients. The participants said they expected to be complimented on their work ethic for working while ill, and only 9% of program leaders accurately estimated ILI presenteeism in trainees. Of the 23 program managers who participated, 6 (26%) said they had come to work with ILI symptoms.

"House staff responded that they would come to work with sore throat alone (88%), cough alone (87%), or nasal congestion (89%). Sixty-eight (35%) responded that they would come to work with fever alone. Only 4 (2%) reported that they would not work with any of the symptoms listed," the authors wrote.

The authors concluded by suggesting a need to change attitudes, practices, and culture regarding sick-leave policies.
Mar 18 Am J Infect Control study

Flu starting to decline in some Northern Hemisphere regions

Flu activity continues at elevated levels in many parts of the Northern Hemisphere, but is showing some signs of decline in some countries in Europe, Western Asia, and Eastern Asia, the World Health Organization (WHO) said yesterday in its latest global flu update.

In North America, the dominant strain has shifted to H3N2 from the 2009 H1N1 strain, with both influenza A strains circulating in Europe.

Among tropical regions, flu activity remained high in Southern Asia, including India where the 2009 H1N1 strain is predominant. In Southeast Asia, Thailand reported a sharp increase in flu activity, mainly from influenza B.

In the Southern Hemisphere's temperate regions, flu is mainly at interseasonal levels, but some parts of Australia are reporting flu circulation above expected levels, which involves cocirculation of both influenza A strains.

Globally, lab testing of samples through Mar 3 reflects very little influenza B activity: 97.1% of samples were influenza A and 2.9% were influenza B. Of subtyped influenza A strains, 59.5% were 2009 H1N1 and 40.5% were H3N2.
Mar 18 WHO global flu update