PAHO urges vigilance for NDM resistance mechanism

The Pan American Health Organization (PAHO) recently urged countries to strengthen surveillance and control of the New Delhi metallo-beta-lactamase–producing (NDM) antibiotic resistance, based on continued spread and detection in several countries.

The first findings in the Americas occurred in 2010 in the United States and Canada in patients who had received medical care outside the region. Since then, more countries have reported the NDM resistance mechanism, and six reported the discovery of it in a range of organisms in 2013: Argentina, Brazil, Mexico, Honduras, Nicaragua, and Costa Rica.

So far, 12 of the region's countries have reported the NDM mechanism in Enterobacteriaceae. Three have reported the NDM mechanism in Acinetobacter.

PAHO repeated the recommendations it made in 2011 and 2012 and highlighted the importance of establishing timely prevention and infection control in health services, as well as for surveillance and detection.

The NDM factor, initially reported in 2010, can make gram-negative bacteria resistant to nearly all antibiotics, and some experts have said it has the potential to become a global health problem, because few antibiotics for such bacteria are in the drug development pipeline.
Mar 7 PAHO epidemiologic update

Measles outbreaks in NYC, British Columbia

Health officials in New York City and British Columbia are battling measles outbreaks, according to health department statements.

The New York City Department of Health and Mental Hygiene (NYC Health) said on Mar 7 that so far it has detected 16 measles cases in northern Manhattan and the Bronx. Seven cases were in adults, and four hospitalizations have been reported so far.

NYC Health said it is working with area hospitals to prevent further exposures in emergency departments and that it is asking pediatric clinics to identify and vaccinate children who have not had their measles, mumps, and rubella (MMR) immunization.

It also urged adults who are unsure of their vaccination status to be revaccinated or take a blood test to see if they are immune to measles. The health department said several adults sickened in the outbreak thought they had been vaccinated, but lacked documentation.
Mar 7 NYC Health press release

British Columbia's Fraser Health on Mar 8 warned residents about a measles outbreak in an eastern part of its service area east of Vancouver that has low immunization coverage. It said the most recent exposure was linked to a school in Chilliwack that has traditionally low immunization rates.

In a statement, it said two cases have been confirmed and that it is following up on dozens of linked suspected cases.

Fraser health said it is contacting affected families to offer immunoglobulin or vaccine to help curb additional infections, which it said are a concern as students and families prepare for spring break travel. It added that relatively low immunization levels in some parts of its eastern region have resulted in several measles clusters in the past, most recently in the fall of 2013.
Mar 8 Fraser Health press release

Study: Rising temps increase malaria burden at higher altitudes

The incidence of malaria moves to higher elevations in warmer years, say findings of a study in Science that gives the first hard evidence that climate change will increase the burden of malaria, according to its authors. The topic of temperature's effects on malaria has remained controversial because of the complex etiology of the disease.

The researchers, from the University of Michigan and the London School of Hygiene & Tropical Medicine (LSHTM), studied the number of malaria infections in two highland areas of South America and East Africa that had kept detailed records of times and locations of malaria cases. The areas comprise 124 municipalities in the Antioquia region of western Colombia (1993 to 2005) and 159 kebeles (administrative units) in the Debre Zeit area of Ethiopia (1993 to 2005).

When they analyzed the year-to-year incidence of malaria cases against average annual temperatures, the authors found that in years with warmer temperatures the median altitude of malaria infections increased, and in cooler years the median altitude decreased.

"This is indisputable evidence of a climate effect," said lead author Mercedes Pascual, PhD, of the University of Michigan, in an LSHTM press release.

The authors say that the spread of malaria with rising temperatures will require even greater control efforts, especially in areas with large populations living at high altitudes. In the Ethiopian area studied, they say, about 37 million people (43% of the country's population) live in the highlands.

"Our findings here underscore the size of the problem and emphasize the need for sustained intervention efforts in these regions, especially in Africa," they say.
Mar 7 Science study abstract
Mar 6 LSHTM press release

Uganda reports 121 cases of meningococcal meningitis

Uganda's health ministry has reported 121 cases of meningococcal meningitis, including 5 deaths in recent weeks in the country's northwestern West Nile subregion, according to a report from the World Health Organization's (WHO's) Regional Office for Africa.

Of the cases, 26 have been in South Sudan refugees who crossed into Uganda because of the ongoing civil strife in their country.

The index case was reported in Adjumani district on Jan 31. Since then, health officials have confirmed 14 to 18 cases per week, but in the most recent week the number jumped to 29, the WHO statement said.

Thirty-two of 84 samples tested positive for Neisseria meningitidis serogroup W135, the regional office said.
Mar 6 WHO statement