PAHO chikungunya count rises by more than 32,000
The number of chikungunya infections in the Americas has increased to 1,343,372, a rise of 32,504, the Pan American Health Organization (PAHO) said in its latest update. The bump in cases was slightly higher than the 28,768-case increase recorded the week before.
PAHO's latest count includes 1,310,925 suspected, 28,910 confirmed, and 3,537 imported cases. Most of the imported cases are from the United States, which has 2,549,13 more than the previous week.
The US Centers for Disease Control and Prevention (CDC) said in a Mar 24 update that so far 68 chikungunya cases, all of them travel related, have been reported in 19 states so far this year. No locally transmitted cases have been reported. US territories have reported 52 chikungunya cases this year, all of them locally transmitted infections in Puerto Rico and the US Virgin Islands.
Most of the increase this week came from Nicaragua, which submitted 10 weeks' worth of data, and Colombia.
The death toll from the disease remained the same at 184.
Mar 28 PAHO update
Mar 24 CDC update
Saudis report another MERS case; camel serum suggested as treatment
Saudi Arabia reported another MERS-CoV (Middle East respiratory syndrome coronavirus) case today, while researchers raised the possibility of using camel antibodies to treat MERS patients.
The latest patient is a 65-year-old expatriate woman in Riyadh who is in stable condition, the Saudi Ministry of Health (MOH) reported. She is not a healthcare worker and had no contact with other MERS patients in healthcare or community settings, but the statement did not indicate whether she had any contact with animals.
The MOH also announced the death of a 57-year-old Saudi man in Hofuf whose case was reported earlier. In addition, the ministry noted the recovery of a 50-year-old male expatriate in Najran.
The latest events raised the MOH's cumulative MERS count to 973 cases, with 422 deaths, 532 recoveries, and 19 patients still in treatment or home isolation.
Mar 31 MOH statement
Meanwhile, researchers reported recently in the Journal of Virology that they used antibodies from camels to protect mice from MERS-CoV and to help infected mice recover from the disease.
The authors, from the United States and China, wrote that serum from recovered MERS patients may be useful for treating infected persons but is not readily available, and that most camels in the Arabian Peninsula carry MERS-CoV antibodies because of past infections. They used serum from camels to treat mice infected with human MERS-CoV isolates.
"The study, a successful proof-of-concept study, showed that prophylactic or therapeutic treatment with high-titer MERS immune camel sera diminished weight loss and pathological changes in lung tissues, and cleared the infections in the mice," says a press release from the American Society for Microbiology (ASM), publisher of the Journal of Virology.
"Our results suggest that these antibodies might prove therapeutic for MERS patients, and might protect uninfected household members and healthcare workers against MERS," corresponding author Stanley Perlman, MD, PhD, said in the release. He is a professor in the departments of microbiology and pediatrics at the University of Iowa.
Mar 18 J Virol study
Mar 30 ASM press release
Study: Sofosbuvir for hepatitis C cost-effective only in sickest patients
For cost-effectiveness, oral sofosbuvir-based treatment for hepatitis C virus (HCV) types 2 and 3 would best be reserved for only those patients with advanced liver disease or for whom other treatments have failed, say the authors of a study published yesterday in the Annals of Internal Medicine.
The researchers, from Boston Medical Center (BMC), simulated clinical outcomes, measured as quality-adjusted life years (QALYs) gained, and costs in 2013 US dollars for eight treatment strategies, including sofobuvir-based treatments, the first all-oral treatment approved for US HCV infections. They also calculated the incremental cost-effectiveness ratio (ICER) of treatments by dividing additional costs of each treatment into QALYs gained over the next less expensive treatment.
They found that for patients with cirrhosis, the ICER of sofosbuvir treatment was less than $100,000 for each QALY gained whether or not patients have been treated previously with other therapies, a cost commonly cited as the "US willingness-to-pay threshold" per QALY gained, say the authors. By contrast, in noncirrhotic HCV patients who are treatment-naive, the cost was calculated as more than $200,000 per QALY gained.
The authors give two reasons for the non-cost-effectiveness of sofosbuvir treatment in treatment-naive noncirrhotic HCV patients. First, pegylated interferon-ribavirin, which is less-expensive, has an efficacy rate of about 80% in these patients but is not an option in treatment-experienced patients. Second, the risk of death from HCV is low in patients without cirrhosis, and not all develop cirrhosis, so sofosbuvir therapy does not translate directly into substantial increases in life expectancy in this group.
In addition to limiting the candidates for sofosbuvir treatment, the authors say the cost-effectiveness of the treatment could be improved by lowering the cost of the agent. "At its current cost, access to sofosbuvir will likely be unequal and restricted and will limit the number of people ultimately cured of HCV infection in the United States," they say.
Mar 30 Ann Intern Med study abstract
Mar 30 BMC press release
Resistant infections tied to endoscopes thought to be fully decontaminated
Current industry standards for cleaning and maintenance of endoscopes are insufficient for complete decontamination, say the authors of a report on a cluster of antibiotic-resistant Escherichia coli (CRE) infections published yesterday in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA).
The cases of 49 patients with AmpC E coli infection who were patients at a hospital in Washington state from January 2012 to August 2013 were reviewed. Gene sequencing showed 35 (71%) of them to have a strain of bacteria with an identical mutation, including all 10 with carbapenem-resistant (CR) infection.
All 35 had complicated biliary or pancreatic disease and had undergone endoscopic retrograde cholangiopancreatography (ERCP) at least once during the study period. Mortality at 30 days was 16% overall and 56% for the CR patients.
An evaluation of reprocessed ERCP scopes at the hospitalshowed that 2 of 8 were contaminated by the same bacteria on pulsed-field gel electrophoresis. They had all been cleaned at a level exceeding the manufacturer's guidelines. Environmental cultures were negative, and no breaks in infection-control procedures were known.
A press release from SHEA says the hospital has taken "costly and extraordinary measures," including quarantining and culturing ERCP scopes after cleaning but that even that has not been entirely successful.
"We suspect endoscope-associated transmission of pathogenic bacteria might be both more common than recognized and not adequately prevented by current endoscope reprocessing guidelines," conclude the authors. They suggest re-evaluation of endoscope design and of reprocessing standards and say endoscopists should inform patients of the risk for endoscope-related bacterial transmission.
The report comes in the wake of reports in February of antibiotic-resistant infections linked to the use of reusable duodenoscopes in seven patients at a hospital in Los Angeles.
Mar 30 Infect Control Hosp Epidemiol study abstract
Mar 30 SHEA press release
Related Feb 19 CIDRAP News item
