News Scan for Apr 12, 2017

News brief

Hungary, Romania confirm more H5N8 avian flu outbreaks

Two European countries—Hungary and Romania—reported more highly pathogenic H5N8 avian influenza outbreaks in poultry and wild birds today, and Hong Kong officials confirmed H5N6 in a wild bird found dead in Kowloon, a major urban area.

Hungary reported two outbreaks on commercials farms, one housing geese and the other producing ducks. The events began on Apr 5 and Apr 8, respectively, and both occurred in the city of Bacs-Kiskun County in the south central part of the country, according to a report from the World Organization for Animal Health (OIE). More than 21,000 birds were affected.

In a separate report to the OIE, Romanian officials reported four more H5N8 outbreaks, three in backyard poultry and one involving a mute swan found dead. The outbreaks began from Mar 14 to Apr 4, affecting four locations in the south, including the capital city of Bucharest. Besides the swan, the virus killed 9 of 33 susceptible poultry among the three backyard holdings.

Elsewhere, Hong Kong's government today announced that a red-whiskered bulbul found dead on a playground in Kowloon tested positive for H5N6. A statement from the Agriculture, Fisheries and Conservation Department (AFCD) said cleaning and disinfection has been increased at the site where the bird was found. No poultry farms are within 3 kilometers of the finding, but AFCD is contacting poultry farmers to remind them to strengthen their biosecurity against avian flu.

Since early 2016, Hong Kong had detected H5N6 in a few wild birds found dead, chicken carcasses that have washed ashore, and environmental samples.
Apr 12 OIE report on H5N8 in Hungary
Apr 12 OIE report on H5N8 in Romania
Apr 12 Hong Kong AFCD press release

First MERS case reported in UAE in 10 months

The United Arab Emirates (UAE) yesterday reported its first case of MERS-CoV since June of 2016.

The National, a UAE newspaper, reported that the patient is hospitalized and being treated for MERS-CoV (Middle East respiratory syndrome coronavirus). So far, no other details about the patient have been released.

In 2016, the UAE reported three cases, two tied to camel exposure. The vast majority of current MERS cases are found in neighboring Saudi Arabia, where the World Health Organization identified an outbreak in 10 people exposed in a hemodialysis unit of a hospital in Wadi Aldwaser last week.

Since 2012, when the virus was first detected in humans, 1,956 cases, at least 748 of them fatal, have been reported, according to the European Centre for Disease Prevention and Control.
Apr 11 The National story

Parent peers may reduce vaccine hesitancy, study says

A new study shows that implementing a program of parent volunteers who were trained to become immunization advocates was associated with reduced hesitancy toward vaccines among peers, with the percentage of "vaccine-hesitant" parents declining from 22.6% to 14%.

The study, published in the journal Health Promotion Practice, was based on a 3-year community intervention program, "Immunity Community," conducted in Washington state. In 2011, that state had a 6.3% school entry vaccination exemption rate, three times the national average.

Parent volunteers who identified themselves as being vaccine advocates were trained in positive dialogue with vaccine-hesitant community members. Surveys showed the parent volunteers had a statistically significant impact on the attitudes of their peers. The percentage of survey participants concerned about other parents not vaccinating their children increased from 81.2% to 88.6%. Although attitudes changed, the researchers found no statistically significant changes in parental behaviors.

"The approach builds on findings that parents' social networks are a strong predictor of vaccine acceptance and that likable, trustworthy messengers are positively received," the authors concluded. "Results show statistically significant shifts in certain vaccine-related knowledge and attitudes among parents in prioritized communities."
Apr 11 Health Promot Pract study

Jury delivers $454 million fraud verdict against surgical gown maker

A California federal court jury on Apr 7 found that Kimberly-Clark Corp and its medical technology group Halyard Health misled buyers about the protection of their MicroCool surgical gowns, awarding $454 million in compensatory and punitive damages, the Associated Press (AP) reported on Apr 10.

The class-action lawsuit was filed by more than 400 hospitals and health centers in California. The suit said the companies falsely claimed that the gowns protected against serious diseases such as Ebola.

A 2016 CBS "60 Minutes" investigation said Halyard Health for years sold surgical gowns that it knew were defective and quoted a former marketing director who said gowns didn't consistently pass leak tests and that it did not notify customers or the Food and Drug Administration. The company sells about 13 million gowns a year, supplying a quarter of the US market, which has included the federal government's Strategic National Stockpile.

Kimberly-Clark said it would appeal the verdict, which it said was baseless and excessive. Nearly 70 million of the gowns have been sold without any injury complaints, it added.
Apr 10 AP story
May 2, 2016, CIDRAP News scan "CBS report says US firm knowingly sold defective surgical gowns"

Study: El Nino shifts cholera threat to East Africa

East Africa's cholera cases increase by 50,000 during El Nino years, according to a mapping study led by Johns Hopkins University Bloomberg School of Public Health researchers.

Since weather forecasters generally know 6 to 12 months before an El Nino pattern occurs, the findings could help public health officials plan ahead to reduce the impact of the outbreaks, the authors said. The team published its findings Apr 10 in Proceedings of the National Academy of Sciences (PNAS).

The researchers used mapped cholera clusters before, during, and after El Nino years, using 360 data sets and analyzing 17,000 annual observations from 3,710 locations from 2000 through 2014. Though the total number of cholera cases in Africa didn't vary based on El Nino weather patterns, the geographic impact shifted to East Africa, which saw a rainfall increase that came with a threefold increase in cholera. Areas that see massive rainfall can experience sewer system problems and contaminated drinking water, and dry conditions can threaten clean water supplies, forcing populations to consume water from contaminated sources.

The investigators said 2015-16 was an El Nino year, which was followed by a large outbreak in Tanzania.

Justin Lessler, PhD, study coauthor and associate professor of epidemiology at Bloomberg, said in a press release from the school, "Knowing there is elevated cholera risk in a particular region can help reduce the number of deaths that result. If you have cholera treatment centers available, fast, supportive care can reduce the fatality rate from cholera from as high as 30% to next to nothing."
Apr 10 PNAS abstract
Apr 10 Johns Hopkins press release

Stewardship / Resistance Scan for Apr 12, 2017

News brief

ASP tied to lower broad-spectrum antibiotic use in pediatric hospital

A German study in Infection found that implementation of an antibiotic stewardship program (ASP) was associated with lower rates of broad-spectrum antibiotic prescribing, better dosage accuracy, shorter therapy, and cost savings in a pediatric hospital.

The study enrolled children from four non-surgical pediatric wards in a 61-bed Munich hospital that admits about 3,800 children a year. The researchers compared 273 patients in the pre-ASP period (Sep-Dec 2014) with 263 in the post-intervention period (Sep-Dec 2015).

The investigators found that use of cephalosporins and fluoroquinolones decreased by 35.5% and 59.9%, respectively, while use of penicillins increased by 15.0%. Overall days of therapy and length of therapy dropped 10.5% and 7.7%, respectively. In addition, dosage accuracy climbed from 78.8% to 97.6%, and guideline adherence for community-acquired pneumonia improved from 39.5% to 93.5%.

In addition, the ASP saved €330,000 ($351,000) per year, the authors said.

They conclude, "Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety."
Apr 10 Infection study

Study reveals spread of drug-resistant MRSA strains in Ireland

A new study in PLoS One reveals the emergence and extensive spread of multiple strains of a multidrug-resistant, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clone within and between hospitals, healthcare facilities (HCFs), and communities in Ireland.

In the study, researchers investigated 89 MRSA isolates (of the community-associated ST1-MRSA-IV clone) recovered from multiple hospital, healthcare, and community sources from 2013 to 2016. The vast majority of the isolates (78 of 89, or 88%) were healthcare-associated (HCA) MRSA, with many (46 isolates) recovered from a single hospital outbreak and the rest from 16 separate hospitals and 4 HCFs. Eleven of the isolates were community-associated.

Seventy-five of the isolates (84%) were multidrug resistant, exhibiting phenotypic resistance to three or more clinically relevant antibiotic classes, with 50 of 89 isolates (56%) showing high-level resistance to mupirocin.

Whole-genome sequencing and single-nucleotide variation analysis of the isolates identified the concurrent circulation of two closely related strains of ST1-MRSA-IV and multiple sporadic strains. Further investigation revealed that strain 1 spread within and between five different hospitals, two HCFs, and the community, with healthcare workers as a possible reservoir of the strain. Isolates from strain 2 were recovered from eight hospitals, one nursing home, and the community. The outlier strains were recovered from eight hospitals and the community.

"The extensive spread of this CA-MRSA clone within and between the Irish community and hospitals/HCFs highlights the need for infection prevention and control measures that consider CA-MRSA transmission routes into hospitals," the authors write.

Since current national guidelines in Ireland recommend MRSA screening only for patients at risk of HCA-MRSA, the authors argue that infection prevention and control measures should now consider CA-MRSA risk factors as well. They also suggest screening of healthcare workers, as travel of staff between facilities is common in Ireland.
Apr 11 PLoS One research article

Very high rate of MRSA colonization found in Portuguese swine

Researchers in Portugal have found a high rate of MRSA colonization in swine and swine workers at two Portuguese farms, according to a study yesterday in PLoS One.

The aim of the study was to assess whether healthy pigs are contributing to the reservoir of MRSA in Portugal, which has a nosocomial MRSA prevalence of nearly 50%, one of the highest in Europe. For the investigation, researchers evaluated the prevalence, antimicrobial resistance patterns, and clonal profile of MRSA isolates from two pig farms and looked for possible transmission to workers on the farms and their families.

The researchers screened nasal samples from a total of 101 piglets, 5 farm workers, and 4 household members for MRSA colonization. Overall, 99% of the piglets (49 of 50 on farm A and all 51 on farm B), 80% of the farm workers (4 of 5), and 25% of the household members (1 of 4) were nasally colonized with MRSA. All of the116 isolates recovered belonged to a single sequence type—ST398, the main livestock-associated MRSA lineage—associated with two predominant spa types, t011 and t108.

High rates of the isolates were resistant to tetracycline (100%), clindamycin (97%), erythromycin (96%), chloramphenicol (84%), and gentamycin (69%), with 12% showing resistance to quinupristin-dalfopristin.

The authors suggest the high rate of MRSA colonization among the pigs might be caused by animal-to-animal transmission aided by the crowded conditions on the farms, a theory supported by the spread of only two spa types. In addition, they argue, the fact that two of the farmers carried the same lineage found in the pigs "corroborates the idea that pig farming is a significant risk factor for MRSA carriage in humans."
Apr 11 PLoS One research article