News Scan for Jul 27, 2016

News brief

Possible case of Angolan yellow fever in Brazil as vaccine trial launches

The Pan American Health Organization (PAHO), in its weekly yellow fever report yesterday, noted that genetic testing is under way to see if a Brazilian man picked up the disease after visiting Angola in March. The 58- year-old man from Niteroi died on Apr 2.

The outbreak so far has predominantly affected Angola and the Democratic Republic of the Congo, with only Uganda, Kenya and China reporting international transmission of the Angola strain. PAHO also said that Brazil, Colombia, and Peru are still the only countries in the Americas with confirmed cases of jungle yellow fever. Peru has 78 confirmed and suspected cases in 2016, more than the last 9 years combined.

In related news, the National Institute of Allergy and Infectious Diseases (NIAID) announced today that it's begun an early stage clinical trial for a new yellow fever vaccine. The vaccine was developed by Danish biopharmaceutical company Bavarian Nordic.

Though the current yellow fever vaccine has been safe and effective since its inception in 1937, it's in limited supply and has some shortcomings.

"Yellow fever has recently re-emerged as a major public health threat in parts of Africa. Although a vaccine exists to prevent this serious disease, it is currently in short supply, and it is not recommended for certain populations, such as pregnant women and people older than 60 years," said NIAID Director Anthony S. Fauci, MD, in a news release.
Jul 26 PAHO update
Jul 27 NIAID news release

E coli infections in 2 states trigger ground beef recalls

A cluster of Escherichia coli O157:H7 infections in New Hampshire and an investigation into an E coli illness in a Colorado resident triggered two separate beef recalls yesterday, according to a pair of notices from the US Department of Agriculture's Food Safety and Inspection Service (FSIS).

The FSIS said that on Jul 20 New Hampshire health officials notified it of 14 E coli illnesses, and the trace-back investigation for 8 of the patients led to the identification of a single day of production of beef products at PT Farm, based in North Haverhill, N.H. The recall involves nearly 8,000 pounds of ground beef, ground beef patties, and subprimal cuts produced between Jun 6 and Jun 16. The products were shipped to retail and institutional locations in Maine, Massachusetts, New Hampshire, and Vermont.

Meanwhile, state and county health officials in Colorado notified the FSIS on Jul 14 of an E coli infection from June, and the FSIS found a possible link to ground beef products made by Ranch Foods Direct, based in Colorado Springs, Colo. Trace-back and lab findings found contamination in the products on Jul 25, and the investigation is continuing.

The recall involves about 2,600 pounds on nonintact beef items produced on Jun 6, 7, and 8. They were sent to wholesale and retail locations in Colorado.

For both recalls, the FSIS said the items may still be in consumers' freezers. E coli infection can cause dehydration, bloody diarrhea, and cramps and can lead to a potentially fatal kidney condition called hemolytic uremic syndrome.
Jul 26 FSIS recall linked to New Hampshire cluster
Jul 26 FSIS recall linked to Colorado illness

Chinese officials report 2 new H7N9 avian flu cases

Chinese officials have reported two new cases of H7N9 avian flu, one of which occurred in June, according to separate posts today by FluTrackers, an infectious disease news message board.

One case involves a 36-year-old man from Hebei province, health officials from Beijing reported. He had exposure to live poultry before he got sick and is hospitalized in Beijing in critical condition.

The other patient is from Henan province and is a 54-year-old female farmer. Provincial authorities reported her illness on Jul 20 but provided no other information, including when her illness began.

The two newly reported cases bring the total number since the outbreak began in China in 2013 to 802, according to a case list maintained by FluTrackers.
Jul 27 FluTrackers post on Hebei case
Jul 27 FluTrackers post on Henan case
FluTrackers H7N9 case list

South Sudan reports 271-case cholera outbreak with 14 deaths

Health officials in South Sudan have reported 271 cholera cases in the past 2 weeks, including 14 deaths, the World Health Organization (WHO) said on Jul 25 while detailing response efforts.

The WHO Regional Office for Africa said in a news release that the agency and its partners are ramping up surveillance and treatment efforts. It has established a cholera treatment center at Juba Teaching Hospital in Juba, the country's capital and largest city. It is the only referral hospital in South Sudan. The WHO has also set up eight rehydration points across the country.

The WHO and its health partners also began an immunization campaign yesterday using oral vaccine. The effort is designed to reach 14,000 people, including targeted populations such as displaced people. The WHO has also delivered supplies like tents and enough cholera kits to treat 400 people.

"Cholera is an acute diarrhoeal disease that causes massive loss of body fluids and can be deadly within hours if not adequately treated. WHO is taking all the necessary control measures to support the Ministry of Health to respond to the situation urgently, and put an end to this outbreak," said Abdulmumini Usman, PhD, WHO representative to South Sudan.
Jul 25 WHO news release

Drug Resistance Scan for Jul 27, 2016

News brief

Risk factors identified for patient-to-patient spread of dangerous superbug

A new study has determined that there are three key factors that increase the risk for patient-to-patient transmission of carbapenemase-producing carbapenem-resistant Enterobacteriaceceae (CP-CRE), dangerous drug-resistant bacteria that tends to strike patients in hospitals and nursing homes who are on ventilators, require catheters, or are taking long courses of antibiotics.

The study, published Jul 25 in Infection Control Hospital & Epidemiology, found that 96% of patient-to-patient CP-CRE transmissions had at least one of the following risk factors:

Contact for more than 3 days with an infected individual
Mechanical ventilation
Infection with another multidrug-resistant organism

The study was based on data from more than 3,000 adult patients screened for CP-CRE because they had been in contact with an infected patient from 2008 through 2012. Fifty-three of those patients tested positive for the pathogen.

"Identifying high-risk groups helps us to avoid excessive screening that can be risky and expensive, and to determine who should be screened and who might be a candidate for pre-emptive isolation or antibiotics," lead author Vered Schechner, MD, MSc, an infection control physician at Tel Aviv Sourasky Medical Center, said in a news release from the Society for Healthcare Epidemiology of America (SHEA), which publishes the journal.

The researchers also found that patients who were taking cephalosporin antibiotics were less likely to acquire the superbug than those taking other types of antibiotics. But when those patients were compared with patients receiving no antibiotics, cephalosporins did not appear to have a protective effect.

CP-CRE is a subset of CRE that produces an enzyme that breaks down carbapenems and related antimicrobials. According to the Centers for Disease Control and Prevention, CP-CRE strains have been targeted for prevention because it is believed they are behind the spread of CRE infections.
Jul 25 Infect Control Hosp Epidemiol study
Jul 25 SHEA news release

Multidrug-resistant Campylobacter coli cluster reported in Canada

A team of researchers in Canada has documented a small outbreak of multidrug-resistant Campylobacter coli that occurred in Montreal in 2015.

The researchers say six men between the ages of 35 and 62 were diagnosed as having enteric C coli infections resistant to erythromycin, tetracycline, and ciproflaxin between Jan 14 and Feb 7 of 2015. The results of an epidemiologic and molecular investigation suggest the infection was sexually transmitted; the six men—whose cases were not linked to each other—were reported to be gay, and four of them reported having had unprotected sex in the week before symptom onset. Five of the men were HIV-positive. Food was not suspected to be the source of the infection.

Several of the researchers involved in the study wrote about a similar drug-resistant C coli cluster in Montreal in 2010-11. That cluster involved 10 patients and was also determined to involve sexual transmission.

The researchers say few C coli clusters have been reported, and that outbreaks caused by this Campylobacter species may be underestimated. They recommend that gay men be counseled about sexually transmitted infections, including the use of barriers during genital, oral, and anal sex.

The research was published yesterday in Emerging Infectious Diseases.
Jul 26 Emerg Infect Dis dispatch
May 2013 Emerg Infect Dis report on 2011-12 outbreak