News Scan for Jul 11, 2013

News brief

WHO confirms latest MERS-CoV case, death

The World Health Organization (WHO) today confirmed Saudi Arabia's most recently announced Middle East respiratory syndrome coronavirus (MERS-CoV) case, raising the global total from the disease to 81 confirmed illnesses.

The patient is a 66-year-old man from the Asir region who has underlying health conditions and his hospitalized in stable condition. Saudi Arabia's health ministry first announced his illness on Jul 8.
Jul 11 WHO statement

In other developments, the US Centers for Disease Control and Prevention (CDC) yesterday posted new tools to help health providers prepare for MERS cases.

One is aimed at health providers, walking them through steps to take when preparing to transport and care for patients who are possibly infected with MERS-CoV. The other is for health facilities and includes steps such as developing surge capacity plans and plans for visitor restriction if the disease is circulating in the community.
Jul 9 CDC checklists for MERS-CoV

In a brief note in today's Morbidity and Mortality Weekly Report (MMWR), the CDC warned health providers that in the coming months the US healthcare system might be called on to care for patients infected with MERS-CoV.

It urged them to keep up to date with the latest guidance about the disease on the CDC's Web site.
Jul 11 MMWR report

Kids' mild H7N9 cases show striking contrast to adults' cases

Surveillance during the H7N9 influenza outbreak in China this spring uncovered only two mild H7N9 cases, both in children in Shanghai, indicating that mild disease is uncommon, researchers reported yesterday in a letter to Emerging Microbes & Infections.

Chinese health officials reported that surveillance had uncovered 17 H7N9 cases in Shanghai adults by Apr 10, all of them severe. By May 31, 10 had died and the rest had been released from the hospital.

During that time, Shanghai's Sentinel Surveillance System for Influenza-like Illness had detected 1,799 symptomatic patients whose throats were swabbed. Polymerase chain reaction testing turned up only 2 H7N9 cases, both in boys under 4 years old.

Not only were clinical courses dramatically different between the adult and child cases, but x-rays showed striking contrasts. A radiograph of one of the children revealed clear lung texture, compared with abnormal chest x-rays in patients with severe disease similar to severe 2009 H1N1, H5N1 avian flu, or SARS (severe acute respiratory syndrome).
Jul 10 Emerg Microbe Infect abstract

Study finds pneumococcal vaccine for kids protected adults too

Since the introduction of the seven-strain pneumococcal vaccine for US kids in 2000, pneumonia-related hospitalizations have dropped by 168,000 a year, including a substantial decrease in adults, according to a study today in the New England Journal of Medicine.

Researchers used data from the Nationwide Inpatient Sample database from 1997 through 1999 and again from 2007 through 2009 to determine the hospitalization rates for pneumonia before and after the vaccine's availability.

They found that the annual rate among children younger than 2 years declined by 551.1 per 100,000 children, or about 47,000 hospitalizations. The rate for those 85 years old or older declined by 1,300.8 per 100,000, or 73,000 hospitalizations. For adults aged 18 to 39, 65 to 74, and 75 to 84, the rate per 100,000 declined by 8.4, 85.3, and 359.8, respectively.

For all age-groups, the age-adjusted annual reduction per 100,000 was 54.8, or about 168,000 fewer pneumonia-related hospitalizations.
Jul 11 N Engl J Med abstract

New polyomavirus identified in dead California dolphin

A polyomavirus never before seen in a dolphin apparently killed a female short-beaked dolphin calf found on a San Diego beach in October 2010. Findings from researchers who studied a biological sample from the animal were published yesterday in PLoS One.

Polyomaviruses are known to cause disease in birds but until now have appeared in mammals only as the cause of mild or subclinical infection.

A necropsy was performed in California. The dolphin had multifocal ulcerative lesions in the trachea and bronchi with signs of an infection of possible viral origin. A sample was sent to the Center for Infection and Immunity at Columbia University's Mailman School of Public Health for further study. There, DNA sequencing and other tests showed the presence of polyomavirus.

Genetic analysis showed the virus to be distinct from members of the Polyomaviridae family studied previously.

Further research will help reveal whether this virus is an existing dolphin virus that is more widespread but does not normally cause serious illness or if it has jumped species and could be a threat in dolphins, the authors said.
Jul 10 PLoS One article
Jul 10 Columbia University press release

Food Outbreak Scan for Jul 11, 2013

News brief

Salmonella strain in 2012-13 chicken outbreak found earlier on same farm

The strain of Salmonella Heidelberg associated with a 2012-13 multistate outbreak declared over just yesterday was also found on the outbreak farm in 2004, state and federal health professionals said today in Morbidity and Mortality Weekly Report (MMWR).

The outbreak sickened 134 people in 13 states, with the vast majority of cases in the Pacific Northwest (see map below). Of 105 patients whose outcomes were known, 33 (31%) were hospitalized. No deaths were reported.

The Centers for Disease Control and Prevention (CDC) said in an update yesterday that the outbreak appears to be over. The case total is up by six cases since the previous CDC update on Mar 5.

Patient ages range from less than 1 to 94 years, with a median of 22. Illness-onset dates range from Jun 4, 2012, to Apr 16, 2013.

According to the MMWR report, 36 (71%) of 51 patients who had brand information said they had exposure either to Foster Farms chicken or to another brand likely produced by Foster Farms, of Livingston, Calif.

Also, data from the National Antimicrobial Resistance Monitoring System (NARMS) showed that from 2002 to 2011 the outbreak strain was identified in 48 chicken samples. All but one were from Foster Farms.

Foster Farms chicken was linked to illness in a 2004 investigation by officials from Washington state and the US Department of Agriculture (USDA), according to an editorial note on the MMWR report. Following a 2004 USDA assessment of the farm, the agency issued a Notice of Intended Enforcement to Foster Farms, after which uploads of the outbreak strain decreased on PulseNet, followed by an increase in 2009.

"The historical significance of this pattern in the Pacific Northwest suggests the need for ongoing surveillance and intervention to prevent additional illnesses," the editorial stated.
Jul 12 MMWR report
Jul 10 CDC final outbreak update

Persons infected with the outbreak strain of Salmonella Heidelberg, by state (CDC map).

Study: Salmonella serotypes linked with certain food commodities

In foodborne disease outbreaks caused by Salmonella, certain serotypes are distinctly associated with animal-derived food commodities, while others are associated with plant-derived ones, which could help guide outbreak investigations and control measures, according to a study yesterday in Emerging Infectious Diseases.

The authors studied the causes and food sources of the 1,491 Salmonella outbreaks reported to the CDC's Foodborne Disease Outbreak Surveillance System from 1998 through 2008. Of the total outbreaks, 1,193 (80%) were caused by a single serotype, 595 (50%) had an implicated food, and 403 (34%) could be assigned to a single food commodity, say the authors.

They found that more than 80% of outbreaks caused by Salmonella Enteritidis, Heidelberg, or Hadar were attributed to eggs or poultry.

Of outbreaks caused by Salmonella Javiana, Litchfield, Mbandaka, Muenchen, Poona, or Senftenberg, more than 50% were from plant-derived foods. Serotypes Typhimumium and Newport were associated with many different food varieties.

According to the authors, "The results of our analysis can provide guidance to investigators when forming hypotheses about contaminated food sources during outbreak investigations" and in pinpointing contaminated ingredients.
Jul 10 Emerg Infect Dis article

Cases in Ireland may be tied to European hepatitis berry outbreak

Three hepatitis cases in Ireland may be tied to an ongoing outbreak of hepatitis A infections linked to frozen berries that has affected Italians as well as travelers to Italy from Germany, the Netherlands, and Poland, the European Centre for Disease Prevention and Control (ECDC) said yesterday.

None of the three Irish patients traveled to Italy or had contact with other known hepatitis-infected individuals, the ECDC said in a news release. But viral isolates from the patients show an identical genetic sequence to cases in the Italian outbreak.

Since Jan 1, 15 outbreak cases in Germany, the Netherlands, and Poland have been linked to the outbreak, the ECDC said in a rapid outbreak assessment. In addition, in the first 6 months of this year Italy has had more than 200 hepatitis cases above the expected level, which the agency said are "likely to be associated with this outbreak."

The onset of illness dates in the Irish cases were in April, while the most recently reported cases in Italy had illness onsets in June.

Mixed frozen berries are the most likely source of the outbreak in Italy, the ECDC said. In late May an Italian distributor withdrew mixed frozen berries from the market after the outbreak strain was confirmed in a package. Because the berry mix might still be in people's freezers, the ECDC expects additional cases.

Other hepatitis A outbreaks are being investigated in the Nordic countries and in travelers returning from Egypt, the ECDC said in its assessment. In the United States, 143 hepatitis A cases have been linked to a frozen berry mix containing pomegranate seeds from Turkey.
Jul 10 ECDC news release
Jul 10 ECDC rapid outbreak assessment