News Scan for Jun 15, 2017

News brief

Three more MERS hospital-cluster cases reported in Riyadh

Saudi Arabia today reported three more MERS-CoV illnesses linked to ongoing hospital-related outbreaks in Riyadh, according to a statement from the country's Ministry of Health (MOH).

All three of the people contracted their MERS-CoV (Middle East respiratory syndrome coronavirus) infections while they were hospital patients. All are men, including two Saudis ages 29 and 79 and a 67-year-old expat. All have symptoms. Two are listed in critical condition, and the other is stable.

With the new cases reported today, 35 illnesses since Jun 1 have been linked to illness clusters in Riyadh involving three hospitals.

The cases lift Saudi Arabia's overall MERS-CoV total since the first human cases were detected in 2012 to 1,642, including 673 deaths. Twenty people are still being treated for their infections.
Jun 15 Saudi MOH statement
Jun 13 CIDRAP News story "WHO details Saudi MERS clusters as outbreak grows"

DRC reports new suspected case of Ebola

The World Health Organization (WHO) African regional office released a new situation report on the current outbreak of Ebola in the Democratic Republic of the Congo (DRC), noting one additional suspected case of the viral disease since the last report on Jun 9.

In the last week, DRC health officials have investigated 33 suspected cases, with only 1 being a possible infection.

The last confirmed case was isolated on May 17. To date, there have been 5 confirmed, 3 probable, and 1 suspected case. Ninety percent of simulated modeling predictions show no more cases in the next 30 days, the WHO said.

In addition, the overall national risk of Ebola has been downgraded from "high" to "moderate." All cases have been located in the Likati Health Zone, a remote part of northern DRC.
Jun 12 WHO update

Researchers confirm natural chikungunya infection in Brazilian mosquitoes

A research team based in Brazil has for the first time in the country identified natural chikungunya infection in a mosquito carrier to the virus.

They detailed their experience collecting and analyzing 248 mosquitoes in and around homes in Aracaju, Brazil, yesterday in PLoS Neglected Tropical Diseases. The city is the capital of Sergipe state in northeast Brazil, and its residents had reported being sick with symptoms similar to chikungunya or other related diseases.

Experts have said it's difficult to find positive mosquito samples, even in outbreak settings. Several months passed in Brazil's Zika outbreak before the virus was isolated in a mosquito sample.

In the new study, researchers collected the mosquitoes during the first week of February 2016. They captured four types of mosquitoes, and Culex quinquefasciatus were most common, making up 78.2% of the insects. Chikungunya virus was identified in one female Aedes aegypti mosquito, a type that made up 20.2% of the mosquitoes. No Zika or dengue viruses were found in any of the mosquitoes they examined.

Genetic analysis showed that the virus isolated from the mosquito belonged to ECSA, one of three chikungunya genotypes. Both ECSA and Asian genotypes have been reported in Brazilian patients.

Ae aegypti and Ae albopictus are found in all of Brazil's states, and lab studies have shown that they are possible chikungunya vectors. The researchers said their findings will help with the design of surveillance and vector-control programs.
Jun 14 PLoS Negl Trop Dis report

WHO launches new emergency preparedness and response portal

The World Health Organization (WHO) today announced the launch of an online video series designed to arm public health responders with the latest information on epidemics, pandemics, and health emergencies.

The OpenWHO platform has three main channels. One is "Outbreak," which features scientific information on high-threat diseases such as Ebola, yellow fever, and pandemic influenza. The others include "GetSocial!" with a focus on risk communication, community engagement, and social mobilization, and "Ready for Response," which includes courses on the WHO's emergency response framework, the incident management system, and predeployment training for those who may be sent for emergency response.

Other advantages of the system are that it can host an unlimited number of subscribers, beyond what the WHO's Web sites can offer. The platform is hosted by the Hasso Plattner Institute, an external service provider based in Germany. Also, the video, audio, and animation can be presented in multiple languages. All content is in English, with much of it available in French and Arabic.

In a note to journalists, the WHO said it can make the courses available in local languages and dialects, as it recently did for responders in the Democratic Republic of Congo when it translated the introductory Ebola course into Lingala, the local language used in the outbreak area.

The courses use a smaller bandwidth so that people from any country can use them, and courses are available for offline viewing through applications for Android and IOS devices.
OpenWHO portal
OpenWHO FAQ

Study finds 5% CRE rate in DC-area healthcare facilities

A study today in Infection Control and Hospital Epidemiology found a 5.2% rate of the highly antibiotic-resistant bacteria known as carbapenem-resistant Enterobacteriaceae (CRE) in Washington, DC–area acute-care hospitals (ACHs) and long-term care facilities (LTCFs), establishing a baseline figure for the city.

This study included 16 facilities in the district: all 8 ACHs, 5 of 19 skilled nursing facilities, both of the city's long-term acute-care facilities, and the sole inpatient rehabilitation facility. Of 1,022 perianal swabs tested, 53 were positive for CRE, for an overall prevalence of 5.2%. The rate varied from 5.0% in ACHs to 7.0% in LTCFs. The inpatient rehab center had no CRE-positive patients.

The median prevalence rate by facility was 2.7%, with one center having a 29.4% rate. Male patients demonstrated a significantly higher prevalence (7.1%) compared with females (3.7%). Patients aged 20 to 39 years had the highest prevalence of any age-group, at 8.0%.

Of the positive samples, 18 (34.0%) were genetically similarity to at least 1 other sample, possible evidence of CRE spread within and between facilities.

"CRE is a significant clinical and public health concern, with a potential for widespread and rapid transmission within and between facilities," said lead author Roberta DeBiasi, MD, MS, in a press release from the Society for Healthcare Epidemiology of America (SHEA), publisher of the journal. "Our study demonstrates the strength of a collaborative approach within a city or region to determine the prevalence of multi-drug resistant organisms in healthcare facilities."
Jun 15 Infect Control Hosp Epidemiol study
Jun 15 SHEA news release

UK Campylobacter rates decreasing in store-bought chicken

A survey published yesterday by the Food Standard Agency (FSA) in the United Kingdom showed a 30% reduction of Campylobacter in poultry sold in retail grocers. Across the market, 6.5% of chickens tested positive for the bacteria; during the same time last year, that percentage was 9.3%.

The survey was based on samples from 1,051 whole fresh chickens tested from January through March of this year. This is the third year the survey was conducted, part of the FSA's effort to reduce bacterial foodborne illnesses.

According to the FSA, Campylobacter is the most common cause of food poisoning in the United Kingdom. Major retailers, including Aldo and Lidl, had lower levels of the bacterium on their chicken than did independent butchers.

The pathogen reduction saved the country an estimated £13 million ($16.6 million US) in terms of fewer days off work and National Health Service costs.
Jun 14 FSA news release
Jun 14 FSA full report

Flu Scan for Jun 15, 2017

News brief

Study identifies H7N9 mutations that could ease spread among humans

Researchers looking for mutations that might make H7N9 avian influenza more easily transmissible among people identified three amino acid changes that would make the virus more likely to bind to human airway receptors. A team of researchers from the United States, including those from The Scripps Research Institute, and the Netherlands reported its findings today in PLoS Pathogens.

The scientists focused on mutations that could occur in the H7 hemagglutinin (HA) protein, which allows the virus to latch onto host cells. They didn't test the mutations in H7N9 viruses, because of gain-of-function rules and concerns. Rather, they used molecular modeling and knowledge of the HA structure to flag mutations that have the capacity to make the virus more specific to human, rather than avian, airway receptors. Then they produced an HA with different combinations of the mutations in an experimental cell line (not H7N9) and tested how strongly they bound to human and avian receptors.

The team found that mutations in three amino acids bound more strongly to human receptors, signaling a specificity switch from bird to human types. In another experiment, they found that the H7 mutants also attached to cells from human tracheal tissue.

The researchers concluded that understanding the mutations that might allow the virus to spread more easily in humans is a useful tool for surveillance in poultry and humans, as their identification may serve as an early warning.
Jun 15 PLoS Pathog study

Spanish study finds no reduced flu vaccine effect in consecutive seasons

As opposed to results of recent studies from Canada, findings of a study from Spain published yesterday indicated that getting immunized against influenza does not lower the protective effect of flu vaccine in the subsequent season.

Writing in PLoS One, investigators noted that their test-negative case-control study included data on patients 9 years old and older from the 2010-11 flu season through the 2015-16 season. It included 1,206 cases of 2009 H1N1 flu, 1,358 H3N2 cases, and 1,079 influenza B cases.

They found a flu vaccine effectiveness (VE) across the seasons of 53% for H1N1 for persons vaccinated in the current season only, compared with a 50% VE for those vaccinated in both the current and previous seasons. For H3N2, VE rates were 17% and 3%, respectively, and for flu B 57% and 56%, respectively.

The authors conclude, "Our results suggested no interference between the previous and current influenza vaccines against A(H1N1)pdm09 and B viruses, but a possible negative interference against A(H3N2) virus."
Jun 14 PLoS One study
Feb 10 CIDRAP News story "Studies shed light on effects of serial flu shots, current vaccine's benefits"
Apr 5, 2016, CIDRAP News story "Prior-year vaccination cut flu vaccine effects in 2014-15"

DRC, Belgium, Nigeria report more avian flu outbreaks

The Democratic Republic of Congo (DRC) yesterday reported 11 more highly pathogenic H5N8 avian flu outbreaks, all in village ducks and chickens in Ituri province, according to a report to the World Organization for Animal Health (OIE).

The location of the latest outbreaks is the same area in the DRC's northeastern corner where H5N8 was initially reported in late May, which signaled the DRC's first outbreaks involving the subtype. Over the past few months H5N8 has turned up in a handful of African nations.

The new events had start dates ranging from May 17 to Jun 3. The virus killed 6,927 of 17,272 susceptible birds, and the survivors were slated for culling.

In other H5N8 developments, Belgium reported three more outbreaks in wild birds, officials said today in an OIE notification. The events began from Jun 13 to Jun 15, affecting locations in Luxembourg, Hainaut, and West Flanders provinces. The virus killed 45 of 101 susceptible birds, and the rest were destroyed as part of the response measures.

The outbreaks follow a Jun 2 report of an outbreak involving a family of birds that includes pheasants and quail.

Elsewhere, Nigeria reported one new H5N1 outbreak in backyard poultry, according to a report today from the OIE. The event began on May 15 in Adamawa state in the east, killing 50 of 200 layers.
Jun 14 OIE report on H5N8 in the DRC
Jun 15 OIE report on H5N8 in Belgium
Jun 15 OIE report on H5N1 in Nigeria