News Scan for Mar 12, 2018

News brief

MERS case in Saudi Arabia linked to camel contacts

The Saudi Arabian Ministry of Health (MOH) announced a new case of MERS-CoV over the weekend.

A 56-year-old Saudi man from Jeddah diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) is in stable condition. The MOH said he had direct contact with camels, a known risk factor for contracting the disease.

Saudi Arabia's MERS-CoV total cases since 2012 have now reached 1,815, including 736 deaths. Nine people are still being treated for their infections.
Mar 8 MOH report

Disease X enters WHO's priority list

Alongside known threats such as MERS-CoV, chikungunya, and Zika virus, the World Health Organization's (WHO's) priority disease list for 2018 includes "disease X," an epidemic "caused by a pathogen currently unknown to cause human disease."

The priority list is released annually after a conference in Geneva in an effort to guide the WHO's research and development arm. "The R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown 'Disease X' as far as possible," the WHO said.

The list, which features Ebola and Marburg virus, MERS-CoV and severe acute respiratory syndrome (SARS), Rift valley fever, Lassa fever, and Zika, among others.

The WHO said the chosen diseases all lack efficacious treatments and vaccines. The WHO said dengue, yellow fever, influenza, cholera, and plague all exist outside the scope of the blueprint, but still pose a major threat to public health.

The WHO said an emphasis on rapid and accurate diagnostics was needed for each of the diseases listed, and also noted that in the future, a drug-resistant pathogen might emerge and be prioritized.
Mar 12 WHO statement

Yellow fever continues to climb in Brazil among unvaccinated travelers

A total of 10 unvaccinated travelers have contracted yellow fever while in Brazil in recent months, according to the latest outbreak update from the WHO.

In addition to seven previously reported cases among travelers, there are new cases among visitors from Romania, Argentina, and Switzerland. Brazil is experiencing one of the largest yellow fever outbreaks in recent history, with 723 confirmed human cases of yellow fever, including 237 deaths, reported between Jul 1, 2017 and Feb 28, 2018.

As of Feb 28, the WHO said 23% of the targeted population in Brazil has been reached as part of a massive campaign to vaccinate the citizens of Bahia, Rio de Janerio, and Sao Paulo states.

"Despite the significant efforts made to vaccinate large portion of the population, the increasing number of human cases and the persistence and geographical spread of epizootics among non-human primates illustrate the potential risk of further spread to new areas within Brazil that were not previously considered as at risk and where therefore yellow fever immunization coverage is low," the WHO said.

A new story from the Associated Press (AP) said government skepticism and doubts about fractional dosing are fueling Brazil's low uptake of the vaccine. In addition, there have been antivaccine rumors on the social media messaging app, WhatsApp, that spread the idea that the current vaccine is ineffective against yellow fever.
Mar 9 WHO statement
Mar 12 AP story

South Sudan government announces Rift Valley fever outbreak

South Sudan's health and livestock ministries today declared a Rift Valley fever (RVF) outbreak affecting three counties in Eastern Lakes state, which comes in the wake of a joint mission with representatives from the WHO and the United Nations Food and Agriculture Organization (FAO) that took place on Mar 6.

The outbreak began in December with the deaths of three people from the same village who had experienced severe hemorrhagic illness. RVF is primarily an animal disease, but people can contract infections through contact with blood or body fluids from infected animals, mainly livestock. Also, people can be infected from bites from infected mosquitoes or other biting insects. The WHO said person-to-person spread has not been documented.

In a statement today from the WHO Regional Office for Africa, 40 suspected cases were reported as of Mar 9, but the illnesses have been reclassified based on investigations and lab results. The new case total reflects 6 lab-confirmed, 3 probable, and 12 suspected RVF cases.

Animal illnesses and deaths have been epidemiologically linked to the human cases, and 1 of 7 animal samples was positive for RFV in tests at Uganda Virus Research Institute. In addition, 8 of 12 samples collected in animals were positive for the virus in tests at the World Organization for Animal Health (OIE) reference lab in South Africa.

A Mar 8 OIE report on the animal lab findings said a few cases of miscarriage in cattle herds occurred after heavy flooding in November 2017, which resulted in swampy areas that contributed to an increase in mosquito populations. No cattle deaths were reported, but clinical signs were consistent with RVF.

The WHO has helped establish a multisector response, and a joint contingency plan has been developed and will be rolled out in Eastern Lakes state to ensure that RFV is contained, the WHO said. Eastern Lakes state is in central South Sudan.

Evans Liyosi, the WHO representative to South Sudan, said in the statement, "Financial contributions from the European Union Humanitarian Aid (ECHO) and the United States Agency for International Development (USAID) allowed WHO to deploy experts and provide technical and logistical support."
Mar 12 WHO African regional office report
Mar 8 OIE report on RVF in South Sudan

Stewardship / Resistance Scan for Mar 12, 2018

News brief

Infection risk tool shows promise in Dutch study

Research by Dutch investigators suggests that a user-friendly, visual instrument for measuring the quality of infection control and antimicrobial use could be useful for targeting interventions in hospitals and nursing homes.

In a new study in Antimicrobial Resistance and Infection Control, the investigators describe the application of the Infection Risk Scan (IRIS) method at a hospital, several nursing homes, and a rehabilitation clinic in the Netherlands. IRIS consists of a bundled set of objective, reproducible measurements combining patient- and healthcare-related variables, which are used to establish a risk profile for the patient population and an improvement plot for the facility. Results are visualized in a spider plot using traffic light colors to make the results straightforward and easy to understand.

The IRIS variables include hand hygiene compliance, environmental contamination using adenosine triphosphate (ATP) measurements, prevalence of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E), availability of infection control preconditions, personal hygiene of healthcare workers, appropriate use of indwelling medical devices, and appropriate antimicrobial use. But risk factors can be added or switched.

The implementation of IRIS at five hospital wards showed high levels of environmental contamination and provided the basis for targeted actions that resulted in measurable improvements. Hand hygiene compliance increased from 43% to 66%, and ATP levels were significantly reduced. In 19 nursing homes, large differences were observed, with environmental contamination as the common denominator. In addition, a significant difference in ESBL-E prevalence (mean 11%, range 0% to 21%) was observed. At the rehabilitation center, 17% of residents were found to be ESBL-E carriers.

"In conclusion, the bundle approach and visualization of the IRIS makes it a complete and useful infection prevention tool," the authors write. "The broader implementation of IRIS can raise the standard of infection control and make it more transparent in various healthcare settings, e.g. nursing homes."
Mar 9 Antimicrob Resist Infect Control study

High rates of multidrug resistance found in Ghana hospital

In another new study in Antimicrobial Resistance and Infection Control, a team of African researchers reports high rates of multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana.

In the study, conducted at a 1,000-bed tertiary care government hospital in the Ashanti region of Ghana from February through August 2015, researchers examined 200 clinical, non-duplicate gram-negative bacteria randomly selected from urine, pus, wound swab, pleural fluid endotracheal tubes, gastric lavage, and blood specimens. Multidrug resistance was defined as isolates that were resistant to at least one agent in three or more antibiotic classes.

Of the 200 isolates obtained, Escherichia coli was the most frequent pathogen (49 isolates, 24.5%), followed by Pseudomonas aeruginosa (39, 19.5%), Klebsiella pneumoniae (38, 19%), and Enterobacter spp. (12, 6%). Multidrug resistance was observed in 89.5% of the isolates, ranging from 53.8% in Enterobacter to 100% in Acinetobacter spp. and P aeruginosa, with high resistance to ampicillin (94.4%), trimethoprim sulfamethoxazole (84.5%), cefuroxime (79%), cefotaxime (71.3%), cefoxitin (57.5%), and amoxacillin-clavulanate (51.5%).

Urinary tract infection was diagnosed in 34.5% of patients, sepsis in 14.5%, wound infection (surgical and chronic wounds) in 11%, and pulmonary tuberculosis in 9%. The largest proportion of patients were those 60 years and over (24.5%), followed by children under 10 (24%). The lowest prevalence was in those 10 to 19 years old (9.5%).

The authors of the study say the results should inform the empiric treatment of infections at the hospital.
Mar 9 Antimicrob Resist Infect Control study