News Scan for Nov 13, 2017

News brief

MERS sickens 2 more in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) reported two new cases of MERS-CoV infection today.

A 51-year-old Saudi man from Afif is in stable condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus), the MOH announced today. The man had direct contact with camels. A 75-year-old woman from Unayzah was also diagnosed as having MERS. The woman is not a healthcare worker, and her infection is listed as "primary," meaning it's unlikely she contracted the virus from another person. She is in critical condition.

The new cases bring Saudi Arabia's MERS-CoV case count since 2012 to 1,744, including 705 deaths. Ten patients are still being treated, according to the MOH.

On Nov 10 the World Health Organization (WHO) released details of a recent MERS-CoV case in Oman. A 27-year-old man in Sharqiyah Region who had direct contact with camels prior to symptom onset, and his illness marks that country first case since August.

The WHO said Oman's agriculture ministry has been notified and is investigating the virus in camels and that health officials are monitoring 10 family contact and health workers.

Globally, the WHO has reported 2,103 laboratory-confirmed cases of infection with MERS-CoV including at least 733 related deaths since 2012.
Nov 13 MOH report
Nov 10 WHO report

Nigeria's number of confirmed yellow fever cases climbs to 15

Nigeria's number of suspected yellow fever cases in has risen to 179 as of Nov 7, according to an update from the Nigeria Center for Disease Control (NCDC). Samples have been collected from 98 patients, and so far, 38 were positive for yellow fever and 1 was inconclusive based on testing in Nigeria. Further testing on the positive samples at the Pasteur Institute in Dakar showed that 15 were positive, and tests are still underway on 9 other specimens.

Twenty-four deaths have been reported, including two among the confirmed case-patients, according to the NCDC.

Seven of Nigeria's 36 states have reported suspected cases, but only 3 have reported confirmed cases: Kwara, Kogi, and Zamfara.

The outbreak began in the middle of September with the confirmation of a case in Kwara state. The outbreak prompted a yellow fever vaccination campaign in October targeting 874,000 people. Another round of vaccination is slated for December.
Nov 7 NCDC yellow fever situation update

Trump nominates Alex Azar to lead HHS

President Donald Trump today on Twitter announced that he has nominated Alex Azar, a former pharmaceutical executive, to head the US Department of Health and Human Services (HHS). Trump wrote, "Happy to announce, I am nominating Alex Azar to be the next HHS Secretary. He will be a star for better healthcare and lower drug prices!"

If confirmed, Azar would replace Tom Price, MD, who resigned in September amid controversy over he spent more than $1 million on noncommercial aircraft travel for his trips for HHS.

Azar is an attorney who worked as general counsel and deputy secretary at the HHS during the George W. Bush administration. The Washington Post reported today had worked on the administration's response to the 9/11 terrorist attacks and the anthrax attacks and helped formulate policies on use of stem cells and Medicare prescription drug benefits.

He served as president of Lilly USA, an affiliate of Eli Lilly and Co., before stepping down in January to become a healthcare consultant.

According to the Post, Azar's selection was anticipated by lawmakers from both parties, with Republican praising his qualifications and experience and Democrats raising concerns about his pharmaceutical industry ties and how he might continue implementation of the Affordable Care Act.
Nov 13 Post story

Disneyland shuts down two cooling towers after Legionnaire's cases

Disneyland announced that two cooling towers located in the theme park in Anaheim, Calif., are shut down after Orange County health officials confirmed them to be the source of 12 cases Legionnaire's disease reported 3 weeks ago.

The Los Angeles Times reported over the weekend that 9 of the 12 patients had visited Disneyland, and the others had spent time in Anaheim within the last month. One person died and 10 were hospitalized.

Disneyland first learned of the cases on Oct 27.

"On Oct. 27, we learned from the Orange County Health Care Agency of increased Legionnaires’ disease cases in Anaheim. We conducted a review and learned that two cooling towers had elevated levels of Legionella bacteria," Pamela Hymel, MD, chief medical officer for Walt Disney Parks and Resorts, said in a statement Friday. "These towers were treated with chemicals that destroy the bacteria and are currently shut down."

The towers are in a backstage area near the New Orleans Square Train Station.
Nov 11 Times story

Canadian study enumerates cost of flu

A new study from Canadian researchers determined that the average cost per case of influenza requiring hospitalization from 2010 to 2013 was $14,612, and the average hospital stay was nearly 11 days. The information is meant to support national influenza vaccination efforts as a cost-saving measure.

The study, published in Influenza and Other Respiratory Viruses, only included laboratory-confirmed cases of influenza, and the costs are higher than previous estimates. The data were collected from 27 participating hospitals in 6 provinces, with the largest portion of participants living in Ontario (66.8%).

Of the 2,943 adult admissions included in analysis, 14% resulted in Intensive Care Unit (ICU) admissions. Length of stay was the determining factor of cost, the authors wrote. Each day of hospitalization cost an average of $1,254 Canadian dollars.

"Influenza places a significant burden upon the healthcare system in Canada that has hitherto been underestimates," the authors concluded.
Nov 10 Influenza Other Respir Viruses study

Stewardship / Resistance Scan for Nov 13, 2017

News brief

HHS report notes stewardship, resistance progress in the US

Almost two thirds of US hospitals now have full-scale antibiotic stewardship programs and the incidence of several antimicrobial-resistant (AMR) infections are declining in the country, according to a progress report on 2 years of US efforts to combat AMR, the Department of Health and Human Services (HHS) said today.

The report, published by the HHS Office of the Assistant Secretary for Planning and Evaluation, also highlights the US government response to the emerging threat of MCR-1, the gene that confers resistance to colistin, an antibiotic of last resort. In its case study on MCR-1 risk, HHS describes a targeted response across federal agencies.

The report highlights progress made and steps needed for the five goals established in the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) in 2015: (1) slow AMR bacteria; (2) strengthen national One Health efforts; (3) advance the development of rapid tests; (4) accelerate basic and applied science for developing new antibiotics, other drugs, and vaccines; and (5) improve international collaboration. Officials plan to implement these goals by 2020.

As part of its assessment of goal 1, the report notes that methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in US hospitals declined 13% from 2011 to 2014 and a further 5% by 2016. And Clostridium difficile infections dropped in US hospitals 8% from 2011 to 2014 and an additional 7% by 2016.

In addition, the percentage of US hospitals having programs that meet all seven of the Centers for Disease Control and Prevention's Core Elements of Antibiotic Stewardship rose to 46% in 2015 and to 64% in 2016. The report also noted that Veterans Health Administration centers saw a 10% decline in inpatient antimicrobial use.

As part of goal 2 efforts, HHS noted that the Food and Drug Administration doubled annual retail meat testing from 6,700 food samples in 2015 to about 17,280 in 2017. And testing of chicken parts by US Department of Agriculture inspectors increased from 3,850 facilities in 2015 to 8,000 in 2016.
Nov 13 HHS progress report
March 2015 CARB Action Plan

Northern Ireland report rise in bacteremia, drug-resistant infections

Northern Ireland's first report on antimicrobial use and resistance, also published today, notes that resistance levels in several common pathogens have risen in recent years, but the country has seen no change in antibiotic use since 2014.

The report, published by the country's Public Health Agency (PHA), notes that the percentage of Escherichia coli resistant to piperacillin-tazobactam increased from 8.8% in 2009 to 15.6% in 2016. And Klebsiella pneumoniae resistant to the combination therapy increased from 8.6% to 19.0% in the same period. The PHA report also notes that the number of reported bloodstream infections caused by E coli increased from 980 to 1,487 and by K pneumonia from 143 to 208 from 2009 to 2016.

Total consumption of antibiotics in primary and secondary care remained at 32 doses per 1,000 inhabitants per day from 2014 through 2015, the report found. Of the doses prescribed, 85% were in primary care. The most frequently used antibiotics in both primary and secondary care in Northern Ireland were penicillins (37.7% and 31.1%, respectively), tetracyclines and related drugs (25.8% and 9.9%), and macrolides (14.3% and 8.5%).

The authors of the report concluded, "While the proportion of isolates that are resistant to key antibiotics has not changed very much over time, the absolute number of resistant infections has increased because of the overall rising number of infections."
Nov 13 PHA annual report

Experiments slated to test E coli resistance in space

Yesterday the National Aeronautics and Space Administration (NASA) launched E coli samples to the International Space Station (ISS) for experiments on antibiotic resistance, Space.com reported.

The bacterial specimens were launched to the ISS on Orbital ATK's Cygnus cargo spacecraft along with many other science experiments and supplies for the Expedition 53 crew. Experiments will examine how microgravity affects the ability of E coli to thrive while exposed to antibiotics. The project was developed through a partnership between NASA's Ames Research Center and the Stanford University School of Medicine.

"Bacterial antibiotic resistance may pose a danger to astronauts in microgravity, where the immune response is weakened," NASA said in a news release. "Scientists believe that the results of this experiment could help design effective countermeasures to protect astronauts' health during long-duration human space missions."

The experiment will determine the lowest concentration of antibiotic that inhibits E coli growth. The resulting data may be useful for prescribing correct antibiotic doses for future astronauts, NASA said.
Nov 12 Space.com story
Nov 3 NASA news release