News Scan for Nov 14, 2016

News brief

More MERS in Saudi Arabia

The Saudi Arabia Ministry of Health (MOH) reported two new cases of MERS-CoV today and over the weekend.

On Nov 12, the MOH said a 51-year-old Saudi man from Tabuk was diagnosed as having Middle East respiratory syndrome coronavirus (MERS-CoV). He is currently in critical condition. Health officials said the man had direct contact with camels, a known risk factor for MERS.

Today the MOH said a 58-year-old Saudi woman from Afif is in stable condition after being diagnosed with the respiratory virus. Her case involves a primary source of the infection, which means she did not contract it from another person.

The new developments lift Saudi Arabia's MERS-CoV total to 1,479 cases, 617 of them fatal. Eight people are still being treated for their infections.
Nov 12 MOH report
Nov 14 MOH report

Brazil reports 136,000 new chikungunya cases

The Pan American Health Organization (PAHO) late last week reported 137,528 new chikungunya cases—almost all of them in Brazil, which documented 5 weeks' worth of data. The newly reported infections also included 29 fatalities attributed to the mosquito-borne disease.

Countries and territories in the Americas have now reported 441,075 suspected, confirmed, and imported cases this year, according to the Nov 11 PAHO update, but numbers are sure to climb higher because Brazil has yet to report on the most recent 8 weeks of data.

The 2 previous weeks saw increases of only 452 and 440 cases, respectively.

Brazil's total increased by 136,708, bringing its 2016 total to 352,810. It is the hardest-hit country this year by a wide margin. Guatemala saw the next-highest increase. It had 496 new cases and 4,827 for the year.

The 29 newly reported deaths in Brazil plus 1 in Colombia put the number of 2016 fatalities at 135.

Starting in the Caribbean territory of St. Martin, the Americas' chikungunya outbreak began in 2013 and has now sickened 2,319,515 people.
Nov 11 PAHO update

Study shows steady rate of ventilator-associated pneumonia

A new study in the Journal of the American Medical Association (JAMA) reported that although the Centers for Disease Control and Prevention (CDC) report a recent decrease of ventilator-associated pneumonia (VAP), the Medicare Patient Safety Monitoring System (MPSMS) found a stable rate (10%) over the same period, raising questions of reliability in VAP reporting.

According to the CDC's National Healthcare Safety Network (NHSN), ventilator-associated pneumonia decreased by 62% and 71% in medical and surgical intensive care units respectively, in the years between 2006 and 2012. But the MPSMS has independently measured VAP rates and shown they hover at around 10% each year.

Researchers randomly selected 1,856 Medicare patients 65 years and older with principal diagnoses of acute myocardial infarction (AMI), heart failure, pneumonia (including a primary diagnosis of sepsis or respiratory failure and a secondary diagnosis of pneumonia), and selected major surgical procedures. Using a standard definition of VAP (patients who received invasive mechanical ventilation for 2 or more consecutive days without a physician diagnosis of pneumonia prior to the onset of mechanical ventilation), the researchers showed rates stayed between 9.7% and 10.8% between 2006 and 2013.

"…[T]he dichotomy between VAP rates reported to the NHSN and measured in the MPSMS supports the concern that surveillance using traditional definitions may be unreliable. The ongoing risk to patient safety represented by VAP supports the NHSN’s decision to explore more objective surveillance targets," the authors wrote.
Nov 11 JAMA article

New BARDA director named

Assistant Secretary for Preparedness and Response Nicole Lurie, MD, announced on Nov 11 a new director of the Biomedical Advanced Research and Development Authority (BARDA), Rick Bright, PhD, a virology expert who has worked in the biotechnology industry, at PATH (Program for Appropriate Technology in Health), and with BARDA since 2010.

In a statement, Lurie said Bright's selection for the post came after a nationwide search and with the input of subject matter experts and leaders across the government's medical countermeasure partners. "In a strong field, Rick Bright stood out, with a clear vision for leading BARDA and collaborating with PHEMCE [Public Health Emergency Medical Countermeasures Enterprise] partners in a rapidly changing mission space." In his new position, Bright is also the new Deputy Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services (HHS).

In his most recent position with BARDA, Bright directed its Influenza and Emerging Infectious Diseases Division. Bright started his new position yesterday.

Lurie thanked Richard Hatchett, MD, who has served as acting director, especially at a time when he jump-started Zika vaccine, diagnostic, and screening efforts while continuing other programs, plus launching a new program to combat antibiotic resistance. "We are grateful for Richard's continued role in the BARDA leadership team," she said.
Nov 11 HHS press release

In another emergency preparedness development, HHS awarded $6.8 million in contracts to support public health emergency preparedness and response applied research, according to a Nov 10 report from Global Defense, an infectious disease and preparedness news site.

The contracts focus on information management and risk communications, surge management, biosurveillance, countermeasures and mitigation, incident management, and community resilience. Six organizations were awarded funding: UPMC Center for Health Security, Rand Corporation, PWC Public Sector LLP, Harvard, Drexel University, and the CNA Corporation.
Nov 10 Global Defense report

Study suggests airborne spread in infections from heart surgery device

An international investigation into Mycobacterium chimaera infections linked to contaminated heater-cooler devices (HCD) used during heart surgery found the pathogen in HCD water circuits and in air samples while the devices were running, which suggests airborne transmission to the surgical site occurred. Researchers from Switzerland, Germany, and the United States published their findings today in Infection Control and Hospital Epidemiology.

The outbreak is linked to the LivaNova3T HCD, made in London and used on most hospitals around the world. In October the CDC warned patients and health providers about the infection risk. Clusters of infections had previously been reported in open-heart surgery patients from locations that include Switzerland, Germany, and Pennsylvania as far back as 2011.

According to the study, new HCDs at the manufacturing site were contaminated with M chimaera, and whole-genome sequencing suggests a point-contamination source.

To prevent future M chimaera infections, the study authors recommend steps such as strict separation of contaminated HCDs from the air of critical medical areas, educating clinicians on the risks of M chimaera, and screening surgery patients who were exposed to the devices for prolonged and unexplained fevers.

Rami Sommerstein, MD, with Bern University Hospital in Switzerland, said in a press release from the Society for Healthcare Epidemiology of America (SHEA), "While our understanding of the causes and the extent of the M chimaera outbreak is growing, several aspects of patient management, device handling and risk mitigation still require clarification."
Nov 14 Infect Control Hosp Epidemiol abstract
Nov 14 SHEA press release
Oct 14 CIDRAP News story "CDC warns of infection tied to heart surgery device"

Zika Scan for Nov 14, 2016

News brief

Study confirms mosquito capacity to transmit Zika, chikungunya at same time

New experiments suggest that mosquitoes can infect humans with Zika and chikungunya viruses in a single bite, according to a study presented today at the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH).

Researchers from Colorado State University allowed mosquitoes to feed on blood that contained dengue, chikungunya, or Zika, either alone in combination, according to a ASTMH press release. So far they've found that the insects can secrete enough of Zika and chikungunya in their saliva to transmit both diseases at the same time.

It's not currently clear if the mosquitoes can pass all three diseases at the same time to humans, though an earlier lab study found that Aedes mosquitoes can carry dengue and chikungunya at the same time, which was confirmed by the Colorado State group.

The team raised concerns about the rising opportunities for mosquitoes to encounter more than one of these viruses at a time. Claudia Ruckert, PhD, who presented the study at the meeting, said in the press release, "We need to understand more about what happens in both mosquitoes and people when all of these viruses are circulating in close proximity."

In another key finding from the study, coinfection with chikungunya inhibits Zika infection in Aedes mosquitoes, meaning one virus might outcompete the other in the vector, which affect the epidemiology of cocirculating viruses.
Nov 14 ASTMH abstract

Brazil case reports find severe neuro problems for 3 mosquito-borne viruses

Brazilian scientists who studied neurologic complications in hospital patients during a 4-month period in 2015 when Zika, dengue, and chikungunya were circulating found that all three diseases can lead to severe problems, including a rare disorder called Opsoclonus-myoclonus-ataxia syndrome (OMS), according to another report to be presented this week at the ASTMH annual meeting.

The team described findings from 21 patients who were treated at a facility in the northeastern city of Salvador-Bahia during an unprecedented outbreak involving all three mosquito borne viruses. They said they were very surprised to see the two cases of OMS, also called dancing eyes-dancing feet syndrome, in two unrelated patients in the same hospital at about the same time. However, they said it's difficult to sort out what coinfection combination was to blame: one patient had Zika and dengue, while the other was sick with chikungunya and dengue.

It's possible that OMS was triggered by an autoimmune disorder, similar to the pattern seen in Zika patients who experience Guillain-Barre syndrome (GBS), the group suggests, noting that they also saw GBS in patients who didn't have Zika, but did have either chikungunya or dengue.

Isadora Siqueira, MD, PhD, with Brazil's Oswaldo Cruz Foundation, said in an ASTMH press release that each of the viruses has the potential to cause a range of neurological complications, some of them severe, and that patients should be monitored for symptoms. "What's very difficult is to determine is whether having a coninfection with two of these viruses increases the risk of neurological problems. We are still looking closely at the case of the patients who was infected with both chikungunya and dengue."
Nov 16 ASTMH abstract