News Scan for Oct 16, 2017

News brief
Topics
MERS-CoV
Avian Influenza (Bird Flu)
Foodborne Disease
Hepatitis

Saudi Arabia identifies new MERS cases linked to camels

The Saudi Arabian Ministry of Health (MOH) reported two new cases of MERS-CoV over the last few days, both linked to camel exposure.

On Oct 13, a 60-year-old Saudi man from Jazan was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms. He is in stable condition, and the MOH said the man had direct contact with camels.

Yesterday the MOH said a 25-year-old male expatriate in Riyadh also had MERS. He is in stable condition and also had direct contact with camels. Neither patient is a healthcare worker.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,731, including 701 deaths. Four patients are still being treated, according to the MOH.
Oct 13 MOH update
Oct 15 MOH update

 

European officials say H5N6, African flu developments warrant scrutiny

European health officials today posted an overview of extensive avian influenza activity, mostly involving highly pathogenic H5N8, over the past winter and spring months that included more than 2,700 outbreaks in poultry, other captive birds, and wild birds, spanning 23 countries.

The report also came with a warning that highly pathogenic H5N6 could follow in H5N8's footsteps, a concern not only for the food supply, but also because—unlike other strains recently detected in Europe—H5N6 in Asian has been linked to sometimes-fatal human illnesses.

The joint report from the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) detailed outbreaks reported from Oct 19, 2016, to Aug 31, 2017. Most of the highly pathogenic events involved H5N8, but a much smaller number of H5N5 outbreaks were reported, along with one involving H5N6. Also, 65 low-pathogenic H5 outbreaks were reported in four countries, mostly in France.

Monitoring in other parts of the world shows a potential risk of long-distance spread of H5N6 from Asia to wintering groups in Western Europe, similar to what occurred with H5N8 and H5N1. Also, the experts noted that the situation in Africa with H5N8 and H5N1 is rapidly evolving, which calls for stronger collaborative efforts to closely monitor avian influenza developments.
Oct 16 ECDC-EFSA joint report

In related developments, a recent avian flu outbreak in the Netherlands has been confirmed as low-pathogenic H5N2, according to a notification today from the World Organization for Animal Health (OIE).

The outbreak began on Oct 11, striking a commercial farm in Zeeland province in the far southwest. No poultry deaths from the virus were reported, but officials destroyed 41,504 susceptible birds to curb the spread of the virus.
Oct 16 OIE report on low-path H5N2 in the Netherlands

 

California declares hepatitis A outbreak an emergency

Governor of California Edmund G. (Jerry) Brown, Jr., on Oct 13 declared the state's ongoing hepatitis A outbreak an emergency, which will allow the state to buy hepatitis A vaccine directly from manufacturers.

This is the largest outbreak in the United States in the 22 years since the hepatitis A vaccine has been available, and the current federal supply of the vaccine is not sufficient to meet California's needs, the governor said in his proclamation.

As of Oct 6, the outbreak total is 576 cases, including 18 deaths. Most of the cases have occurred in homeless people and illicit drug users. The outbreak is transmitted through person-to-person contact and contact with fecally contaminated environments.

The California Department of Health (CDPH) said San Diego, Santa Cruz, and Los Angeles counties have declared local outbreaks. The vast majority of cases (490) and all deaths have been reported in San Diego County.
Oct 13 Gov. Brown proclamation
Oct 6 CDPH update

Stewardship / Resistance Scan for Oct 16, 2017

News brief
Topics
Antimicrobial Stewardship
Gonorrhea

Gonorrhea in Seattle-area MSM increasingly less susceptible to key drug

Seattle researchers report that, among men who have sex with men (MSM) in Seattle and King County, Washington, 5% have gonorrhea with reduced susceptibility to azithromycin, according to a study today in Clinical Infectious Diseases.

The researchers looked at data from a county sexually transmitted disease clinic from 2012 to 2016, with an emphasis on the most recent 3 years. The US Centers for Disease Control and Prevention recommends that gonorrhea be treated with ceftriaxone plus azithromycin, so resistance to azithromycin could affect gonorrhea control efforts.

The analysts found that, in 2012 and 2013, none of the 263 patients from whom Neisseria gonorrhoeae was isolated showed reduced susceptibility to azithromycin, and 93% of these cases involved MSM. In 2014, 2015, and 2016, in contrast, the rates of reduced susceptibility among MSM were 5.4%, 4.8%, and 4.6%, respectively, for a 5.0% cumulative rate.

The authors conclude, "The World Health Organization recommends changing treatment guidelines when >5% of isolates are resistant to a recommended drug. The emergence of potentially resistant [azithromycin] gonorrhea should prompt reconsideration of current treatment recommendations, and highlights the need to develop new therapies for gonorrhea."
Oct 16 Clin Infect Dis study

 

Screening study identifies new antibiotic resistance genes

Swedish researchers who analyzed more than 10,000 bacterial genomes and plasmids from human and environmental samples across the globe found 76 novel resistance genes, which formed 59 previously undescribed gene families of metallo beta-lactamase enzymes. The genes enable resistance to carbapenems, a group of antibiotics reserved for serious infections caused by multidrug-resistant pathogens.

Writing in the Oct 12 edition of Microbiome, the investigators focused on identifying class B1 novel metallo beta-lactamases, which are the most clinically important enzyme subclass. In a press release, from Chalmers University of Technology in Sweden, they said resistance genes are rare, and a lot of DNA data need to be examined before a new gene is identified.

They also noted that identifying a resistance gene is challenging if it hasn't been seen before. So the group developed new computational methods to find DNA patterns associated with antibiotic resistance, and by testing the ones they found in the lab, they could see if their predictions were correct.

Eighteen of 21 genes they tested had the ability to hydrolyze imipenem in an Escherichia coli host. Also, two of the novel genes had atypical zinc-binding motifs in their active sites that hadn't been seen before in metallo beta-lactamases.

As part of their study, the team conducted a phylogenetic analysis, showing that metallo beta-lactamases fell into five evolutionary origin groups. Except for one, all previously characterized mobile metallo beta lactamases probably came from genes in Shewanella, a family of marine bacteria, and other Proteobacterial species.

The experts concluded that the findings more than double the number of known B1 metallo beta-lacamases, and the next step is to look for genes that provide resistance to other types of antibiotics. Erik Kristiansson, PhD, professor of biostatistics at Chalmers and the study's principal investigator, said, "The novel genes we discovered are only the tip of the iceberg."
Oct 12 Microbiome abstract
Oct 16 Chalmers University press release

This week's top reads

  1. Common diabetes drug lowers SARS-CoV-2 levels, clinical trial finds

    The mean SARS-CoV-2 viral load was reduced 3.6-fold with metformin.

    Stephanie Soucheray
    metformin

  2. Trial data support non-antibiotic treatment for bacterial vaginosis

    The trial found that the broad-spectrum antiseptic dequalinium chloride was noninferior to metronidazole, and more tolerable.

    Chris Dall
    Bacterial vaginosis

  3. Study: HHS's COVID vaccine campaign saved $732 billion in averted infections, costs

    Researchers say the campaign encouraged 22 million Americans to complete their primary COVID-19 vaccine series, preventing nearly 2.6 million infections.

    Mary Van Beusekom
    Vaccine assembly line

  4. Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows

    Researchers who examined cow mammary gland tissue found wide expression of avian and human influenza A receptors, which could explain high virus loads in milk of infected cows.

    Lisa Schnirring
    cow udders

  5. With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key

    Wastewater treatment systems that have no intake of animal-related sewage could serve as sentinels for human disease, experts say.

    Mary Van Beusekom
    Wastewater plant

  6. Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals

    Monitoring of about 70 farm workers found no symptoms, and the state's wastewater sampling pilot has found no flu rise.

    Lisa Schnirring
    vet and dairy herd

  7. High-risk patients with COVID symptoms should use PCR rather than rapid tests, study suggests

    The sensitivity of RATs was 47%, compared with RT-PCR and 80% versus viral culture.

    Mary Van Beusekom
    Stack of rapid COVID tests

  8. USDA genome study sheds light on H5N1 avian flu spillover to cows, but data gaps remain

    In other developments, the USDA said ground beef samples were negative for the virus and Michigan and Colorado announced emergency measures.

    Lisa Schnirring
    dairy cows in barn

  9. Case report bolsters evidence for H5N1 avian flu spread from cow to Texas dairy worker

    The patient worked at a farm where the illness was suspected in cows and in a region where H5N1 was confirmed in other dairy herds.

    Lisa Schnirring
    milking parlor worker

  10. USDA reports more H5N1 detections in poultry, wild birds

    Also, another avian flu outbreak was reported in backyard poultry in Idaho.

    Lisa Schnirring
    farm pigeons