News Scan for Sep 05, 2017

News brief

New case of MERS in Saudi Arabia linked to camels

The Saudi Arabian Ministry of Health (MOH) noted a new case of MERS-CoV over the weekend in a person who had direct contact with camels, a known risk factor for the virus.

A 57-year-old Saudi man from Hail was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms of the virus. He is in critical condition.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,708, including 693 deaths. Eight patients are still being treated, according to the MOH.

In other MERS news, the World Health Organization (WHO) said no cases of MERS were detected during last week's hajj, a pilgrimage that brings millions of Muslims to Saudi Arabia. Approximately 2.4 million people visited Mecca last week, and the WHO supported the MOH in monitoring for MERS and cholera. No disease outbreaks were detected.
Sep 2 MOH report
Sep 3 WHO story

Study: Combination treatment may be better than colistin for CRE infections

A study of US patients with carbapenem-resistant Enterobacteriaceae (CRE) infections has found that ceftazidime-avibactam may be a reasonable treatment alternative to colistin, researchers reported yesterday in Clinical Infectious Diseases.

The results come from CRACKLE (Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae), a prospective, observational study of patients at 18 US hospitals who have had a culture from which CRE is isolated. In this arm of the study, investigators evaluated 137 patients initially treated with either ceftazidime-avibactam, a combination therapy recently approved by the Food and Drug Administration for treatment of complicated urinary tract and intra-abdominal infections, or colistin, a standard yet toxic treatment for multidrug-resistant CRE infections.

The patients were chronically and acutely ill, with almost half (46%) presenting with bloodstream infections. Other common infections included respiratory tract infection (22%) and urinary tract infections (19%). Almost all patients (97%) were infected with Klebsiella pneumoniae. Efficacy, safety, and benefit-risk analyses were performed using intent-to-treat analyses with partial credit and desirability of outcome ranking (DOOR) approaches, and analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW).

Of the 137 patients, 38 initially received ceftazidime-avibactam and 99 were treated with colistin. IPTW-adjusted all-cause hospital mortality at 30 days was 9% in the ceftazidime-avibactam group compared with 32% for the colistin patients, representing a 23% difference in mortality. When analyzing patient disposition at 30 days, patients treated with ceftazidime-avibactam were found to have an IPTW-adjusted 64% probability of a better outcome compared with patients treated with colistin.

"The use of ceftazidime-avibactam was associated with improved clinical outcomes, especially decreased all-cause hospital mortality, and improved benefit-risk outcome," the authors write. They say the findings will need to be confirmed in a randomized controlled trial.
Sep 4 Clin Infect Dis abstract

Cholera cases top 600,000 in Yemen; WHO to investigate spike

The World Health Organization (WHO) reports that Yemen now has more than 600,000 cholera cases in what has become the world’s largest outbreak of the food and water-borne disease, Reuters reported today.

A total of 612,703 cases and 2,048 deaths have been recorded since the second wave of the outbreak began in April. According to the story, some of Yemen's districts are seeing a sharp rise in cases. Overall, however, new cases have slowed across the country, dropping from 5,000 new cases per day at the beginning of the summer to 3,000 currently.

"WHO is currently investigating the reason for this increase. A key aim of the investigation will be to determine whether the numbers are accurate and whether the spike in suspected cases is, in fact, caused by cholera or another diarrhoeal disease like rotavirus," WHO spokesman Tarik Jasarevic told Reuters.

Yemen's cholera outbreak has been made worse by crumpling health infrastructure and ongoing military conflict that has displaced more than 12 million people.
Sep 5 Reuters story

With adjustment in Brazil, chikungunya totals in the Americas drop 28,000

In ruling out more than 28,000 suspected chikungunya cases, Brazil has dropped its case count considerably, leading to a substantial drop in overall cases in the Americas this year, the Pan American Health Organization (PAHO) said late last week in its most recent update.

Brazil adjusted its number of suspected cases from 58,837 the week before to 21,784 last week—a difference of 37,053, according to the Sep 1 PAHO update. But it added 8,665 confirmed cases, bringing that total to 112,963. Brazil's 2017 total cases, therefore, are now listed at 134,747, which is 28,388 fewer than listed in the previous week's update.

Only three other nations reported changes in their case totals. Nicaragua and Bolivia showed slight increases, while Peru adjusted its total downwards slightly as it ruled out a number of previously suspected cases. The overall case decline for the week in the region, therefore, was 28,361 cases. PAHO is now reporting 144,551 suspected, confirmed, and imported chikungunya cases in 2017.

Since the Americas outbreak began in 2013 on St. Martin, the region has now reported 2,531,262 cases.
Sep 1 PAHO update

Flu Scan for Sep 05, 2017

News brief

Working group calls for better research for maternal influenza

The results of a World Health Organization (WHO) working group investigation into pregnancy and influenza research from 2014 to 2017 showed mixed results when it came to the extent that maternal vaccine protected pregnant women and infants up the age of 6 months from influenza.

Despite several associations between maternal influenza and poor fetal outcome, the working group said robust evidence for detailing the effects of maternal influenza was lacking.

"Available data are currently insufficient to estimate the potential impact of maternal immunization programs on severe influenza illness," the authors write. But the lack of evidence should not stop countries from implementing maternal vaccination programs, because the economic burden of influenza on pregnant women is substantial, and programs are relatively easy to implement given the frequency of prenatal healthcare visits.

The working group's conclusions were published Sep 1 in Vaccine. The group said that, outside the 2009 H1N1 pandemic, there were few studies that measured fetal outcomes and maternal influenza vaccination status.
Sep 1 Vaccine study

Flu still rising in Australia; levels high in parts of Asia

Though flu in some Southern Hemisphere countries has plateaued or is declining, activity in Australia and New Caledonia is still rising, with parts of South and Southeast Asia also reporting increased activity, according to an update yesterday from the WHO.

Globally, H3N2 is the dominant strain, but Southern Hemisphere countries such as Australia are seeing influenza B activity, as well.

Meanwhile, India and Nepal are reporting high flu activity, mainly from the 2009 H1N1 virus. In Southeast Asian countries such as Thailand and Myanmar, flu levels have been on the rise in recent weeks, with both 2009 H1N1 and H3N2 detected. The Philippines and Vietnam are reporting illnesses from all of the seasonal flu strains.

In Southern China and Hong Kong, which saw big flu spikes this summer mainly caused by H3N2 are now reporting decreases in illness levels. In Western Africa, flu activity continues in many countries, but little activity was reported from Eastern Africa.

Low or no activity was reported in other parts of the world, and in North America, activity from flu and other respiratory viruses stayed low, with cocirculation of H3N2 and influenza B strains.
Sep 4 WHO global flu update

H5N8 avian flu strikes more poultry and other species in South Africa

South Africa reported more highly pathogenic H5N8 avian flu outbreaks in both poultry and other types of birds, including one at a zoo in Johannesburg, according to notifications today from the World Organization for Animal Health (OIE).

The new poultry outbreaks began from Aug 21 to Aug 30, affecting three commercial farms in Western Cape province in the southwest, including two that house ostriches, and a backyard holding in Mpumalanga province in the east. Between the four locations, the virus killed 99 of 51,327 susceptible birds, and the remaining ones were slated for culling.

Both of the two outbreaks in wild birds occurred in Johannesburg, the country's largest city, and began on Aug 28. One killed 34 sacred ibises and the other killed a blue crane at a zoo.
Sep 5 OIE report on H5N8 in South African poultry
Sep 5 OIE report on H5N8 in South African wild birds