News Scan for Jan 12, 2017

News brief

Officials confirm 5 new cases of H7N9 in China

China today reported five new H7N9 avian flu cases in humans, most of whom are in critical condition.

According to the Centre for Health Protection (CHP) in Hong Kong, a 50-year-old woman from Nanchang is hospitalized in critical condition in Jiangxi province. And a 59-year-old man from Yiyang who worked with poultry is also listed in critical condition in a Hunan province hospital, the CHP said.

In addition, a 17-year-old boy from Xiamen who had contact with poultry is hospitalized in the city of Putian, according to a report translated by Avian Flu Diary (AFD), an infectious disease tracking blog.

Finally, a poultry trade worker, a 31-year-old woman from Taizhou, is hospitalized with H7N9 in Jiangsu province, and a 72-year-old woman who recently traveled from Guangdong province to Macao is also hospitalized, AFD noted in separate posts.

The older woman was hospitalized in Zhongshan, Guangdong, on Jan 8, then traveled to Macao, where she was again hospitalized again on Jan 10. This is the second imported case in Macao this season; Guangdong has been the site of 15 cases of H7N9 this winter, according to AFD.
Jan 12 CHP press release
Jan 12 AFD H7N9 case update post
Jan 12 AFD post on Macao patient

WHO: Low-dose inactivated polio vaccine to be used in Southeast Asia

Today the World Health Organization's (WHO's) Southeast Asian region said it will use fractional injectable inactivated polio vaccine (IPV) dosing in light of the global shortage of polio vaccines, following the successful rollout of the strategy in India and Sri Lanka in 2016.

Fractional dosing consists of two doses of IPV (each dose is one fifth of a full dose) given to infants at age 6 weeks and 14 weeks. Studies have confirmed this dosing schedule confers the same immunity as one full dose of IPV.

India began using the fractional IPV early last year in eight of the country's states, and Sri Lanka soon followed. According to the WHO, Bangladesh will begin using fractional dosing this year.

The WHO's Southeast Asian region received polio-free certification in March of 2014 and hasn't reported a wild-type polio case in 6 years.

"By using fractional IPV, countries are saving vaccine and vaccine cost, without compromising on the protection that the vaccine provides to children against polio," the WHO said.
Jan 13 WHO press release

CDC says only 7 states have hand sanitation laws for animal exhibits

A report today from the Centers for Disease Control and Prevention (CDC) found that only seven states—New Jersey, New York, North Carolina, Pennsylvania, Utah, Washington, and Wisconsin—have laws mandating hand washing or hand sanitation stations near animal exhibits. The report was published in Morbidity and Mortality Weekly Report (MMWR).

Animal contact exhibits, including petting zoos and state and county fairs, have been linked to disease transmission, including that caused by Salmonella and Cryptosporidium. A survey of state laws found that, despite being recommended by the National Association of State Public Health Veterinarians, hand washing stations were not widely required. In the seven states with laws, only four states (New York, North Carolina, Pennsylvania, and Wisconsin) specified where hand washing or sanitations stations be located.

The authors said that the report could help guide other states to draft hand washing legislation. "Proper hand washing is an effective way to prevent transmission of disease to persons at animal exhibits; however, outbreaks at animal contact exhibits continue to occur, in part because of a lack of hand washing stations…The results of this assessment of state laws related to hand sanitation at animal contact exhibits can be used as a tool for other jurisdictions interested in establishing similar laws."
Jan 13 MMWR study

Stewardship / Resistance Scan for Jan 12, 2017

News brief

New Web site details CDC investments in fight against antibiotic resistance

The Centers for Disease Control and Prevention (CDC) has released a new online tool that will enable users to find out how the agency is financially supporting efforts to combat antibiotic resistance across the country.

The CDC AR Investment Map is an interactive site where you can click on individual states to find out how much money the CDC is providing in fiscal year 2016 to state health departments to help tackle antibiotic resistance. The site also includes a detailed breakdown of the funding for each state by activity, including investments in public health laboratories to help identify antibiotic-resistant threats more quickly, in healthcare-associated infection control programs to prevent the spread of drug-resistant bugs, and in efforts to improve antibiotic use.

Overall, Congress appropriated $160 million to the CDC in 2016 to fight antibiotic resistance. The agency says the investments detailed on the new Web site will work toward meeting national goals to prevent drug-resistant infections as outlined in the National Action Plan for Combating Antibiotic-Resistant Bacteria.
CDC Antibiotic Resistance Investment Map

Study describes drug-resistant Candida auris biofilms

A study today in Emerging Infectious Diseases reports that Candida auris, a drug-resistant yeast that's been associated globally with life-threatening invasive diseases, has the capacity to form antifungal-resistant biofilms.

In the study, researchers grew biofilms from strains of C auris and compared them with biofilms grown from C albicans and C glabrata, two other types of yeast that can also cause invasive infections. Biofilms are complex communities of bacteria that form on any surface exposed to bacteria and water and can tolerate higher doses of antibiotics than their planktonic counterparts. Biofilm formation, the authors write, "is a key driver of C albicans pathogenicity and is associated with patient death."

The researchers found that C auris formed biofilms that were significantly reduced compared with C albicans but much greater than the biofilms formed by C glabrata. And when they tested the C auris biofilms and planktonic cells against a selection of antifungal agents, they found that the biofilms could resist some of the agents that were active against planktonic cells. The researchers were particularly interested to find that the antifungal caspofungin, which is normally highly effective against Candida biofilms, was inactive against C auris biofilms.

"These features contribute not only to C auris virulence but also to its survival in hospital environments, increasing its ability to cause outbreaks," the authors write.

The disinfectant chlorhexidine, however, was effective, exhibiting the greatest activity against C auris biofilms and planktonic cells. As a result, the authors conclude that while it is unlikely that the spread of C auris can be controlled by antifungal stewardship approaches alone, chlorhexidine "can be advocated for topical control of C auris at standard concentrations for skin and wound cleaning and disinfection."

C auris was first identified in the ear of a Japanese patient in 2009 and has caused hospital outbreaks across Asia and South America. In November, the CDC said 13 cases have been identified in the United States.
Jan 12 Emerg Infect Dis dispatch