Drexel meningitis strain matches Princeton outbreak strain

The Drexel University student who died last week from serogroup B meningococcal disease had the same strain that has infected Princeton University students, suggesting that the outbreak strain is still present at Princeton, the Centers for Disease Control and Prevention (CDC) said today.

Scientists used "genetic fingerprinting" to match the strain from the Drexel student, who died on Mar 10, to the strain in the eight-case Princeton outbreak, the CDC said in a news release. The finding is cause for vigilance for additional cases, the agency added.

A "high percentage" of Princeton undergrads and eligible graduate students received two doses of serogroup-B-containing Bexsero, a meningococcal vaccine approved for use in Europe, Canada, and Australia but not the United States. Federal officials approved it for emergency use to combat Princeton's outbreak and another at the University of California at Santa Barbara. The US-approved vaccines cover other, more common, serogroups.

Princeton students who received two Bexsero doses should be protected against serogroup B disease, but they may carry meningococcal-causing bacteria in their throats, the CDC said. The Drexel student had been in close contact with Princeton students about a week before he fell ill. Drexel is in Philadelphia, and Princeton in about 45 miles away in Princeton, N.J.

Philadelphia-area health officials have been following up with close contacts of the Drexel student and have found no additional meningococcal cases, the CDC said. The agency added, "At this time, CDC does not recommend limiting social interactions or canceling travel plans as a preventive measure for meningococcal disease."
Mar 18 CDC news release
Mar 13 CIDRAP News story "Serogroup B implicated in Drexel U meningitis death"

TB continues European decline amid MDR-TB challenges

The number of tuberculosis (TB) infections in Europe continued its decline according to the latest numbers for 2012, but the region isn't making much headway in successfully treating patients who have multidrug-resistant TB (MDR-TB), the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization's (WHO's) European regional office said in statements today.

According to 2012 surveillance data from 29 countries, the number of TB cases was down 6%, which fits with the average annual decline of 5% each year since 2008, according to the ECDC statement.

The latest findings also revealed that treatment success rates for MDR-TB patients are stable, but at a very low level, with only 1 in 3 (34%) patients finishing their treatment successfully. More than half die, fail treatment, or stop taking their treatments.

ECDC director Marc Sprenger, MD, PhD, said in the statement, "If we are not able to diagnose and treat patients with multidrug-resistant tuberculosis early and successfully, this not only puts patients' lives at risk but also paves the way for XDR TB [extensively drug-resistant TB]. This is why it is essential to enable healthcare workers across Europe to fully support all MDR TB patients during the full course of treatment and make sure they finish it successfully."

Zsuzsanna Jakab, the WHO's regional director for Europe, said in a statement that there is an urgent need for new TB drugs with shorter and more effective treatment regimens. "A key objective for new treatments should be to reduce treatment duration from 2 years to 2 weeks," she added.

The ECDC also released a detailed surveillance report for 2012 and a report on health system factors that influence treatment of MDR-TB patients. In the surveillance report, the ECDC said the 32 countries with the lowest notification levels of new and relapsed cases are mostly high-income locations in the western and central part of the region. Among high-priority countries that account for 85% of the disease burden, the largest contribution comes from Russia.

For the health system report, the ECDC performed case studies on MDR-TB treatment in four counties: Austria, Bulgaria, Spain, and the United Kingdom. Among the conclusions are that increased use of rapid molecular testing is needed to improve outcomes, that multidisciplinary decision-making about treatments is key, and interactions between health workers and patients should be taken into account.

The ECDC and WHO released the findings in advance of World TB Day, an global event observed on Mar 24 to raise awareness of the disease's burden and its prevention.
Mar 18 ECDC press release
Mar 18 ECDC-WHO joint press release
ECDC 2012 TB surveillance report
ECDC healthcare system technical report on MDR-TB treatment

Poultry inspection rule draws more fire

A proposed food safety rule aimed at streamlining systems in poultry processing plants, which has drawn fire before, now faces a letter request from 68 members of Congress to US Department of Agriculture (USDA) Secretary Tom Vilsack to suspend action, according to a story in Food Safety News (FSN) today.

"While we strongly support modernizing our food safety system and making it more efficient, modernization should not occur at the expense of public health, worker safety, or animal welfare," said the group.

Objections to the rule, called the Modernization of Poultry Slaughter Inspection rule, have come from health, labor, and consumer groups since its unveiling in 2012, and concerns were raised in a report last fall from the Government Accountability Office (GAO). GAO claimed that results of three pilot projects, which included chicken, turkey, and hog processing plants, had not been thoroughly evaluated, says the FSN story.

The proposed rule calls for plant workers rather than government inspectors to take over most of the inspection and sorting of carcasses, which supposedly will speed up processing lines, as outlined in a CIDRAP News story last fall.

The letter from the group in Congress asks that the GAO concerns be addressed as well as concerns about worker safety. In addition, it asks whether humane slaughter of poultry has been addressed by the USDA's Food Safety and Inspection Service (FSIS) and whether the agency has consulted stakeholders. A House Appropriations Agriculture Subcommittee hearing during which Vilsack and Rep. Rosa DeLauro (D-CT), one of the letter writers, spoke about the proposal was held Mar 14, according to FSN.
Mar 18 FSN story
Sep 4, 2013, CIDRAP News story on GAO report
Aug 2013 GAO report

WHO reports 3 polio cases in Cameroon, raises risk to 'very high'

Cameroon has reported three cases of polio since the beginning of the year, the WHO noted yesterday.

Cases of wild poliovirus type 1 (WPV1) were reported with onset of paralysis on Jan 6, 25, and 31 from three new regions: North West, Adamaoua, and Centre, "confirming continued WPV transmission and geographic expansion of infected areas following detection of four cases in October 2013," the agency said in an update.

In addition, genetic sequencing of the WPV1 isolates suggests prolonged undetected circulation of poliovirus in the country, the WHO said.

The agency added, "Due to continued poliovirus circulation in Cameroon, gaps in surveillance, and influx of vulnerable refugee populations from Central African Republic, WHO is elevating the risk assessment of international spread of polio from Cameroon to very high."

The nation is conducting nationwide polio immunization campaigns.
Mar 17 WHO update

Canada detects new pig coronavirus

Agriculture officials in Ontario today announced the first confirmed cases of a new type of coronavirus in pigs, the first such detections in Canada. In February, animal health scientists in Ohio found the virus, called swine deltacoronavirus (SDCV) on four of the state's pig farms.

The virus is closely related to a coronavirus detected in Hong Kong in 2012. Though it doesn't spread to humans or pose a food safety threat, the clinical signs in pigs appear to resemble other swine diseases that are caused by coronaviruses: porcine epidemic diarrhea (PED) and transmissible gastroenteritis (TGE).

Ontario's agriculture ministry said in a statement that the virus was detected in follow-up tests on farms where pigs had clinical signs of vomiting and diarrhea but tested negative for PED and TGE. Samples from six Ontario farms tested positive for the virus at Ontario's Animal Health Laboratory and at the US Department of Agriculture National Animal Disease Center in Ames, Ia.

SDCV infections in pigs are similar but distinct from PED and TGE, and mortality rates from the disease appear to be lower than for PED. SDCV can cause vomiting and diarrhea in all age-groups of pigs and can be lethal in nursing pigs. Today's announcement noted that technological advances allow new viruses to be detected on a regular basis; that numerous coronaviruses can infect humans, other mammals, and birds; and that it's not surprising to find an additional coronavirus in swine.
Mar 18 Ontario agriculture ministry statement
Feb 12 CIDRAP News scan "Ohio scientists find new coronavirus in pigs"