News Scan for Sep 13, 2016

News brief

3 new strains of norovirus cause epidemic in Australia

Scientists from the University of New South Wales (UNSW) have identified three new strains of norovirus that have caused an epidemic of gastrointestinal disease in Australia this winter. Officials estimate that hundreds of thousands of Australians— most in nursing homes, hospitals, cruise ships, and daycares—have been infected with these new strains.

Researchers said two of the viruses are hybrids that evolved from the Sydney 2012 strain, and the other strain likely originated in Asia. According to a press release today from UNSW, the strains are named Kawasaki 308, New Orleans 2009/Sydney 2012 and GII.P16/Sydney 2012.

The last global norovirus epidemic originated in Sydney in 2012. Researchers don't yet know how widely these strains will spread.

Norovirus is the most common cause of gastrointestinal infection worldwide, leading to 684 million infections per year. It's usually self-limiting, but about 220,000 people die from complications of norovirus infection annually.
Sep 13 UNSW press release

Study finds high rate of MDR pathogens in hospitalized Syrian children

Researchers at a hospital in Israel are reporting a high rate of multidrug-resistant (MDR) pathogen carriage among Syrian children who were ill or wounded during the ongoing Syrian civil war.

The study, conducted at Israel's Galilee Medical Center and published in Emerging Infectious Diseases yesterday, involved 128 children admitted to the hospital for multiple trauma and acute or chronic illness from March 2013 to February 2016. Of the 128 children, 107 were screened for five MDR pathogens: extended-spectrum beta-lactamase-producing Enterobacteriaceae(ESBL), carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus, MDR Acinetobacter baumannii (MDR-AB), and vancomycin-resistant Enterococcus.

The researchers identified MDR pathogens in 89 of the 107 children (83%), with all five classes of pathogen being represented. Infections were present in 24 of the children (19%), with urinary tract, surgical site, and bone infections being the most prevalent. Two thirds of infections were caused by ESBL, 20% by MDR-AB, and 15% by CRE.

Previous studies have found a high rate of MDR pathogen carriage among Syrian refugees treated in Italy, Germany, and Lebanon.

The authors of the study said the findings imply that there is probably a high carriage rate of MDR pathogens among healthy children in Syria, as well as a high rate of MDR pathogen acquisition in the Syrian healthcare system. They also added that the destruction of hospital infrastructure and inadequate infection control, on top of the widespread use of antimicrobials that preceded the war, have likely made the situation worse.

They recommend that healthcare centers caring for patients from Syria isolate those patients upon admission to prevent the transmission of MDR pathogens.
Sep 12 Emerg Infect Dis letter

Nigeria: 284 ill, 154 dead from Lassa fever in Nigeria

It's been 1 year since a Lassa fever cases began appearing in Nigeria, and now officials say 284 people have contracted the disease while 154 have died, with new cases popping up across the country each day. According to a story in the Nigerian newspaper Vanguard, the current outbreak may be the country's largest in history.

Dr. Chikwe Ikpeazu, director-general of the Nigeria Centers for Disease Control, said Lassa fever is not yet an epidemic, but recent deaths could change that status. The news article said that unlike the country's response to the related Ebola virus, there's been complacency by the Nigerian government to address Lassa fever.

Critics say the dearth of medical professionals and proper surveillance mechanisms have allowed it to erupt since the first wave of cases were reported in August of 2015.

"Currently, the likely risk for medical personnel is the newest security threat confronting Nigeria. With the deaths of many doctors in the country, the threat of possible epidemic of the disease cannot be ruled out coupled with the resurgence of wild polio virus at a time Nigeria is facing serious economic challenges," Vanguard reporters said.

Lassa fever is a viral hemorrhagic fever that causes deafness in 25% of patients. The disease often causes maternal death, and 80% of women infected during their third trimester experience fetal loss. Lassa virus is part of the arenavirus family of viruses, and humans become infected when they come in contact with food contaminated by rodent excrement. The virus is endemic is rodents in West Africa.
Sep 11 Vanguard story

PAHO reports spike in cholera cases in Haiti

The Pan American Health Organization (PAHO) reported yesterday that Haiti accounts for 96% of all cholera cases in the Americas and is on pace to see more cases this year than in 2014 or 2015.

So far in 2016, three countries have reported a total of 27,839 cases of the waterborne disease. Ecuador has 1 case, the Dominican Republic has 1,039, and Haiti, which has been battling a cholera epidemic since October of 2010, reported 26,799 cases, including 242 deaths.

In all of 2014 Haiti had 27,754 cases, and last year it reported 36,065. In 2013 the country had almost 59,000 cases.

The Dominican Republic has already had twice the number of cases as it did in all of 2015, reporting 1,039 so far. There have been 18 deaths from cholera in that country, compared with 15 for all of last year.

Last month, the United Nations (UN) admitted that UN peacekeepers sent to Haiti after the January 2010 earthquake caused the cholera epidemic by dumping human waste into the Artibonite River.

The ongoing cholera epidemic in Haiti is the worst in human history.
Sep 12 PAHO report

New antibiotic candidate for C diff diarrhea receives boost from FDA

The Food and Drug Administration (FDA) has granted Qualified Infectious Disease Product (QIDP) designation to the antibiotic candidate MGB-BP-3 for the treatment of Clostridium difficile–associated diarrhea (CDAD).

According to a press release from biopharmaceutical company MGB Biopharma, The QIDP designation was granted after a phase 1 study of the oral formulation of MGB-BP-3 confirmed that the compound was well tolerated in healthy volunteers and had a noted effect on C difficile bacteria. The company says it is now preparing for a phase 2 clinical trial to investigate the compound's safety and efficacy in patients with CDAD.

The QIDP designation, created by the Generating Antibiotic Incentives Now (GAIN) Act of 2012, provides incentives for the creation of new antibacterial and anti-infective products. Those incentives include priority review and an additional 5 years of marketing exclusivity.
Sep 12 MGB Biopharma press release

Avian Flu Scan for Sep 13, 2016

News brief

Study notes evidence of airborne H5N2 1 km from affected US barns

Researchers detected H5N2 highly pathogenic avian influenza (HPAI) viruses in air samples collected inside, immediately outside, and up to 70 meters from affected barns during the 2015 outbreak in the Midwest, according to a study in this month's issue of Avian Diseases. They also found H5N2 RNA in air samples up to 1 kilometer from barns that housed infected flocks.

Researchers from the University of Minnesota and U.S. Department of Agriculture obtained air samples from 3 affected farms in Minnesota, 1 in Iowa, and 2 in Nebraska. Flock sizes ranged from 4,205 to 1.8 million poultry.

Samples were obtained inside the barns and at various distances from them to help assess the possibility of airborne spread of the disease. The investigators used polymerase chain reaction to detect live virus.

Five of the six flocks analyzed had positive air samples. Among the 382 samples tested, 33% tested positive, 38% suspected, and 30% negative. A total of 26 of 37 (67%) sampling events collected inside and 18 of 40 (45%) collected at 5 meters were positive for H5N2. Sampling at distances from 70 meters to 1 kilometer resulted in about 2% positives and 58% suspected findings. The researchers found HPAI H5N2 viruses in particles up to 2.1 micrometer in diameter.

The authors conclude, "These findings demonstrate HPAI virus aerosolization from infected flocks, and that both the transport of infectious aerosolized particles and the deposition of particles on surfaces around infected premises represent a potential risk for the spread of HPAI."
September Avian Dis abstract

Ghana reports 3 H5N1 outbreaks in backyard poultry

Ghana reported three outbreaks of HPAI H5N1 in backyard poultry flocks that occurred last month, according to a new report from the World Organization for Animal Health (OIE).

Affected flocks ranged in size from 119 to 300 birds in locations in south Ghana, near the coast. The two chicken flocks in Greater Accra region were reported to be living in deep litter. The other flock, which was the smallest, comprised turkeys, chickens, and guinea fowl in Central region. The outbreaks began from Aug 13 to Aug 23.

All told, 179 poultry died from the disease and 440 were destroyed to prevent disease spread, for a total of 619 birds.
Sep 10 OIE report