News Scan for Jan 31, 2018

News brief

CDC director steps down after report of tobacco stock purchases

Brenda Fitzgerald, MD, director of the US Centers for Disease Control and Prevention (CDC), resigned today after a report that she bought tobacco stocks while leading the agency.

Anne Schuchat, MD, the CDC's principal deputy director who served as interim CDC director before Fitzgerald began her tenure last year, will resume that role, the Wall Street Journal and other news sources reported.

In a news release, Department of Health and Human Services (HHS) spokesman Matt Lloyd said, "This morning Secretary Azar accepted Dr. Brenda Fitzgerald’s resignation as Director of the Centers for Disease Control and Prevention. Dr. Fitzgerald owns certain complex financial interests that have imposed a broad recusal limiting her ability to complete all of her duties as the CDC Director. Due to the nature of these financial interests, Dr. Fitzgerald could not divest from them in a definitive time period."

HHS oversees the CDC. HHS Secretary Alex Azar was sworn in just 2 days ago.

Fitzgerald's resignation came less than a day after Politico reported she had bought shares in Japan Tobacco Inc. shortly after she took the helm at the CDC last summer. She had also owned stock in five other tobacco companies before she became CDC director, Politico reported. Fitzgerald had already faced criticism over other investments that posed conflict-of-interest concerns.
Jan 31 Wall Street Journal story
Jan 31 HHS news release
Jan 30 Politico story

Study highlights Zika, dengue, chikungunya co-infection

A study yesterday in BMC Infectious Diseases reports three cases of patients at the Colombian-Venezuelan border infected with the related Zika, dengue, and chikungunya viruses simultaneously, as well as frequent co-infection with any two of the viruses.

Colombian investigators assessed 157 blood samples from patients with fever and other symptoms consistent with dengue. Eighty-two patients tested positive for one or more viruses: 47 (29.9%) for chikungunya, 33 (21.0%) for dengue, and 29 (18.5%) for Zika. In addition, 7.6% were infected with both dengue and chikungunya viruses, 6.4% with dengue and Zika, and 5.1% with chikungunya and Zika, with attack rates of 14.9, 12.4, and 9.9 cases per 100,000 inhabitants, respectively.

Three patients (1.9%) were co-infected with all three of the mosquito-borne viruses, for an attack rate of 5.0 cases per 100,000 inhabitants.

The authors conclude, "It is necessary to improve the differential diagnosis in patients with acute febrile syndrome and to study the possible consequences of this epidemiological overview of the clinical outcomes of these diseases in endemic regions."

In a related study in Emerging Infectious Diseases, French Polynesian and French researchers determined that dengue virus seroprevalence (antibodies in blood) was more than 83% in the general population of French Polynesia and around 60% in schoolchildren in 2014 and 2015. And chikungunya virus seroprevalence was less than 3% before Zika virus emerged on the archipelago in 2013 but 76% afterward.
Jan 30 BMC Infect Dis study
Jan 30 Emerg Infect Dis report

PAHO details continued malaria rise in Americas region last year

In a snapshot of malaria activity in the Americas in 2017, the Pan American Health Organization (PAHO) said yesterday that cases showed a rise, continuing an increasing trend observed since 2015.

In 2017, five countries reported an increase in malaria cases: Brazil, Ecuador, Mexico, Nicaragua, and Venezuela. Also, Cuba and Costa Rica reported local cases, and Honduras reported illnesses from areas where the disease hadn't been detected recently.

Brazil, for example, reported 174,522 cases from January through November of 2017, a steep rise from 117,832 cases reported during the same period in 2016. Much of the activity was in states that were hot spots in 2016, with the exception of Mato Grosso. The hardest-hit areas in 2017 were Amazonas, Para, and Acre states.

PAHO in early 2017 warned of the threat of increasing malaria cases and the potential for the disease to become reestablished in areas where transmission had been interrupted. It said member states responded based on PAHO's alert, but the further rise in 2017 shows that challenges and gaps in the response remain.

For 2018, PAHO urged endemic countries to intensify surveillance, improve diagnosis and treatment capacity, and to periodically analyze data to identify clusters to help target the medical response. It advised officials in areas with low transmission to quickly investigate new cases so that steps can be taken to interrupt transmission establishment or reestablishment.
Jan 30 PAHO malaria epidemiologic update

Stewardship / Resistance Scan for Jan 31, 2018

News brief

Georgia health officials investigate 3 MDR-TB cases

The Georgia Department of Public Health (GDPH) tuberculosis program is assisting with the investigation of two confirmed multidrug-resistant tuberculosis (MDR-TB) cases in the northeastern part of the state, according to Nancy Nydam, a communications official with the GDPH.

The two patients are receiving treatment, and a third possible case is under evaluation. Contacts, including children, are undergoing screening with blood tests and x-rays.

Out of an abundance of caution, the GDPH has alerted hospital emergency departments and health providers who may see patients from Hart, Franklin, or Stephens counties, or areas nearby. "This is a proactive, precautionary step to screen individuals with signs and symptoms of TB, especially due to the number of influenza-like illnesses that so many people are experiencing," Nydam told CIDRAP News. Symptoms of can include prolonged cough, coughing up blood or blood-stained mucus, fever, night sweats, weight loss, or malaise.
CDC MDR-TB fact sheet

CDC closes investigation into puppy-related Campylobacter outbreak

The Centers for Disease Control and Prevention (CDC) yesterday announced an end to its investigation into a multistate outbreak of multidrug-resistant Campylobacter linked to puppies from Petland pet stores.

Since the last update in mid-December, the agency confirmed 16 more cases, bringing the totals to 113 cases in 17 states. Although the investigation is over, the CDC said there could still be more cases reported because people could be unaware of the risks after coming into contact with infected puppies and dogs.

No deaths were reported during this outbreak, but there were 22 hospitalizations. Illnesses started from Jan 12, 2017 to Jan 7, 2018. Bacteria isolated from 5 ill people and 7 puppies showed that the Campylobacter was resistant to common, first-line antibiotics, including azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline.

Almost all patients (99%) reported contact with a puppy in the week prior to illness, 87% reported contact with a puppy from a Petland store, and 25 were employees of Petland stores. Whole-genome sequencing during the outbreak showed that Campylobacter isolates were closely related.

"Pet owners should be aware that any puppy or dog, regardless of where it is purchased or adopted, may carry germs like Campylobacter that can make people sick," the CDC said. "Always wash your hands thoroughly with soap and water right after touching puppies and dogs or after picking up their poop."
Jan 30 CDC notice