first_imgDec 2, 2009 (CIDRAP News) – The World Health Organization (WHO) said today that oseltamivir (Tamiflu)-resistant pandemic H1N1 cases in hospital settings suggest that treatment doses may need to be increased in immunocompromised patients who have flu symptoms.The agency made this statement after a teleconference with experts about two recent clusters of resistant cases. It also concluded that the events don’t signal a public health threat.The WHO, in a statement, said emergence of drug-resistant flu in severely immunosuppressed or immunocompromised patients is expected and has been well documented in seasonal flu.In late October a Welsh hospital detected an outbreak of oseltamivir-resistant pandemic H1N1 in eight patients who had severe hematologic disorders. Edwina Hart, health minister for the Welsh Assembly Government, said today in a statement that three of the patients appear to have been infected in the hospital.Three are still hospitalized, one in critical care. All are responding to treatment with a different antiviral, she said.Hart said so far there is no evidence that the resistant strain spread outside the hospital and that it does not appear to be any more severe than nonresistant strains.In the United States between mid October and early November, four cases occurred in severely immunocompromised patients who were hospitalized at Duke University Medical Center in North Carolina. Three of the patients died, but officials aren’t sure what role the pandemic H1N1 virus played in their deaths.The hospital said in a statement today that extensive testing and screening by the US Centers for Disease Control and Prevention, along with the state and the university, have shown no other cases of oseltamivir-resistant pandemic flu so far. Daniel Sexton, MD, an infectious disease specialist and director of the Duke Infection Control Outreach Network, said more work is under way to better understand the nature of the four cases.The WHO said investigations at the two hospitals are reassuring and that the resistant virus has not been detected in any staff caring for the patients, which suggests that it doesn’t spread easily to otherwise healthy people, particularly when good infection controls are in place. It said surveillance found no spread to other hospital wards or the wider community.Experts participating in the WHO’s conference call emphasized that severely immunocompromised patients are especially vulnerable to infection, difficult to treat, and more likely to develop resistance, the agency said. They urged physicians to be extremely vigilant with these patients, because their underlying conditions or treatment may mask early flu symptoms and oseltamivir resistance can develop rapidly.Though clinical judgment is still key, doctors who treat immunocompromised patients for flu symptoms may need to increase the oseltamivir dose and continue it without interruption during the course of acute illness, the WHO said.Once physicians detect oseltamivir-resistant pandemic H1N1 in a ward treating these vulnerable patients, they should consider switching to zanamivir as the drug of choice for treatment and prophylaxis.Experiences with oseltamivir-resistant seasonal H1N1 show how quickly the strains can spread and become established, and neuraminidase inhibitors have improved clinical outcomes in patients with severe pandemic flu, the WHO stated. “This experience underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance.”Over the past 2 weeks the number of documented oseltamivir-resistant H1N1 cases has risen from 57 to 96, in line with recent increases in global pandemic activity and a resulting increase in use of the drug, the WHO reported. About a third of the cases occurred in patients who had hematologic malignancy, were undergoing chemotherapy, or were undergoing post transplant treatment.”The clusters in the two hospital wards should be viewed in the context of these overall trends,” the WHO said, adding that though all oseltamivir-resistant cases warrant investigation, there’s no evidence that they are a public health threat.See also:Dec 2 WHO pandemic briefing notelast_img read more

first_imgFeb 3, 2011 Foodborne botulism a persistent problem for Alaska NativesFoodborne botulism is more than 800 times more common in Alaska natives than among the overall US population, mainly because of consumption of uncooked meat from aquatic game such as seals, whales, and walruses, according to a report in Clinical Infectious Diseases. Researchers from federal and state health agencies found records of 317 botulism cases and 159 outbreaks from 1947 through 2007. Sixty-one percent of the patents were female. The overall mean annual incidence was 6.9 cases per 100,000 Alaska Natives; those older than 60 were hardest hit, with a mean annual incidence of 26.6 per 100,000. The overall case-fatality rate (CFR) was 8.2%, but the CFR since 1980 has been 4.0% or lower. The fatality rate was higher in cases in which the disease was misdiagnosed and antitoxin treatment delayed.Clin Infect Dis reportClin Infect Dis related editorial (extract) China finds good safety profile for H1N1 vaccineAn evaluation of the safety of China’s 2009 H1N1 vaccine campaign found few serious adverse events, with a Guillain-Barre syndrome (GBS) rate that was below the country’s background level. The findings were published online yesterday by the New England Journal of Medicine. China conducted its vaccine campaign from Sep 21, 2009, through Mar 21, 2010. Priority groups included healthcare workers, school children and staff, and people with underlying medical conditions. About 90 million people received the vaccine, a nonadjuvanted split-virus vaccine made by 10 producers. A review of adverse events reported to China’s vaccine safety surveillance system showed that the adverse event rate was 90 per 1 million doses. Just over 80% of the 8,067 adverse events were determined to be vaccine related, and only 1,083 were defined as more serious. Eleven cases of GBS were reported, which at 0.1 per 1 million doses is well below China’s background rate of 1.9 per 1 million population. The authors concluded that the vaccine had a solid safety profile with no evidence of increased GBS risk.Feb 2 N Engl J Med abstract Survey finds 12% of food workers stayed on job while sickIn a multistate survey, 11.9% of restaurant workers said they had worked at least two shifts while suffering vomiting or diarrhea in the previous year, according to a report published in the February issue of the Journal of Food Protection. The survey included interviews with 491 restaurant workers and 387 of their managers in the nine states that participate in the Centers for Disease Control and Prevention’s Environmental Health Specialists Network. The states involved were California, Connecticut, Georgia, Iowa, Minnesota, New York, Oregon, Rhode Island, and Tennessee. Restaurants were selected randomly, and only one chain restaurant was included in each state. Factors associated with employees working while sick included (1) a high volume of meals served, (2) no requirement for workers to report illness to managers, (3) a lack of on-call workers, (4) inexperienced managers, and (5) male workers. “Our findings suggest that policies that encourage workers to tell managers when they are ill and that help mitigate pressures to work while ill could reduce the number of food workers who work while experiencing vomiting or diarrhea,” the report says.J Food Prot abstract Experimental blood test for vCJD called promisingBritish scientists have devised a blood test for variant Creutzfeldt-Jakob disease (vCJD)—the human counterpart of bovine spongiform encephalopathy (mad cow disease)—that achieved better than 70% sensitivity in the lab, according to a report published online today by the Lancet. The test involves using stainless steel particles to tag abnormal prion protein, the vCJD infective agent, in blood and then using a combination of PrP-specific antibodies and conventional assays to detect the agent. The scientists used the test to look for PrP in a set of 190 masked blood samples from 190 volunteers, including 21 with vCJD, 27 with sporadic CJD, 42 with other neurologic diseases, and 100 normal controls. The test identified 15 of the 21 samples from vCJD patients and correctly classified all 169 vCJD-negative samples, showing 71.4% sensitivity and 100% specificity. The study is praised in an accompanying editorial by Luisa Gregori of the US Food and Drug Administration (not speaking officially for the FDA). Gregori calls the study “the first report of an assay capable of discriminating vCJD-infected blood from blood of individuals who at the time of sampling were either healthy or affected by non-vCJD neurodegenerative disorders.” She notes that while vCJD is very rare, it has had enormous effects on transfusion medicine. A reliable blood test would not only be useful for identifying asymptomatic cases, but also, potentially, for screening blood donations, she writes.Feb 3 Lancet article abstractFeb 3 Lancet editorial (extract)last_img read more

first_img Scharff’s enhanced-model estimates for costs linked to two major foodborne pathogens differ considerably from those offered by the US Department of Agriculture (USDA) in May 2010. The USDA estimated that Salmonella infections from all sources cost the country about $2.65 billion a year, versus $11.39 billion in the new report. For E coli O157:H7, the USDA estimate was $478.4 million, compared with Scharff’s estimate of $635 million. On a per-case basis, the most costly foodborne disease by far is Vibrio vulnificus infection, at $2.79 million, according to the enhanced model. Other highly expensive ones are Clostridium botulinum (botulism), $1.68 million, and L monocytogenes, $1.28 million. May 2010 story about USDA estimate of E coli and Salmonella costs In an earlier study, Scharff used the CDC’s 1999 figures to estimate that foodborne illness cost the nation up to $152 billion a year. He revised his estimate to reflect the newer, lower numbers from the CDC. When it released the lower estimates, the CDC said the decreases were mainly due to better data and new estimation methods. Mar 3, 2010, CIDRAP News story on earlier cost-estimate study In the basic model, the overall cost burden for foodborne diseases is estimated at $51.0 billion (90% credible interval [CI], $31.2 billion to $76.1 billion), well below the enhanced-model estimate of $77.7 billion (90% CI, $28.6 billion to $144.6 billion). The overall average cost per case of illness is $1,068 in the basic model and $1,626 in the enhanced model. Jan 3, 2012 (CIDRAP News) – Although the estimated annual toll of foodborne illnesses and deaths in the United States was revised sharply downward by federal officials in 2010, foodborne disease still costs the nation up to $77.7 billion a year, according to a new study in the Journal of Food Protection. Scharff puts the overall burden from Escherichia coli O157:H7 infections at $635 million a year. Non-O157 strains of Shiga toxin–producing E coli , which have been the focus of increased concern in recent years, cost the nation an estimated $154 million, which is higher than Scharff’s previous estimate, according to the report. Dec 15, 2010, CIDRAP News story on revised CDC estimates of foodborne illness burden Scharff’s new study presents two different sets of cost estimates based on two different models. His “basic” model includes medical costs, productivity losses, and deaths, whereas his “enhanced” cost-of-illness model assigns costs for pain, suffering, and functional disability as well as the other factors. But neither model includes costs to the food industry or to public health agencies, nor costs due to certain long-term sequelae, such as post-infectious irritable bowel syndrome, the author notes. He estimated costs associated with 30 classes of pathogens, including 20 types of bacteria, 5 parasites, and 5 viruses. See also: In his report, Scharff offers a note of caution on the use of his numbers: “Total cost figures are useful as measures of the scope of the problem, but the numbers do not by themselves provide economic justification for any particular program aimed at reducing foodborne illness.” According to the enhanced model, the most expensive foodborne diseases are associated with Salmonella, at $11.39 billion per year; Campylobcter, $6.88 billion; norovirus, $3.68 billion; Toxoplasma gondii, $3.46 billion; and Listeria monocytogenes, $2.04 billion. The study, by Robert L. Scharff of Ohio State University, is based on the Centers for Disease Control and Prevention’s (CDC’s) December 2010 estimate that the nation has 48 million cases of foodborne illness with 3,000 deaths annually. Those numbers replaced an often-cited 1999 CDC estimate of 76 million cases with 5,000 deaths each year. Scharff RL. Economic burden from health losses due to foodborne illness in the United States. J Food Protect 2012;75(1):123-31 [Abstract]last_img read more

first_img Even as reported TB cases in Europe declined slowly from 2005 to 2010, treatment success rates edged downward. The rates “are dramatically low now at 68.7% and 47.6% among new and previously treated TB patients, mainly due to presence of MDR TB,” the release states. The success rate among MDR TB patients was 56.3%. Vaccine plan announcedMeanwhile, the coalition known as the Stop TB Partnership announced today the release of a plan for developing TB vaccines called “Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade.” The plan is to be published in Tuberculosis. For example, in northern Uzbekistan, 65% of the patients treated by MSF in 2011 had MDR TB, the organization said. Of those patients, 30% to 40% came to the clinic for the first time, an “unprecedented number,” suggesting that drug resistance was not only spurred by incorrect treatment but was also spreading on its own. In those 18 countries, the report says, the rate of newly detected and relapsed TB cases is about eight times as high as in the rest of the region: 68.5 versus 8.4 per 100,000 population. “Our region has the lowest TB treatment success rate and the highest M/XDR TB rate in the world,” said Zsuzanna Jakab, WHO regional director for Europe, in the release. “TB has not spared any country in our region, but has hit hardest in the 18 high priority TB countries mainly in the eastern part of the region.” For the EU and EEA, TB cases reported in 2010 totaled 73,996, of which 79% were new, the report says. The case total was 7% (5,685) lower than the previous year. Full ECDC report (172 pages) Fewer cases in EuropeThe European report provides sets of data for (1) the 53 countries of the WHO’s European Region, with a population of 894.5 million, and (2) the EU and European Economic Area (EEA), comprising the 27 EU members plus Iceland, Liechtenstein, and Norway, with a population of 504 million. “This confirms the general decrease in reported TB cases over the last five years across Europe,” the ECDC release says. “However, rising numbers of multidrug- and extensively drug-resistant tuberculosis (M/XDR TB) pose a serious threat in the attempt to eliminate TB, highlighting the importance of early detection and adequate treatment of tuberculosis in the region.” MSF said it wants governments, international donors, and drug companies to fight the spread of drug-resistant TB with new financing and new efforts to develop affordable diagnostic tools and drugs. “Far shorter and less toxic drug regimens are needed, along with currently non-existent formulations for children, and a point-of-care diagnostics test,” the group said. “Regulatory measures need to be enforced to prevent further spread of the disease due to mismanagement by practitioners.” Mar 20 press release about the TB vaccine blueprint MDR TB data called alarmingAlso today, MSF warned in a press release, “Alarming new data suggest that the global scope of [MDR TB] is much more vast than previously estimated, requiring a concerted international effort to combat this deadlier form of the disease.” Mar 20 MSF press release The reports and statements were issued in connection with World TB Day, Mar 24, which marks the date in 1882 when Robert Koch discovered the TB bacillus. In India, over-the-counter drug sales and an unregulated private health sector continue to fuel the development of drug resistance, MSF said. An estimated 99,000 people are infected with MDR TB each year, of whom only 1 % receive adequate treatment.center_img Between 2000 and 2010, vaccine researchers moved an unprecedented 15 candidate vaccines into clinical trials, but much more work is needed, the coalition said. It called for increased global collaboration, leadership, and commitment. Mar 19 ECDC press release The vaccine plan was developed with support from the WHO, the Bill & Melinda Gates Foundation, the US National Institute of Allergy and Infectious Diseases, and other groups. Also today, a coalition of TB organizations released a 10-year strategic plan for developing better TB vaccines, and the medical aid group Medecins Sans Frontieres (MSF), or Doctors Without Borders, said new data suggest that multidrug-resistant TB (MDR TB) is more widespread globally than previously thought. “To address the many challenges posed by TB, ideal vaccine regimens must protect babies at birth from childhood TB, and prevent infection with the organism in older children and adults,” the group said. It said the only existing vaccine—Bacille Calmette-Guérin (BCG)—protects children from severe forms of TB in the first years of life, but it doesn’t prevent pulmonary TB, which affects adolescents and adults. A vaccine also is needed to protect people with latent TB from actually getting sick. Officials estimate that TB caused 60,000 deaths in the region in 2010, or 6.7 per 100,000 people. It also says the region had a case-detection rate of 74%, showing that its surveillance system is highly sensitive. Among new cases in the European Region, 13.7% were MDR TB, compared with 12% in 2009, according to the report. The share of MDR TB among previously treated cases was much higher, at 48.7%, up from 47% in 2008. The region had more than 29,000 patients with MDR cases. The WHO European Region had 309,648 new TB cases in 2010, 2.6% fewer than in 2009, according to the report and an accompanying press release from the European Centre for Disease Prevention and Control (ECDC). The overall TB case total for the region was estimated at 418,000. Mar 20, 2012 (CIDRAP News) – The tuberculosis toll in Europe continued a slow overall decline in 2010, but the treatment success rate for the disease is slipping as drug-resistant strains of TB grow more common, according to a report released today by the European Union (EU) and the World Health Organization (WHO). The experts who wrote the plan concluded that “effective solutions will remain out of reach unless the world scales up efforts to solve the scientific puzzles now hindering development of vaccines against the airborne pathogen,” the coalition said in a press release. “Wherever we look for drug-resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem,” said MSF President Dr. Unni Karunakara. “With 95 percent of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR TB are being severely undermined by a retreat in donor funding—precisely when increased funding is needed most.” See also: The report also says that TB in children is still a major concern in the region, with about 10,000 TB cases reported in children younger than 15.last_img read more

first_imgApr 6, 2012 (CIDRAP News) – The intravenous antiviral peramivir was used in close to 1,300 severely ill patients under an emergency authorization during the 2009 flu pandemic, but its impact and safety profile remain unclear, in part because of patchy data collection, according to reports and commentary published in Clinical Infectious Diseases (CID) this week.The Centers for Disease Control and Prevention (CDC) estimated that 1,274 patients received the IV drug under an Emergency Use Authorization (EUA). Food and Drug Administration (FDA) officials estimated that about 16% of the patients died, which is in the range of fatality rates reported for hospitalized H1N1 patients generally, according to the reports.Also, many adverse events were reported in the treated patients, but those were generally attributed to their already-severe illness at the time of treatment and other factors. Rashes were the only adverse reactions that seemed clearly related to the drug, but data gaps left the overall safety picture incomplete.”Despite extensive and thoughtful efforts, the post hoc data collection described in this issue provided a limited and incomplete view of the experience,” wrote Andrew T. Pavia, MD, a pediatric infectious disease expert at the University of Utah, in a commentary. “The EUA mechanism as described in the Project BioShield Act of 2004 was not designed for prospective data gathering.”Peramivir is a neuraminidase inhibitor, like oseltamivir (Tamiflu, given orally) and zanamivir (Relenza, given by inhalation), but is not yet licensed by the FDA. The FDA issued an EUA for peramivir on Oct 23, 2009, for the sake of seriously ill patients who needed an IV antiviral. The EUA remained in force until June 2010. The CDC managed distribution of the drug to clinicians who requested it.In one of the CID reports, CDC officials write that they received 1,371 clinician requests for peramivir and delivered 2,129 5-day adult-treatment course equivalents to 563 hospitals.Data from three surveys were used to estimate how many patients were treated. The surveys included a reminder survey about reporting adverse events, a hospital pharmacy survey, and a clinician survey seeking patient data. From these, the CDC estimated that at least 1,274 patients, median age 49, received the drug.The reminder survey results yielded data on 844 patients. Adverse events were reported in 260 (31%) of these, but most of the events could have been due to flu itself or underlying diseases, according to Pavia. Because of the survey design and the lack of a control group, the relationship of the adverse events to peramviir could not be determined, he said.The clinician survey drew a response rate of only 12%, with data on 127 patients. “The results paint a picture of very ill patients and late treatment,” Pavia commented. Ninety-two percent of the patients were on mechanical ventilation when peramivir treatment was started. When treatment ended, 30 (24%) of the patients had died. The available data did not permit a conclusion on whether the drug influenced outcomes.The second CID report was written by FDA officials who analyzed reports submitted to the Adverse Events Reporting System (AERS) about peramivir patients. The FDA received 369 reports covering 900 adverse events in 344 patients.The FDA investigators could not determine if any adverse events other than rash were due to peramivir, as missing data, severe illness, and other factors complicated the review, according to Pavia. The estimated overall mortality among the treated patients, about 16%, “did not differ from overall mortality of 14% to 46% in published series of hospitalized patients with pH1N1 influenza,” he wrote.Despite the limitations, the reports “highlight the first effective use of the EUA to provide a potentially lifesaving medication that was not yet licensed during a large-scale bioemergency,” Pavia wrote. “The delivery of drug to more than 1,100 critically ill patients within 24 hours of the request represents an enormous effort and logistical tour de force.”But he adds that the EUA was not initiated until close to the peak of the second wave of the pandemic, “and there may have been missed opportunities to make the drug available earlier.”Pavia suggests that more complete clinical data on patients treated under an EUA could be collected by providing data forms or links to secure Web sites when the drugs are delivered. Clinical research networks established in advance of emergencies would also improve data collection.The US House–passed version of the reauthorization for the Pandemic and All-Hazards Preparedness Act would expand the FDA’s ability to plan in advance for EUAs and to collect data during and after an emergency, but the Senate version does not include those provisions, Pavia said. Passage of the language in the House version is critical, he said.Yu Y, Garg S, Yu P, et al. Peramivir use for treatment of hospitalized patients with influenza A(H1N1)pdmo9 under Emergency Use Authorization, October 2009 – June 2010. Clin Infect Dis 2012 (early online publication) [Abstract]Sorbello A, Jones SC, Carter W, et al. Emergency use authorization for intravenous peramivir: evaluation of safety in the treatment of hospitalized patients infected with 2009 H1N1 influenza A virus. Clin Infect Dis 2012 (early online publication) [Abstract]Pavia AT. What did we learn from the Emergency Use Authorization of peramivir in 2009? (Commentary). Clin Infect Dis 2012 (early online publication) [Access page]See also: Oct 26, 2009, CIDRAP News storylast_img read more

first_imgApr 24, 2012 (CIDRAP News) – US agriculture officials today announced that the first US case of bovine spongiform encephalopathy (BSE) since 2006 was found recently in a California dairy cow, but they were quick to add that the case represents no danger to the food supply.The case was detected through the government’s surveillance program for BSE, or mad cow disease, the US Department of Agriculture (USDA) said. The carcass is being held under state authority at a California rendering plant and will be destroyed.”It was never presented for slaughter for human consumption, so at no time presented a risk to the food supply or human health,” USDA Chief Veterinary Officer John Clifford said in a statement.The case is only the fourth one reported in the United States. The first case was found in a Canadian-born cow in 2003.BSE is a brain disease of cattle that is always fatal and is believed to be the cause of a similar fatal disease, variant Creutzfeldt-Jakob disease, or vCJD, that can strike people who eat meat from infected cattle. Cattle contract BSE by eating contaminated feed.However, Clifford said in the statement that the California cow tested positive for “atypical BSE, a very rare form of the disease not generally associated with an animal consuming infected feed.”Atypical BSE differs from classic BSE in that cattle that have it are usually older and generally appear healthy, said Jeff Bender, DVM, an animal health expert at the University of Minnesota in St. Paul.Bender said he believes the last BSE case in the United States, found in an Alabama cow in 2006, also was an atypical one. There has been no evidence of a link between atypical BSE and human disease, he said.The emergence of BSE in British cattle in the 1990s led to a series of safeguards to stop the disease, starting with a ban on feeding cattle with protein derived from cattle and other ruminants. After the first US BSE case was found, the USDA banned “specified risk materials”—cattle parts most likely to contain the BSE agent if an animal is infected—from the food supply. “Downer” cattle, those that can’t walk when brought to the slaughterhouse, also were banned from the food chain.”Evidence shows that our systems and safeguards to prevent BSE are working, as are similar actions taken by countries around the world,” said Clifford. “In 2011, there were only 29 worldwide cases of BSE, a dramatic decline and 99% reduction since the peak in 1992 of 37,311 cases. This is directly attributable to the impact and effectiveness of feed bans as a primary control measure for the disease.”Clifford said the California case was detected through the USDA’s “targeted surveillance system” but did not say whether the cow showed any signs of illness. Testing was done at the USDA’s National Veterinary Services Laboratory in Ames, Iowa.The results are being shared with animal health reference labs in Canada and England that are affiliated with the World Organization for Animal Health (OIE), Clifford said.”These labs have extensive experience diagnosing atypical BSE and will review our confirmation of this form of the disease,” he added. “In addition, we will be conducting a comprehensive epidemiological investigation in conjunction with California animal and public health officials and the FDA.”Clifford asserted that the new case “in no way affects the United States’ BSE status as determined by the OIE,” because the nation has all the recommended safeguards.In an online statement posted on YouTube, Clifford said, “This announcement today should not disrupt trade. We follow international guidelines through the OIE, and those international standards are based on safe trade in both animals and animal products. It’s our interlocking safeguards that protect both animal health as well as human health.”In a separate statement this afternoon, Agriculture Secretary Tom Vilsack said, “USDA has no reason to believe that any other US animals are currently affected, but we will remain vigilant and committed to the safeguards in place.”Despite the reassurances, cattle futures prices on the Chicago Mercantile Exchange fell after the USDA announcement, Bloomberg News reported.See also: Apr 24 USDA statementApr 24 USDA press conference on YouTubeApr 24 Vilsack statementMay 2006 CIDRAP News story on last BSE case in USlast_img read more

first_imgJul 20, 2012Multistate E coli O145 outbreak called over; no source identifiedThe US Centers for Disease Control and Prevention (CDC) today said a nine-state outbreak of Escherichia coli O145 infections “appears to be over,” but the source of contamination remains unknown. Eighteen people were confirmed infected with the outbreak strain, up from 15 cases in six states in the CDC’s last update on Jun 19. Four patients were hospitalized, and one, in Louisiana, died. Dates of illness onset ranged from Apr 15 to Jun 12. “Based on interviews conducted, a source for these infections was not identified,” the CDC said. Cases by state are: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1). The new cases were in Kentucky, Maryland, and Virginia. The outbreak was first reported by Louisiana and Georgia officials in early June. The O145 strain is one of six non-O157 E coli strains that the US Department of Agriculture recently began testing for in beef trim.Jul 20 CDC updateJul 18 CIDRAP News item on non-O157 testingStudy: Listeria causes most years of life lost among enteric pathogens in Germany German scientists found that Listeria leads the list of enteric pathogens in that country as far as years of potential life lost (YPLL), according to a study today in Epidemiology & Infection. Using notification data from 2004 through 2008, the team assessed the impact of Campylobacter, L monocytogenes, norovirus, rotavirus, Salmonella, and Shiga toxin–producing E coli (STEC). They found the highest mortality rate was associated with salmonellosis (0.55 per 1 million population), but that Listeria accounted for the highest YPLL, at 4,245. When they removed deaths in people 70 and older, they found that Listeria still led substantially, with 2,306 YPLL, followed by STEC (757) and rotavirus (648). While acknowledging that routine surveillance captures only a fraction of cases and deaths, the authors conclude, “Weighting death by age permits a different view on the disease burden individual enteric pathogens cause and particularly underscores the public health importance of listeriosis prevention.”Jul 20 Epidemiol Infect abstractlast_img read more

first_imgSep 17, 2012Flu antibody’s precision targeting may spur new treatments, vaccinesScientists report that they have mapped the structure of a human antibody that zeroes in on the precise part of the flu virus’s hemagglutinin protein that latches onto host cells, a finding that they say may spur the quest for new flu treatments and a broadly protective flu vaccine. Researchers from the Scripps Research Institute and Sea Lane Biotechnologies found the antibody, called C05, by screening billions of antibodies generated from the bone marrow of patients who had been exposed to certain flu strains, says a Scripps press release. The team found that the antibody could bind to proteins from a variety of influenza A viruses, including subtypes H1, H2, H3, and H9. In addition, C05 protected cells in lab cultures from these viruses, prevented infections in mice, and “rescued” mice when used as post-infection treatment. C05 is “almost unique” among broadly neutralizing flu antibodies in that it specifically recognizes and blocks the receptor-binding site (RBS) on the head of the hemagglutinin molecule, the release says. The RBS changes little from strain to strain, whereas the surrounding structures vary. Using x-ray crystallography and other methods, the scientists determined that C05 avoids grabbing the variable regions around the flu RBS. “Instead it uses a single elongated protein loop to reach in and make a ‘one-handed’—or ‘one-fingered’—grab of the RBS itself,” the release says. “The antibody apparently works best when two of these active loops, one on each arm, grab two viral RBSs on separate hemagglutinins.” This precision targeting suggests that C05 could contribute to antibody-based therapies for severe flu infections, the statement said. In addition, a universal flu vaccine might be more effective if it could be designed to elicit such antibodies.Sep 16 Nature reportSep 16 Scripps press releaseFlu-malaria co-infection not uncommon in Kenyan preschoolersAbout 5% of Kenyan children under 5 years old who contracted influenza or malaria were co-infected with the other disease, which tended to increase hospitalization time, a study in the Journal of Infectious Diseases found. Researchers from Kenya and the US Centers for Disease Control and Prevention (CDC) analyzed data on flu and malaria infections confirmed from July 2009 through June 2011 in Kenyan kids under 5 at two rural sites. They found that 45.0% (149/331) of influenza patients were co-infected with malaria, while only 6.2% (149/2408) of malaria-positive patients were co-infected with flu. The overall rate of co-infection was 5.4% (149/2,739). The team found that children with influenza were less likely than those without to have malaria (risk ratios [RRs], 0.57-0.76), and kids with malaria were less likely than those without to have flu (RRs, 0.36-0.63). The length of hospital stay for co-infected children was 2.7 and 2.8 days longer than for flu-only infected children at the two sites, and 1.3 and 3.1 days longer than for those with only malaria, both of which were significant differences.Sep 14 J Infect Dis abstractSecond plague case connected to infected Oregon catHealth officials in Oregon’s Crook County said a second plague infection has been linked to an incident in June when a man was infected after he was bitten while attempting to remove a mouse from a cat’s mouth, according to a Sep 14 Oregonian story. Karen Yeargain, LPN, Crook County’s communicable disease coordinator, told the paper that CDC lab tests confirmed that a woman also involved in the incident had been infected with plague, as well. She was treated with antibiotics and didn’t become seriously ill. However, the man had a serious infection, was hospitalized in intensive care for a month, and lost his fingers and toes. The woman had been living with the man’s family and was also bitten when they were trying to take the mouse out of the cat’s mouth. Emilio DeBess, DVM, Oregon’s state public health veterinarian, said in July that CDC testing confirmed that the man’s cat was infected with Yersinia pestis, which causes plague and is typically spread by the bite of an infected flea.Sep 14 Oregonian storyJun 13 CIDRAP News Scan “Oregon man critical with suspected plague infection”CIDRAP plague overviewSaudi polio expert urges Taliban to lift banSaudi Arabia’s former health minister in a recent visit to Pakistan appealed to Taliban leaders to lift their ban on polio vaccination, The News International, a newspaper based in Karachi, reported today. In a meeting with journalists in Peshawar yesterday, Dr Hussain Gezairy put out a call to the Taliban’s senior leaders to lift the ban for the benefit of future generations and the rest of the world and to keep health matters separate from other issues. He added that the same vaccine has been used to eradicate polio from most of the Muslim world, including Saudi Arabia. Gezairy complimented the work some of Pakistan’s banned militant organization have done to support polio immunization. Two such groups recently allowed government immunizers access to children in the Tirah valley of the volatile Khyber Agency. The Taliban has barred polio vaccination in parts of Pakistan to protest recent US drone strikes. Gezairy is an advisor to the World Health Organization on polio eradication issues.Sep 17 News International storylast_img read more

first_imgWHO confirms 2 recent H7N9 cases in ChinaThe World Health Organization (WHO), citing Chinese officials, today confirmed two H7N9 avian flu cases reported by the media yesterday and provided further details.The first patient is a 3-year-old boy from Guangdong province who became sick Oct 29, was admitted to a local hospital on Oct 31, and was transferred to another hospital on Nov 4. He is in stable condition and had contact with live poultry, the WHO said.The second patient, a 64-year-old woman from Zhejiang province, is a farmer who also had contact with live poultry, the agency said. She became ill Oct 30, was admitted to a local hospital on Oct 31, and was transferred to another hospital on Nov 3, where she remains in critical condition.The two cases bring the total H7N9 count to 139 lab-confirmed cases and 45 deaths. Six of those patients still remain hospitalized, the WHO said.Nov 6 WHO statement Cargill to start labeling products that contain finely textured beefCargill Beef of Wayzata, Minn., yesterday announced that it will label beef products that contain finely textured beef, a product derogatorily labeled “pink slime” by critics last year, which led some retailers to pull products that contained it.”Our research shows that consumers believe ground beef products containing Finely Textured Beef should be clearly labeled,” said John Keating, Cargill Beef president, in a company news release. “We’ve listened to the public, as well as our customers, and that is why today we are declaring our commitment to labeling Finely Textured Beef.”The company said the labeling will be in place for the product “prior to the 2014 grilling season.” Finely textured beef consists of beef trimmings that are heated slightly, centrifuged to remove liquefied fat, and treated to kill bacteria. The process helps save meat that would otherwise be discarded, industry officials have said.Cargill said finely textured beef is 95% lean. It announced a Web site dedicated to providing information on the product.Last year the controversy caused South Dakota–based Beef Products Inc. (BPI) to close three of its four plants that made the product. Nov 5 Cargill news release May 8, 2012, CIDRAP News scan on BPI plant closings Doctors group: Focus measles response on youngest kidsMeasles outbreak response in Africa needs to focus on the youngest children, who are most affected, according to a report by Medecins Sans Frontieres (Doctors Without Borders) on a resurgence of the disease in sub-Saharan Africa, published yesterday in PLoS Medicine.The group compared and contrasted two measles outbreaks that accounted for most measles cases in the region in recent years. In the Democratic Republic of the Congo, 128,111 measles cases occurred in 2010 and 2011, including 1,454 deaths. Sixty percent of those cases occurred in Katanga province, which saw an attack rate (AR) of 0.71% and a case-fatality rate (CFR) of 1.40%.That contrasts with Malawi, which had 134,039 measles cases in 2010 but only 304 deaths. That country’s AR was 0.96%, but its CFR was only 0.23%.Age differences between the two outbreaks were dramatic. In Katanga, the median age of patients was 2 years, with 80% of reported case-patients 5 years old or younger and only 6% 10 years or older. In Malawi, the median age of patients was 7 years, with 41% of reported cases in children 5 years old or younger and 28% 15 years or older.”Differences in measles epidemiology and country-specific control goals necessitate more than a one-size-fits-all strategy,” the authors summarized. “The youngest children—who account for the most deaths and complications—should be prioritized by the outbreak response.”Nov 5 PLoS Med reportlast_img read more

first_imgVaccine advisers recommend Prevnar 13 for seniorsA federal vaccine advisory group yesterday recommended that adults age 65 and older receive the Prevnar 13 pneumococcal conjugate vaccine, according to a press release from Pfizer Inc., the vaccine’s maker. Using the vaccine alongside the current 23-valent pneumococcal vaccine is thought to provide broader protection.The Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC), considered the issue yesterday during a 2-hour Webinar.The vaccine, which protects against pneumonia caused by 13 serotypes of Streptococcus pneumoniae, was approved in 2010 for use in young children, and in 2011 the Food and Drug Administration (FDA) approved its use in adults age 50 and older. In 2012, Pfizer sought an ACIP recommendation for use in seniors, but the panel said it wanted to wait and analyze data from ongoing studies on herd immunity benefits in older people resulting from the vaccine’s use in children.A 23-valent pneumococcal vaccine has been used in seniors for several years. In 2012 ACIP recommended the vaccine for adults age 19 and older who have certain underlying medical conditions.ACIP voted to recommend Prevnar 13 vaccination in adults 65 and older who have not received a pneumococcal vaccine or whose history is unknown, followed by a dose of 23-valent vaccine. It also advised that adults who have already received one or more doses of 23-valent vaccine should receive a dose of Prevnar 13.The panel said it would reevaluate the routine use of Prevnar 13 in seniors in 2018 and revise its advice as needed.Luis Jodar, PhD, Pfizer’s’ vice president of vaccines, said in the statement, “This additional ACIP meeting recognizes the importance of implementing an adult recommendation for Prevnar 13 in advance of the U.S. influenza season, the time of year when this population is most likely to be considering vaccination.”Aug 13 Pfizer press release Aug 13 ACIP meeting agenda Study finds MRSA colonization common in rectal, groin areasAlthough the front part of the nasal passages is known as a leading site for colonization of methicillin-resistant Staphylococcus aureus (MRSA), the rectal and groin areas are not far behind, according to a recent study in Infection Control and Hospital Epidemiology.Researchers obtained swabs from 480 men and 265 women within 72 hours of admission at a Chicago hospital from March 2011 through April 2012. Of the 115 who tested positive for the presence of community-acquired MRSA, 62% had colonization of the anterior nares (nostrils), compared with 58% in the perirectal region, 56% in the groin, 44% in the throat, and 38% in the axilla (armpits).Also, 43% harbored MRSA in both the perirectal and groin areas. All told, 92% had colonization outside the nose.Five of the 115 patients colonized had a MRSA infection, and 4 of those colonized had multidrug-resistant strains.”While people colonized with MRSA may not be sick, the bacteria can become aggressive and lead to infection in the person or others,” said lead author Kyle Popovich, MD, MS, in a press release from the Society for Healthcare Epidemiology of America (SHEA), which publishes the journal.Popovich said the findings “may have important implications [for] MRSA surveillance programs nationwide.”September Infect Control Hosp Epidemiol study Aug 13 SHEA news release Analysis finds LAIV more effective than TIV in kidsA meta-analysis of the only two randomized controlled trials of live attenuated influenza vaccine (LAIV) in children showed that LAIV was slightly more effective against moderate-to-severe influenza than against milder flu in children younger than 6 years, according to a study in Vaccine. It was also significantly more effective than trivalent inactivated vaccine (TIV).The first trial was a 2-year placebo-controlled study of more than 1,300 US children 15 to 71 months old. Overall LAIV efficacy versus placebo was 95.4% in year 1 and 88.5% in year 2 against moderate-to-severe flu and 91.4% in year 1 and 84.2% in year 2 against milder flu.The second was a 1-year TIV-controlled study involving 4,166 US, European, and Asian children 6 to 59 months old. The relative efficacy of LAIV versus TIV was 52.2% for moderate-to-severe flu and 45.0% for milder flu.Aug 12 Vaccine study Fecal transplants may treat more than just C difficile infectionsFecal transplants are known mainly as a treatment for patients with recurrent Clostridium difficile infection (CDI), but studies reported at a conference this week suggest that the approach can help combat other gut diseases as well, according to the American Gastroenterological Association (AGA).The studies are being presented at the James W. Freston Conference in Bethesda, Md., the AGA said in a press release.New York City researchers reported some success with fecal microbiota transplantation (FMT) for patients who have irritable bowel syndrome (IBS), with overall symptoms resolving or improving in 9 of 13 patients enrolled. Eight of 11 patients with abdominal pain noted improvement or resolution after FMT.The treatment was less successful in relieving flatus, but overall well-being improved, the authors reported.Study abstractAnother report said 10 of 16 patients who received FMT for inflammatory bowel disease (IBD; ulcerative colitis or Crohn’s disease) had fewer flares in the ensuing months. Three of the 10 had no flares during an average 21-month follow-up period, while the other 7 had fewer flares than before, and none had more, said researchers from Montefiore Medical Center in the Bronx, N.Y.Several other disease markers also improved during the follow-up, while medication requirements decreased, according to the abstract.Study abstract Still another research team, from Minnesota and Massachusetts, reported that a preparation of gut bacterial spores in pill form was effective in treating CDI, suggesting that this treatment has potential for replacing actual fecal transplantation.The medication, called SER-109 and described as an “oral Ecobiotic ecology of commensal spores,” was used to treat 15 patients who had recurrent CDI that was adequately controlled with antibiotics. Thirteen of the 15 were free of CDI for the 8-week post-treatment follow-up period; the other 2 had transient diarrhea within 9 days after treatment but were free of CDI at 8 weeks. The researchers concluded that the cure rate was 100%.”The spore ecology worked at low dose and rapidly repaired the dysbiosis caused by chronic antibiotic treatment for C. difficile by inducing the formation of a diverse, healthy microbiome,” the abstract states.Study abstract Aug 14 AGA press releaselast_img read more