News Scan for Sep 24, 2018

News brief

Nigeria reports suspected monkeypox cases tied to UK illness

The Nigeria Centre for Disease Control (NCDC) said today that six suspected monkeypox cases are associated with one of the recent monkeypox illnesses in England, in a report that noted two new confirmed cases in the same Nigerian state as the suspected cases.

"A cluster of six suspected cases with epidemiological linkages to one of the cases in the UK has been identified in Rivers State and is being investigated in collaboration with the State team," the NCDC said in an update posted Sep 21. "In addition, two new confirmed cases have been recorded in Rivers that are not linked to the cluster described above."

Public Health England confirmed the UK's first monkeypox case on Sep 7, and a second, unrelated case on Sep 11. Both cases involved men who had been in Nigeria. The NCDC did not specify which UK case might be linked to the six-case Nigerian cluster.

With the 2 new confirmed cases, Nigeria has now confirmed 115 monkeypox cases and listed 4 additional illnesses as probable cases since September 2017. Seventeen states have now confirmed cases, with Rivers (34 cases), Bayelsa (20), and Cross River (9) reporting the most. Seven of the infections have proved fatal.

So far in 2018 the NCDC has confirmed 37 cases (2 deaths) and listed 1 as probable, in 15 states. The vast majority (79%) of case-patients have been male, and adults aged 21 to 40 have been most affected.
Sep 21 NCDC update
Sep 20 CIDRAP News story "UK monkeypox case exposed health workers, officials say"

Saudi Arabia announces new case of MERS

The Saudi Arabian Ministry of Health (MOH) confirmed one new case of MERS in an epidemiologic report for week 39—this week.

A 50-year-old Saudi man from Afif was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) and is currently hospitalized, the MOH said. The man's illness is listed as "primary," meaning it is unlikely he contracted the virus from another person. The MOH also said he had no contact with camels, a known risk factor for MERS.

The new cases appear to have lifted the global MERS-CoV total to 2,255 cases since 2012, at least 798 of them fatal.
Sep 24 Saudi MOH report

Illinois records first case of Heartland virus

The Illinois Department of Public Health (IDPH) announced the state's first case of the tick-borne Heartland virus on Sep 21.

IDPH identified the patient as a resident of Kankakee County but gave no other information regarding the patient's prognosis. Kankakee is approximately 60 miles south of Chicago.

Heartland virus, which is spread by the lone star tick, has been reported in more than 30 Americans in the Midwest and southern United States since it was first identified in 2009 in two Missouri farmers. Heartland presents like other tick-borne diseases and can include fever, rash, chills, and fatigue.

"We've been seeing much warmer weather than usual for this time of the year, which people have taken advantage of by spending time outside," said IDPH Director Nirav D. Shah, MD, JD. "While the weather is still warm, continue to take steps to protect yourself from tick bites."

Most people recover fully from Heartland virus, although there have been cases that resulted in hospitalization and death. There is no cure or vaccine for the virus.
Sep 21 IDPH press release

PAHO reports more than 6,000 measles cases in Americas

Since the first of the year, the Pan American Health Organization (PAHO) has recorded 6,629 measles cases, including 72 deaths, in 11 countries in North, Central, and South America.

The strong majority of cases (4,605, 62 deaths) are from Venezuela, which has been battling a resurgence of the virus since last year. According to PAHO, the national incidence rate is 14.5 per 100,000 population, and the states with the highest incidence rates are Delta Amacuro (208.8 per 100,000 population), the Capital District (125.0), and Amazonas (77.3).

Brazil has recorded 1,735 cases, including 10 deaths, in an outbreak that's spilled over from Venezuela. Strains of measles in that country are identical to those circulating in Venezuela, PAHO said.

PAHO said the Brazilian outbreak is ongoing, but cases have decreased recently in Roraima state, one of the epicenters of the outbreak. Children under the age of 4 are the most likely to be infected in this outbreak, PAHO said.

The United States has recorded 124 cases this year, and Colombia has confirmed 85.

PAHO said all member states should emphasize measles, mumps, and rubella vaccination campaigns to achieve 95% coverage rates, especially among infants.
Sep 21 PAHO report

Stewardship / Resistance Scan for Sep 24, 2018

News brief

New platform to detect and track drug-resistant infections in the works

The office of New York Governor Andrew Cuomo announced today that the New York State Department of Health (DOH) will partner with ILÚM Health Solutions to develop a research program to detect, track, and manage antibiotic-resistant infections at healthcare facilities across the state.

According to a press release from the governor's office, DOH and ILÚM—a wholly owned subsidiary of Merck & Co.—will work together to develop an infectious disease platform and real-time information service that tracks drug-resistant organisms, patients, and outcomes, delivers relevant insights to help healthcare providers make better treatments decisions, and connects DOH to state facilities. The collected data will also be used to aid in the development of new diagnostic tools.

"Through public-private partnerships and investments in advanced research, New York State is working to help curb the spread of infectious diseases," Lieutenant Governor Kathy Hochul said in the press release. "This new partnership will make significant strides in detecting and managing infections, helping to ensure the health and safety of New Yorkers."

Under the terms of the agreement, ILÚM will invest up to $48.6 million in the project over 5 years, and the New York State Life Sciences Initiative will commit $22.4 million. A pilot program at select facilities will be evaluated for efficiency and efficacy before the program is expanded throughout the state.
Sep 24 NY governor's office press release

CTX-M genes found in E coli isolates from US cattle, retail meat samples

A new study by US Food and Drug Administration (FDA) researchers has identified and characterized Escherichia coli carrying the extended-spectrum beta-lactamase (ESBL) gene CTX-M in food-producing animals and animal products in the United States. The study was published in the September issue of Microbial Drug Resistance.

While CTX-M-producing E coli strains have become increasingly prevalent in hospitals in the United States and around the world and have been identified in bacteria from healthy animals in several countries, there have been fewer reports of CTX-M ESBLs in bacteria from food animals and animal products in the United States. Intestinal carriage of CTX-M–producing bacteria in food-producing animals and contamination of retail meat is a concern because it may contribute to increased incidences of infections with ESBL-producing bacteria in humans.

To investigate the presence of CTX-M–carrying E coli in US food animals, the researchers conducted antibiotic susceptibility tests to determine which E coli isolates from cattle, chicken breasts, ground turkey, ground beef, and pork chops collected by the National Antimicrobial Resistance Monitoring System (NARMS) from 2011 through 2015 were likely ESBL producers. They then performed whole-genome sequencing on the 18 phenotypically positive ESBL E coli isolates to characterize the resistome, plasmids, and resistance genes in all strains.

Their analysis revealed that all of the isolates were resistant to at least three antimicrobial classes and carried various CTX-M genes, including blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTX-M-27, and blaCTX-M-32. Notably, this is the first report of E coli isolates from the NARMS retail meat program carrying blaCTX-M-14 and blaCTX-M-15, the two most frequently identified CTX-M genes worldwide. In addition, conjugation testing performed on seven of the isolates showed the CTX-M genes could be transferred to other E coli strains.

The authors conclude, "While the prevalence of these two successful CTX-M enzymes is low from domestic food animal sources, monitoring will continue to help determine whether this mechanism is becoming more widespread among animal and food strains of E. coli in the United States."
Sep 1 Microb Drug Resist study