MRSA emerged long before methicillin was introduced, researchers findA study today in Genome Biology suggests methicillin-resistant Staphylococcus aureus (MRSA) emerged several years before methicillin was used to treat S aureus infections.To identify the origins of MRSA, which first started to appear shortly after methicillin was introduced in the United Kingdom in 1959 in response to widespread penicillin resistance in S aureus, researchers conducted whole genome sequencing on a collection of 209 MRSA isolates recovered in Europe between 1960 and 1989. In reconstructing the evolutionary history of the isolates, they hoped to identify when the first MRSA lineage arose, and when it acquired the staphylococcal cassette chromosome mec (SCCmec), a collection of genes containing the mecA gene, which is associated with methicillin resistance.The earliest MRSA isolates belonged to sequence type (ST) 250, and further investigation of 122 isolates with precise dates and places of origin indicated that a SCCmec element had initially been acquired by S aureus around or before 1946. The researchers theorize that widespread use of penicillin to treat S aureus in the 1940s and 1950s then selected for strains carrying the mecA gene, which also encodes penicillin resistance. That would explain why MRSA began to appear within a year of methicillin being introduced in the clinic.”Our study provides important lessons for future efforts to combat antibiotic resistance,” corresponding author and molecular biologist Matthew Holden, PhD, says in a press release from the University of St. Andrews. “It shows that new drugs which are introduced to circumvent known resistance mechanisms, as methicillin was in 1959, can be rendered ineffective by unrecognized, pre-existing adaptations in the bacterial population.”Holden and his colleagues say the findings highlight the importance of continual surveillance of pathogen populations for evidence of emerging adaptations and resistance patterns.Jul 20 Genome Biol study Jul 20 University of St. Andrews press release Australian surveillance shows increase in drug-resistant gonorrheaAn Australian surveillance system set up last year to provide early warning of the spread of resistant bacteria has detected more than 1,000 cases across the country resistant to last-line antibiotics and an increase in antibiotic-resistant gonorrhea, according to a report yesterday from the Australian Commission on Safety and Quality in Health Care (ACSQHC).The first report of the National Alert System for Critical Antimicrobial Resistance (CARAlert) revealed 1,064 instances of highly resistant bacteria from Mar 17, 2016, to Mar 31, 2017. Scientists reported at least one strain of bacteria that cannot be treated by last-line antibiotics in every state and territory. These strains are called critical antimicrobial resistances (CARs), and at least 37% of all CARs were from patients in the community, not from hospitalized patients.An average of 86 entries were made to CARAlert each month.Before December 2016, the most commonly reported CARs were carbapenemase-producing Enterobacteriaceae (CPE). One type of CPE, called the IMP type, is now endemic on the eastern seaboard.Since December, the most frequently reported type of CAR was azithromycin-resistant Neisseria gonorrhoeae, which accounted for 67% of all CARs reported to the CARAlert system in February this year and 62% in March. Azithromycin is a key gonorrhea antibiotic.Jul 19 ACSQHC report Jul 19 ACSQHC news release WHO: HIV strains becoming resistant to common antiviralsThe World Health Organization (WHO) warned today of growing drug resistance in more than 10% of people beginning antiretroviral treatment for HIV.The information was based on data from 11 countries surveyed in Africa, Asia, and Latin America. In six of those countries, 10% of newly diagnosed HIV (human immunodeficiency virus) patients have a strain that’s resistant to antivirals. Once the 10% resistance threshold is crossed, the WHO recommends that a country re-evaluate which antivirals are used as first-line treatment.According to the WHO, mathematical modeling shows that, in the next 5 years, 135,000 deaths and 105,000 new infections could occur if resistance patterns continue. This would raise HIV treatment costs by an additional $650 million in the 5-year period.”Antimicrobial drug resistance is a growing challenge to global health and sustainable development,” said Tedros Adhanom Ghebreyesus, PhD, director-general of the WHO. “We need to proactively address the rising levels of resistance to HIV drugs if we are to achieve the global target of ending AIDS by 2030.”Resistance to antiretrovirals occurs when people do not take the drugs as prescribed, which often happens when people do not have consistent access to HIV care. The levels of HIV in their blood increase, and they can transmit the new, resistant virus to others, the WHO said.Jul 20 WHO news release
MERS infects 2 more in Saudi ArabiaSaudi Arabia reported two more MERS-CoV cases, according to an update to its week 44 epidemiologic report today.Neither of the patients had contact with camels, a factor known to raise the risk of contracting MERS-CoV (Middle East respiratory syndrome coronavirus). One patient is a 62-year-old man from the city of Omluj in Tabuk region in the northwest, and the other is a 53-year-old man from Riyadh in the central part of the country.Both are hospitalized and thought to have primary exposure, meaning the virus probably wasn’t transmitted from another patient.Since the first human cases were detected in 2012, at least 2,266 MERS-CoV cases have been reported, at least 803 of them fatal. Most of the cases have been reported in Saudi Arabia.Oct 31 Saudi MOH report Maternal-fetal transmission found in 26% of Zika pregnanciesA new prospective cohort study conducted in French Guiana found that, in cases of maternal Zika virus infection, 26% of fetuses became congenitally infected. Of those, 21% suffered severe complications at birth, and 14% did not survive until birth. The study was published in the British Medical Journal (BMJ).The study was conducted at the French Guiana Western Hospital Center during the 2016 Zika epidemic. The hospital admitted 1,690 pregnant women from Jan 1 through Jul 15, 2016, and tested all for Zika.A total of 498 pregnant women tested positive for the virus, and 305 fetuses were included in the study. Seventy-six fetuses tested positive for Zika via testing of the umbilical cord, or placenta, amniotic fluid, cerebrospinal fluid, urine, or blood. Of the 76 fetuses, 34 were asymptomatic at birth, 15 had mild or moderate symptoms of congenital Zika syndrome (CZS), 16 had severe complications, and 11 suffered fetal loss.The authors said only 13% (approximately one in eight) of all fetuses born to mothers positive for Zika virus presented with “severe adverse outcomes.” This rate is similar to other congenital illnesses, including cytomegalovirus infection.”The burden of CZS might be lower than initially described in South America and may not differ from other congenital infections,” the authors concluded. Oct 31 BMJ study Flu elevated in parts of South Asia, Southeast Asia, rising elsewhereFlu in the Southern Hemisphere, which is nearing the end of its season, continued to decline, and though overall activity in the Northern Hemisphere is still at interseasonal levels, activity is starting to increase in Europe and North America, the World Health Organization (WHO) said this week, based on data from the first half of October.In southern Asia, flu remain elevated, mainly due to the 2009 H1N1 virus, and in Nepal, detections of H3N2 and influenza B increased, the WHO said. Flu activity also rose in some Southeast Asian countries, such as Laos, where 2009 H1N1 is the dominant strain, and Myanmar, where health officials are mainly seeing H3N2 and influenza B.Globally, of viruses that tested positive for flu in the first part of October, 84.2% were influenza A and 15.8% were influenza B. Of subtyped influenza A viruses, 80.1% were the 2009 H1N1 strain.Oct 29 WHO global flu update Study highlights role for blood tests for enterovirus in childrenTesting blood for enteroviruses is helpful for diagnosing young children with fever without a source of sepsis-like syndrome, according to a study of French pediatric patients over two seasons, a research team reported yesterday in The Lancet Infectious Diseases.Enteroviruses are a frequent cause of acute meningitis and increasingly implicated in sepsis-like disease and with fevers without a known source. Though testing cerebrospinal fluid (CSF) is the gold standard for diagnosis, researchers wanted to assess polymerase chain reaction (PCR) testing for the virus in blood.The group’s prospective observational study included newborns, infants, and children ages 2 through 16 from 35 French pediatric and emergency departments at 16 hospitals. The study enrolled 822 patients with fever without a source, sepsis-like syndrome, or suspected meningitis who underwent enterovirus testing in blood and in CSF from June through October of 2015 and 2016.Overall, enterovirus was detected in 357 (43%) of children, which included 191 (54%) who had positive blood and CSF samples, 45 (13%) with a positive blood test but negative in CSF, and 40 (11%) with positive blood findings but no CSF available for testing. Only 81 children (23%) whose CSF was positive for enterovirus had negative findings in blood sample testing.The researchers said the findings suggest that adding blood testing, or using it when CSF isn’t available, significantly increases yield, detecting 24% of infections that wouldn’t have been diagnosed otherwise. Testing positivity, however, varied by age, with blood-test-positives more frequent in children ages 2 and younger. In older children with suspected meningitis, enterovirus detection was more frequent in CSF than in blood.In a commentary in the same issue, two experts from the department of pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado said blood isn’t routinely tested and isn’t included in many clinical guidelines for managing febrile children, but the study findings suggest that it can contribute to the diagnostic assessment of young children with unknown fever or sepsis-like syndrome, including when CSF isn’t available for testing.They said enterovirus testing is most cost-effective during seasonal circulation and that ideally, results should be available quickly, which can help clinician avoid unnecessary antibiotic prescribing. “The novel information contained in this article should be incorporated into future guidelines for febrile neonates and infants with fever without source, by including recommendations for blood PCR testing for enteroviruses,” they wrote.Oct 30 Lancet Infect Dis abstract Oct 30 Lancet Infect Dis commentary
The World Health Organization (WHO) today detailed eight more MERS-CoV cases in Oman, some of which—including two fatalities—are part of a second illness cluster, and others apparently part of an earlier cluster.Meanwhile, over the weekend and through today, Saudi Arabia’s Ministry of Health (MOH) reported four more MERS-CoV (Middle East respiratory syndrome coronavirus) cases, mostly from Riyadh.Two health workers among latest Oman patientsLast month, Oman reported a cluster of five MERS-CoV patients in Al Batinah North governorate, all of them women from the same family.Today’s WHO update notes four more cases from Al Batinah North, and all are in women ages 30 to 77 who had secondary exposure, meaning they likely contracted the virus from another patient. One is a healthcare worker with an asymptomatic infection, and two of the other women are likewise asymptomatic. The fourth is hospitalized.The new cluster includes four men ages 30 to 68 from Ash Sharqiyah South governorate, which is in northeastern Oman, and three are considered secondary cases, though one also had exposure to camels. The source isn’t known for the fourth patient. The 30-year-old man is a healthcare worker.All four of the men have or had symptoms, with onsets ranging from Jan 27 to Feb 10. Two died from their infections.Whole-genome sequencing is under way to better clarify transmission patterns, and the agriculture ministry is investigating dromedary camel farms of one of the patients, and test results are pending. Also, the health ministry has stepped up infection prevention and control measures in emergency departments, particularly in triage areas.The WHO warned that infection prevention and control measures are critical for preventing the spread of MERS-CoV in healthcare settings, especially because the early phase of symptoms consists of nonspecific symptoms. The agency recommends standard precautions for all patients, droplet precautions for those with acute infection, contact precautions and eye protection in those with probable and confirmed cases, and airborne precautions when performing aerosol-generating procedures.As of Feb 21, health officials have identified and screened 69 contacts of the Al Batinah North patients and 57 contacts of the South Sharqiyah patients.The new illnesses boost the number of MERS-CoV cases in Oman this year to 13. Since its first case in 2013, the country has reported 24 cases, 7 of them fatal. Globally, the WHO has received reports of 2,357 MERS-CoV infections since 2012, 820 of them fatal. The vast majority are from Saudi Arabia.Saudi Arabia reports 4 more casesSaudi Arabian MOH, meanwhile, reported four new MERS-CoV cases, three of them in Riyadh, according to epidemiologic updates.Two of the Riyadh patients are women ages 39 and 55 who are listed as secondary MERS cases, suggesting possible household or healthcare exposure, according to the ministry’s epidemiologic week 10 report. Neither woman reported recent camel contact.The third patient from Riyadh is a 62-year-old man who had contact with camels and is listed as a primary case, the MOH said in an update to its epidemiologic week 9 report. He is currently hospitalized.The fourth new case involves a 61-year-old man from Al Duwadimi in central Saudi Arabia about 120 miles west of Riyadh who is listed as a secondary case-patient, meaning he was likely exposed by a sick person. The MOH noted his case today in its epi week 10 update.The latest infections push Saudi Arabia’s MERS-CoV total so far this year to 87, which includes 51 from Wadi ad-Dawasir, where a large hospital outbreak was recently reported, along with some illnesses linked to camel exposure.See also:Mar 4 WHO statementMar 3-4 Saudi MOH epidemiologic week 10 reportMar 2 Saudi MOH epidemiologic week 9 report
MERS infects 3 more in Saudi Arabia, 1 fatallySaudi Arabia’s Ministry of Health (MOH) today reported three more MERS-CoV cases, all secondary infections in Khafji where two other cases were recently reported, potentially signifying a household or healthcare cluster.The patients are all men, one of whom was a 56-year-old man who died from his MERS-CoV (Middle East respiratory syndrome coronavirus) infection, the MOH said in an update to its epidemiologic week 14 report. The others are ages 49 and 59. It’s not known whether any of the three had recent camel contact.Khajfi is in northeastern Saudi Arabia near the border with Kuwait. The two earlier patients were a 75-year-old man who had contact with camels and whose illness was reported on Mar 29 and a 25-year-old man with secondary exposure whose infection was reported on Mar 31.The trio of new cases lifts the country’s total for the year to 119 infections, which includes 57 linked to a large outbreak in Wadi ad-Dawasir.Apr 4 Saudi MOH update Cholera vaccine campaign starts in wake of Mozambique cyclone floodingGlobal health groups launched an oral cholera vaccine campaign yesterday in Beira, Mozambique, to curb an outbreak following severe flooding from the devastating effects of Cyclone Idai, which struck the country and three of its neighbors in March.In a press release yesterday, the World Health Organization (WHO) said nearly 1,500 cholera cases and one death have already been reported and nine cholera treatment centers are already admitting patients.Nearly 900,000 doses of oral cholera vaccine from the global stockpile arrived in Mozambique on Apr 2. The stockpile is funded by Gavi, the Vaccine Alliance, which also supports the campaign’s operational costs. The campaign will be conducted by Mozambique’s health ministry with support from the WHO and other partners, including UNICEF, the International Federation of the Red Cross and Red Crescent Societies, Doctors Without Borders, and Save the Children.Seth Berkley, MD, Gavi’s chief executive officer, said in the statement that the cyclone left Beira’s water and sanitation infrastructure in ruins, providing conditions for the spread of cholera, which is endemic in the country. “This cyclone has already caused enough devastation and misery across south east Africa; we have to hope these vaccines will help stop a potentially major outbreak and prevent yet more suffering.”Apr 3 WHO press release
High COVID-19 viral load in hospital patients tied to higher risk for deathHigh SARS-CoV-2 viral load at hospital admission may place patients with and without cancer at higher risk for death, a new multicenter observational study published in Cancer Cell suggests.Researchers at Weill Cornell Medicine used surrogate markers to measure the viral load of SARS-CoV-2, which causes COVID-19, in 100 cancer patients and 2,914 patients without cancer admitted to one of three New York City hospitals from Mar 15 to May 14.The in-hospital death rate was 38.8% in all patients with a high viral load, 24.1% among those with a medium viral load, and 15.3% among those with a low viral load (P < 0.001).Similarly, cancer patients with a high viral load had the highest death rate (45.2%), while 28.0% of cancer patients with a medium load and 12.1% with a low load died (P = 0.008). Patients with hematologic cancers (affecting blood and blood-forming organs), especially those who had undergone chemotherapy or targeted treatments, had higher median viral loads than non-cancer patients. "We suspect that this finding may be from the underlying immunodeficiencies conferred by either the hematologic malignancies or the administered therapies, which may decrease the ability to inhibit proliferation of SARS-CoV-2," said co- author Lars Westblade, PhD, a pathologist at Weill Cornell Medicine, in a Cell Press news release.High viral loads at admission were associated with increased age; underlying conditions such as congestive heart failure, diabetes, chronic kidney disease; and use of inhaled or oral steroids before hospitalization. Hispanic patients were less likely than those of other ethnicities to carry a high viral load at admission.Cancer patients were more likely than patients without cancer to be white (42.0% vs 21.2%; P < 0.001), be former smokers (29.0% vs 16.5%; P = 0.001), have coronary artery disease (25.0% vs 14.8%; P = 0.004), and have congestive heart failure (14.0% vs 6.2%; P = 0.002). Proportions of cancer and non-cancer patients requiring oxygen support, intubation, and vasopressors (to regulate blood pressure) and who died in the hospital were similar."These findings highlight the critical role of viral load in SARS-Co-V pathogenesis and suggest that providing [viral load] value results to clinicians could serve as a valuable tool in the care of hospitalized patients with COVID-19," they wrote.Sep 15 Cancer Cell study and news release Eastern equine encephalitis case reported in IndianaState health officials in Indiana this week reported a probable human case of eastern equine encephalitis (EEE) and the detection of the virus in horses in northern Indiana.The Indiana State Department of Health (ISDH) identified the probable case in a LaPorte Country resident. Three horses in northern Indiana have also tested positive for the virus. Health officials are urging residents of northern Indiana to protect themselves from mosquito bites.EEE is rare but can cause serious illness and death in people, with a fatality rate of around 33% or higher. Children under 15 and adults over 50 are at greatest risk of severe illness if infected."Eastern equine encephalitis virus disease is rare in humans but can cause permanent complications and even death," State Health Commissioner Kris Box, MD, said in a press release. "While all Hoosiers are at risk for mosquito-borne diseases, northern Indiana residents need to be especially vigilant right now."Health officials recommend that people avoid being outdoors when mosquitoes are active, use an Environmental Protection Agency–approved insect repellent, cover exposed skin in places where mosquitoes are active, and eliminate mosquito breeding grounds from their property.Sep 15 ISDH press release High-path H5 avian flu outbreaks hit poultry in KazakhstanAnimal health officials in Kazakhstan today reported seven highly pathogenic H5 avian flu outbreaks in poultry in the north near the Russian border, where several similar outbreaks were recently reported, according to a notification today from the World Organization for Animal Health (OIE).The outbreaks began from Sep 11 to Sep 14, striking backyard and village poultry. The virus killed 1,763 of 67,794 susceptible birds, and response actions include movement restrictions, vaccination, and disinfection.The report said the source of the virus is contact with wild birds and that the outbreaks mark the first appearance of the virus in Kazakhstan.Russia recently reported a spate of H5 outbreaks, including some involving H5N8 in southwestern Siberia, which isn't far from Kazakhstan's outbreak area. UK veterinary officials have noted that similar outbreaks in Russia in the summer of 2016 heralded widespread H5N8 outbreaks in Europe that winter, and they urged poultry owners to remain vigilant.Sep 17 OIE report on H5 in Kazakhstan Sep 14 CIDRAP News scan "H5N8 avian flu strikes more poultry in Russia"
Florida reports more dengue cases in Miami-Dade and Monroe countiesThe Florida Department of Health (Florida Health) this week announced that a second local dengue case has been reported from Miami-Dade County, and last week it confirmed another local dengue case in Monroe County, raising the total in the county, which includes the Florida Keys, to 56.In a statement on the new Miami-Dade case, health officials urged residents to take precautions such as draining standing water, covering skin and clothing with repellent, and covering doors and windows with screens to keep mosquitoes out. This is the county’s second locally acquired dengue case of 2020.Florida Health announced the new Monroe County case on Sep 17, noting that indications suggest that the patient contracted dengue locally and is expected to make a full recovery. It noted that dengue symptoms can resemble severe flu, with patients experiencing severe muscle aches and pain, fever, and sometimes a rash. Typically, there are no respiratory symptoms.Sep 21 Florida Health statement on Miami-Dade case Sep 17 Florida Health statement on Monroe County case Three countries report more high-path avian flu in poultry, waterfowlIn the latest highly pathogenic avian flu outbreak developments, the Philippines reports another outbreak involving H5N6, Russia confirmed more H5N8 detections in wild birds, and Taiwan reported more H5N5 events in poultry, according to the latest notifications from the World Organization for Animal Health (OIE).In the Philippines, the H5N6 outbreak began on Aug 10, affecting backyard poultry in Rizal province on Luzon, the country’s largest island. The virus killed 20 of 171 susceptible birds, and 10 owners have surrendered their flocks for culling. The source of the virus is thought to be contact with wild birds. The last H5N6 outbreak in the Philippines occurred in July and affected a commercial layer farm in Pampagna province.Russia reported six more H5N8 outbreaks in wild birds, with start dates ranging from Aug 14 to Sep 7, all in the southwest, where recent poultry outbreaks were reported. The virus killed five waterfowl and sickened a tufted duck, which was destroyed as part of the outbreak response.Finally, Taiwan reported two more H5N5 outbreaks, which struck poultry farms in Yunlin County, killing 5,728 of 27,477 susceptible birds. Taiwan reported its first H5N5 outbreak a year ago, followed by more sporadic detections, including earlier this month.Sep 22 OIE report on H5N6 in the Philippines Sep 22 OIE report on H5N8 in Russia Sep 21 OIE report on H5N5 in Taiwan