News Scan for Feb 20, 2017 – CIDRAP

Officials confirm 6 new MERS cases, 1 death in Saudi Arabia

Over the past 4 days, Saudi Arabia's Ministry of Health (MOH) reported a flurry of MERS cases, one of them fatal and all involving men.

The MOH said on Feb 17 that a 74-year-old Saudi man from Jeddah was in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus) infection. The man had direct contact with camels, and the MOH listed the patient as deceased in an update yesterday. The update said he had a preexisting condition.

Also yesterday, the MOH reported two more cases in men who had direct contact with camels. A 57-year-old from Jeddah and a 67-year-old from Riyadh are both listed in critical condition.

Finally today, the MOH announced three more new cases in Saudi men. A 63-year-old from Muhayil is in critical condition and had direct contact with camels. A 49-year-old from Riyadh is also in critical condition. The source of his infection is listed as "primary," meaning it is unlikely he contracted the virus from another person, but camel contact is not mentioned. And a 61-year-old from Jeddah with MERS is in stable condition. His infection is also listed as primary.

The cases raise the country's MERS total to 1,563 cases, including 650 deaths. Eleven patients are still being treated for the disease. Feb 17 MOH report Feb 19 MOH report Feb 20 MOH report

A new study in the Journal of the Pediatric Infectious Diseases Society reports high rates of antimicrobial resistance in Indian neonatal and pediatric bloodstream infections.

The meta-analysis of 82 papers on antibiotic resistance in Indian children published from 2000 through 2015 included a total of 50,545 blood cultures, with the majority of bloodstream infections (78.7%) being reported from neonatal intensive care units. Among the 72 studies that reported gram-positive bacteria, the median percentage of gram-positive bacteria was 29.2%. In the 81 studies that reported on gram-negative bacteria, the median percentage among all reported positive cultures was 61%. Staphylococcus aureus was found to be the most common gram-positive isolates (median, 14.7%) and Klebsiella pneumoniae was found to be the most common gram-negative isolate (median, 26%).

Fifty percent of the S aureus isolates were methicillin resistant, with high resistance for S aureus to erythromycin (53%), cefotaxime (57%), and cotrimoxazole (57.7%) also noted. High levels of resistance were reported in K pneumoniae to ampicillin (95.2%) and cephalosporins (over 60%). After age stratification, the median resistance of common gram-negative pathogens to the World Health Organization-recommended combination of ampicillin and gentamicin for the treatment of neonatal sepsis was found to be extremely high (K pneumoniae/ampicillin 95.9%; K pneumoniae/gentamicin 75%; Escherichia coli/ampicillin 92.9%; E coli gentamicin 55.6%), with high resistance to cephalosporins also noted.

The authors note that while national guidelines for antimicrobial use have been launched in India, the study highlights a need for similar guidelines in neonates and children. More importantly, they write, "the awareness about the magnitude of antibiotic resistance and the essence of rational antibiotic use needs to be highlighted more urgently among practicing physicians and families." Feb 18 J Pediatric Infect Dis Soc study

The World Organization (WHO) said today that 11 cases of Seoul virus, a disease transmitted by rats, have been identified in the United States since December. Two of the 11 patients have been hospitalized, and all cases have been tied to rat-breeding practices. This is the first known Seoul outbreak connected to pet rats in the United States.

The US Centers for Disease Control and Prevention reported eight US Seoul virus cases on Jan 24.

So far people in Wisconsin, Minnesota, and Colorado have tested positive for the disease, which is a rare type of hantavirus that is transmitted from rats to humans through urine, droppings, or saliva of infected rodents, or after exposure to dust from their nests or bedding. The disease is not transmitted from person to person, and no treatment exists for the virus. Rarely, hemorrhagic fever with renal syndrome can develop.

All of the cases have been tied to ratteries or home pet rat-breeding sites. According to the WHO, follow-up investigations indicate that infected rats may have been distributed or received in Alabama, Arkansas, Colorado, Illinois, Indiana, Iowa, Louisiana, Michigan, Minnesota, Missouri, North Dakota, South Carolina, Tennessee, Utah, and Wisconsin. All affected facilities are limited to the pet rat trade. Feb 20 WHO report Jan 25 CIDRAP News scan on CDC report

Three new studies published today look at how Zika spread so rapidly in the Americas, and why and how the virus causes significant brain damage and microcephaly in children.

Authors writing in bioRxiv, a preprint server, generated 100 Zika virus genomes in an effort to understand how and why the virus spread so rapidly in 2015 and 2016. They found the samples had great genomic diversity, and dating analysis showed that four clades of the virus circulated in early- to mid-2015, a full year before the first detected case in several countries, including Peru and United States (in Florida). The study highlights the difficulties of Zika surveillance in countries where other flaviviruses also circulate.

A cell-culture study in Stem Cell Reports helps explain why Zika virus can cause microcephaly, or small head circumference, in infants. Scientists from the University of Texas Medical Branch at Galveston (UTMB) said that microcephaly occurs when the Zika virus attacks a developing fetus's stem cells. The authors discovered that the Asian, but not African, lineage of Zika viruses causes the stem cells to stop proliferating in the developing fetus.

"We discovered that the Asian lineage Zika virus halted the proliferation of brain stem cells and hindered their ability to develop into brain nerve cells," said Ping Wu, MD, PhD, senior author on the study and UTMB professor in the Department of Neuroscience & Cell Biology, in a press release from UTMB. "This difference seems to be linked with a Zika-induced change in global gene expression pattern, it remains to be seen which genes are responsible."

Finally today, JAMA Pediatrics published the results of a September 2016 workshop sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health to identify the key components of caring for children born with Zika-related microcephaly and other complications.

Many children, experts agree, may not have microcephaly at birth but may develop neurologic disorders because of prenatal Zika infection. Further study will be needed to anticipate and predict outcomes for children who were exposed, the experts said. Feb 20 bioRxiv study Feb 20 Stem Cell Reports study Feb 20 UTMB news release Feb 20 JAMA Pediatrics study

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News Scan for Feb 20, 2017 - CIDRAP