H5N1

A belated MERS report from Lebanon

Thanks to a recent update from ECDC, I found this statement on the website of the Lebanese Ministry of Public Health: Press Release on 19/06/2017 Concerning the diagnosis of infection with the MERS Coronavirus. The Google translation, edited:

A media statement on 19/6/2017 with respect to the diagnosis of infection with emerging MERS Coronavirus 

The Ministry of Public Health diagnosed a case of human infection with the emerging coronavirus Middle East respiratory syndrome on June 16, 2017. 

The  patient had returned from Saudi Arabia and complained for several days of high fever without the presence of acute respiratory symptoms. He has received necessary treatment and is currently in good health at his home, where he is under domestic isolation and control by the Ministry of Public Health. The Ministry also monitors all contacts who come into contact with patient or were near him during his travel and residence in Lebanon. 

Note that this is the second case of the disease diagnosed in Lebanon; the first recorded case was in 2014 and was treated at the time  using preventive measures taken by the Ministry without transmission of the virus to any other citizen.

Current Zika virus transmission - List of countries: ECDC adaptation of WHO's Zika virus country classification scheme

ECDC has published Current Zika virus transmission - List of countries: ECDC adaptation of WHO's Zika virus country classification scheme. The introduction:

A revised scheme has been developed by WHO, in collaboration with the US CDC and ECDC, to categorise the epidemiological profile of vector-borne Zika virus transmission in countries and territories. The classification can be applied at the national level as well as subnational level when the necessary information is available. 

ECDC has adapted the classification scheme to reflect the risk to travellers more accurately. It replaces the previous ECDC classification and the WHO interim guidance on Zika virus surveillance published in April 2016.

Click or tap through for the full list plus maps.

European Commission adopts its second action plan against antimicrobial resistance

Via ECDC: European Commission adopts its second action plan against antimicrobial resistance.

Today, the European Commission has adopted a new action plan against antimicrobial resistance (AMR). The action plan takes a One Health approach and addresses AMR in bacteria from humans, animals and in the environment.  

With the new action plan, which builds on a previous action plan published in 2011 and taking into account the recommendations of its evaluation, the European Commission will enhance its support to EU Member States to deliver innovative, effective and sustainable responses to AMR, focusing on measurable and concrete outcomes. The specific actions included in the plan build on three main pillars: 

1. Making the EU a best practice region: there are significant differences between EU countries in the extent to which effective national policies dealing with AMR have been implemented; the Commission aims to support all EU Member States to raise their level to that of the highest performing countries. 

2. Boosting research, development and innovation: actions in this pillar aim to provide valuable input for science-based policies and legal measures to combat AMR, and to address knowledge gaps. 

3. Shaping the global agenda: the aim is to promote EU research efforts and initiatives on AMR on an international level. 

In parallel, the European Commission is launching EU guidelines on the prudent use of antimicrobials in human health. These guidelines are based on a proposals prepared by ECDC with input from EU Member States experts and stakeholders. 

ECDC Director Dr. Andrea Ammon said: “ECDC welcomes this renewed effort to tackle the increasing threat posed by antimicrobial resistance and highlights once more its commitment to support both the European Commission and the EU Member States in their initiatives to address this issue”. She added: “It’s not too late to turn the tide on antimicrobial resistance, but we need to make sure that we act now”.

Hong Kong: CHP notified of six human cases of avian influenza A(H7N9) in Mainland

Via the Centre for Health Protection: CHP notified of human cases of avian influenza A(H7N9) in Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (June 30) monitoring a notification from the National Health and Family Planning Commission that six additional human cases of avian influenza A(H7N9) were recorded from June 23 to 29, and strongly urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.      

The three male and three female patients, aged from 4 to 72, had onset from June 11 to 23. Four of them are from Yunnan and one each from Guizhou and Shanxi. Among them, five were known to have exposure to poultry or poultry markets.

Health, wealth, and the US Senate

Via NEJM, an editorial: Health, Wealth, and the U.S. Senate. Excerpt:

Perhaps in a nod to pleas for a reform less “mean” than the AHCA, the Senate bill would phase down federal funding for the ACA’s Medicaid expansion more slowly than House Republicans proposed to do — but it would impose the same cuts in the long run, and it would implement an even more draconian version of the House’s proposal to cap federal Medicaid funding per enrollee or turn the program into block grants. 

All told, the bill would cut more than $700 billion from the program over the next decade. The poorest Americans, those requiring nursing home care, and those with disabilities or mental illness would suffer. These attacks on Medicaid would undercut health care for the 74 million Americans who rely on it. 

Women’s health care would also suffer major blows under the BCRA. In states that chose to stop mandating coverage of maternity care, women of child-bearing age could be forced to pay unaffordably high rates for basic pregnancy coverage. Planned Parenthood would be defunded for a year, severely restricting access not just to family planning services but to an array of important preventive care services, including cancer screenings, for millions of low-income women. Another provision would prohibit the use of tax credits for any individual insurance plan that covered abortion services (with exceptions for rape, incest, and risk to the woman’s life). 

And at a time when about 60,000 Americans are dying each year from opioid overdoses, the Senate bill would drastically reduce the funds available for confronting this massive crisis and providing affected people the help they need to become functioning, contributing members of society. 

In addition to removing many people with opioid use disorder from the Medicaid or individual-insurance rolls, the BCRA would provide a mere $2 billion over 10 years for efforts that experts estimate would cost $183 billion. 

The public response to the very similar House bill indicates that the GOP’s approach to health care reform is deeply unpopular throughout the country, with an approval rating below 20%5 — and for good reason. Like many U.S. physician and hospital organizations that are speaking out against the BCRA, we whole-heartedly oppose sacrificing Americans’ health care and health to further enrichment of the wealthy. The future of our health care system and the lives of our patients are at stake.

Meanwhile, this morning Donald Trump is calling on the Senate to repeal Obamacare now and create a new health law later.

Saudi Arabia: No new MERS cases, two recoveries, one death on June 30

Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded. Two persons in Riyadh have recovered, one of them a 57-year-old expatriate healthcare worker. A 70-year-old Saudi man in Riyadh has died.

Cholera vaccine faces major test in war-torn Yemen

Via Science, a June 28 report by Kai Kupferschmidt: Cholera vaccine faces major test in war-torn Yemen. Excerpt:

Imagine a poor, war-ravaged country the size of Spain where more than 20 million people are threatened by a deadly disease that’s spreading fast from city to city. You have 1 million doses of a vaccine at your disposal. Who would you try to protect?  

That’s the question facing public health experts and international groups fighting an explosive cholera outbreak in Yemen. On 15 June, a group managing the modest global reserve of cholera vaccine decided to dispatch 1 million doses to the country, about half of what it had in stock; vaccina­tion is set to begin in early July. It will be one of the biggest tests yet for the vaccine. But where to deploy it is still under debate, says Dominique Legros, a cholera expert at the World Health Organization (WHO) in Geneva, Switzerland. 

Health workers have limited experience with the vaccine—which consists of killed bacteria and is given orally—in large emer­gency situations. The global stockpile was created only 4 years ago and has been used mostly for smaller campaigns. “How do we use the vaccine to stop an outbreak from spreading? We’re still learning,” says Melissa Ko of GAVI, the Vaccine Alliance in Geneva, which funds the stockpile. 

Experts have de­cided to stretch the supply by giving just one rather than the recommended two doses but are still debating where to target their efforts. And some caution that, because of the vaccine’s limited efficacy, even a plentiful supply might have only a modest impact on the massive epidemic.

Iranian city soars to record 129ºF (54ºC): Near hottest on Earth in modern measurements

Via The Washington Post: Iranian city soars to record 129 degrees: Near hottest on Earth in modern measurements. Excerpt:

A city in southwest Iran posted the country’s hottest temperature ever recorded Thursday afternoon, and may have tied the world record for the most extreme high temperature.  

Etienne Kapikian, a forecaster at French meteorological agency MeteoFrance, posted to Twitter that the city of Ahvaz soared to “53.7°C” (128.7 degrees Fahrenheit). Kapikian said the temperature is a “new absolute national record of reliable Iranian heat” and that it was the hottest temperature ever recorded in June over mainland Asia. Iran’s previous hottest temperature was 127.4. 

Weather Underground’s website indicates the temperature in Ahvaz climbed even higher, hitting 129.2 degrees at both 4:51 and 5 p.m. local time. 

If that 129.2 degrees reading is accurate, it would arguably tie the hottest temperature ever measured on Earth in modern times. 

Christopher Burt, a weather historian for Weather Underground, has exhaustively analyzed world temperature extremes and determined the 129.2 degree readings posted in Mitribah, Kuwait on July 21, 2016, and Death Valley, Calif., on June 30, 2013, are the hottest credible temperature measurements that exist in modern records.

CIDRAP: New colistin resistance gene identified in China

Via CIDRAP, a June 28 report by Chris Dall: New colistin resistance gene identified in China. Excerpt:

Researchers in China have discovered another gene that confers resistance to the last-resort antibiotic colistin. 

In a study yesterday in mBio, the researchers report that the MCR-3 gene was discovered in a fecal sample obtained from an apparently healthy pig at a farm in Shandong province during a routine surveillance study of antimicrobial resistant bacteria. The gene was located on a colistin-resistant Escherichia coli isolate, on a plasmid that contained 18 additional antibiotic resistance genes. 

The authors of the study say they're concerned the gene may already be widely disseminated, and that scientists should be on the lookout for it. "Screening for the mcr-3 gene should be urgently included in the surveillance of colistin-resistant Gram-negative pathogens from animals, humans, and the environment," they write. 

A third mobile colistin-resistance gene 

The discovery was made by several members of the research team that first reported the discovery of the mobile colistin resistance gene MCR-1 in E coli from pigs, pork products, and humans in China in November 2015. That finding raised international concern, given that colistin is an antibiotic of last resort for multidrug-resistant bacterial infections. The gene's location on plasmids, which are highly mobile pieces of DNA that can be shared within and between different bacterial species, means that resistance to colistin can quickly spread.  

Since then, MCR-1 has been identified in bacteria from humans, animals, and the environment in more than 30 countries, including the United States, and studies have documented the spread of the gene to the clinical setting in China. Earlier this year, Chinese scientists reported an outbreak of MCR-1–carrying Klebsiella pneumoniae among patients in a pediatric leukemia ward.  

In addition, six different variants of the MCR-1 gene have been reported, along with a second mobile resistance gene, MCR-2.  

Challenge of liquid stressed protective materials and environmental persistence of Ebola virus

Thanks to my Tyee colleague Andrew Nikiforuk for sending the link to this article in Scientific Reports: Challenge of Liquid Stressed Protective Materials and Environmental Persistence of Ebola Virus. The abstract:

After the largest Ebola virus outbreak in history, experts have attempted to answer how the Zaire ebolavirus species emerged in West Africa and caused chains of human-to-human transmission. The widespread and untimely infection of Health Care Workers (HCW) in the affected countries accelerated spread of the virus within the community. Among the reasons attributed to this trend, it must be considered that HCW were exposed to the virus in their occupational environment. 

The contribution of environmental conditions to the spread of Ebola in West Africa was examined by investigating the effect of temperature/humidity on the virus’s environmental persistence and by modeling if saturation (liquid stress) allows for penetration of Ebola virus through personal protective equipment (PPE). Ebola-Makona virus persisted on PPE and materials found in outbreak settings for less than 72 hours at 27 °C and 80% relative humidity (RH). A difference in virus penetration was observed between dry (5%, 1/21 tests) and saturated (33%, 7/21 tests) samples of PPE. Infectious virus particles penetrated through saturated coupons of Tyvek Micro Clean, Tychem QC, whole surgical masks and N95 respirators. 

These findings suggest inclusion of saturation or similar liquid stress simulation in protective equipment testing standards.