H5N1

Screening for infectious diseases among newly arrived asylum seekers, Bavaria, Germany, 2015

Eurosurveillance has published Screening for infectious diseases among newly arrived asylum seekers, Bavaria, Germany, 2015.  The conclusion:

The prevalence of TB, HIV and hepatitis B in asylum seekers arriving in Bavaria was generally very consistent with the reported prevalence in the respective countries of origin. Overall, it can be concluded that for most notifiable infectious diseases, the low absolute number of infectious cases among asylum seekers screened in Bavaria, suggests no additional risk for the resident population. 

The main concern from a public health perspective might be the increase in absolute numbers of notified TB cases compared with the previous years. This highlights the importance of early TB case finding and consequent follow-up for both the asylum seeker population and the resident population. As a result of the low prevalence of Salmonella spp. and Shigella spp. found in the screening, a symptom-based screening was implemented in Bavaria. 

A country-based screening approach appears to be reasonable and resource-effective, since our data are in accordance with the reported national HIV and hepatitis B prevalence data for different countries of origin. Mandatory screening of specific diseases in asylum seekers originating from countries with higher prevalence of those diseases could facilitate early diagnosis and therefore provision of treatment to affected individuals while saving resources.

CIDRAP: MCR-1-carrying Shigella found in China

Via CIDRAP, Chris Dall writes: MCR-1-carrying Shigella found in China. Excerpt:

Scientists in China have for the first time identified the colistin-resistance gene MCR-1 in a species of bacteria that's one of the leading causes of diarrhea worldwide. 

In a study today in Applied and Environmental Microbiology, the scientists report that they identified the gene in a single isolate of Shigella flexneri found in pig stool samples from a farm in Guangxi province. The isolate was among more than 2,000 S flexneri isolates, mostly from stool samples of patients, screened by the scientists. 

Since the existence of the MCR-1 gene was first reported in Escherichia coli samples from pigs, pork products, and humans in China in 2015, it has been detected in more 30 countries. But it's mostly been found in E coli and other Enterobacteriaceae from animals and humans, mainly Klebsiella pneumoniae and Salmonella enterica. The gene has heightened concerns about antibiotic resistance because it confers resistance to a drug that is considered a last resort for treatment of infections caused by multidrug-resistant bacteria. 

Another concern about MCR-1 is its mobility. Because the gene is located on mobile pieces of DNA called plasmids, it can be shared within and between different species of bacteria, which means that other multidrug-resistant pathogens can acquire resistance to colistin. This raises the specter of bacterial infections that are impossible to treat with current antibiotics.  

The authors of the study say that finding the isolate in S flexneri from pig feces suggests it could be circulating on Chinese farms and beyond.

Safety blunders expose lab staff to potentially lethal diseases in UK

Via The Guardian: Safety blunders expose lab staff to potentially lethal diseases in UK. Excerpt:

Safety breaches at UK labs that handle harmful bacteria, viruses and fungi have spread infections to staff and exposed others to potentially lethal diseases, the Guardian has learned. 

The Health and Safety Executive (HSE) has investigated a series of mistakes over the past two years that led to scientists falling ill at specialist labs run by hospitals, private companies, and even Public Health England (PHE), the government agency which exists to protect and improve the nation’s health and wellbeing. 

One scientist at a PHE laboratory became sick after contracting Shigella, a highly contagious bacterial infection that causes most cases of dysentery in Britain. The incident led the HSE to send the agency an enforcement letter to improve its health and safety practices. 

The HSE held formal investigations into more than 40 mishaps at specialist laboratories between June 2015 and July 2017, amounting to one every two to three weeks. Beyond the breaches that spread infections were blunders that led to dengue virus – which kills 20,000 people worldwide each year – being posted by mistake; staff handling potentially lethal bacteria and fungi with inadequate protection; and one occasion where students at the University of the West of England unwittingly studied live meningitis-causing germs which they thought had been killed by heat treatment. 

Of the scientists who became infected in the line of work, one was admitted to hospital after falling ill with salmonella poisoning at Pall Life Sciences, a private medical company. Another picked up a paratyphoid infection at Nottingham University Hospitals NHS Trust; four contracted Shigella at Brighton and Sussex University Hospitals NHS Trust, and a biomedical scientist at The Royal Free Hospital in London became sick with two different strains of gastrointestinal bug after testing an infected stool sample.

In Britain, microbes that are a risk to human health are ranked by hazard groups. The most harmful are listed in groups 3 and 4. Group 3 bugs, such as those that cause anthrax and leprosy, can pose a serious hazard to employees, and may spread to the community, but there is usually a vaccine or treatment. Group 4 pathogens, such as Ebola, are more dangerous. These are a serious threat to employees and the community, and there is often no vaccine or treatment. The germs must be handled in labs that meet strict safety and security requirements. 

The HSE investigated a number of close shaves. In August 2015, scientists at Bristol University accidentally posted live dengue virus – a group 3 germ carried by mosquitoes in south-east Asia – to Glasgow University’s Centre for Virus Research. Because the person who packed the material had no idea it contained live dengue, the parcel did not meet safety requirements for posting dangerous agents. With luck, the package did not leak; it arrived in one piece and was spotted on arrival at the lab, where staff destroyed the material. 

On another occasion, a diagnostic lab called Viapath posted a hazard group 3 bacteria called Chlamydia psittaci, which can cause pneumonia, to PHE’s infectious disease unit in north London. The sample was improperly labelled and, on arrival, was handled in a way that could have infected the PHE lab worker. The HSE found failings on both sides.

Infectious disease screening in asylum seekers: Range, coverage and economic evaluation in Germany, 2015

Via Eurosurveillance: Infectious disease screening in asylum seekers: range, coverage and economic evaluation in Germany, 2015. Excerpt from the discussion section:

This study analysed the compulsory medical screening of asylum seekers in Germany and provided estimates of the coverage and costs relative to expected yields. By listing and comparing state-level policies, we generated a comprehensive nation-wide overview of the content of screening programmes. 

Our study reveals substantial heterogeneity with respect to the range of compulsory screening tests stipulated by state policies and illustrates how this affects the proportion of asylum seekers screened as a consequence of the quota-based allocation system. The heterogeneity in screening policies leads to different economic impacts with respect to the distribution of the costs of receiving asylum seekers; federal states with the same level of economic strength mobilise different amounts of resources per asylum seeker for medical screening implementation. 

A high number and proportion of newly arrived asylum seekers were affected by compulsory screening for STIs (hepatitis B, syphilis or HIV) and stool examinations, in addition to the mandatory chest X-ray performed in asylum seekers ≥ 16 years of age. This resulted in total costs for Germany of more than 10 million EUR in 2015, a conservative, lower-bound estimate assuming full reimbursement according to statutory insurance fees. 

The sensitivity analysis showed that the total costs at the upper-bound using private fees could be up to 30% higher, which further argues in favour of the introduction of electronic health cards for asylum seekers and their integration into the regular healthcare system in Germany. 

We found high costs of medical screening relative to expected yields, raising questions on the cost-effectiveness of screening for some of the pathogens or diseases. By far the highest cost per identified case with respect to the initial screening test was found for Shigella spp. (> 80,000 EUR), followed by Salmonella spp. and TB (each > 5,000 EUR), syphilis (> 1,000 EUR), as well as HIV (> 700 EUR) and hepatitis B infections (> 600 EUR). 

Considering the co-existing private fee arrangements for conducting the medical screenings, the benefits of screening relative to programme costs are likely to be even lower, especially for infections with HIV, hepatitis B and enteropathogens.

US: Detained child's Shigellosis 'went untreated for weeks' at US immigration center

Via The Guardian: Detained child's disease 'went untreated for weeks' at US immigration center. Excerpt:

Five-year-old Briany nibbled her nails as she peeked from behind her mother. Her eyes rimmed with dark circles, she continued to ask if she could go out to play. Her mother, Gladis, shook her head.

Briany is being treated for Shigellosis, a diarrheal disease caused by the Shigella group of bacteria, which according to the Centers for Disease Control and Prevention is behind about 500,000 cases of diarrhea each year in the US. Briany lives with her mother as a detainee at the Berks County Residential Center in Leesport, Pennsylvania. 

Her case is a worrying one, which the Pennsylvania department of human services has reported to the US Department of Health and the Centers for Disease Control and Prevention. Briany’s condition, it is alleged, went untreated for weeks, exposing more than 40 other children of migrant mothers to a highly infectious disease. 

As the US struggles to cope with the arrival of thousands of migrants from Central America, time spent at the federal facility in which Gladis and Briany are held suggests a problem born of institutional neglect and with troubling potential consequences. 

The Berks County Residential Center was once a 96-bed nursing home. Converted in 2001, it now holds more than 80 migrants who have come to the US to escape gang violence, rape and economic despair. 

The Berks facility’s license to operate expired on 21 February. Because the facility continues to hold adults despite being licensed only to hold children, the state chose not to renew the license. As the decision is under appeal, the facility can continue to operate.

ECDC: CDTR week 49

ECDC has published Summary of Public health threats, CDTR week 49/2015. Click or tap through to download the full report and use the links. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period 29 November to 5 December and includes updates on Zika virus infection, influenza and refugee movements. 

Zika – Multistate (World) 

In February 2014, Chile confirmed the first case of autochthonous transmission of Zika virus infection (ZIKV) on Easter Island (Chile). Since then, ZIKV infections have spread to the Americas. In 2015, autochthonous cases have been reported in Brazil, Chile (Easter Island), Colombia, El Salvador, Guatemala, Mexico, Panama, Paraguay, Suriname and Venezuela. Autochthonous cases have also been reported from Cape Verde and in the Pacific area (French Polynesia, Samoa, Fiji, New Caledonia, Solomon Islands and Vanuatu). 

Possible links between ZIKV infection in pregnancy and microcephaly of the foetus have been under investigation since October 2015 when the Brazilian Ministry of Health reported an unusual increase in cases of microcephaly after the ZIKV outbreak in the North eastern states. Similar findings are also reported from French Polynesia. 

On 24 November 2015, ECDC published a rapid risk assessment on Microcephaly in Brazil potentially linked to the Zika virus epidemic. 

Influenza in Europe 

In the past week, the intensity of influenza activity across the WHO European Region was low in most of the 40 countries that reported data. All parts of Europe reported sporadic or local geographic spread of influenza. ECDC monitors influenza activity in Europe during the winter season and publishes its report weekly on the Flu News Europe website. 

Refugee movements – Multistate 

According to media or public health authorities’ sites, vaccination campaigns among refugees in several countries in Europe (Germany, Sweden and Norway) have been initiated or are being recommended. ECDC published a rapid risk assessment on shigellosis among refugees in the EU.

ECDC: Shigellosis among refugees in the EU

Via ECDC: Shigellosis among refugees in the EU. Click or tap through to  read the risk assessment.

​More than 80 cases of shigellosis have been diagnosed among refugees in EU countries between July and November this year. These countries include Austria, Greece, Germany, the Netherlands, Finland and Sweden. 

The occurrence of shigellosis among refugees is not unexpected as the disease is endemic in the countries of origin where people are fleeing from, as well as in some of the countries they travel through. The risk to the general population in Europe remains low. 

Transmission of shigellosis often occurs via the faecal-oral route. Person-to-person transmission of Shigella is effective in crowded conditions where it is more difficult to maintain good personal hygiene. Therefore, refugees can be vulnerable to a Shigella infection as personal hygiene is difficult to maintain during travel, and they often encounter overcrowding during their journey and at reception facilities. 

Since Shigella is well adapted to low temperatures, and transmission can also occur in the coldest months of the year, the number of shigellosis cases among refugees is unlikely to decrease in the coming months. 

The risk to the general population in Europe of being affected by single cases or outbreaks of shigellosis among refugee populations remains low, since factors which contribute to the transmission such as compromised hygiene, overcrowding and limited access to clean water are specific to some refugee reception facilities. 

However, cleaners of the hosting facilities for incoming refugees, together with other workers and volunteers, should be considered at possible risk to shigellosis.