Friday, March 30, 2012

UK HPA reports increase in shigellosis cases with MSM


In the United Kingdom, the incidence of Shigella infections is usually related to foreign travel. However, according to a Health Protection Agency (HPA) study published Friday, researchers see an increase in dysentery cases from Shigella in men who have sex with men (MSM).
According to an HPA news release Friday, two outbreaks consisting of 20 cases of Shigella flexneri in MSM last year in Greater Manchester and London caused the HPA to performed “enhanced surveillance” to determine the magnitude of the problem in the country.
The enhanced surveillance, which ran from September to December 2011, picked up 145 cases of shigella infection, of which 31 were UK acquired. Of these 31 cases, they were predominantly male and just under half reported MSM activity within the previous week. The investigation showed that these men attended regular health checkups and all reported having a casual male partner in the preceding week.
These findings suggest that the UK acquired cases in men who have sex with men may be transmitted through sex or through secondary contact.
The enhanced surveillance was incorporated because it is unusual to see outbreaks of shigellosis absent of foreign travel.
Dr Isabel Oliver, head of the outbreak control team said, “Our investigation has revealed a strong association between UK acquired shigella and onward transmission in men who have sex with men.
“We also know that the cases are not part of one large outbreak, but are small clusters happening across the country, therefore it is important to be aware of simple precautions to stop the spread of the infection.
Health officials advise the following:
  • See your doctor if you have diarrhea, particularly bloody diarrhea.
  • Wash hands before preparing or eating food, after going to the toilet and before and after sex.
  • Avoid having sex until treated for the infection and making a full recovery.
Shigellosis is an acute bacterial disease of the intestines caused by several species of the bacterium, Shigella. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, cramps and occasionally toxemia.
It can cause bacillary dysentery because of the invasive ability of the organism that may result ulcerations and abscesses of the intestines.
It rarely spreads to the bloodstream.
More severe complications may include convulsions in children, Reiter's syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.
This diarrheal disease is found worldwide with the vast majority of cases and deaths being in children. Outbreaks usually occur where there are crowded conditions and where personal hygiene is poor: prisons, day care centers and refugee camps are three examples.
It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those that are primarily responsible for transmission are those that fail to wash their hands thoroughly after defecation.
Because Shigella is resistant to gastric acid, a person can get infected with as little as 10 organisms.
After getting infected symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection till approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.
Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.
Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, an antibiotic susceptibility test should be performed to determine which antibiotic will be effective.



Thursday, March 29, 2012

CDC issues malaria alert for travelers to Great Exuma, Bahamas


Photo/CDC

The US Centers for Disease Control and Prevention (CDC) responded to a recent case of malaria in a US traveler to the Bahamas by issuing a malaria alert Tuesday.
The agency received an official report of the confirmed case of a US traveler who traveled to Great Exuma, Bahamas between February and March of this year.
The individual has no history of additional international travel.
The CDC is advising travelers who may stay overnight in Great Exuma, Bahamas only, to take prophylactic antimalarial drugs.
Atovaquone/proguanil (Malarone), chloroquine, doxycycline, or mefloquine are all acceptable according to the US public health agency.
Travelers to other islands presently do not need to take an antimalarial drug. This recommendation is expected to be temporary.
The alert goes on to say travelers should monitor their health during travel and for up to 1 year after return from the Bahamas for any symptoms of malaria, which are flu-like, such as fever and chills. If symptoms occur the traveler should seek immediate medical care and inform the health-care provider of their travel to an area currently experiencing a malaria outbreak.
According to the CDC, about 1,300 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from malaria-risk areas, many from sub-Saharan Africa and South Asia.
Malaria is not endemic to the Bahamas and no malaria cases had been reported from the country since 2008.



Sunday, March 25, 2012

WHO: 639 deaths from meningococcal meningitis seen in African Meningitis Belt


Enhanced surveillance in the meningitis belt of Sub-Sahara Africa reveals outbreaks of meningococcal meningitis in the area have killed 639 people during the first 10 weeks of the year.
Nearly 6,700 suspected cases have been reported in 14 countries according to World Health Organization (WHO) Global Alert and Response (GAR) Friday.
According to the GAR, W135 serogroup of Neisseria meningitidis (Nm) bacteria is the predominate cause of the outbreaks. In Chad, Neisseria meningitidis serogroup A is predominant.
The WHO reports that the countries affected are implementing mass vaccination campaigns and treatment in response to the surveillance reports.
The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has approved the release of 117,500 doses of polysaccharide ACW vaccine to Côte d'Ivoire, 195,540 doses of polysaccharide ACYW vaccine to Ghana and 359,000 doses of conjugate Men A vaccine to Chad, along with injection materials and ceftriaxone (antibiotic) when necessary. The ICG constitutes of United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF), International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO.
The WHO is closely monitoring events in Africa.
Travelers to the area are advised to keep their vaccination status up to date.  WHO emphasizes that individuals planning to travel to countries in the African Meningitis Belt obtain vaccine to protect against the four serogroups responsible for the epidemic disease (tetravalent vaccine ACYW135).
The countries in the African Meningitis Belt under enhanced surveillance include Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan and Togo.
The "belt" has an estimated 300 million people in its total area.

 

Foot-and-Mouth Disease spread threatens North Africa and the Middle East-FAO


Photo/CIA

A new strain of foot-and-mouth disease (FMD), SAT2, is devastating livestock in Egypt and the UN agency, Food and Agricultural Organization (FAO) warns that without immediate action, the virus could threaten more of North Africa and the Middle East.
In a FAO news release Thursday, there are nearly 41,000-suspected cases of FMD in Egypt according to estimates. At least 4,600 animals have died, mostly calves.
Millions of livestock are at risk in Egypt. The FAO says 6.3 million buffalo and cattle and 7.5 million sheep and goats are at risk from the new strain of virus where there is no immunity against it.
The FAO says Egypt needs regional help in obtaining vaccines.
An FAO emergency team was in Egypt assessing the situation. Egypt has FMD vaccines; however, they do not provide protection against the SAT2 strain.
Egyptian Veterinary Services are reportedly working on producing a vaccine against the SAT2 strain, and even when it is produced; it takes up to two weeks to confer immunity. Biosecurity measures are being implemented to limit the spread of the virus.
FMD is a severe, highly contagious viral disease of cattle and swine. It also affects sheep, goats, deer, and other cloven-hooved ruminants. FMD is not a threat to people and no human health risks are associated with the disease. FMD is caused by a virus. Signs of illness can appear after an incubation period of 1 to 8 days, but often develop within 3 days.
There are seven known types and more than 60 subtypes of the FMD virus. Vesicles (blisters) followed by erosions in the mouth or on the feet and the resulting excessive salivation or lameness are the best known signs of the disease. FMD, however, can be confused with several similar diseases, including vesicular stomatitis and swine vesicular disease. Whenever mouth or feet blisters or other typical signs are observed and reported, laboratory tests must be completed to determine whether the disease causing them is FMD.
Though the virus has a relatively low mortality rate of 2-5%, to stop the rapid spread of the disease, slaughtering of large quantities of animals is required.


Saturday, March 24, 2012

CDC recommends polio boosters for travelers to 44 countries

Polio is a devastating disease that can cause paralysis and death; fortunately, it is preventable through immunization.
For US travelers to endemic countries or countries at risk for reestablishment or importation of the poliovirus, ensuring your polio vaccination is up to date is imperative.
The US Centers for Disease Control and Prevention (CDC) issued a travel notice Thursday recommending polio boosters to travelers to 44 countries that fall into one of the categories above.
The list includes the three endemic countries, Afghanistan, Nigeria, and Pakistan, plus India, which was removed off the polio endemic list last month.
The African nations of Angola, Chad, Democratic Republic of the Congo and South Sudan are on the list due to known or suspected persistent imported wild poliovirus and are considered polio-endemic for travel purposes.
The rest of the countries on the list have reported cases of poliomyelitis related to importation or re-established transmission of the virus or are at risk for poliovirus importation because they are located near endemic, re-established transmission, or recently infected countries: Cameroon, Central African Republic, China, Côte d'Ivoire, Guinea, Kenya, Mali, Niger, Benin, Burkina Faso, Burundi, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea-Bissau, Iran, Kazakhstan, Kyrgyzstan, Liberia, Mauritania, Namibia, Rwanda, Senegal, Sierra Leone, Somalia,  Tajikistan, Tanzania, Togo, Turkmenistan, Uganda, Uzbekistan, and Zambia.
In addition to ensuring your polio immunization is up to date, the CDC recommends you follow safe food and water practices and good hand hygiene. These are not only good recommendations for preventing polio, but also a number of other diseases.
Polio is caused by the poliovirus types 1, 2 and 3. All three types cause paralysis, with wild poliovirus type 1 being isolated from paralysis cases most often.
This viral infection is primarily spread from person to person through the fecal-oral route. However, in places where sanitation is very good, transmission though throat secretions may be considered more important.
Polio is recognized in about 1 percent of infections by flaccid paralysis, while over 90 percent of infections are unapparent.
Paralysis of poliomyelitis is usually asymmetric and the site of paralysis depends on the location of nerve cell destruction on the spinal cord or brain stem. Legs are affected more often than the arms.
Paralysis of the respiration can be life threatening.
Polio must be differentiated from other paralytic diseases like botulism and Guillain-Barre Syndrome.
Most cases of polio are in children under the age of three.
Prevention of polio is through immunization, either through the live oral poliovirus vaccine (OPV) or the inactivated poliovirus vaccine (IPV).
 


Thursday, March 22, 2012

IDSA: Most sinus infections are viral and don’t require antibiotics

Photo credit: 
training.seer.cancer.gov 

With sinus infections affecting one in seven people (14%) annually, sinus infections are ranked fifth as the reason antibiotics are prescribed.
However, in the newly published guidelines Wednesday  from the Infectious Diseases Society of America (IDSA), they say that up to 98 percent of sinus infections are caused by a virus and do not require antibiotic treatment.
The IDSA, in their never-ending quest to prevent the misuse and overuse of antibiotics, which ultimately lead to drug-resistance, prepared the guidelines to help doctors distinguish between viral and bacterial sinus infections. 
According to Anthony W. Chow, MD, chair of the guidelines panel and professor emeritus of infectious diseases at the University of British Columbia, Vancouver, “There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics ‘just in case.’ However, if the infection turns out to be viral – as most are – the antibiotics won’t help and in fact can cause harm by increasing antibiotic resistance, exposing patients to drug side effects unnecessarily and adding cost.”
The guidelines offer some of the following diagnosis and treatment recommendations for physicians:
·         How to tell the difference – The guidelines note a sinus infection is likely caused by bacteria and should be treated promptly with antibiotics if:
- symptoms last for 10 days or more and are not improving (previous guidelines suggested waiting seven days); or
- symptoms are severe, including fever of 102 or higher, nasal discharge and facial pain lasting 3-4 days in a row; or
- symptoms get worse, with new fever, headache or increased nasal discharge, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.
·         Shorter treatment time – Most guidelines to date have recommended 10 days to two weeks of antibiotic treatment for a bacterial infection. However, the IDSA guidelines suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The IDSA guidelines still do recommend children receive antibiotic treatment for 10 days to two weeks.
·         Avoid decongestants and antihistamines – Whether the sinus infection is bacterial or viral, decongestant and antihistamines are not helpful and may make symptoms worse. Nasal steroids can help ease symptoms in people who have sinus infections and a history of allergies.  
·         Saline irrigation may help – The guidelines note nasal irrigation using a sterile solution – including sprays, drops or liquid – may help relieve some symptoms. However, the guidelines note this may not be helpful in children because they are less likely to tolerate the discomfort of the therapy.
The IDSA is quick to point out, the voluntary guidelines are not intended to take the place of a doctor’s judgment, but rather support the decision-making process, which must be individualized according to each patient’s circumstances.
In addition, the guidelines offer a change in the standard of care for bacterial sinus infections. They recommend treating bacterial sinus infections with amoxicillin-clavulanate versus the current standard of care, amoxicillin. The addition of clavulanate helps to overcome antibiotic resistance by inhibiting an enzyme that breaks down the antibiotic. The guidelines also recommend against using other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim-sulfamethoxazole, due to increasing drug resistance.
A sinus infection, called acute rhinosinusitis, is inflammation of the nasal and sinus passages that can cause uncomfortable pressure on either side of the nose and last for weeks. Most sinus infections develop during or after a cold or other upper respiratory infection, but other factors such as allergens and environmental irritants may play a role.


Monday, March 19, 2012

Single-dose oral cholera vaccine may soon be available in the US

Photo/CDC

The Menlo Park, CA biotech vaccine company, PaxVax Corp. announced Monday, the US Food and Drug Administration has accepted its investigational new drug (IND) application for PXVX-0200, a single-dose oral cholera vaccine. This will allow the company to begin clinical trials. PaxVax intends on starting Phase 3 trials in 2012.
According to a PaxVax news release:
PXVX-0200, is a single dose, oral, live, attenuated vaccine against cholera, which was previously approved and marketed in six countries under the brand name “Orochol.” Unlike currently available cholera vaccines requiring two doses over the course of weeks before effectiveness, this vaccine’s rapid onset of protection in as little as seven days after a single administration makes it ideal for people preparing to travel to areas where cholera is endemic or where it has recently caused an epidemic.
Currently there is not a cholera vaccine available in the United States. There are two oral cholera vaccines available worldwide, Dukoral (manufactured by SBL Vaccines) which is World Health Organization (WHO) prequalified and licensed in over 60 countries, and ShanChol (manufactured by Shantha Biotec in India), which is licensed in India and is pending WHO prequalification according to the Centers for Disease Control and Prevention (CDC). Both of these vaccines are two-dose vaccines and require multiple weeks to establish immunity.
PaxVax CEO, Kenneth Kiley optimistically says, “We expect our cholera vaccine will be the first vaccine for cholera available in the United States, and the only one-dose oral vaccine in the world”.
Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.
It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).
The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals. Drinking water can be contaminated at the source, during transport or during storage at home. Food can get contaminated by soiled hands, during preparation or while eating.
Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.
According to the World Health Organization, the global disease burden is estimated to be 3--5 million cases and 100,000--130,000 deaths per year.


Sunday, March 18, 2012

Sex workers in developing countries 14 times more likely to be infected with HIV

Photo/Kay Chernush for the US State Dept.

Although it is not a big surprise that prostitutes who have sex with multiple partners daily are at a greater risk of contracting HIV, as Stefan Baral, MD, associate director of the Johns Hopkins Bloomberg School’s Center for Public Health and Human Rights notes, “the scope and breadth of their disproportionate risk for HIV infection had not been systematically documented”.
In a study, “Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis”, published Thursday in The Lancet Infectious Diseases, researchers from the Bloomberg School of Public Health determined that female sex workers in developing countries are nearly 14 times more likely to be infected by HIV compared to the rest of country’s population.
A meta-analysis of 102 previous published studies representing nearly 100,000 female sex workers in 50 countries was studied. Researchers found HIV prevalence in female sex workers in low- and middle-income countries was found to be about 12 percent, which equated to an increased risk of infection for sex workers 14 times that of other women in these countries. 
Other findings include:
In 26 countries where background levels of HIV were considered “medium” to “high,” approximately 31 percent of the female sex workers were found to have HIV and were 12 times more likely to be infected compared with women from the general population.
Sex workers in Asia had a 29 percent increased risk for HIV infection compared to other women, which was the greatest disparity among the regions studied. Sex workers in Africa and Latin America were 12 times increased risk compared to other women in these regions.
The HIV disease burden in this population is disproportionately high and the data suggests an urgent need to scale up access to quality HIV prevention programs. In addition to antiretroviral treatment and ongoing HIV prevention for sex workers, Dr. Baral says, “considerations of the legal and policy environments in which sex workers operate, and the important role of stigma, discrimination, and violence targeting female sex workers globally will be required to reduce the disproportionate disease burden among these women.”



Saturday, March 17, 2012

Foot and Mouth Disease creating havoc on Egypt’s livestock industry

Photo/Lawrence Livermore National Laboratory

The North African country of Egypt is already suffering through reported food shortages and food inflation and now a severe, rapidly spreading virus is infecting thousands of cows as Egyptian farmers accuse the government of incompetence.
A strain of the highly contagious viral disease, Foot and Mouth Disease (FMD) is spreading through dozens of provinces in Egypt infecting and killing thousands of cows. According to a Washington Post report Friday, Egypt’s local press quoted veterinary official Essam Abdel-Shakour as saying that 24,500 livestock have been infected with the disease over the past two weeks leaving 2,000 young cattle dead. . Most of the infections have come in the Nile Delta provinces in northern Egypt.
It appears that the outbreak is caused by a new strain SAT2, possibly a related strain of FMD that has circulated through neighboring countries Libya and Sudan.
According to a report from the Egyptian news source, youm.com, shipments of sheep were smuggled into Egypt across the border with Libya. The Egyptian authorities are trying to obtain appropriate vaccines abroad and claim that tighter measures are being undertaken to prevent the spread of the disease prior to the arrival of vaccines. Steps are also being undertaken to prepare the production of the relevant vaccines at the Ministry's Serum and Vaccine Laboratory (Abbassiyah).
In an effort to contain the spread, cattle markets are closed throughout the country.


Friday, March 16, 2012

With a decrease in acorns will come a surge in Lyme disease says ecologist

Photo/USDA

A New York disease ecologist is sounding the alarm bells for the Northeastern United States as he is warning of a swell of Lyme disease cases this spring according to a Friday news release.
Dr. Richard Ostfeld, an ecologist at the Cary Institute of Ecosystem Studies in Millbrook, NY says this surge in the bacterial infection will be due to decreasing acorn crops and white-footed mice populations.
He explains this acorn-mice phenomenon saying, “We had a boom in acorns, followed by a boom in mice. And now, on the heels of one of the smallest acorn crops we’ve ever seen, the mouse population is crashing. This spring, there will be a lot of Borrelia burgdorferi-infected black-legged ticks in our forests looking for a blood meal. And instead of finding a white-footed mouse, they are going to find other mammals—like us.”
Acorn crops, like other crops, vary from year-to-year, so in a lull year it will affect the mouse winter survival and breeding decreasing the population of this rodent.
Ecologists at Cary have been looking at this connection for some time:
In 2010, acorn crops were the heaviest recorded at their Millbrook-based research site. And in 2011, mouse populations followed suit, peaking in the summer months. The scarcity of acorns in the fall of 2011 set up a perfect storm for human Lyme disease risk.
The larval stage of the ticks that feed on the boom of mice in last year will be looking for a blood meal in their nymphal stage, the stage where the tick is well suited to transmitting Borrelia burgdorferi, the bacterium that causes Lyme.
Contrary to popular belief, a mild winter like we are presently experiencing does not cause an increase in ticks according to Dr. Ostfeld, but it can bring adult tick out of dormancy early.
Lyme disease is tick borne, bacterial infection that is relatively common in the United States. Ixodes scapularis is the vector for Lyme disease in the Northeast. In addition it is also the vector for human granulocytic anaplasmosis and babesiosis. Because of this, co-infections with multiple diseases are seen.
First discovered in 1975 in a town in Connecticut where it derives its name, Lyme disease is caused by the spirochete, Borrelia burgdorferi (Bb). It is the most prevalent vector-borne illness in the U.S., with the majority of cases occurring in the Northeast.
The disease is characterized by a distinctive skin lesion known as erythema migrans (EM) and possibly systemic, chronic symptoms including neurological, rheumatologic and cardiac involvement over time (months to years). Some reports say that the optic nerve may also be affected.
The EM which is the first manifestation in the majority of cases is a red papule that expands slowly frequently showing a clear center (bull’s eye). They may be seen singly or in multiples.
With or without EM, other early symptoms may include malaise, fatigue, fever, headache and stiff neck. Body aches and migratory joint pain may also be seen.


Thursday, March 15, 2012

NJ health issues Listeria warning on the heels of pregnant woman’s infection

Nearly two weeks after a 38-week pregnant woman was diagnosed with a Listeria monocytogenes infection, the New Jersey Department of Health and Senior Services (NJDHSS) issued a warning Thursday advising the public not to eat any cheese products produced by El Ranchero del Sur of South River, NJ.
The woman was diagnosed with the potentially fatal infection on Mar 2 at a New Brunswick hospital.
The Middlesex County Health Department performed an investigation on her infection and samples of cheese products were analyzed by the NJDHSS Public Health Environmental and Agricultural labs, who confirmed the presence of Listeria monocytogenes in a sample of Los Corrales Queso Fresco Fresh Cheese and Banana Leaf code dated 03/16/12.
El Ranchero del Sur agreed to a voluntary recall its products and to close its production plant while the investigation is in progress.
According to the NJDHSS health alert, El Ranchero del Sur cheese products can be found primarily in Mexican and Latin American grocery stores, restaurants, and other hispanic food establishments under the name brands El Ranchero, Los Corrales, and Carnes Don Beto with the plant number 34-0013669 marked on the label. All products are 14 ounces in weight except for the Queso Hebra Oaxaca String Cheese ball in 10 pound packages.
Listeria monocytogenes is bacteria that is normally found in the environment and has been found in animals, birds and vegetation. It can be found in raw foods and processed foods that get contaminated after processing. Some of the most common foods that are associated with listeriosis are raw milk, soft cheeses, vegetables, and many ready to eat meats like hot dogs, deli meats and pâtés.
Those at greatest risk of serious listeria infection include pregnant women, newborns, the elderly, and adults with weakened immune systems (AIDS patients have a significantly high chance, up to 300 times, of contracting the disease).
Most healthy persons show no symptoms of this disease. Initial symptoms of food borne listeriosis include fever, muscle aches, fatigue and sometimes gastrointestinal symptoms, such as nausea, vomiting, or diarrhea. Primarily in high risk groups but occasionally in healthy adults, the infection can spread to the blood and central nervous system where it can cause sepsis and meningitis.
Due to a naturally depressed immune system, pregnant women are about 20 times more likely than other healthy adults to contract this disease. Though many women may only experience mild flu-like symptoms, infections during pregnancy can have devastating consequences to the fetus which include stillbirth or miscarriage, premature delivery and serious infections in the newborn.
What things can you do to prevent this infection? The CDC offers recommendations to the general public and high risk groups:
• Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.
• Wash raw vegetables thoroughly before eating.
• Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.
• Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.
• Wash hands, knives, and cutting boards after handling uncooked foods.
• Consume perishable and ready-to-eat foods as soon as possible
Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above:
• Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
• Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
• Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pastuerized milk.
• Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may be eaten.
• Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.
This food borne illness affects about 2500 Americans each year. Only salmonella rivals listeria as far as food borne fatalities in this country.
This is a very hardy bacterium that can survive and even grow at refrigeration temperature. Because of this factor, Listeria presents challenges for us all.
 


Phase I clinical trials complete for HFMD vaccine, INV21

Hand, foot and mouth disease (HFMD) is a viral infection that affects approximately 2 million children annually in Southeast Asia. Some strains of the infection such as enterovirus 71 (EV 71) are more virulent and can cause not only mild disease, but debilitating or life-threatening disease.
Earlier this week, Fort Collins, CO vaccine company, Inviragen, announced successful results in the Phase 1 clinical trial of the HFMD vaccine, INV21.
According to an Inviragen news release Monday, after healthy adults received two doses of the highly purified virus particle vaccine, 100 percent of the study participants produced a protective immune response against EV 71.
In addition, the company reports that the vaccine was safe and well tolerated in the study population.
Principal Investigator of this clinical trial and  associate professor of the Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore. Dr. Paul Tambyah said, “The results of this first INV21 clinical trial are very promising. We look forward to continued collaboration on HFMD research and carrying out large scale trials in partnership with Inviragen to bring successful vaccine candidates such as INV21 closer to clinical use to help protect vulnerable children in this part of the world.”
Vulnerable children in Southeast Asia?
The Singaporean Ministry of Health has reported a three-fold increase in cases of HFMD in the first nine weeks of 2012. During this period, there were 5,568 cases of HFMD, compared to 1,908 during the same period last year.
Vietnam was hit extraordinarily hard by HFMD in 2011 with over 100,000 cases and 166 fatalities. This year appears to be a continuation of last. The Huffington Post reports the childhood virus has already sickened 12,000 and killed 11 as of Mar 9.
EV-71 has been implicated in HFMD outbreaks in Southeast Asia over the several years. EV 71 is a non-polio enterovirus.
EV 71 is transmitted through direct contact with discharge from the nose and throat, saliva, fluid from blisters or the stools of an infected person. Cases are most infectious during the first week of acute illness but may continue to shed virus in stool for weeks.
HFMD is typically a benign and self-limiting disease. Most common in young children, it presents as fever, oral lesions and rash on the hands, feet and buttocks. The oral lesions consist of rapidly-ulcerating vesicles on the buccal mucosa, tongue, palate and gums. The rash consists of papulovesicular lesions on the palms, fingers and soles which generally persist for seven to 10 days and maculopapular lesions on the buttocks.
However, complications associated with HFMD caused by EV-71 include encephalitis, aseptic meningitis, acute flaccid paralysis, pulmonary edema or hemorrhage and myocarditis. Most deaths in HFMD occur as a result of pulmonary edema or hemorrhage.
What’s next for INV21?
Inviragen’s COO, Dr. Joseph Santangelo said, “Our two-dose INV21 vaccine induced neutralizing antibody responses in all of the immunized adults in this Phase 1 trial and we look forward to exploring the vaccine’s safety and immunogenicity in children in future clinical trials later this year.”


Wednesday, March 14, 2012

Gastroenteritis-associated deaths more than double according to CDC study

Photo/CDC-Dr. Gilda Jones

Gastroenteritis goes by many monikers, stomach bug and stomach flu to name a couple, and today we learn from a Centers for Disease Control and Prevention study that this condition is the cause of death for over 17,000 people annually.
In an eight-year study period (1999-2007), researchers show gastroenteritis-associated deaths from all causes increased from nearly 7,000 to more than 17,000 per year according to a CDC press release Wednesday.
The infectious agents most commonly implicated in gastroenteritis-associated deaths are Clostridium difficile and norovirus.
According to the study, which was  presented today at the International Conference on Emerging Infectious Diseases in Atlanta, deaths from C. difficile increased dramatically from approximately 2,700 to 14,500 deaths per year.
The press release states that C difficile, which causes diarrhea, accounted for two-thirds of the deaths. Much of the recent increase in the incidence and mortality of C. difficile is attributed to the emergence and spread of a hypervirulent, resistant strain of C. difficile.
The highly contagious norovirus is the second leading infectious cause of gastroenteritis-associated deaths accounting for 800 annually. Norovirus causes more than 20 million illnesses annually, and it is the leading cause of gastroenteritis outbreaks in the United States.
Clostridium difficile is a bacterium found throughout nature; soil, water and the intestines of humans and various animals. It has been isolated in the feces of 3% of healthy adults according to one study. It is however more prevalent in hospitalized adults with colonization rates of up to 30 percent seen.
It is implicated as a causative bacterium of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC). The problem is when there is a decrease of normal intestinal flora typically due to the use of antibiotics (the list of antibiotics is quite long). This allows the C. difficile that is normally in check, to flourish and produce some potent toxins that results in diarrhea or the potentially life-threatening PMC.
Noroviruses are a group of viruses that cause the “stomach flu,” or gastroenteritis in people.
The symptoms include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. In most people, the illness is self-limiting with symptoms lasting for about 1 or 2 days. In general, children experience more vomiting than adults do.
Norovirus is spread person to person particularly in crowded, closed places. Norovirus is typically spread through contaminated food and water, touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth and close contact with someone who is vomiting or has diarrhea.
CDC scientists used data from the National Center for Health Statistics to identify gastroenteritis-associated deaths from 1999 to 2007 among all age groups in the United States. Adults over 65 years old accounted for 83 percent of deaths.


CDC issues travel notice about sleeping sickness

Photo/CDC-Blaine Mathison

The US Centers for Disease Control and Prevention (CDC) issued a travel notice Monday concerning the prevention of African trypanosomiasis. This notice comes after two European tourists contracted the deadly parasitic disease after a holiday in Kenya, which included a two day excursion to the Masai Mara National Reserve.
A study published in the Journal of Travel Medicine last year shows that during the last decade, cases of human African trypoanosomiasis were reported in travelers who traveled to national parks, wildlife reserves, and game parks in Tanzania, Malawi, Zambia, and Zimbabwe.
The CDC reports that, on average, the infection is reported in one US traveler per year; it is usually acquired in East African game parks.
According to the travel notice, you can do the following to help prevent contracting African sleeping sickness:
No vaccine or drug can prevent African trypanosomiasis. You can prevent the disease by avoiding tsetse flies.
Tsetse flies are found in woodland and savannah areas, and they bite during daylight hours. If you are touring or hunting in a game park, you are most likely to be exposed to tsetse flies. Travelers to cities are not at risk. Take the following steps to avoid tsetse fly bites:
  1. Wear protective clothing, including long-sleeved shirts and pants. The tsetse fly can bite through thin fabrics, so clothing should be made of medium-weight material.
  2. Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.
  3. Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles.
  4. Avoid bushes. The tsetse fly is less active during the hottest period of the day. It rests in bushes but will bite if disturbed.
  5. Use insect repellent. Although insect repellents have not proven effective in preventing tsetse fly bites, they are effective in preventing other insects from biting and causing illness.
If you are bitten by a tsetse fly during your trip (the bite is often painful), watch for symptoms and see your doctor immediately if you get sick. Be sure to mention that you have been traveling in Africa and that you were bitten by a tsetse fly.
The following treatment information for sleeping sickness is provided by the CDC’s Yellow Book:
Travelers who sustain tsetse fly bites and become ill with high fever or other manifestations of Human African trypanosomiasis (HAT) are advised to seek early medical attention. The infection can usually be cured by a course of antitrypanosomal therapy. Imported HAT is rare in the United States, and inexperienced physicians should consult with an infectious disease or tropical medicine specialist for diagnosis and treatment. Physicians can consult with CDC for assistance with diagnosis and clinical management (            404-718-4745      ncidpbdpi@cdc.gov). Treatment drugs (suramin, melarsoprol, eflornithine) are provided by CDC under investigational protocols.