Saturday, June 14, 2014

Global MERS update

The following is the latest update on the global Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak from the ECDC.

Since April 2012 and as of 13 June 2014, 828 cases of MERS-CoV have been reported by local health authorities worldwide, including 318 deaths.

Cases and deaths by region:

Middle East:

Saudi Arabia: 700 cases/287 deaths
United Arab Emirates: 71 cases/9 deaths
Qatar: 7 cases/4 deaths
Jordan: 18 cases/5 deaths
Oman: 2 cases/2 deaths
Kuwait: 3 cases/1 death
Egypt: 1 case/0 deaths
Yemen: 1 case/1 death
Lebanon: 1 case/0 deaths
Iran: 3 cases/1 death


UK: 4 cases/3 deaths
Germany: 2 cases/1 death
France: 2 cases/1 death
Italy: 1 case/0 deaths
Greece: 1 case/0 deaths
Netherlands: 2 cases/0 deaths


Tunisia: 3 cases/1 death
Algeria: 2 cases/1 death


Malaysia: 1 case/1 death
Philippines: 1 case/0 deaths


United States of America: 2 cases/0 deaths

Twenty one cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), USA (2), Italy (1), Malaysia (1), Philippines (1), Greece (1), Netherlands (2) and Algeria (2). In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities.

Image/Philippines DOH

Thursday, June 12, 2014

Bedbugs: What are they and how to check for infestations

According to the Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA), the United States is experiencing an alarming increase in the number of bedbug populations. In addition to being found in private residences, such as apartments and single-family homes, bedbugs are increasingly affecting restaurants, hotels, hospitals, and schools and day care centers.
Cimex lectularius/CDC

Bed bugs are small insects that feed on human blood. They do not transmit diseases, but their bites can leave itchy red welts on their victims. Adult bed bugs appear reddish-brown and have a flattened, oval shape. They are wingless and look about the size of an apple seed. They are big enough to be seen, but they hide in cracks in furniture, floors, walls, suitcases or clothing.

Most bed bug bites are initially painless, but they may turn into large, itchy skin welts. These wounds do not have a red spot in the center like lea bites. Some people don’t develop welts at all and can carry bugs without knowing it.

Although bed bugs are a nuisance, they are not known to spread disease.

“Although bedbugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights,” said board-certified dermatologist Seemal R. Desai, MD, FAAD, who maintains a private practice in Plano, Texas and serves as clinical assistant professor of dermatology at University of Texas Southwestern Medical Center. “The most common sign of bedbugs is having bite marks on your body, which can sometimes turn into itchy welts.”

To help find bedbugs before they find you (and your belongings), Dr. Desai recommends looking for the following signs near places where you sleep:
  1. A sweet, musty odor: If you notice a sweet, musty odor in your hotel room, cruise ship cabin, or other sleeping area, there may be a heavy bedbug infestation in the room. Bedbugs produce chemicals to help them communicate, although not everyone will notice the smell.
  2. Specks of blood on bedding, mattresses, or upholstered furniture: Look carefully at your blankets, sheets and mattress pads, and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bedbug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.
  3. Exoskeletons: Bedbugs have an outer shell that they shed and leave behind. Do you see shell-like remains on the mattress, mattress pad or beneath couch cushions?
  4. Tiny, blackish specks: If you see blackish specks on the bedding, mattress, or headboard, it could be bedbug excrement.
  5. Eggs: After mating, female bedbugs lay white, oval eggs in cracks and crevices. Keep in mind that these will be small, as a bedbug is only about the size of an apple seed.
“Most people who get bedbugs do so while traveling, making it critical to keep an eye out for infestations,” said Dr. Desai. “If you do get bedbugs and have many bites or a bite that looks infected, see a board-certified dermatologist. A dermatologist can treat an infection and help relieve the itch.”

How can I get rid of Bed Bugs? 
Non-chemical eradication methods like vacuuming, steaming, laundering and sealing mattresses in plastic can help, but these methods usually do not completely eradicate a bed bug population. Also, bed bugs have become resistant to some types of insecticides, making it difficult to get rid of them. For this reason, you will probably need to consult a licensed pest control company, which should: 

• Inspect your home to confirm the presence of bed bugs. 
• Find and eliminate their hiding places. 
• Treat your home with special cleaning and/or pesticides if necessary. 
• Make return visits to make sure bed bugs are gone.


4,000 pounds of beef products recalled because the dorsal root ganglia may not have been completely removed

WASHINGTON, June 11, 2014 – Fruitland American Meat, a Jackson, Mo. establishment is recalling approximately 4,012 pounds of fresh beef products because the dorsal root ganglia may not have been completely removed, which is not compliant with agency regulations that require their removal in cattle 30 months of age and older, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. 
The products subject to recall include:
  • 40-lb. cases containing two, roughly 20-lb. cryovac packages of bone-in “Rain Crow Ranch Ribeye” bearing the establishment number “EST. 2316” inside the USDA mark of inspection with the following production dates: 9/5/13, 9/10/13, 9/11/13, 9/26/13, 10/2/13, 10/3/2013, 11/8/13, 11/22/13, 12/17/13, 12/26/13, 12/27/13,1/16/14, 1/17/14, 1/23/14, 1/31/14, 2/13/14, 2/14/14, 2/21/14, 2/28/14, 3/8/14, 3/20/14, 4/4/14 or 4/25/14 printed on the box. 
  • Quartered beef carcasses stamped with the USDA mark of inspection and establishment number “EST. 2316.”   
The products were produced and packaged on various dates between September 2013 and April 2014. The bone-in ribeye roasts were the source material of concern.
Fruitland American Meat advises that the bone-in ribeye roasts were distributed to a restaurant in New York, NY, and a Whole Foods distribution center in Connecticut which services its stores in New England. The quartered carcasses were distributed to an FSIS-inspected establishment in Missouri for further processing and distribution, and to a restaurant in Kansas City, Mo. All products would have been processed into smaller cuts with no identifying consumer packaging.
The problem was discovered by FSIS during a review of company slaughter logs. The problem may have occurred as a result of the way some company employees were recording information and determining the age of various cattle. Dorsal root ganglia, branches of the nervous system located in the vertebral column are considered specified risk materials (SRMs) and must be removed from cattle 30 months of age and older in accordance with FSIS regulations. SRMs are tissues that may contain the infective agent in cattle infected with Bovine Spongiform Encephalopathy (BSE), as well as materials that are closely associated with these potentially infective tissues. Therefore, FSIS prohibits SRMs from use as human food to minimize potential human exposure to the BSE agent.
Every animal received ante-mortem inspection by an FSIS Public Health Veterinarian. This involves observing each animal at rest and in motion and there is no indication that any of the cattle slaughtered displayed any signs of BSE.
FSIS and Fruitland American Meat have received no reports of adverse reactions due to consumption of these products. Anyone concerned about a reaction should contact a healthcare provider.
FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list will be posted on the FSIS website at
Consumers and media with questions about the recall should contact company sales manager James Fortner at 573-243-3107.

Saturday, June 7, 2014

Oritavancin's potential

DURHAM, N.C. – In the battle against stubborn skin infections, including methicillin-resistant Staphylococcus aureus (MRSA), a new single-dose antibiotic is as effective as a twice-daily infusion given for up to 10 days, according to a large study led by Duke Medicine researchers.

Researchers said the advantage of the new drug, oritavancin, is its potential to curtail what has been a key driver of antibiotic resistance: a tendency for patients to stop taking antibiotics once they feel better. In such instances, the surviving bacteria may become impervious to the drugs designed to fight them.

“The prolonged activity is what makes oritavancin distinctive,” said G. Ralph Corey, M.D., lead author of the study published June 5, 2014, in the New England Journal of Medicine (NEJM). “This drug has a long half-life, which allows for a single-dose treatment.”

Corey, a professor of medicine and infectious diseases at Duke University School of Medicine, led a three-year study of oritavancin that encompassed two large clinical trials enrolling nearly 2,000 patients. Findings from the trials will be presented to the U.S. Food and Drug Administration as part of the drug’s approval application.

Results reported in the NEJM are for the first of the two clinical trials, which included 475 patients randomized to take the investigational drug, and 479 patients following a typical regimen of vancomycin, including two infusions a day, for seven to 10 days.

Researchers found that the single intravenous dose of oritavancin was as effective as vancomycin in shrinking the size of the lesion and reducing fever. Both were also similar in rates of requiring a rescue antibiotic.

The new antibiotic also performed similarly to vancomycin in reducing the area of the wound by 20 percent or more within the first 48-72 hours of treatment, and in curing the patients of infection, including those infected with MRSA.

“Having a single-dose drug could potentially prevent hospitalizations or reduce the amount of time patients would spend in the hospital,” Corey said.

In addition to Corey, study authors include Heidi Kabler of Sunrise Hospital and Medical Center in Las Vegas; Purvi Mehra and William O’Riordan of Sharp Chula Vista Medical Center in Chula Vista, Calif.; Sandeep Gupta of MV Hospital and Research Center in Lucknow, India; J. Scott Overcash of Sharp Grossmont Hospital in San Diego; Ashwin Porwal of Inamdar Multispecialty Hospital in Pune, India; Philip Giordano of Orlando Health in Orlando, Fla.; Christopher Lucasti of Somers Point, N.J.; and Antonio Perez, Samantha Good, Hai Jiang and Greg Moeck of The Medicines Company.

The study was funded by The Medicines Company, which owns and is seeking to market oritavancin. Corey was a paid consultant to The Medicines Company and the principle investigator of the SOLO trials, the three-year study of oritavancin.

China: 433 H7N9 avian influenza cases reported on the mainland

The Hong Kong Centre for Health Protection (CHP) of the Department of Health (DH) today (June 4) received notification of four additional human cases of avian influenza A(H7N9) in Jiangsu (two cases) and Shandong (two cases) from the National Health and Family Planning Commission.
The two patients in Jiangsu are a man and a woman, both aged 51, who are now hospitalised for treatment. The two cases in Shandong involve a man aged 61 who had poultry exposure and died and a man aged 33 who is hospitalised for management.
A total of 433 human cases of avian influenza A(H7N9) have been confirmed in the Mainland, including Zhejiang (138 cases), Guangdong (108 cases), Jiangsu (56 cases), Shanghai (41 cases), Hunan (23 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Shandong (five cases), Beijing (four cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one imported case from Zhejiang) and Hebei (one case).

Image/Cynthia S. Goldsmith and Thomas Rowe

Thursday, June 5, 2014

Florida DOH reminds public of dangers of Naegleria fowleri

The Florida Department of Health cautions those who swim frequently in Florida’s lakes, rivers and ponds during warm temperatures about the possible presence of Naegleria fowleri. Contact with this amoeba is rare, but the organism targets a person’s brain and usually results in death. Adverse health effects on humans can be prevented by avoiding nasal contact with the waters, since the amoeba enters through the nasal passages.

Naegleria fowleri seen under direct fluorescent antibody
 (DFA) stain/CDC
Though there are only 34 reported cases in Florida since 1962, Naegleria fowleri can cause Primary Amebic Meningoencephalitis (PAM) disease which usually leads to death once infected. As a precaution, health officials recommend the following:

• Avoid water-related activities in bodies of warm freshwater, hot springs and thermally polluted water such as water around power plants.
• Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
• Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
• Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.
• Please note exposure to the amoeba may also occur when using neti pots to rinse your sinuses of cold/allergy-related congestion or conducting religious rituals with tap water. Use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.

If you experience any of these symptoms after swimming in any warm body of water, contact your health care provider immediately: headache, fever, nausea, disorientation, vomiting, stiff neck, seizures, loss of balance, or hallucinations. It is essential to seek medical attention right away, as PAM usually becomes fatal within five days of exposure.

Remember, this disease is rare and effective prevention strategies can allow for a safe and relaxing summer swim season.