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Zika virus adds to dengue and chikungunya threat in Brazil
Clusters of acute exanthematous illness in Brazil have been linked since 2014 to the Zika virus, but research also suggests the concurrent transmission of dengue and chikungunya by the same vectors, a new report reveals.
Zika virus is an emerging mosquito-borne flavivirus that causes a denguelike illness characterized by exanthema, low-grade fever, conjunctivitis, and arthralgia. In a letter to the journal Emerging Infectious Diseases published online, Dr. Cristiane W. Cardoso of the Municipality of Health in Salvador, Brazil, and her coauthors describe the challenges Brazilian public health authorities faced in clinically differentiating Zika virus infections from dengue and chikungunya viruses, also circulating in Brazil from February 2015 to June 2015 (Emerg Infect Dis. 2015 Dec. doi: 10.3201/eid2112.151167).
All three viruses are etiologic agents of acute exanthematous illness, which suggests that the three Aedes mosquito−transmitted viruses were co-circulating in the state of Salvador. The research highlights the challenge in clinically differentiating the infections during outbreaks. The researchers were not able to determine the specific incidence of each virus but write that the low frequency of fever and arthralgia, which are indicators of dengue and chikungunya, point to Zika virus as the probable cause of several reported cases in 2015.
Dr. Cardoso says the spread of Zika virus represents a challenge for public health systems because of the risk for concurrent transmission of dengue and chikungunya by the same vectors – Aedes aegypti and Aedes albopictus mosquitoes – which are abundant throughout tropical and subtropical regions. The authors also suggest that an increase in reports of Guillain-Barré syndrome during the outbreak deserves further investigation to determine whether the syndrome is associated with Zika infection.
To read the entire letter, click here.
On Twitter @richpizzi
Clusters of acute exanthematous illness in Brazil have been linked since 2014 to the Zika virus, but research also suggests the concurrent transmission of dengue and chikungunya by the same vectors, a new report reveals.
Zika virus is an emerging mosquito-borne flavivirus that causes a denguelike illness characterized by exanthema, low-grade fever, conjunctivitis, and arthralgia. In a letter to the journal Emerging Infectious Diseases published online, Dr. Cristiane W. Cardoso of the Municipality of Health in Salvador, Brazil, and her coauthors describe the challenges Brazilian public health authorities faced in clinically differentiating Zika virus infections from dengue and chikungunya viruses, also circulating in Brazil from February 2015 to June 2015 (Emerg Infect Dis. 2015 Dec. doi: 10.3201/eid2112.151167).
All three viruses are etiologic agents of acute exanthematous illness, which suggests that the three Aedes mosquito−transmitted viruses were co-circulating in the state of Salvador. The research highlights the challenge in clinically differentiating the infections during outbreaks. The researchers were not able to determine the specific incidence of each virus but write that the low frequency of fever and arthralgia, which are indicators of dengue and chikungunya, point to Zika virus as the probable cause of several reported cases in 2015.
Dr. Cardoso says the spread of Zika virus represents a challenge for public health systems because of the risk for concurrent transmission of dengue and chikungunya by the same vectors – Aedes aegypti and Aedes albopictus mosquitoes – which are abundant throughout tropical and subtropical regions. The authors also suggest that an increase in reports of Guillain-Barré syndrome during the outbreak deserves further investigation to determine whether the syndrome is associated with Zika infection.
To read the entire letter, click here.
On Twitter @richpizzi
Clusters of acute exanthematous illness in Brazil have been linked since 2014 to the Zika virus, but research also suggests the concurrent transmission of dengue and chikungunya by the same vectors, a new report reveals.
Zika virus is an emerging mosquito-borne flavivirus that causes a denguelike illness characterized by exanthema, low-grade fever, conjunctivitis, and arthralgia. In a letter to the journal Emerging Infectious Diseases published online, Dr. Cristiane W. Cardoso of the Municipality of Health in Salvador, Brazil, and her coauthors describe the challenges Brazilian public health authorities faced in clinically differentiating Zika virus infections from dengue and chikungunya viruses, also circulating in Brazil from February 2015 to June 2015 (Emerg Infect Dis. 2015 Dec. doi: 10.3201/eid2112.151167).
All three viruses are etiologic agents of acute exanthematous illness, which suggests that the three Aedes mosquito−transmitted viruses were co-circulating in the state of Salvador. The research highlights the challenge in clinically differentiating the infections during outbreaks. The researchers were not able to determine the specific incidence of each virus but write that the low frequency of fever and arthralgia, which are indicators of dengue and chikungunya, point to Zika virus as the probable cause of several reported cases in 2015.
Dr. Cardoso says the spread of Zika virus represents a challenge for public health systems because of the risk for concurrent transmission of dengue and chikungunya by the same vectors – Aedes aegypti and Aedes albopictus mosquitoes – which are abundant throughout tropical and subtropical regions. The authors also suggest that an increase in reports of Guillain-Barré syndrome during the outbreak deserves further investigation to determine whether the syndrome is associated with Zika infection.
To read the entire letter, click here.
On Twitter @richpizzi
FROM EMERGING INFECTIOUS DISEASES
Louse-borne relapsing fever appears again in Europe
The reemergence of an early-20th-century fever is an example of how increased migration from war-torn and resource-poor countries has created new routes for the spread of vectorborne diseases.
Louse-borne relapsing fever (LBRF) caused by the bacterium Borrelia recurrentis was a major public health problem in Eastern Europe and Northern Africa during World Wars I and II. A new study published online in Emerging Infectious Diseases reveals that several cases of LBRF have been reported in multiple European nations among asylum seekers from Eritrea (Emerg Infect Dis. 2016 Jan. 22[1]. doi: 10.3201/eid2201.151580).
Poor living conditions, famine, war, and refugee camps are major risk factors for epidemics of LBRF, writes Dr. Alessandra Ciervo of the department of infectious, parasitic and immune-mediated diseases at the Istituto Superiore di Sanità in Rome. Indeed, recent cases of LBRF in the Netherlands, Switzerland, and Germany occurred in asylum seekers who had been in refugee camps in Libya or Italy. Dr. Ciervo and her coauthors report on three sample LBRF cases among patients in Italy who migrated from Somalia after traveling in several countries in Africa and crossing the Mediterranean.
The researchers conclude that, because the cases suggest that more migrants and refugees are infected, LBRF should be considered an emerging disease among migrants and refugees, and diagnostic suspicion of LBRF should lead to early diagnosis among refugees from the Horn of Africa and in persons in migrant camps.
To read the entire research letter, click here.
On Twitter @richpizzi
The reemergence of an early-20th-century fever is an example of how increased migration from war-torn and resource-poor countries has created new routes for the spread of vectorborne diseases.
Louse-borne relapsing fever (LBRF) caused by the bacterium Borrelia recurrentis was a major public health problem in Eastern Europe and Northern Africa during World Wars I and II. A new study published online in Emerging Infectious Diseases reveals that several cases of LBRF have been reported in multiple European nations among asylum seekers from Eritrea (Emerg Infect Dis. 2016 Jan. 22[1]. doi: 10.3201/eid2201.151580).
Poor living conditions, famine, war, and refugee camps are major risk factors for epidemics of LBRF, writes Dr. Alessandra Ciervo of the department of infectious, parasitic and immune-mediated diseases at the Istituto Superiore di Sanità in Rome. Indeed, recent cases of LBRF in the Netherlands, Switzerland, and Germany occurred in asylum seekers who had been in refugee camps in Libya or Italy. Dr. Ciervo and her coauthors report on three sample LBRF cases among patients in Italy who migrated from Somalia after traveling in several countries in Africa and crossing the Mediterranean.
The researchers conclude that, because the cases suggest that more migrants and refugees are infected, LBRF should be considered an emerging disease among migrants and refugees, and diagnostic suspicion of LBRF should lead to early diagnosis among refugees from the Horn of Africa and in persons in migrant camps.
To read the entire research letter, click here.
On Twitter @richpizzi
The reemergence of an early-20th-century fever is an example of how increased migration from war-torn and resource-poor countries has created new routes for the spread of vectorborne diseases.
Louse-borne relapsing fever (LBRF) caused by the bacterium Borrelia recurrentis was a major public health problem in Eastern Europe and Northern Africa during World Wars I and II. A new study published online in Emerging Infectious Diseases reveals that several cases of LBRF have been reported in multiple European nations among asylum seekers from Eritrea (Emerg Infect Dis. 2016 Jan. 22[1]. doi: 10.3201/eid2201.151580).
Poor living conditions, famine, war, and refugee camps are major risk factors for epidemics of LBRF, writes Dr. Alessandra Ciervo of the department of infectious, parasitic and immune-mediated diseases at the Istituto Superiore di Sanità in Rome. Indeed, recent cases of LBRF in the Netherlands, Switzerland, and Germany occurred in asylum seekers who had been in refugee camps in Libya or Italy. Dr. Ciervo and her coauthors report on three sample LBRF cases among patients in Italy who migrated from Somalia after traveling in several countries in Africa and crossing the Mediterranean.
The researchers conclude that, because the cases suggest that more migrants and refugees are infected, LBRF should be considered an emerging disease among migrants and refugees, and diagnostic suspicion of LBRF should lead to early diagnosis among refugees from the Horn of Africa and in persons in migrant camps.
To read the entire research letter, click here.
On Twitter @richpizzi
FROM EMERGING INFECTIOUS DISEASES
IOM report outlines viral outbreak preparedness
Developing medical countermeasures (MCMs) before an emerging infectious disease hits is a ‘national security imperative,’ according to an Institute of Medicine Workshop Summary, and global health security strategies that effectively utilize public-private partnerships should be a top priority for health professionals and governments.
The IOM and several of its partner organizations coconvened a workshop panel on “Rapid Medical Countermeasure Response to Infectious Diseases: Enabling Sustainable Capabilities through Ongoing Public- and Private-Sector Partnerships,” in Washington on March 26-27, 2015. Meeting minutes are available online at the IOM website. The organization recently released a summary report on the panel’s discussions.
Although the panelist’s discussions do not officially reflect the conclusions of the IOM, participants at the workshop discussed the nation’s capacity to provide rapid access to MCMs when infectious disease outbreaks occur. Other topics discussed included preparedness gaps, the sustainability of public-private partnerships, case studies of past incidents of emerging threats such as influenza and coronaviruses, and lessons learned from the Ebola outbreak of 2014.
“Between events such as H1N1 influenza outbreaks, mission capabilities need to be sustained so capacity is not lost when the next event emerges. Additionally, many regulations and policies have been developed in response to past events, instead of looking forward to potential future needs and creating capabilities and partnerships in a systematic matter,” the report summary noted.
To read the full summary report, click here.
Developing medical countermeasures (MCMs) before an emerging infectious disease hits is a ‘national security imperative,’ according to an Institute of Medicine Workshop Summary, and global health security strategies that effectively utilize public-private partnerships should be a top priority for health professionals and governments.
The IOM and several of its partner organizations coconvened a workshop panel on “Rapid Medical Countermeasure Response to Infectious Diseases: Enabling Sustainable Capabilities through Ongoing Public- and Private-Sector Partnerships,” in Washington on March 26-27, 2015. Meeting minutes are available online at the IOM website. The organization recently released a summary report on the panel’s discussions.
Although the panelist’s discussions do not officially reflect the conclusions of the IOM, participants at the workshop discussed the nation’s capacity to provide rapid access to MCMs when infectious disease outbreaks occur. Other topics discussed included preparedness gaps, the sustainability of public-private partnerships, case studies of past incidents of emerging threats such as influenza and coronaviruses, and lessons learned from the Ebola outbreak of 2014.
“Between events such as H1N1 influenza outbreaks, mission capabilities need to be sustained so capacity is not lost when the next event emerges. Additionally, many regulations and policies have been developed in response to past events, instead of looking forward to potential future needs and creating capabilities and partnerships in a systematic matter,” the report summary noted.
To read the full summary report, click here.
Developing medical countermeasures (MCMs) before an emerging infectious disease hits is a ‘national security imperative,’ according to an Institute of Medicine Workshop Summary, and global health security strategies that effectively utilize public-private partnerships should be a top priority for health professionals and governments.
The IOM and several of its partner organizations coconvened a workshop panel on “Rapid Medical Countermeasure Response to Infectious Diseases: Enabling Sustainable Capabilities through Ongoing Public- and Private-Sector Partnerships,” in Washington on March 26-27, 2015. Meeting minutes are available online at the IOM website. The organization recently released a summary report on the panel’s discussions.
Although the panelist’s discussions do not officially reflect the conclusions of the IOM, participants at the workshop discussed the nation’s capacity to provide rapid access to MCMs when infectious disease outbreaks occur. Other topics discussed included preparedness gaps, the sustainability of public-private partnerships, case studies of past incidents of emerging threats such as influenza and coronaviruses, and lessons learned from the Ebola outbreak of 2014.
“Between events such as H1N1 influenza outbreaks, mission capabilities need to be sustained so capacity is not lost when the next event emerges. Additionally, many regulations and policies have been developed in response to past events, instead of looking forward to potential future needs and creating capabilities and partnerships in a systematic matter,” the report summary noted.
To read the full summary report, click here.
Legionellosis cases continue to increase nationwide
Data from the first 3 years of the Center for Disease Control and Prevention’s Active Bacterial Core surveillance (ABCs) program on legionellosis confirm that incidences of disease caused by the bacteria are increasing across the United States, according to the latest Morbidity and Mortality Weekly Report (MMWR. 2015 Oct 30;64[42]:1190-1193).
The ABCs program, which launched in 2011, identified 1,426 cases of legionellosis over the 3-year time span, and incidence rates of 1.3 (2011), 1.1 (2012), and 1.4 (2013) cases per 100,000 individuals in the general population. This corroborates similar findings made by the National Notifiable Diseases Surveillance System (NNDSS) between 2000 and 2011, which reported an increase in the crude incidence rate of legionellosis nationwide from 0.39 to 1.36 cases per 100,000 individuals.
The two main clinical syndromes associated with legionellosis are Legionnaires’ disease, which is a severe form of pneumonia; and Pontiac fever, a milder illness without pneumonia.
“During 2000-2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis,” says the report, led by Dr. Kathleen I. Dooling of the CDC’s National Center for Immunization and Respiratory Diseases.
The report also states that “ABCs data during 2011-2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died.” Furthermore, incidence increased with age among the ABCs program cohort. Those younger than 50 years of age had a 0.4 incidence rate per 100,000 individuals; patients between 50 and 64 years old had a 2.5 per 100,000 incidence rate; those who were 65-79 years old had a 3.6 per 100,000 incidence rate; and individuals 80 years and older had an incidence rate of 4.7 per 100,000 individuals.
“Among cases identified during 2011-2013, 79% occurred in persons aged >50 years, 65% were in males, and 72% of patients were white,” says the report, adding that “1,300 (91%) received a diagnosis of legionellosis on the basis of urine antigen testing, which only detects Lp1 species.”
The ABCs program defined a confirmed case of legionellosis as “the isolation of Legionella from respiratory culture, detection of Legionella antigen in urine, or seroconversion (a more than fourfold rise in antibody titer between acute and convalescent sera) to Lp1.” Unlike NNDSS, ABCs recorded clinical and race data for each patient found to have legionellosis, finding that incidence rates among blacks were higher than among whites per 100,000 individuals: 1.0 vs. 1.5, respectively.
The report concludes by calling for further research into the disparities in legionellosis cases based on race, age, and geography, as well as the need for “more sensitive laboratory tests for legionellosis because proper diagnosis is needed for treatment and public health action.”
This study was supported by the CDC.
Data from the first 3 years of the Center for Disease Control and Prevention’s Active Bacterial Core surveillance (ABCs) program on legionellosis confirm that incidences of disease caused by the bacteria are increasing across the United States, according to the latest Morbidity and Mortality Weekly Report (MMWR. 2015 Oct 30;64[42]:1190-1193).
The ABCs program, which launched in 2011, identified 1,426 cases of legionellosis over the 3-year time span, and incidence rates of 1.3 (2011), 1.1 (2012), and 1.4 (2013) cases per 100,000 individuals in the general population. This corroborates similar findings made by the National Notifiable Diseases Surveillance System (NNDSS) between 2000 and 2011, which reported an increase in the crude incidence rate of legionellosis nationwide from 0.39 to 1.36 cases per 100,000 individuals.
The two main clinical syndromes associated with legionellosis are Legionnaires’ disease, which is a severe form of pneumonia; and Pontiac fever, a milder illness without pneumonia.
“During 2000-2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis,” says the report, led by Dr. Kathleen I. Dooling of the CDC’s National Center for Immunization and Respiratory Diseases.
The report also states that “ABCs data during 2011-2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died.” Furthermore, incidence increased with age among the ABCs program cohort. Those younger than 50 years of age had a 0.4 incidence rate per 100,000 individuals; patients between 50 and 64 years old had a 2.5 per 100,000 incidence rate; those who were 65-79 years old had a 3.6 per 100,000 incidence rate; and individuals 80 years and older had an incidence rate of 4.7 per 100,000 individuals.
“Among cases identified during 2011-2013, 79% occurred in persons aged >50 years, 65% were in males, and 72% of patients were white,” says the report, adding that “1,300 (91%) received a diagnosis of legionellosis on the basis of urine antigen testing, which only detects Lp1 species.”
The ABCs program defined a confirmed case of legionellosis as “the isolation of Legionella from respiratory culture, detection of Legionella antigen in urine, or seroconversion (a more than fourfold rise in antibody titer between acute and convalescent sera) to Lp1.” Unlike NNDSS, ABCs recorded clinical and race data for each patient found to have legionellosis, finding that incidence rates among blacks were higher than among whites per 100,000 individuals: 1.0 vs. 1.5, respectively.
The report concludes by calling for further research into the disparities in legionellosis cases based on race, age, and geography, as well as the need for “more sensitive laboratory tests for legionellosis because proper diagnosis is needed for treatment and public health action.”
This study was supported by the CDC.
Data from the first 3 years of the Center for Disease Control and Prevention’s Active Bacterial Core surveillance (ABCs) program on legionellosis confirm that incidences of disease caused by the bacteria are increasing across the United States, according to the latest Morbidity and Mortality Weekly Report (MMWR. 2015 Oct 30;64[42]:1190-1193).
The ABCs program, which launched in 2011, identified 1,426 cases of legionellosis over the 3-year time span, and incidence rates of 1.3 (2011), 1.1 (2012), and 1.4 (2013) cases per 100,000 individuals in the general population. This corroborates similar findings made by the National Notifiable Diseases Surveillance System (NNDSS) between 2000 and 2011, which reported an increase in the crude incidence rate of legionellosis nationwide from 0.39 to 1.36 cases per 100,000 individuals.
The two main clinical syndromes associated with legionellosis are Legionnaires’ disease, which is a severe form of pneumonia; and Pontiac fever, a milder illness without pneumonia.
“During 2000-2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis,” says the report, led by Dr. Kathleen I. Dooling of the CDC’s National Center for Immunization and Respiratory Diseases.
The report also states that “ABCs data during 2011-2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died.” Furthermore, incidence increased with age among the ABCs program cohort. Those younger than 50 years of age had a 0.4 incidence rate per 100,000 individuals; patients between 50 and 64 years old had a 2.5 per 100,000 incidence rate; those who were 65-79 years old had a 3.6 per 100,000 incidence rate; and individuals 80 years and older had an incidence rate of 4.7 per 100,000 individuals.
“Among cases identified during 2011-2013, 79% occurred in persons aged >50 years, 65% were in males, and 72% of patients were white,” says the report, adding that “1,300 (91%) received a diagnosis of legionellosis on the basis of urine antigen testing, which only detects Lp1 species.”
The ABCs program defined a confirmed case of legionellosis as “the isolation of Legionella from respiratory culture, detection of Legionella antigen in urine, or seroconversion (a more than fourfold rise in antibody titer between acute and convalescent sera) to Lp1.” Unlike NNDSS, ABCs recorded clinical and race data for each patient found to have legionellosis, finding that incidence rates among blacks were higher than among whites per 100,000 individuals: 1.0 vs. 1.5, respectively.
The report concludes by calling for further research into the disparities in legionellosis cases based on race, age, and geography, as well as the need for “more sensitive laboratory tests for legionellosis because proper diagnosis is needed for treatment and public health action.”
This study was supported by the CDC.
FROM MMWR
Key clinical point: Data from the first 3 years of the CDC’s Active Bacterial Core surveillance program provides evidence confirming that legionellosis rates across the United States are steadily rising.
Major finding: ABCs identified 1,426 legionellosis cases during 2011-2013, for an incidence of 1.3 cases per 100,000 population over the 3 years.
Data source: Analysis of 1,426 legionellosis cases from 2011-2013 collected by the CDC’s ABCs program.
Disclosures: Study supported by the CDC.
Ebola virus may persist in semen 9 months after symptom onset
Male survivors of Ebola virus disease (EVD) may still have the virus present in their semen as long as 9 months after the onset of symptoms, according to a new study published in the New England Journal of Medicine.
The study – led by Dr. Gibrilla Deen of Connaught Hospital in Freetown, Sierra Leone – enrolled 100 male survivors of EVD in Sierra Leone, of whom 93 provided a semen specimen at some time after the onset of symptoms, which was analyzed for Ebola virus RNA. Specimens were analyzed via a reverse-transcriptase polymerase chain reaction assay.
Results indicated that 46 of the 93 men (49%) who provided the initial semen sample tested positive for Ebola virus RNA. All 9 (100%) of the men whose specimens were analyzed 2-3 months after the onset of symptoms tested positive. Of the 40 whose specimens were received 4-6 months after symptom onset, 26 (65%) tested positive. Eleven of the 43 (26%) whose specimens were obtained 7-9 months after symptom onset were positive, as well.
“Ebola survivors face an increasing number of recognized health complications,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, in a statement, adding that “this study provides important new information about the persistence of Ebola virus in semen and helps us make recommendations to survivors and their loved ones to help them stay healthy.”
All participants were aged 18-58 years, with a mean of 30 years. While 63% of subjects had at least 6 years of formal education, 22% had less than that, and 15% had no formal education of any kind. Only 10% of subjects reported a monthly income of moe than $1,000, while 43% reported not knowing their income at all. None of the participants reported a history of HIV, tuberculosis, or diabetes diagnoses.
“Because semen-testing programs are not yet universally available, outreach activities are needed to provide education regarding recommendations and risks to survivor communities and sexual partners of survivors in a way that does not further stigmatize [the] survivors of EVD,” according to the study.
The authors of the study acknowledge that their findings are potentially limited by the size of their sample, as well as the lack of data on the risk of trasmission via sexual intercourse or other sex acts from men with Ebola virus RNA in their semen. Follow-up analysis of the current findings is underway.
Dr. Deen did not report any relevant financial disclosures.
Male survivors of Ebola virus disease (EVD) may still have the virus present in their semen as long as 9 months after the onset of symptoms, according to a new study published in the New England Journal of Medicine.
The study – led by Dr. Gibrilla Deen of Connaught Hospital in Freetown, Sierra Leone – enrolled 100 male survivors of EVD in Sierra Leone, of whom 93 provided a semen specimen at some time after the onset of symptoms, which was analyzed for Ebola virus RNA. Specimens were analyzed via a reverse-transcriptase polymerase chain reaction assay.
Results indicated that 46 of the 93 men (49%) who provided the initial semen sample tested positive for Ebola virus RNA. All 9 (100%) of the men whose specimens were analyzed 2-3 months after the onset of symptoms tested positive. Of the 40 whose specimens were received 4-6 months after symptom onset, 26 (65%) tested positive. Eleven of the 43 (26%) whose specimens were obtained 7-9 months after symptom onset were positive, as well.
“Ebola survivors face an increasing number of recognized health complications,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, in a statement, adding that “this study provides important new information about the persistence of Ebola virus in semen and helps us make recommendations to survivors and their loved ones to help them stay healthy.”
All participants were aged 18-58 years, with a mean of 30 years. While 63% of subjects had at least 6 years of formal education, 22% had less than that, and 15% had no formal education of any kind. Only 10% of subjects reported a monthly income of moe than $1,000, while 43% reported not knowing their income at all. None of the participants reported a history of HIV, tuberculosis, or diabetes diagnoses.
“Because semen-testing programs are not yet universally available, outreach activities are needed to provide education regarding recommendations and risks to survivor communities and sexual partners of survivors in a way that does not further stigmatize [the] survivors of EVD,” according to the study.
The authors of the study acknowledge that their findings are potentially limited by the size of their sample, as well as the lack of data on the risk of trasmission via sexual intercourse or other sex acts from men with Ebola virus RNA in their semen. Follow-up analysis of the current findings is underway.
Dr. Deen did not report any relevant financial disclosures.
Male survivors of Ebola virus disease (EVD) may still have the virus present in their semen as long as 9 months after the onset of symptoms, according to a new study published in the New England Journal of Medicine.
The study – led by Dr. Gibrilla Deen of Connaught Hospital in Freetown, Sierra Leone – enrolled 100 male survivors of EVD in Sierra Leone, of whom 93 provided a semen specimen at some time after the onset of symptoms, which was analyzed for Ebola virus RNA. Specimens were analyzed via a reverse-transcriptase polymerase chain reaction assay.
Results indicated that 46 of the 93 men (49%) who provided the initial semen sample tested positive for Ebola virus RNA. All 9 (100%) of the men whose specimens were analyzed 2-3 months after the onset of symptoms tested positive. Of the 40 whose specimens were received 4-6 months after symptom onset, 26 (65%) tested positive. Eleven of the 43 (26%) whose specimens were obtained 7-9 months after symptom onset were positive, as well.
“Ebola survivors face an increasing number of recognized health complications,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, in a statement, adding that “this study provides important new information about the persistence of Ebola virus in semen and helps us make recommendations to survivors and their loved ones to help them stay healthy.”
All participants were aged 18-58 years, with a mean of 30 years. While 63% of subjects had at least 6 years of formal education, 22% had less than that, and 15% had no formal education of any kind. Only 10% of subjects reported a monthly income of moe than $1,000, while 43% reported not knowing their income at all. None of the participants reported a history of HIV, tuberculosis, or diabetes diagnoses.
“Because semen-testing programs are not yet universally available, outreach activities are needed to provide education regarding recommendations and risks to survivor communities and sexual partners of survivors in a way that does not further stigmatize [the] survivors of EVD,” according to the study.
The authors of the study acknowledge that their findings are potentially limited by the size of their sample, as well as the lack of data on the risk of trasmission via sexual intercourse or other sex acts from men with Ebola virus RNA in their semen. Follow-up analysis of the current findings is underway.
Dr. Deen did not report any relevant financial disclosures.
FROM NEJM
Key clinical point: Men who have survived Ebola virus disease can have the virus present in their semen for 9 months after onset of symptoms.
Major finding: Forty-six of the 93 men (49%) who provided semen specimens tested positive for Ebola virus RNA. The subjects tested positive at intervals of 2-8 months post onset of symptoms.
Data source: Cohort study of 100 male EVD survivors.
Disclosures: Dr. Deen did not report any relevant financial disclosures.
Carbapenem resistance on the rise in children
The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.
Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.
“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.
The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.
Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).
The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.
The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.
Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.
“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.
The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.
Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).
The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.
The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.
Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.
“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.
The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.
Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).
The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.
FROM EMERGING INFECTIOUS DISEASES
Key clinical point: The prevalence of carbapenem-resistant Enterobacteriaceae in children has increased significantly since 1999.
Major finding: The prevalence of carbapenem-resistant Enterobacteriaceae isolates increased from 0% to 0.47% during 1999-2012.
Data source: Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories.
Disclosures: The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.
Parasitic infection emerging in the Southwestern U.S.
SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.
“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”
To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.
In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.
“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”
Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.
SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.
“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”
To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.
In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.
“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”
Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.
SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.
“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”
To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.
In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.
“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”
Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.
AT IDWEEK 2015
Key clinical point: Lesions containing a zoonotic parasite known as Onchocerca lupi are appearing in humans who reside in the Southwestern United States.
Major finding: In three of six human cases, nodules containing Onchocerca lupi were located in the cervical spinal canal.
Data source: A case report of the first six people in the United States to be infected with Onchocerca lupi.
Disclosures: The researchers reported having no financial disclosures.
Ebola virus in semen raises possibility of sexual transmission
BRISBANE, AUSTRALIA – The first possible case of sexual transmission of the Ebola virus has been recorded in Liberia, Dr. Nicola Low reported at the World STI & HIV Congress 2015.
The woman diagnosed with the Ebola virus had no contact with any other Ebola patients, despite extensive contact tracing. The only possible source of the virus was sexual contact with a man who had been ill with the disease and recovered 6 months before he had contact with her.
Dr. Low, of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, said that while only a partial genetic sequence was available for the male Ebola survivor’s virus, the sequence was very similar to that of the virus taken from the infected woman.
“It cannot be definitively confirmed as sexual transmission, but it is highly suggestive,” Dr. Low told conference attendees.
Dr. Low showed data from a study of 100 male Ebola virus survivors, which demonstrated that the virus could persist in semen for up to 9 months after the first onset of symptoms.
“In the first 3 months after symptom onset, all men had Ebola virus detected in semen and even after 6 months, the majority still had Ebola virus detected in semen, so the persistence in semen seems to be far longer than we have previously suspected,” she said.
There is growing evidence of “immunologically privileged” sites, such as the gonads and eyes, where the virus can persist long after the disease itself has resolved, Dr. Low said.
The persistence and potential sexual transmission of the Ebola virus has implications for management of Ebola virus disease survivors, but also demands further research, Dr. Low said.
“We need this information because it needs to [inform] safe sex guidelines to tell people how to look after themselves and protect their partners during an Ebola epidemic,” she said. “The advice is that men who have had Ebola should be offered semen testing monthly until they have two negative reverse transcriptase PCR [tests], and if they have had no semen testing, they should avoid sex or have [only] safe sex for at least 6 months after onset of symptoms.”
Despite the presence of Ebola virus in semen, Dr. Low said the likelihood of sexual transmission appears to be low.
“Our assumption is that the viral load in semen is probably not very high, but we don’t know that for sure,” Dr. Low said in an interview. “If it’s not really very infectious, then it’s not going to cause very many cases.”
Dr. Low reported having no financial disclosures.
BRISBANE, AUSTRALIA – The first possible case of sexual transmission of the Ebola virus has been recorded in Liberia, Dr. Nicola Low reported at the World STI & HIV Congress 2015.
The woman diagnosed with the Ebola virus had no contact with any other Ebola patients, despite extensive contact tracing. The only possible source of the virus was sexual contact with a man who had been ill with the disease and recovered 6 months before he had contact with her.
Dr. Low, of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, said that while only a partial genetic sequence was available for the male Ebola survivor’s virus, the sequence was very similar to that of the virus taken from the infected woman.
“It cannot be definitively confirmed as sexual transmission, but it is highly suggestive,” Dr. Low told conference attendees.
Dr. Low showed data from a study of 100 male Ebola virus survivors, which demonstrated that the virus could persist in semen for up to 9 months after the first onset of symptoms.
“In the first 3 months after symptom onset, all men had Ebola virus detected in semen and even after 6 months, the majority still had Ebola virus detected in semen, so the persistence in semen seems to be far longer than we have previously suspected,” she said.
There is growing evidence of “immunologically privileged” sites, such as the gonads and eyes, where the virus can persist long after the disease itself has resolved, Dr. Low said.
The persistence and potential sexual transmission of the Ebola virus has implications for management of Ebola virus disease survivors, but also demands further research, Dr. Low said.
“We need this information because it needs to [inform] safe sex guidelines to tell people how to look after themselves and protect their partners during an Ebola epidemic,” she said. “The advice is that men who have had Ebola should be offered semen testing monthly until they have two negative reverse transcriptase PCR [tests], and if they have had no semen testing, they should avoid sex or have [only] safe sex for at least 6 months after onset of symptoms.”
Despite the presence of Ebola virus in semen, Dr. Low said the likelihood of sexual transmission appears to be low.
“Our assumption is that the viral load in semen is probably not very high, but we don’t know that for sure,” Dr. Low said in an interview. “If it’s not really very infectious, then it’s not going to cause very many cases.”
Dr. Low reported having no financial disclosures.
BRISBANE, AUSTRALIA – The first possible case of sexual transmission of the Ebola virus has been recorded in Liberia, Dr. Nicola Low reported at the World STI & HIV Congress 2015.
The woman diagnosed with the Ebola virus had no contact with any other Ebola patients, despite extensive contact tracing. The only possible source of the virus was sexual contact with a man who had been ill with the disease and recovered 6 months before he had contact with her.
Dr. Low, of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, said that while only a partial genetic sequence was available for the male Ebola survivor’s virus, the sequence was very similar to that of the virus taken from the infected woman.
“It cannot be definitively confirmed as sexual transmission, but it is highly suggestive,” Dr. Low told conference attendees.
Dr. Low showed data from a study of 100 male Ebola virus survivors, which demonstrated that the virus could persist in semen for up to 9 months after the first onset of symptoms.
“In the first 3 months after symptom onset, all men had Ebola virus detected in semen and even after 6 months, the majority still had Ebola virus detected in semen, so the persistence in semen seems to be far longer than we have previously suspected,” she said.
There is growing evidence of “immunologically privileged” sites, such as the gonads and eyes, where the virus can persist long after the disease itself has resolved, Dr. Low said.
The persistence and potential sexual transmission of the Ebola virus has implications for management of Ebola virus disease survivors, but also demands further research, Dr. Low said.
“We need this information because it needs to [inform] safe sex guidelines to tell people how to look after themselves and protect their partners during an Ebola epidemic,” she said. “The advice is that men who have had Ebola should be offered semen testing monthly until they have two negative reverse transcriptase PCR [tests], and if they have had no semen testing, they should avoid sex or have [only] safe sex for at least 6 months after onset of symptoms.”
Despite the presence of Ebola virus in semen, Dr. Low said the likelihood of sexual transmission appears to be low.
“Our assumption is that the viral load in semen is probably not very high, but we don’t know that for sure,” Dr. Low said in an interview. “If it’s not really very infectious, then it’s not going to cause very many cases.”
Dr. Low reported having no financial disclosures.
EXPERT ANALYSIS FROM THE WORLD STI & HIV CONGRESS 2015
HHS funds development of experimental Ebola drug
The U.S. Department of Health & Human Services’ Office of Assistant Secretary for Preparedness and Response (ASPR) and Regeneron Pharmaceuticals have entered into an agreement for the purpose of advancing the development of a new experimental drug for treating the Ebola virus disease, according to a statement from the department.
The agreement represents the newest contribution of ASPR’s Biomedical Advance Research and Development Authority (BARDA) toward fighting the Ebola epidemic in West Africa. BARDA has promised to pay up to $38 million for the drug’s development and manufacturing, including the filing of an investigational new drug application with the Food and Drug Administration. All of the drug produced will be used in studies. “BARDA also could provide an additional $11.3 million to manufacture alternative monoclonal antibodies,” the statement indicates.
The experimental drug is based on three fully human monoclonal antibodies, which bind to a key Ebola viral protein and neutralize the virus. This decreases the amount of virus in the body that a patient’s immune system has to fight.
The drug company’s “technology facilitated the discovery and development of this monoclonal antibody therapeutic candidate in real time in just nine months as compared to the normal development cycle of several years, and the technology may have potential applications in future public health responses,” said BARDA Director Robin Robinson, Ph.D., in the statement.
The U.S. Department of Health & Human Services’ Office of Assistant Secretary for Preparedness and Response (ASPR) and Regeneron Pharmaceuticals have entered into an agreement for the purpose of advancing the development of a new experimental drug for treating the Ebola virus disease, according to a statement from the department.
The agreement represents the newest contribution of ASPR’s Biomedical Advance Research and Development Authority (BARDA) toward fighting the Ebola epidemic in West Africa. BARDA has promised to pay up to $38 million for the drug’s development and manufacturing, including the filing of an investigational new drug application with the Food and Drug Administration. All of the drug produced will be used in studies. “BARDA also could provide an additional $11.3 million to manufacture alternative monoclonal antibodies,” the statement indicates.
The experimental drug is based on three fully human monoclonal antibodies, which bind to a key Ebola viral protein and neutralize the virus. This decreases the amount of virus in the body that a patient’s immune system has to fight.
The drug company’s “technology facilitated the discovery and development of this monoclonal antibody therapeutic candidate in real time in just nine months as compared to the normal development cycle of several years, and the technology may have potential applications in future public health responses,” said BARDA Director Robin Robinson, Ph.D., in the statement.
The U.S. Department of Health & Human Services’ Office of Assistant Secretary for Preparedness and Response (ASPR) and Regeneron Pharmaceuticals have entered into an agreement for the purpose of advancing the development of a new experimental drug for treating the Ebola virus disease, according to a statement from the department.
The agreement represents the newest contribution of ASPR’s Biomedical Advance Research and Development Authority (BARDA) toward fighting the Ebola epidemic in West Africa. BARDA has promised to pay up to $38 million for the drug’s development and manufacturing, including the filing of an investigational new drug application with the Food and Drug Administration. All of the drug produced will be used in studies. “BARDA also could provide an additional $11.3 million to manufacture alternative monoclonal antibodies,” the statement indicates.
The experimental drug is based on three fully human monoclonal antibodies, which bind to a key Ebola viral protein and neutralize the virus. This decreases the amount of virus in the body that a patient’s immune system has to fight.
The drug company’s “technology facilitated the discovery and development of this monoclonal antibody therapeutic candidate in real time in just nine months as compared to the normal development cycle of several years, and the technology may have potential applications in future public health responses,” said BARDA Director Robin Robinson, Ph.D., in the statement.
