Multistate Outbreak of Burkholderia cepacia Infections
US health officials are continuing to investigate a multistate outbreak of infections caused by Burkholderia cepacia complex possibly linked to contaminated oral liquid docusate stool softener products. In its July 8 update, the Centers for Disease Control and Prevention (CDC) advised against treating any patient with oral liquid docusate products. Please go here to review the CDC advisory.
We analyzed data for a retrospective cohort of patients treated for extensively drug-resistant tuberculosis in 2 provinces in South Africa and compared predictors of treatment outcome in HIV-positive patients who received or had not received antiretroviral drugs with those for HIV-negative patients. Overall, 220 (62.0%) of 355 patients were HIV positive. After 2 years, 34 (10.3%) of 330 patients with a known HIV status and known outcome had a favorable outcome. Multivariate analysis showed that predictors of favorable outcome were negative results for acid-fast bacilli by sputum microscopy at start of treatment and weight >50 kg. HIV-positive patients were more likely to have an unfavorable outcome. The strongest predictor of unfavorable outcome was weight <50 kg. Overall outcomes were poor. HIV status was not a predictor of favorable outcome, but HIV-positive patients were more likely to have an unfavorable outcome. These results underscore the need for timely and adequate treatment for tuberculosis and HIV infection. DOWNLOAD FULL ARTICLE ABOVE>
Each year, some 722,000 hospitalized patients will acquire a serious infection as a result of their care. A staggering 75,000 of them will die during their hospitalization due to the HAI.
Recently, in efforts to improve these numbers, the federal government has worked to tie hospitals’ infection metrics with Medicare payments. If hospitals continue to have high HAIs, they will see their Medicare payments reduced. Just in December, CMS announced that 721 hospitals nationwide were going to be penalized for their high rates of hospital-acquired conditions.
Here is a map and searchable list for hospitals who scored worse than the national average on different infection metrics. (Data from the Centers for Medicare & Medicaid Services.)
[See also: Deaths by medical mistakes hit records.]
CAUTI: catheter-associated urinary tract infection
SSI: surgical site infection
CLABSI: central line-associated bloodstream infection
Healthcare Finance’s Henry Powderly contributed to this story.
Fred Soper was shocked. The year was 1967, and decades of painstaking work to eradicate the Aedes aegypti mosquito were unraveling before him. The pest was spreading once again, all over Central and South America, putting residents at risk of yellow fever, hemorrhagic fever and other deadly diseases. As the director emeritus of the Pan American Sanitary Bureau, Soper penned his concerns in a letter to the Brazilian Minister of Health, Dr. Leonel Tavares Miranda de Albuquerque, calling for the creation of a new agency to see to completion the eradication of the mosquito. DOWNLOAD FULL ARTICLE ABOVE.
Resurgence of Yellow Fever in Angola, 2015–2016
To the Editor: Yellow fever virus (YFV) is endemic in tropical and subtropical Africa and South America, and it is transmitted to humans and nonhuman primates through the bites of infected mosquitoes. The virus, a member of the family Flaviviridae, causes yellow fever, which in severe cases manifests as fulminant hemorrhagic fever. Outbreaks of yellow fever in humans occur mostly in the urban cycle of the virus, which involves its transmission through the bites of the day-feeding infected Aedes aegypti mosquitoes (1). As many as 130,000 cases with fever and jaundice or hemorrhage may occur annually with a concomitant 78,000 deaths (2). A low capacity for yellow fever diagnosis and lack of surveillance in disease-endemic countries likely contribute to case underreporting (1).
Although wide-scale yellow fever vaccination, which began in the 1940s and continued through 1960, resulted in a dramatic decrease in the number of outbreaks, waning population immunity and lapse of continued high coverage vaccination in yellow fever–endemic countries have led to the disease’s resurgence in Africa (1–3). Between 1980 and 2012, the World Health Organization received reported of 150 outbreaks in 26 countries in Africa (2). In the past 5 years (2011–2016), outbreaks have been documented in Democratic Republic of Congo, Sudan, Cameroon, Chad, Senegal, Côte d’Ivoire, Uganda, and Sierra Leone (3). During 2005–2016, Sudan was the most affected country; 3 outbreaks were reported, resulting in 1,508 cases and 368 deaths (3,4).
Yellow fever was first recognized in Angola in the 1930s, but not until 1971 (65 cases) and 1988 (37 cases) were sizeable outbreaks reported (5–7). As of July 1, 2016, a total of 3,552 suspected cases, including 875 laboratory-confirmed cases and 355 deaths, had been reported from all 18 provinces of Angola, with most cases occurring in Luanda Province (8). In this account, we provide laboratory confirmation that the first suspected viral hemorrhagic fever cases in Angola were YFV infections and report preliminary sequencing data.
On January 14, 2016, we received whole blood samples from 3 patients who resided in Luanda, Angola, and were suspected of having viral hemorrhagic fever. All were men, two 22 and one 30 years of age. Clinical manifestations in all patients were fever, headache, nausea, and vomiting. Myalgia, malaise, reduced consciousness, and jaundice each occurred in 2 patients; abdominal pain, back pain, ecchymosis, conjunctivitis, and bleeding gums each occurred in 1 patient. Two of the patients died 7 days after disease onset (Technical Appendix[PDF – 71 KB – 1 page] Table). Laboratory diagnosis consisted of testing for filoviruses, arenaviruses, and bunyaviruses, as well as for chikungunya and dengue viruses by using reverse transcription PCR (RT-PCR). All results of RT-PCRs were negative. A real time RT-PCR for YFV, targeting the 5′ noncoding region (9), produced positive results for samples from all 3 patients. The samples were then tested by using a pan-flavivirus RT-PCR targeting the flavivirus NS5 gene region using primers FU1 8993F and cFD2 9258R (10). Resulting amplicons of expected size (266 bp) obtained from 2 of the 3 samples were subjected to conventional Sanger sequencing. Phylogenetic analysis was performed by using a maximum-likehood method in MEGA version 6 (http://www.megasoftware.net) based on the general time reversible model under 1,000 bootstrap iterations, and sequence divergence was determined to calculate the p-distances between sequences. Phylogenetic inference of the sequence data demonstrated 95% nucleotide sequence similarity between the virus from this outbreak and the 14F YFV strain isolated in Angola in 1971 (Figure). PCR and sequencing results were reported to Angolan Public Health Institute on January 19, 2016.
The identification of the outbreak prompted cordon vaccination in Luanda in February 2016, followed by mass vaccination in other areas (8). The initially localized outbreak in Angola developed into the biggest and most widespread yellow fever epidemic recorded in Africa for decades (3,8). Sequencing and phylogenetic analysis indicate that the outbreak virus is highly similar to that identified during the epidemic in Angola in 1971. This finding reiterates the endemicity of yellow fever in Angola and emphasizes the need for consistent routine mass vaccination of the at-risk population to prevent future outbreaks.
We thank the Angolan Ministry of Health and the World Health Organization Country Office in Angola for technical support of this investigation.
The work was financially supported by the World Health Organization Collaborating Centre for Reference and Research on Viral Hemorrhagic Fevers and Arboviruses at the Centre for Emerging and Zoonotic Diseases of the National Institute for Communicable Diseases.
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- Garske T, Van Kerkhove MD, Yactayo S, Ronveaux O, Lewis RF, Staples JE, ; Yellow Fever Expert Committee. Yellow Fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data. PLoS Med. 2014;11:e1001638.
- World Health Organization. Yellow fever. Emergency preparedness and response [cited 2016 Jul 8].http://www.who.int/csr/don/archive/disease/yellow_fever/en/
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- World Health Organization. Yellow fever outbreak in Angola. Situation report W26, 4 July 2016 [cited 2016 Jul 8].http://www.afro.who.int/pt/yellow-fever/sitreps
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Suggested citation for this article: Grobbelaar AA, Weyer J, Moolla N, Jansen van Vuren P, Moises F, Paweska JT. Resurgence of yellow fever in Angola, 2015–2016. Emerg Infect Dis. 2016 Oct [date cited]. http://dx.doi.org/10.3201/eid2210.160818
President Raul Castro called on all Cubans to help eradicate the mosquitoes that carry the Zika virus on Monday and ordered 9,000 army troops to help stave off the disease.
Cuba has yet to detect a case of Zika, but the outbreak is affecting large parts of Latin America and the Caribbean and is likely to spread to all countries in the Americas except for Canada and Chile, the World Health Organization (WHO) has said. DOWNLOAD FULL ARTICLE ABOVE.