CDC notes 9 new Salmonella cases, links outbreak to Cavi brand papayas

Late last week the Centers for Disease Control and Prevention (CDC) confirmed nine new salmonellosis cases in a multistate outbreak and pinned the infections to just one brand: Cavi.

The outbreak now involves 71 confirmed cases, including 27 hospitalizations in eight states, the CDC on Jul 5. The agency first reported the outbreak a week earlier but hadn't at that point identified a particular brand.

"With the exception of Cavi brand whole, fresh papayas, consumers no longer need to avoid papayas imported from Mexico," the CDC said. "Epidemiologic and traceback evidence indicates that Cavi brand whole, fresh papayas distributed by Agroson's LLC are a likely source of this outbreak." The agency did not mention a product recall.

Illness-onset dates range from Jan 14 to Jun 16, but most have occurred since April. No deaths have been recorded. Patients range in age from less than 1 year to 90 years, and, of 40 people with available information, 28 (70%) reported being of Hispanic ethnicity.

New York state has the most cases, with 27, followed by New Jersey (18), Connecticut (14), Massachusetts (5), and Pennsylvania (4). Florida, Rhode Island, and Texas each have reported 1 case.

Jul 5 CDC update

Studies highlight impact of Zika infection during pregnancy

A study of Mexican data shows underreporting of fatal congenital Zika syndrome (CZS), and one conducted in Colombia highlights a high incidence of gestational and neonatal complications in fetuses and infants of women infected during pregnancy.

The first study, by US, Mexican, and Colombian investigators, involved Mexican nationwide data from 2007 through 2017 and was published in Emerging Infectious Diseases. Mexico's Zika outbreak began in November 2015, and the researchers wanted to estimate how maternal Zika infection affected infant deaths from microcephaly (small-than-normal heads and brains).

They note that the rate of infant deaths due to microcephaly rose from 0.80 per 100,000 live births from 2007 through 2015 to 1.17 per 100,000 live births in 2016-17, for an attributable risk of 31.7%. The team also noted that 51 CZS cases were reported in the country from Jan 1, 2016, through Nov 26, 2018, including 11 deaths in 2016-17. Based on the attributable risk, however, one would expect about 17 infant deaths from microcephaly, "indicating that 50% more infants died of microcephaly caused by CZS than were reported."

Jul 6 Emerg Infect Dis study

In the second study, published in the July issue of The Pediatric Infectious Disease Journal, Colombian scientists followed up on 171 pregnancies in women with symptomatic Zika infection.

Seventeen pregnancies ended in miscarriage, while 154 patients gave birth. Of the 171 pregnancies, 90 (52.6%) involved an adverse outcome, with 36% possibly related to Zika infection and the rest of uncertain relation. The rate of adverse outcome by trimester was 39%, 12.5%, and 12%, with the first trimester associated with the highest rate.

The rate of pregnancy loss was 9.4% and of microcephaly in fetuses or newborns was 4.5%, similar to previous studies. The rate of auditory abnormalities in infants was 3%, compared with a 6% rate of eye abnormalities.

July Pediatr Infect Dis J study

Study highlights high burden of melioidosis worldwide

A systematic review of the literature combined with mathematical modeling underscores the high burden of melioidosis—a severe disease of sudden onset caused by Burkholderia pseudomallei—worldwide, which the authors say warrants greater attention.

European and Asian experts reviewed data from 475 studies on melioidosis cases involving 10,175 patients, according to their study in The Lancet Infectious Diseases. Of those, 35.7% had pneumonia, 18.3% intra-abdominal abscesses, and 18.0% sepsis. They estimate that, in 2015, the global burden of the disease was 4.6 million disability-adjusted life-years (DALYs), a measure of the impact on human health. About 99% of the DALYs were due to years of life lost.

The authors conclude, "Melioidosis causes a larger disease burden than many other tropical diseases that are recognised as neglected, and so it should be reconsidered as a major neglected tropical disease."

In a commentary on the study in the same journal, infectious disease experts Katherine B. Gibney, MB BS, PhD, MPH, and Allen C. Cheng, MB BS, PhD, MPH, MS, both of the University of Melbourne, write, "This is an important and well executed study. With these findings, we can compare the burden of melioidosis across regions of the world, and to some extent, compare the global burden of melioidosis with that of other infectious diseases."

In addition to the high contribution of death rates to the DALY burden, Gibney and Cheng also note that the study estimated a high DALY burden in countries with few or no reported cases—a finding predicted by the models used because of the wide underreporting in 45 countries. In fact, the study authors say melioidosis is "probably endemic in a further 34 countries that have never reported the disease."

The death rate from melioidosis can range from 10% to 50%, according to the study and commentary.

Jul 5 Lancet Infect Dis report

Jul 5 Lancet Infect Dis commentary