Weekly Digest: New Ebola outbreak in Republic of Congo; Drug-resistant tuberculosis expected to rise by 2040

12 May 2017
Authors: Ellyse Stauffer, Shalini, Hellen Gelband

A weekly roundup of news on drug resistance and other topics in global health. 

New Ebola outbreak in Republic of Congo. The first Ebola outbreak in the Republic of Congo since 2014 has been confirmed by laboratory tests. Nine suspected cases, including three suspected deaths, have been under investigation since late April. The Minister of Health reported on May 11 that a specimen from one of the deceased had tested positive for the Zaire strain of Ebola. Additional laboratory testing and contact tracing of cases is under way. The outbreak is in a sparsely populated area, Bas-Uele province, which should facilitate containing spread of the virus. [MedPage Today, Washington Post]

Antimicrobial manufacturing contaminating Indian waters. A study published the journal Infection finds high levels of antibiotic and antifungal drug residues in water sources around pharmaceutical production hubs in Hyderabad, India. Scientists from the University of Leipzig tested water samples from 28 sites and found all of them contaminated with about a dozen antibiotics and antifungal agents. In addition, multi-drug resistant bacteria, such as extended-spectrum beta-lactamase producers and carbapenemase-producing Enterobacteriaceae were found in 95 percent of samples. So far, environmental pollution does not figure in the good manufacturing practices (GMP) prescribed by the World Health Organization with regulation left to governments. CDDEP Director Ramanan Laxminarayan, commenting on the need for GMP, said that environmental contamination from bulk manufacturing facilities must be curbed. "This should be a part of GMP without question and pharmaceutical companies throughout the world should be subject to an audit to ensure that they are compliant with what the industry has promised to do." [Infection, TBIJ]

Measles outbreak in Minnesota traced to anti-vaccine sentiment. As of Thursday, 51 cases of measles have been confirmed in Minnesota, most in children under age 10, and more than 40 among Somali-Americans. The vaccination rate among Somalis in Minnesota has fallen as a result of strong pressure on the Somali community from anti-vaccine activists. Kristen Ehresmann, from the Minnesota Department of Health, suggests that the misperception about vaccines leading to autism took hold within the Somali community as parents noted the growing number of Somali children receiving special education services for autism. Many cases of autism were not recognized before coming to the United States. Dr. Michael Osterholm, a former state epidemiologist, labels the situation exploitation of the Somali community by anti-vaccine activists. Osterholm told STAT, “What [activists] say is, ‘Remember, measles is just a five-to-seven-day disease. Autism is forever.’” Minnesota Health Commissioner Ed Ehlinger has requested $5 million from state lawmakers to address the growing infectious disease burden. The measles outbreak is expected to cost the state at least $1 million. [STAT, CIDRAP]

Suspected meningitis outbreak in Liberia. A cluster of sudden deaths and infections over the past month in Liberia may be due to meningitis.. According to the World Health Organization, the unexplained illness has infected 31 people and caused 13 deaths so far. Liberian Minister of Health Bernice Dahn reported that specimens from seven of those who died from the disease were positive for Neisseria meningitides, based on initial results from the U.S. Centers for Disease Control and Prevention. The outbreak began in late April, sparking fears of an Ebola recurrence, but health officials were quick to rule out Ebola, as well as yellow fever and Lassa fever. Public health officials are now exploring the possibility of a mass vaccination campaign. [WHO, CIDRAP]

Drug-resistant tuberculosis expected to rise by 2040. A study in Lancet Infectious Diseases estimates the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in currently high-burden countries India, the Philippines, Russia, and South Africa. Using data from the World Health Organization and surveys to model the prevalence of drug-resistant TB up to 2040, the authors predict that multidrug-resistant (MDR-TB) will reach 12.4 percent of incident cases in India, 8.9 percent in the Philippines, 5.7 percent in South Africa, and 32.5 percent in Russia. Between 8.5 and 9 percent of MDR cases are predicted to be extensively drug-resistant (XDR-TB). Over time, more and more cases will be transmitted from person to person rather than arise through acquired resistance in an individual.  Eighty percent of XDR-TB arose in individual patients in 2000, but by 2040, that figure will be less than 50 percent. The authors conclude that current tools will not reverse the MDR and XDR-TB epidemics without enhanced interventions. [Lancet ID study, MedPage Today]

More cholera deaths in Yemen. The cholera outbreak in Yemen continues to claim lives, including 25 deaths this week. The World Health Organization (WHO) has reported at least 1,360 cholera cases since April 27th. More than 26,000 cases and 130 deaths were reported during an outbreak in Yemen last year, where hospitals have been destroyed and millions of people are struggling to access food and clean water. Humanitarian organizations have warned that the outbreak could spiral out of control and that heavy rains and warm weather are creating a favorable environment for the infection to spread. Nevio Zagaria, the WHO representative in Yemen said, "The cause is that there is two years of war in Yemen. There is a huge impact on the infrastructure, the electricity power is on and off, the water pumping stations are not functioning regularly and this has an impact on the quality of water." The war has also left 18.8 million people in need of humanitarian assistance. [BBC]

Infection Prevention in Asia Pacific: Clinical Infectious Diseases supplement. A supplement to Clinical Infectious Diseases focuses on infection prevention and control in the Asia Pacific region, which has increasing rates of multidrug-resistant organisms and other pathogens with pandemic potential.  High rates of healthcare-associated infections and easy access to antimicrobials without prescriptions are thought to contribute to the increase.  The supplement has three themes: (1) epidemiology and evidence to support interventions for prevention and control of diseases, (2) enhancements to infection prevention and control strategies in healthcare settings, and (3) practices associated with the containment of outbreaks and emerging infectious diseases. [CID, CIDRAP]

Clues about enterococci toughness from early evolution. Researchers from Massachusetts Eye and Ear, the Harvard-wide Program on Antibiotic Resistance and the Broad Institute analyzed the genomes and behaviors of modern enterococci to gain insight into how the bacteria became stronger in response to environmental pressures hundreds of millions of years ago. The authors write, “Enterococci are distinguished from their ancestors and appear to have been selected for, by virtue of having developed a hardened cell wall and the ability to cope with environmental stress—traits that now render them resistant to denaturing solvents, disinfectants, and intrinsically, to many antibiotics.” [Cell, press release]

Image via Scientific Animations (CC BY-SA 4.0)