Archive for January 22, 2016

Epidemiology of Serotype 1 Invasive Pneumococcal Disease, South Africa, 2003–2013

EID FEB 2016 V.22 N.2


Claire von Mollendorf, Cheryl Cohen, Stefano Tempia, Susan Meiring, Linda de Gouveia, Vanessa Quan, Sarona Lengana, Alan Karstaedt, Halima Dawood, Sharona Seetharam, Ruth Lekalakala, Shabir A. Madhi, Keith P. Klugman, Anne von Gottberg, and for the Group for Enteric, Respiratory, and Meningeal Disease Surveillance in South Africa (GERMS-SA)

National Institute for Communicable Diseases, Johannesburg, South Africa (C. von Mollendorf, C. Cohen, S. Tempia, S. Meiring, L. de Gouveia, V. Quan, S. Lengana, S.A. Madhi, K.P. Klugman, A. von Gottberg); University of the Witwatersrand, Johannesburg (C. von Mollendorf, C. Cohen, A. Karstaedt, S. Seetharam, S.A. Madhi, A. von Gottberg); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Tempia), and Pretoria, South Africa (S. Tempia); Chris Hani Baragwanath Academic Hospital, Johannesburg (A. Karstaedt, S. Seetharam); Pietermaritzburg Metropolitan Hospital, Pietermaritzburg, South Africa (H. Dawood); University of KwaZulu-Natal, Pietermaritzburg (H. Dawood); National Health Laboratory Service, Johannesburg (S. Seetharam); National Health Laboratory Service, Polokwane, South Africa (R. Lekalakala); University of Limpopo, Polokwane (R. Lekalakala); Emory University, Atlanta, Georgia, USA (K.P. Klugman)

In South Africa, 7-valent pneumococcal conjugate vaccine (PCV) was introduced in April 2009 and replaced with 13-valent PCV in April 2011. We describe the epidemiology of serotype 1 Streptococcus pneumoniae disease during the pre- and post-PCV eras (2003–2013). Using laboratory-based invasive pneumococcal disease (IPD) surveillance, we calculated annual incidences, identified IPD clusters, and determined serotype 1–associated factors. Of 46,483 IPD cases, 4,544 (10%) were caused by serotype 1. Two clusters of serotype 1 infection were detected during 2003–2004 and 2008–2012, but incidence decreased after 2011. Among children <5 years of age, those who had non–serotype 1 IPD had shorter hospital stays, fewer cases of penicillin-nonsusceptible disease, and lower HIV prevalence and in-hospital death rates than did those with serotype 1 IPD; similar factors were noted for older patients. Serotype 1 IPD had distinctive clinical features in South Africa, and annual incidences fluctuated, with decreases noted after the introduction of PCV13.



January 22, 2016 at 9:02 am

Invasive Group A Streptococcus Infection among Children, Rural Kenya

EID FEB 2016 V.22 N.2


Anna C. Seale, Mark R. Davies, Kirimi Anampiu, Susan C. Morpeth, Sammy Nyongesa, Salim Mwarumba, Pierre R. Smeesters, Androulla Efstratiou, Rosylene Karugutu, Neema Mturi, Thomas N. Williams, J. Anthony G. Scott, Samuel Kariuki, Gordon Dougan, and James A. Berkley

KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya (A.C. Seale, K. Anampiu, S.C. Morpeth, S. Nyongesa, S. Mwarumba, N. Mturi, T.N. Williams, J.A.G. Scott, J.A. Berkley); University of Oxford, Oxford, UK (A.C. Seale, J.A. Berkley); University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia (M.R. Davies); University of Queensland, Brisbane, Queensland, Australia (M.R. Davies); The Wellcome Trust Sanger Institute, Cambridge, UK (M.R. Davies, S. Kariuki, G. Dougan); London School of Hygiene and Tropical Medicine, London, UK (S.C. Morpeth, J.A.G. Scott); Murdoch Children’s Research Institute, Melbourne, Victoria, Australia (P.R. Smeesters); University of Melbourne, Melbourne (P.R. Smeesters); Public Health England, London (A. Efstratiou); Imperial College, London (A. Efstratiou, T.N. Williams); The Kenya Medical Research Institute, Nairobi, Kenya (R. Karugutu, S. Kariuki)

To determine the extent of group A Streptococcus (GAS) infections in sub-Saharan Africa and the serotypes that cause disease, we analyzed surveillance data for 64,741 hospital admissions in Kilifi, Kenya, during 1998–2011. We evaluated incidence, clinical presentations, and emm types that cause invasive GAS infection. We detected 370 cases; of the 369 for which we had data, most were skin and soft tissue infections (70%), severe pneumonia (23%), and primary bacteremia (14%). Overall case-fatality risk was 12%. Incidence of invasive GAS infection was 0.6 cases/1,000 live births among neonates, 101/100,000 person-years among children <1 year of age, and 35/100,000 among children <5 years of age. Genome sequencing identified 88 emm types. GAS causes serious disease in children in rural Kenya, especially neonates, and the causative organisms have considerable genotypic diversity. Benefit from the most advanced GAS type–specific vaccines may be limited, and efforts must be directed to protect against disease in regions of high incidence.


January 22, 2016 at 8:59 am

Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient

EID FEB 2016 V.22 N.2

J.J. Mark Haverkort, A.L.C. (Ben) Minderhoud, Jelte D.D. Wind, Luke P.H. Leenen, Andy I.M. Hoepelman, and Pauline M. Ellerbroek

University Medical Centre of Utrecht, Utrecht, the Netherlands (J.J.M. Haverkort, A.L.C. Minderhoud, L.P.H. Leenen, A.I.M. Hoepelman, P.M. Ellerbroek); University Medical Centre of Utrecht Major Incident Hospital, Utrecht (J.J.M. Haverkort, J.D.D. Wind, L.P.H. Leenen, P.M. Ellerbroek)

The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital’s preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery.


January 22, 2016 at 8:57 am

Zika virus genome from the Americas

The Lancet January 16, 2016 V.387 N.10.015


Antoine Enfissi, John Codrington, Jimmy Roosblad, Mirdad Kazanji, Dominique Rousset

On Oct 1, 2015, a 52-year-old man was hospitalised with exanthema and conjunctivitis at the Academic Hospital in Paramaribo, Suriname. During the next few days, four patients were admitted with mild symptoms including exanthema. Sera from these patients were negative for dengue and chikungunya viruses but positive for Zika virus (ZIKV) by specific real-time reverse transcription PCR.1

ZIKV is an emerging arthropod-borne virus of the family Flaviviridae. It is transmitted by aedes mosquitoes, as are dengue and chikungunya viruses. First isolated in April, 1947, in Uganda, it was until recently considered to cause sporadic benign human infections in Africa and Asia. After the first documented outbreak on Yap Island, Micronesia, in 2007, however, ZIKV caused a large epidemic in French Polynesia in 2013–14, before spreading throughout the Pacific.2 This large epidemic occurred concomitantly with circulation of dengue viruses and unusual increases in severe neurological complications, such as Guillain-Barré syndrome3 and congenital neurological malformations. Also during 2013–14, chikungunya emerged and spread in the Americas. Soon after, the first evidence was found of the emergence of ZIKV in the Americas, in northeast Brazil in May, 2015.4 Autochthonous circulation of ZIKV in other countries started on Oct 16, 2015, in Colombia, followed by Suriname on Nov 12, 2015……



January 22, 2016 at 8:49 am


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