Diverse #vectors and mechanisms #spread #NDM beta-lactamases among #carbapenem resistant #Enterobacteriaceae in the Greater #Boston area (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Diverse vectors and mechanisms spread NDM beta-lactamases among carbapenem resistant Enterobacteriaceae in the Greater Boston area

Nicole Pecora, Xiaomin Zhao, Kathleen Nudel, Maria Hoffmann, Ning Li, Andrew B. Onderdonk, Deborah Yokoe, Eric Brown, Marc Allard, Lynn Bry

DOI: 10.1128/AAC.02040-18



New Delhi metallo-beta-lactamases (NDMs) are an uncommon but emerging cause of carbapenem resistance in the United States. Genomic factors promoting their domestic spread remain poorly characterized. A prospective genomic surveillance program among Boston-area hospitals identified multiple new occurrences of NDM carrying strains of E. coli and E. cloacaecomplex in inpatient and outpatient settings, representing the first occurrences of NDM-mediated resistance since initiating genomic surveillance in 2011. Cases included domestic patients with no international exposures. PacBio sequencing of isolates identified strain characteristics, resistance genes, and the complement of mobile vectors mediating spread. Analyses revealed a common 3114-bp region containing the blaNDM gene, with carriage of this conserved region among unique strains by diverse transposon and plasmid backbones. Functional studies revealed broad capacity for blaNDM transmission by conjugation, transposition, and complex inter-plasmid recombination events. NDMs represent a rapidly spreading form of drug resistance that can occur in inpatient and outpatient settings and in patients without international exposures. In contrast to Tn4401-based spread of Klebsiella pneumoniae carbapenemases (KPCs), diverse transposable elements mobilize NDM enzymes, commonly with other resistance genes, enabling naïve strains to acquire multi- and extensively-drug resistance profiles with single transposition or plasmid conjugation events. Genomic surveillance provides effective means to rapidly identify these gene-level drivers of resistance and mobilization, to inform clinical decisions to prevent further spread.

Copyright © 2018 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; NDM1; USA; Enterobacteriaceae.



#Natality #Decline and Spatial #Variation in Excess #Death Rates During the 1918-1920 #Influenza #Pandemic in #Arizona, #USA (Am J Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Epidemiol. 2018 Dec 1;187(12):2577-2584. doi: 10.1093/aje/kwy146.

Natality Decline and Spatial Variation in Excess Death Rates During the 1918-1920 Influenza Pandemic in Arizona, United States.

Dahal S1, Mizumoto K1,2, Bolin B3, Viboud C, Chowell G1,4.

Author information: 1 Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia. 2 Graduate School of Medicine, Hokkaido University, Hokkaido, Japan. 3 School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona. 4 Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.



A large body of epidemiologic research has concentrated on the 1918 influenza pandemic, but more work is needed to understand spatial variation in pandemic mortality and its effects on natality. We collected and analyzed 35,151 death records from Arizona for 1915-1921 and 21,334 birth records from Maricopa county for 1915-1925. We estimated the number of excess deaths and births before, during, and after the pandemic period, and we found a significant decline in the number of births occurring 9-11 months after peak pandemic mortality. Moreover, excess mortality rates were highest in northern Arizona counties, where Native Americans were historically concentrated, suggesting a link between ethnic and/or sociodemographic factors and risk of pandemic-related death. The relationship between birth patterns and pandemic mortality risk should be further studied at different spatial scales and in different ethnic groups.

PMID: 30508194 DOI: 10.1093/aje/kwy146

Keywords: Pandemic Influenza; H1N1; Spanish Flu; Society; USA; Arizona.


#Seroepidemiology of #Parechovirus A3 Neutralizing #Antibodies, #Australia, the #Netherlands, and #US (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 1—January 2019 / Dispatch

Seroepidemiology of Parechovirus A3 Neutralizing Antibodies, Australia, the Netherlands, and United States

Eveliina Karelehto, Lieke Brouwer, Kimberley Benschop, Jen Kok, Kerri Basile, Brendan McMullan, William Rawlinson, Julian Druce, Suellen Nicholson, Rangaraj Selvarangan, Christopher Harrison, Kamani Lankachandra, Hetty van Eijk, Gerrit Koen, Menno de Jong, Dasja Pajkrt, and Katja C. Wolthers

Author affiliations: Academic Medical Center, Amsterdam, the Netherlands (E. Karelehto, L. Brouwer, H. van Eijk, G. Koen, M. de Jong, D. Pajkrt, K.C. Wolthers); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (K. Benschop); Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia (J. Kok, K. Basile); Sydney Children’s Hospital, Sydney, New South Wales, Australia (B. McMullan); Prince of Wales Hospital, Randwick, New South Wales, Australia (W. Rawlinson); Doherty Institute, Melbourne, Victoria, Australia (J. Druce, S. Nicholson); Children’s Mercy Hospital, Kansas City, Missouri, USA (R. Selvarangan, C. Harrison); Truman Medical Center, Kansas City (K. Lankachandra)



Recent parechovirus A3 (PeV-A3) outbreaks in Australia suggest lower population immunity compared with regions that have endemic PeV-A3 circulation. A serosurvey among populations in the Netherlands, the United States, and Australia before and after the 2013 Australia outbreak showed high PeV-A3 neutralizing antibody prevalence across all regions and time periods, indicating widespread circulation.

Keywords: Parechovirus A3; USA; Netherlands; Australia; Serosurveys.


#Seroprevalence of #Heartland Virus #Antibodies in #Blood Donors, Northwestern #Missouri, #USA (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 2—February 2019 / Dispatch

Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA

Nicole P. Lindsey  , Jay E. Menitove, Brad J. Biggerstaff, George Turabelidze, Pat Parton, Kim Peck, Alison J. Basile, Olga I. Kosoy, Marc Fischer, and J. Erin Staples

Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (N.P. Lindsey, B.J. Biggerstaff, A.J. Basile, O.I. Kosoy, M. Fischer, J.E. Staples); Community Blood Center of Greater Kansas City, Kansas City, Missouri, USA (J.E. Menitove, P. Parton, K. Peck); Missouri Department of Health and Senior Services, St. Louis, Missouri, USA (G. Turabelidze)



We estimated the seroprevalence of Heartland virus antibodies to be 0.9% (95% CI 0.4%–4.2%) in a convenience sample of blood donors from northwestern Missouri, USA, where human cases and infected ticks have been identified. Although these findings suggest that some past human infections were undetected, the estimated prevalence is low.

Keywords: Heartland virus; USA; Missouri; Human; Seroprevalence.


#Clinical Subpopulations in a Sample of North #American #Children Diagnosed With Acute Flaccid #Myelitis, 2012-2016 (JAMA Pediatr, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

JAMA Pediatr. 2018 Nov 30. doi: 10.1001/jamapediatrics.2018.4890. [Epub ahead of print]

Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016.

Elrick MJ1, Gordon-Lipkin E2, Crawford TO1, Van Haren K3, Messacar K4, Thornton N5, Dee E5, Voskertchian A6, Nance JR1, Muñoz LS1, Gorman MP7, Benson LA7, Thomas DL8, Pardo CA1, Milstone AM5,6, Duggal P5.

Author information: 1 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2 Kennedy Krieger Institute, Baltimore, Maryland. 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, California. 4 Department of Pediatrics, Children’s Hospital Colorado, the University of Colorado, Aurora. 5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6 Division of Infectious Disease, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland. 7 Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts. 8 Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.




Acute flaccid myelitis (AFM) is an emerging poliolike illness of children whose clinical spectrum and associated pathogens are only partially described. The case definition is intentionally encompassing for epidemiologic surveillance to capture all potential AFM cases. Defining a restrictive, homogenous subpopulation may aid our understanding of this emerging disease.


To evaluate the extent to which the US Centers for Disease Control and Prevention (CDC) case definition of AFM incorporates possible alternative diagnoses and to assess the plausibility of a case definition that enriches the biological homogeneity of AFM for inclusion in research studies.


Retrospective case analysis of children younger than 18 years diagnosed as having AFM between 2012 and 2016 using the CDC case definition. Group 1 included patients recruited from the United States and Canada based on the CDC case definition of AFM. Group 2 included patients referred to the Johns Hopkins Transverse Myelitis Center for evaluation of suspected AFM. Patients’ records and imaging data were critically reviewed by 3 neurologists to identify those cases with definable alternative diagnoses, and the remaining patients were categorized as having restrictively defined AFM (rAFM). Clinical characteristics were compared between patients with rAFM (cases) and those with alternative diagnoses, and a case description distinguishing these AFM groups was identified. Interrater reliability of this description was confirmed for a subset of cases by a fourth neurologist. Data were analyzed between May 2017 and November 2018.


Proportion of patients with possible alternative diagnosis.


Of the 45 patients who met the CDC AFM case definition and were included, the mean age was 6.1 years; 27 were boys (60%); and 37 were white (82%), 3 were Asian (7%), 1 was Hispanic (2%), and 4 were mixed race/ethnicity (9%). Of the included patients, 34 were classified as having rAFM, and 11 had alternate diagnoses (including transverse myelitis, other demyelinating syndromes, spinal cord stroke, Guillain-Barre syndrome, Chiari I myelopathy, and meningitis). Factors differing between groups were primarily asymmetry of weakness, lower motor neuron signs, preceding viral syndrome, symptoms evolving over hours to days, absence of sensory deficits, and magnetic resonance imaging findings. A case description was able to reliably define the rAFM group.


We present an approach for defining a homogeneous research population that may more accurately reflect the pathogenesis of the prototypical poliomyelitis-like subgroup of AFM. The definition of rAFM forms a blueprint for inclusion criteria in future research efforts, but more work is required for refinement and external validation.

PMID: 30500056 DOI: 10.1001/jamapediatrics.2018.4890

Keywords: Acute Flaccid Myelitis; USA.


#Ebola and #War in the #DRC – Avoiding #Failure and Thinking Ahead (JAMA, summary)

[Source: Journal of the American Medical Association (JAMA), full page: (LINK). Summary, edited.]

Viewpoint / November 29, 2018

Ebola and War in the Democratic Republic of CongoAvoiding Failure and Thinking Ahead

Lawrence O. Gostin, JD1; Matthew M. Kavanagh, PhD1; Elizabeth Cameron, PhD2

Author Affiliations: 1 O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC; 2 Nuclear Threat Initiative, Washington, DC

JAMA. Published online November 29, 2018. doi:10.1001/jama.2018.19743


The Ebola epidemic in the Democratic Republic of Congo (DRC) is exceptionally dangerous, occurring within active armed conflict and geopolitical volatility, including a million displaced persons. With 421 cases, 240 deaths, and the numbers increasing, this Ebola outbreak is the second deadliest in history.1 Recent spread to Butembo, home to 1.2 million people, raised concerns. The DRC, World Health Organization (WHO), and partners are leading a vigorous international response, yet despite deploying an experimental vaccine, cases doubled in October 2018 and many cases had unknown origin.



Corresponding Author: Lawrence O. Gostin, JD, O’Neill Institute for National and Global Health Law, Georgetown University Law Center, 600 New Jersey Ave, NW, Washington, DC 20001 (gostin@law.georgetown.edu).

Published Online: November 29, 2018. doi:10.1001/jama.2018.19743

Conflict of Interest Disclosures: Dr Cameron reports grants from Open Philanthropy Project, Bill & Melinda Gates Foundation, and Global Affairs Canada. No other disclosures were reported.

Additional Contributions: In addition to the authors, the following participated in the expert consultation generating these recommendations: Sharon Abramowitz, Rutgers University; Deus Bazira,University of Maryland; Chris Beyrer, Jennifer Nuzzo, and Leonard Rubenstein,Johns Hopkins Bloomberg School of Public Health; Thomas Bollyky,Council on Foreign Relations; Lauren Carruth,American University; Victor Dzau,National Academy of Medicine; Katie Gottschalk,Georgetown University O’Neill Institute for National and Global Health; Charles Holmes, Rebecca Katz, Emily Mendenhall, and John Monahan,Georgetown University; Bonnie Jenkins,Brookings Institution; Jeremy Konyndyk,Center for Global Development; James Lawler,University of Nebraska; Nicole Lurie,Coalition for Epidemic Preparedness Initiatives; Dawn O’Connell,US Office for the Coalition for Epidemic Preparedness Innovations; Loyce Pace,Global Health Council; Carolyn Reynolds, PATH; Mesfin Teklu Tessema,International Rescue Committee; and Emira Woods,Institute for Policy Studies. We acknowledge experts from the Centers for Disease Control and Prevention and J. Stephen Morrison from the Center for Strategic and International Studies who provided important technical insights.

Keywords: DRC; Ebola; International cooperation; USA; Wars.


Ramping Up the #Response to #Ebola (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]


Ramping Up the Response to Ebola

Jennifer B. Nuzzo, Dr.P.H., and Thomas V. Inglesby, M.D.


Before 2014, it seemed unimaginable to many experts that Ebola would rip through dense urban areas, ultimately sickening nearly 30,000 people and killing more than 13,000.1 Four years later, Ebola is again spreading in urban areas, this time in the Democratic Republic of Congo (DRC). Though there are clear signs that global preparedness for epidemics has been strengthened, efforts to contain the DRC outbreak have not been sufficient. Additional human and financial resources are needed to prevent this outbreak from becoming a major epidemic.



Disclosure forms provided by the authors are available at NEJM.org.

This article was published on November 28, 2018, at NEJM.org.

Author Affiliations: From the Center for Health Security and the Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Keywords: Ebola; DRC; International Cooperation; USA.