AP

“…..The legislation was part of an ongoing effort to improve the country’s laws, and also criminalizes other deep-rooted customs that harm women, including slavery, acid attacks and the dowry system, by which a woman’s family must secure her marriage prospects by paying the groom and his family….”

Clinical Infectious Diseases 

Characterization of Aerosols Generated During Patient Care Activities

Bandeira AC, Campos GS, Ribeiro GS, Cardoso CW, Bastos CJ, Pessoa TL, Araujo KA, Grassi MFR, Castro AP, Carvalho RH, Prates APPB, Gois LL, Rocha VF, Sardi SI. Clinical and laboratory evidence of Haff disease – case series from an outbreak in Salvador, Brazil, December 2016 to April 2017. Euro Surveill. 2017;22(24):pii=30552. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.24.30552

“We describe a series of 15 Haff disease cases from an outbreak in Salvador, Brazil, starting early December 2016. Eleven cases were grouped in four family clusters of two to four individuals, four were isolated cases. All but one patient consumed cooked fish; 11 within 24h before symptoms onset. Cases consumed ‘Olho de Boi’ (Seriola spp.) and ’Badejo’ (Mycteroperca spp.). A total of 67 cases were detected, the last case was reported on 5 April 2017.”

Background:  “….Cases of Haff disease were first described in 1924, in the Baltic region of Prussia and Sweden and involved the consumption of different cooked freshwater fish, such as burbot (Lota lota), pike (Esox sp.) and freshwater eel (Anguilla anguilla) [9]. In the US, the first cases of Haff disease were reported in Texas in 1984, and hereafter the Centers for Disease Control and Prevention (CDC) reported six additional cases of Haff disease in patients from California and Missouri, who had eaten buffalo fish [10]. In 2001, two cases were identified in North Carolina who had eaten baked Atlantic salmon [11] and in 2014, further individual case reports were published, both cases developed symptoms after the ingestion of buffalo fish [12,13]. In 2010, China reported cases associated with the ingestion of crayfish [14].

In Brazil, an outbreak of 27 cases of Haff disease occurred during 4 months in the northern state of Amazonas in 2008 [15] and an additional case from the Amazon region was reported in 2013 [16].

It is considered that the condition is due to an unknown toxin in the aquatic food chain…..”

Case definition:  “We defined cases as patients presenting with (i) sudden onset of muscle pain in more than two body regions e.g. superior limbs, inferior limbs, neck/trapezium region, back region, thorax and abdominal region, not related to intense physical activity; (ii) elevated levels of creatinine phosphokinase (CPK) (more than fivefold above the upper limit of the normal reference value of 170 U/L (i.e. 850 U/L) within 24 hours of presentation; and (iii) patients who recalled an ingestion of fish or fish products within 72 hours before the onset of symptoms.”

Eurosurveillance

Eurosurveillance, Volume 22, Issue 24, 15 June 2017

CDC

Summary of Botulism Cases Reported in 2015

A total of 199 confirmed and 14 probable cases of botulism were reported to CDC in 2015.

Among confirmed cases, infant botulism accounted for 141 (71%) cases, foodborne botulism for 39 (20%) cases, wound botulism for 15 (8%) cases, and botulism of unknown or other transmission category for 4 (2%) cases (Table 1).

Among probable cases, foodborne botulism accounted for 6 (43%) cases and wound botulism for 8 (57%) cases.

The 141 cases of infant botulism were reported from 33 states and the District of Columbia. The median age of patients was 2.7 months with a range of 0 – 10 months; 70 (50%) were girls. Toxin type A accounted for 60 (43%), toxin type B accounted for 79 (56%), and toxin type Bf accounted for 2 (1%). No deaths were reported.

The 39 cases of confirmed foodborne botulism were reported from 7 states (Figure 1). The median age of patients was 59 years with a range of 9 – 92 years; 25 (64%) were women.

There were 5 outbreaks (events with two or more cases) accounting for 37 confirmed cases. One outbreak was associated with home-canned potatoes in a potato salad served at a church potluck (27 cases),† one was associated with fermented seal flipper (4 cases), and one was associated with beets roasted in aluminum foil and kept at room temperature for several days then made into a soup (2 cases). In addition, there were two outbreaks of two cases each living in the same household or facility in which the foodborne source was unknown (Table 2a).

Toxin type A accounted for 34 (87%), and toxin type E accounted for 5 (13%). One death was reported. The 6 cases of probable foodborne botulism (clinically compatible illness, not laboratory-confirmed, with an epidemiologic link to a suspect food) were reported from 3 states. The median age of patients was 53 years with a range of 23 – 73 years; 3 (50%) were women. No deaths were reported. Seal oil was the suspected food source for 2 of the 6 probable cases (Table 2b). There were 15 cases of confirmed wound botulism reported from 5 states. The median age of patients was 49 years with a range of 12 – 61 years; 2 (13%) were women. Toxin type A accounted for 14 (93%), and toxin type B accounted for 1 (7%). Fourteen (93%) were people who inject drugs (PWID). One death was reported.

The 8 cases of probable wound botulism (clinically compatible case who has no suspected exposure to contaminated food and who has a history in the 2 weeks before illness began of either a fresh wound or injection drug use) were reported from 3 states. The median age of patients was 59 years with a range of 28 – 78 years; 1 (12%) was a woman. All 8 were PWID. No deaths were reported. The 4 confirmed botulism cases of unknown etiology were reported from 3 states. The median age of patients was 47 years with a range of 27 – 71 years; 1 (25%) was a woman. Toxin type A accounted for all 4. No definitive route of transmission was identified for these cases.

Two cases were suspected to be adult intestinal colonization, a rare form of botulism thought to have a similar mechanism as infant botulism. The other two cases did not consume a suspect food, have any wounds, or have any known risk factors for adult intestinal colonization. How these persons were exposed to botulinum toxin is unknown. One patient developed botulism in 2015 and died in 2016 during a prolonged hospitalization.

Vaccine

Highlights

Rubinson L, Corey A, Hanfling D. Estimation of Time Period for Effective Human Inhalational Anthrax Treatment Including Antitoxin Therapy. PLOS Currents Outbreaks. 2017 Jul 28 . Edition 1.

doi: 10.1371/currents.outbreaks.7896c43f69838f17ce1c2c372e79d55d.

“…..Results: For antibiotic sensitive infections, treatment with antibiotics alone ≤4 days after spore exposure prevents toxemia. Administration of raxibacumab together with antibiotics protects ≥ 80% of subjects for 3 additional days (7 days post exposure). In the setting of antibiotic resistance, raxibacumab would be protective for at least 6 days post exposure.
Conclusions: Although the animal model of disease does not reflect the potential impact of supportive care (e.g. fluid resuscitation received by critically ill patients) on PA kinetics and raxibacumab PK, the simulations suggest that administration of antitoxin in combination with antibiotics should provide a longer postexposure window for effective treatment than for antibiotics alone. In addition, raxibacumab administration soon after exposure to an antibiotic resistant strain should provide effective treatment…..”

• Raxibacumab, an IgG monoclonal antibody against protective antigen (PA);
• For inhalational anthrax, protective antigen (PA) drives much of the mortality
• Raxibacumab is an anti-PA monoclonal antibody
• The anthrax toxin is a tripartite toxin: lethal factor (LF) and edema factor (EF) have enzymatic activities, while PA binds to cell receptors. PA binds and translocates LF and EF into the cell. Inhibition of PA binding to cell receptors blocks binding and internalization of LF and EF.