Maryn McKenna

Journalist and Author

MRSA in UK Turkeys Raises Questions of Communication, Transparency and Risk

By Leave a Comment

Image: OZinOH (CC), Flickr

Two years ago, I celebrated Thanksgiving here on Superbug by announcing some new studies on resistant bacteria being found in turkey meat in the US. That did not go over well; so this year, I saved the bad-turkey news for the post-holiday week. And here you go:

Just in time for our Thanksgiving — and in the ramp-up to English Christmas, for which turkey is a traditional dish — the UK’s Animal Health and Veterinary Laboratories Agency announced that livestock-associated MRSA, drug-resistant staph, has been found in UK poultry for the first time. From their not-very-informative press release:

The Animal Health and Veterinary Laboratories Agency (AHVLA) has identified the presence of Livestock-Associated Meticillin Resistant Staphylococcus Aureus (LA-MRSA) in poultry on a farm in East Anglia… Once the poultry have been slaughtered and sold the owner will carry out cleansing and disinfection of their accommodation to ensure the next birds do not become colonised when they arrive on site. The AHVLA will revisit the farm after depopulation and thorough cleansing and disinfection to determine whether LA-MRSA is still present.

[Read more…]

'Catastrophic Threat': UK Government Calls Antibiotic Resistance a 'Ticking Time Bomb'

By Leave a Comment

On the heels of the director of the U.S. Centers for Disease Control declaring emerging antibiotic resistance a “nightmare,” the U.K.’s Chief Medical Officer released a report today in which she calls resistance a “catastrophic threat” which poses a national security risk as serious as terrorism. In an interview published overnight, she warns that unless resistance is curbed, “We will find ourselves in a health system not dissimilar to the early 19th century” in which organ transplants, cancer chemotherapy, joint replacements and even minor surgeries become life-threatening.

[Read more…]

A Government Takes Ag Antibiotics Seriously — But Not Our Government

By Leave a Comment

Matt Rourke/AP

It’s always fascinating to me to see how seriously other parts of the world take the issue of antibiotic use in agriculture, given the long struggle in the United States to get the Food and Drug Administration to act and to get legislation through Congress. The European Parliament has voted down any prophylactic antibiotic use, and China has banned growth promoters.

And last week, the UK Parliament examined the issue for the first time in more than a decade, in a long debate that featured some stinging language by members of Parliament and, it must be said, some inadequate responses by a government agency.

[Read more…]

Livestock MRSA Found For First Time In UK Milk

By Leave a Comment

This paper almost slipped by me. It was published quietly a few weeks ago, and it’s a little eyebrow-raising. From EuroSurveillance, the open-access peer-reviewed bulletin of the European Centre for Disease Prevention and Control (Europe’s CDC): The ST398 strain of MRSA, better known as “livestock-associated MRSA” or just “pig MRSA,” has been found for the first time in milk in England. (And therefore probably in cows, or at least on farms.)

Apparently there has been an ongoing study looking for any evidence of MRSA in UK cows, possibly because of this news from last year (of which more in a minute). Between last January and July, the program tested 1,500 samples of milk from farms’ bulk tanks — that’s the cooler in which milk from a number of cows is collected until it can be picked up by a truck for processing — and found seven of the samples were contaminated by MRSA. All seven isolates were MRSA ST398, the livestock-associated strain. Three came from one farm, so five farms had MRSA in their tanks.  According to the paper, this is the first discovery of ST398 in the UK other than one finding in horses in 2009.

[Read more…]

Fast-Spreading Animal Virus Leaps Europe, UK Borders

By Leave a Comment

Photo:

A newly identified disease is moving rapidly through livestock in Europe and has authorities both worried and puzzled. The disease, dubbed Schmallenberg virus for a town in west-central Germany where one of the first outbreaks occurred, makes adult animals only mildly ill, but causes lambs, kids and calves to be born dead or deformed.

The United Kingdom’s Animal Health and Veterinary Laboratories Agency (AVHLA) said today that the virus has been found on 29 farms in England; in the past few weeks they found it in sheep, but today announced that they have identified it in cattle as well. In mainland Europe, it has been identified on several hundred farms in the Netherlands, Germany and Belgium, and most recently in France. The European Center for Disease Prevention and Control has said that the new virus’s closest relatives do not cause disease in humans — but that other more distantly related viruses do:

The new virus belongs to the Bunyaviridae family, genus Orthobunyavirus, Simbu serogroup (preliminary information, based solely on genetic information)… Genetic characterisation has shown that the new virus is closest to the following Simbu serogroup viruses: Shamonda-, Aino- and Akabane-viruses, which do not cause disease in humans.
However, at least 30 orthobunyaviruses are zoonotic and may cause disease in humans, with symptoms ranging from mild to severe — e.g. La Crosse encephalitis virus, California Encephalitis virus, Cache Valley virus, Batai virus, Tahyna virus, Inkoo virus, Snowshoe Hare virus, Iquitos virus and Oropouche virus.

[Read more…]

Flu: Still a problem, just not here

By Leave a Comment

What a difference a year makes: At about this time in 2009, the world was still in the midst of the H1N1 “swine flu” pandemic, though cases had already trended down from their fall peak. Here at the end of 2010, flu has made barely a ripple.

In the United States, seasonal flu has been a non-story: The Centers for Disease Control and Prevention reported last week that flu activity is low by almost every metric: from the number of states where flu is widespread, to proportion of outpatient visits for flu-like illness, to adult deaths from pneumonia and influenza, to flu-related deaths among children.*

Here’s the map of flu activity in the US: By Dec. 18, only one state, Mississippi, was experiencing what is called “widespread” flu, the highest category:

And here’s the trend line for doctor visits for “influenza-like illness” — something that felt to the patient like flu. That black line is what the CDC considers the “epidemic threshold” for a flu season; this year’s case reports, the red line, fall below it:

But if there’s one thing that’s predictable about influenza, it is that it is going to behave in a not-predictable manner. That turns out to be true this year as well — because while the US is having a very mild season, the United Kingdom is getting punched. Look at this, from the BBC’s Health Desk, charting flu cases among adults — and note how close the current peak is to the peak cases during their swine flu epidemic:
The BBC is reporting that flu cases in the UK have risen by 50 percent in a week. Last weekend, the Telegraph reported that cases of flu serious enough to need intensive care had doubled in a week. And today, the Daily Mail is saying that Arrowe Park, a hospital in Wirral near Liverpool, has banned visitors in an attempt to slow down the spread of flu to vulnerable patients from the outside world.

Right now the UK seems to be alone in the intensity of its epidemic. Google’s Flu Trends (which doesn’t seem to sample the UK) is showing high search activity for flu-related terms only in Ukraine and Norway. (“High” is 4th on a scale of 1-5.) HealthMap, which does include the UK in its searches, shows hot spots only in England, Germany, and the east coast of Australia.

All of which makes it sound as though — for the US at least — flu is just not that much of a concern. That assumption would be a mistake, as two new articles underline. In Clinical Infectious Diseases, Jeffery Taubenberger (who recovered the virus of the 1918 pandemic) and co-authors remind us that 2010 marked the 500th anniversary of the first verifiable flu pandemic, suggesting that there are many more to come. And in the latest Scientific American, notable flu reporter Helen Branswell explores how little surveillance for flu there is at crucial chokepoints, such as pig farms, where new flus are likely to emerge. (Story is behind a paywall, but here’s the free podcast.) Branswell warns:

The 2009 influenza pandemic appeared to come out of nowhere. It started as what seemed like a lethal outbreak in Mexico, then spread north of the border. By the time health officials learned that the virus responsible for the alarming explosion of cases was new and an infection threat to most of humankind, they had no way to keep it from spreading around the world. By a stroke of luck, symptoms were mild in the vast majority of cases. What if next time we are not so lucky?

That question weighs heavily on the minds of influenza scientists and public health planners as they prepare for the next big outbreak. And there will be a next time.

*Frustratingly, the CDC doesn’t assign static links to its weekly FluView reports, so if you read this post after Dec. 31, that link may take you to a different report than the one this post references. I’m using data that was on the site Dec. 30 for week 50 of 2010, ending Dec. 18.

Update: Well, that was quick. The link above now goes to the FluView for the week ending Dec. 25. The number of states with “widespread” flu has risen to five: Alabama, Georgia, Mississippi, New York and Virginia. Things are picking up.

Update 2: But they’re picking up much more in the UK, and the spillover from flu cases is affecting hospital operations overall. The Guardian reported Dec. 31:

NHS pressure group Health Emergency today claimed a number of hospitals in East Anglia were on black and red alert, saying the NHS was already struggling as a result of the flu outbreak.

Chairman Geoff Martin said the James Paget University hospital in Great Yarmouth, Norfolk, yesterday declared a black alert – the most severe status level – and that the Norfolk and Norwich University Hospital was on red alert – one step lower.

He said: “We warned that hospitals would be forced on to black alert as the flu cases fill the available beds. Now it’s happening and we do not believe that the chaos is restricted to East Anglia. The NHS is now on the brink of the worst winter crisis in over a decade as the harsh reality of cuts to beds and staffing numbers is exposed with lethal consequences.”

Image: Mine, Brussels, July 2010

More on NDM-1

By Leave a Comment

One of the frustrations of being a working journalist and a blogger is that, when a big blog-story breaks, you’re likely already to be working on something else. And so it is, unfortunately, with NDM-1: I’m on a magazine assignment and will be off interviewing people when I should be blogging.

(This s a great time to recommend that, for any breaking infectious disease news, you follow Crof at H5N1 (@crof) and Michael Coston at Avian Flu Diary (@Fla_Medic), who are dedicated, thoughtful, nimble and smart.)

Since I last posted, there’s been lots of additional coverage of the “Indian superbug.” Much of it, blog and media, is just echo chamber cannibalizing of the earliest reports (including but certainly not only mine), but there are some important new developments worth noting, which I’ll list below.

There are also some important points that are getting lost in the echo-chamber bounce: First, it is not correct to say that every person who acquired this was seeking cheap medical care or engaged in medical tourism; a few of them were treated on an emergency basis while traveling, and a few have no apparent healthcare tie. So this is not a situation of people seeking to save money and, as some commenters seem to be suggesting, receiving their karmic payback. (C’mon: Seriously?) Second, it is also not correct to say that every case of this has been linked to a hospital — it’s quite clear in the Lancet ID paper that in South Asia, a number of the cases were community infections. So it is not just a case of hospitals that are dirty or have poor infection control (which by the way is a problem in the US as well, right?); NDM-1 is already a community bug, which will make detection and defense much more complex.

OK, curated list:

First, if you’re interested in more from me, CNBC asked me to write up a piece about NDM-1, which ran Thursday; and Friday morning I was on the WNYC-FM (and nationally syndicated) radio show The Takeaway.

Second, the list of potential victims of NDM-1 is growing. Most of them have survived, so marking their cases is really a way of measuring the resistance factor’s previously undetected spread:

The UK has released a new statement, updating its earlier warning, and says it has found “around 50” cases carrying NDM-1, an update from the Lancet ID paper. (Side note: This statement, and the earlier warnings, came from the UK’s Health Protection Agency. The UK has just announced that it will be shutting down that agency in a cost-cutting measure. Great timing.)

The government of Hong Kong has announced that it has seen one case of NDM-1, but the patient recovered.

Canada has disclosed that it has had two cases, not the one mentioned in the Lancet ID editorial, in two different provinces.

Australia says that it has had three cases scattered across the country.

Belgium has announced one death.

And finally — sadly but probably not surprisingly — India is objecting to the stigma of being characterized as the source of NDM-1. The study’s first author has disassociated himself from the paper and members of the government are claiming a “pharma conspiracy.” Medical tourism has become a significant industry in India, and it is true  some of these reports cast doubt on its safety. But still, I find this reaction disappointing.

Evading the stigma of an emerging disease is not a new impulse: Recall how the government of China suppressed for 6 months the news of the start of the SARS epidemic. They did not stop the epidemic, of course — it eventually sicked more than 8000 people across the globe and killed about 775 — but their suppression of the details of its spread kept other jurisdictions from mounting a defense in time. From my teaching gigs in Hong Kong I can testify how much bitterness endures in Hong Kong over this.

China’s actions in 2002-03 led to the enactment of the new International Health Regulations by the WHO, which specify that, because expanding epidemics take no notice of borders, it is inappropriate for any government to attempt to impede the free flow of information about their spread. India is a signatory to the IHRs.

I am not suggesting that India is attempting any suppression of news about NDM-1 — there’s no evidence of that — but the volatile language being used does concern me. I acknowledge that India is an extremely open society, with degrees of political expression that can sound surprising from this distance. But let’s hope the government takes its commitment to the IHRs as seriously as any signatory should.

News break: CDC alert on imported novel resistance

By Leave a Comment

There’s a troubling item in this afternoon’s issue of the CDC’s Morbidity and Mortality Weekly Report or MMWR: The first report in the United States of a novel resistance mechanism that renders gram-negative bacteria extremely drug-resistant and that has been linked to medical care carried out in India or Pakistan.

The short item describes three isolates (E. coli, Klebsiella pneumoniae and Enterobacter cloacae) found in three patients in three states between January and June of this year. All three isolates produced New Delhi metallo-beta-lactamase (NDM-1), which has never been recorded in the US before. Because of that novel mechanism, the three isolates were resistant to the carbapenems usually used on the most serious gram-negative infections, in fact to all beta-lactam antibiotics (penicillins, cephalosporins, carbapenems, monobactams, etc.) except for one monobactam, aztreonam — and they were also resistant to aztreonam through another mechanism that hasn’t been identified yet. All three of the patients found carrying this novel resistance factor had undergone medical care in South Asia recently.

This may be the first finding of this mechanism in the US, but it’s been causing alarm in Europe for at least two years.

[Read more…]

MRSA in the House of Lords — the silly, the serious

By Leave a Comment

Thanks to constant reader Pat Gardiner, we have the transcript of the UK House of Lords discussion on community MRSA, called there PVL-MRSA after the toxin. (Go to the linked page, and click down to the time-mark 3.16 pm.) It’s encouraging to see some members of a government taking MRSA seriously. The members are asking for

  • better surveillance
  • better infection control
  • consideration of MRSA as a notifiable disease
  • and promotion of both vaccine research and point-of-care diagnostics.

Hear, hear to Baroness Masham of Ilton for bringing it up.

To get to that discussion, though, you’ll have to click down through some silliness (the ghost of Monty Python is never far from the British government, is it?): a discussion at time-stamp 3.07 p.m. of whether a House of Lords restaurant can afford to serve British bacon, rather than Dutch bacon, given that British bacon is almost twice as expensive and Dutch pigs are associated with MRSA ST398:

Lord Hoyle: My Lords, I thank the noble Lord for that reply, although there is more than a whiff of hypocrisy about it. After all, I and many others on all sides of the House have argued that it should not be a matter of price. We have urged the British consumer to buy British bacon because of the higher welfare standards that are applied in this country. Will the noble Lord also take into account the presence in Dutch bacon of a deadly form of MRSA, ST398, which can cause skin infection, heart trouble and pneumonia? Is he not putting people in this country at risk, particularly as the strain has passed from animals to humans? Indeed, when Dutch farmers go into hospital, they go into isolation. Why is he putting the British consumer and those who buy bacon in this House at risk in this way?

The discussion quickly devolves into foolishness about British Tomato Week — but if you read carefully, you’ll see that behind the silliness, there are serious issues at stake: animal welfare, farming standards, truth in labeling (the Lord Bishop of Exeter advances the very newsworthy claim that pork imported from other countries is subsequently labeled “British” only because it is packaged in the UK) and movement of zoonotic pathogens across national borders thanks to globalized trade.

Sadly, the leader of the discussion — the Chairman of Committees, AKA Lord Brabazon of Tara (no, really) — appears not to have been keeping up with the news, since he notes of ST398:

As far as MRSA is concerned, I read the article in, I think, the Daily Express a couple of weeks ago. I do not think that it has been followed up by anybody else.

Apparently the Lord’s staff have not been keeping up, since MRSA in pigs in the EU has been covered by the Daily Mail, the Independent, comprehensively by the Soil Association, and by, ahem, us.