Reviewed by: Rebekah Moehring, MD, MPH, Duke University

January 2020 held three notable public health stories to follow, with emerging data out of January’s MMWR and the CDC Health Alert Network. 

First, influenza season has been earlier and more B than A, so far. CDC investigators report a field investigation of early influenza B virus-associated illnesses in Louisiana, after a New Orleans facility reported over 1,200 laboratory-confirmed influenza B infections, 23 hospitalizations, and one pediatric fatality. Influenza B primarily occurred in children less than 18 years (95%). The majority (98%) of sequenced viruses belonged to the influenza B/Victoria V2A.3 subclade. Influenza B has not been the predominant virus in the US since the 1992-93 season, and typically occurs at the tail of the annual epi curve instead of the beginning. In 2019-20 thus far, influenza B has accounted for 59% of positive tests nationally. Importantly, influenza B can be particularly severe in children. From 2010-2016, the percentage of B virus was higher among children who died with influenza than the percentage of B detected among the general pediatric population. CDC urges continued promotion of influenza vaccination and timely use of antivirals for all hospitalized patients with influenza and outpatients at high risk for complications, including children <2 years old.

Second, investigators report the emergence of pan-resistant C. auris in three New York patients. C. auris isolated from these patients demonstrated resistance to three anti-fungal classes: azoles, amphotericin, and enchinocandins. Cases had multiple medical comorbidities, lived in long-term care facilities, required mechanical ventilation, and had colonization with other multidrug-resistant bacteria. All three had previously detected C. auris and then acquired echinocandin-resistant C. auris in subsequent cultures, after exposure to echinocandins. Targeted point prevalence, infection prevention assessments, and environmental sampling did not reveal transmission of pan-resistant isolates to other patients or the environment. Other patients did harbor echinocandin susceptible C. auris isolates, however. No epidemiologic links between case patients were discovered. Although rare, the emergence of pan-resistance in the US is concerning. These cases highlight the need for repeated susceptibility testing from serial isolates in patients known to harbor C. auris, as pan-resistance may emerge after exposure to echinocandins.

Finally, Woooo Woooo – Wuhan! Sound the alarms for screening travelers. CDC and WHO are closely monitoring an outbreak of novel coronavirus causing pneumonia in Wuhan City, China. More than 40 confirmed human cases and two deaths were reported in China, with at least 3 exported cases in Thailand and Japan. Chinese authorities quickly identified and then sequenced the causative coronavirus or “2019-nCoV.” Origins of the virus are still being investigated, but zoonotic origin is suspected given many patients had links to a large seafood and animal market. While suspected, there have not been confirmed human-to-human transmissions or infections in healthcare workers. Hundreds of healthcare workers are under surveillance. Thus far, risk to US patients is rated as “low.” However, CDC experts expect this dynamic situation will evolve similarly to SARS and MERS. Information on case definitions and testing are available on the CDC website.

References:

  1. Owusu D, Hand J, Tenforde MW, et al. Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade — Louisiana, 2019. MMWR Morb Mortal Wkly Rep. ePub: 10 January 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6902e1 
  2. Ostrowski et al. Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019. MMWR Morb Mortal Wkly Rep. ePub: 10 January 2020. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901-H.pdf 
  3. Centers for Disease Control and Prevention: Health Alert Network. Notice CDCHAN-00426. Accessed January 19, 2020. https://emergency.cdc.gov/han/han00426.asp 
  4. Centers for Disease Control and Prevention: Health Alert Network. Notice CDCHAN-00424. Accessed January 19, 2020. https://emergency.cdc.gov/han/HAN00424.asp