ANTHRAX, HUMAN, BOVINE - BANGLADESH (18): 65 NEW CASES REPORTED

20-SEP-2010
Subject	PRO/AH/EDR> Anthrax, human, bovine - Bangladesh (18): 65 new cases

[1]

Date: 20 Sep 2010

Source: Iedcr.org [edited]

<http://www.iedcr.org/images/Healthmessages/Anthrax%20Update%20_20%20Sept%202010.pdf>





Government of the People's Republic of Bangladesh Institute of

Epidemiology, Disease Control and Research (IEDCR) Mohakhali, Dhaka-1212:



Number of Cutaneous Anthrax cases from 18 Aug to 20 Sep 2010:



Districts / Total / Change since last posting / In last 24 hours (20

Sep 2010) / Upazillas

(1) Pabna / 58 / 0 / 0 / Bera (11), Santhia (30), Faridpur (17)

(2) Sirajganj / 212 / 2* / 0 / Shadjadpur (56), Belkuchi (54),

Kamarkhanda (92), Ullapara* (10)

(3) Kushtia / 49 / 3* / 1 / Daulotpur (46), Bheramara* (3)

(4) Tangail / 26 / 0 / 0 / Ghatail (14), Gopalpur (12)

(5) Meherpur / 81 / 2 / 1 / Ganghi* (79), Mujibnagar (1) [data from

above URL - Mod.MHJ]

(6) Manikganj / 8 / 0 / 0 / Shaturia (8)

(7) Shatkhira / 1 / 0 / 0 / Sadar (1)

(8) Lalmonirhat / 107 / 31 / 0 / Sadar* (78), Aditmari* (29)

(9) Rajshahi / 8 / 1 / 0 / Chaghat (7), Tamore* (1**)

(10) Narayangonj / 9 / 0 / 0 / Araihajar (9)

(11) Laxmipur / 25 / 25 / 0 / Kamalnagar* (25)

(12) Chittagong / 1 / 1 / 0 / City* (1)

Total: 585 (2)

** Imported from Sirajganj



--

Communicated by:

ProMED-mail <promed@promedmail.org>

[An increase of 65 apparently new cases since 16 Sep 2010. - Mod.MHJ]



******

[2]

Date: 19 Sep 2010

Source: Bdnews24.com [edited]

<http://www.bdnews24.com/details.php?id=173792&cid=13>





Government health officers have detected the 1st case of human

anthrax in Feni on Sunday [19 Sep 2010]. A 50-year-old resident of

Joynagar village under Mohamaya Union of Chagalnaia Upazila was found

to have anthrax during primary tests.



According to government officials, 583 cases [sic] have been detected

until Sunday [19 Sep 2010], with 63 new cases in the last 3 days.



Family members said the woman fell ill after eating beef that her son

had purchased from the local Chandgazi Bazar on 24 Aug 2010. A

boil-like skin lesion appeared on her right thigh. She was treated by

a village doctor and later in a private clinic. Upazila health and

family planning officer Mohammed Khairul Islam and Upazila livestock

officer Nurul Afsar went to the house on Sunday [19 Sep 2010] noon

after learning about the case and confirmed that she had contracted anthrax.



Khairul Islam said that enquiries were underway to ascertain whether

there were any more anthrax patients in the area.



On the previous day, beef traders in Chittagong claimed that their

trading had quartered due to the scare.



--

Communicated by:

ProMED-mail <promed@promedmail.org>



[This upazila does not appear in the official 20 Sep 2010 statistics.

- Mod.MHJ]



******

[3]

Date: 20 Sep 2010

Source: Bdnews24.com [edited]

<http://www.bdnews24.com/details.php?id=173849&cid=2>





Government health officers have detected the 1st case of human

anthrax in Chuadanga. One man, 35, was identified to be infected with

anthrax at Mahmujumma village of the Sadar Upazila on Monday [20 Sep 2010].



Chuadanga Sadar Upazila medical officer Dr Wajed Ashraf Delwar told

bdnews24.com that they were informed of villagers' suspicion about a

father, 30, his wife, 26, and their son, 6, of Boalia village and of

the 35-year-old man of Mahmujumma village of being infected with

anthrax. On such information, a medical team along with district

civil surgeon Dr Lokman Hakim and livestock officer DD Ajoy Roy

visited the spot.



Ajoy Roy told bdnews24.com that they found the 35-year-old man to be

infected. After conducting tests, they said the wife and son had

gotten scabies.



"However, we could not check [the 30-year-old father], as he is

currently in Dhaka. The 35-year-old man left Dhaka after eating beef

at a relative's house. He started showing signs of the disease after

he reached home," the livestock officer added.



--

Communicated by:

ProMED-mail <promed@promedmail.org>

[Another new upazila, but apparently an imported case from Dhaka, so

infected meat has apparently reached the capital. - Mod.MHJ]

Quang Ngai: 6 districts with diseases of cattle, poultry

Today 20 / 9, Quang Ngai province implementing open meetings and disease prevention measures for livestock and poultry in the locality.

According to the Department of Agriculture and Rural Development of Quang Ngai province, from May 8 / 2010 to present, in the districts of Tu Nghia, Son Tinh, Nghia Hanh, Binh Son and Tra Bong influenza A/H5N1 appeared on poultry with the 7300 sick children.

In the district of Son Tinh and Binh Son, Nghia also occur and blue ear pig disease of pigs is 73 children. In addition, foot and mouth epidemic also appeared on herds of Son Tinh and Binh Son and Son Tay, 64 children with the disease.

With the local veterinary conducted destroy all the infected birds and disinfect the area around the outbreak and limit disease spread.

At the meeting, Vice Chairman Truong Ngoc Nhi of Quang Ngai province has directed local initiative in implementing disease control measures for cattle and poultry. Local disease spread to the Chairman of there before the province must be responsible.

One other requirement is also in place to quickly form the station from the provincial disease control to districts and communes; absolutely not for transporting livestock and poultry from the disease to places where there is no translation. The control stations shall come into operation before the latest 25 / 9.

Cambodia-Foot-and-mouth hits four provinces

Monday, 20 September 2010 15:01

FOOT-and-mouth disease is currently affecting cattle in four provinces following outbreaks earlier this month, agriculture officials said yesterday.

Hah Piseth, deputy director of the Ministry of Agriculture’s Department of Animal Health, said the disease was affecting cows in Kampong Cham, Kampong Chhnang, Kandal and Prey Veng provinces. He estimated that the number of cases was roughly the same as last year.

“The ministry has provided medicine to the [provincial] agriculture departments and now the situation has been improving because we have been able to save [some cows] in time,” he said.

Around 50 cows in Kampong Cham died from the disease at the beginning of the month, and around 1,000 others were affected with foot-and-mouth and other diseases, said Mao Bunthoeun, deputy chief of Peam Prothnuos commune, located in Koh Sotin district.

“Two cows that died on Sunday were sent downstream.... We are afraid that this will cause disease to people using the river water,” he said.

Hun Ly, deputy director of the Kampong Chhnang provincial animal health office, said he had ordered his staff to educate villagers about how to treat diseased cattle.

“This virus cannot survive in acid, so we recommend that villagers use sour sauces from lemon or tamarind to clean the mouth and nails of the cows twice a day,” he said. “This will cure the disease.”

But Mao Bunthoeun said farmers would be hampered by the outbreak, warning that it could affect animals needed for the upcoming rice harvest, expected in November.

“Cows that have been cured cannot work for two months, even though farmers will need them,” he said.

Som Sarin, 27, a villager from Rolea Pheaer district in Kampong Chhnang, said that the cost of treating diseased cows was too high, and complained that the animals could only be sold for half their normal value.

“Some villagers have called veterinarians, which costs them 15,000 riels (US$3.55) for each visit, but other people have been going to the forest to search for traditional medicine for their cows,” she said.

Anthrax outbreak in Bangladesh nearly reached 600 victims

Sep 20, 2010

BANGLADESH - The number of victims of the anthrax outbreak in Bangladesh rises up to 585.

Beforehand, The government of Bangladesh have announced a red-alert status after an immediate increase in which nearly half were added from the previous number of 300.


And if remembered, the recent celebration of the end of Ramadan or Eid'l Fitr in Bangladesh was affected by the anthrax wherein it continuous to attack.

The country's officials have also assured that they have enough vaccines for the victims of the said disease.

Quang Binh: swine cause of death is not clear

On 20-09-2010 17:46

Dead pig thrown out rice fields.

NDDT-Day 20-9, remote information United Trach, Bo Trach district (Quang Binh) to know, but right through the herd of people get sick and die away with the number of dozens of children. Meanwhile, local authorities and vets do not know this.


Mr. Duong Van Dien Tiger in rural, remote United Trach said: "Do not know how my family's pigs suddenly quit eating properly roll out hug. 17-9 Immediately, I called the dealer to be 4.5 times our original little pig. May sell off that indicated tissue that gratuitous lot bu ... "Nha Le Thi Hue fill them his way home 500m. We see three ideas that vets should "remember to look for other cycles weasel my clouds are coming here full-body rash, sore." Hue adopted a three sows, seven pigs 20-25kg weight evidence, including three children infected cows. Mr. Hoang Van Long family rearing 10 pigs, but four children died, the remaining cows, in a corner. Four pigs died from his wife sure sack and throw a bomb next to rice fields support.


Meanwhile, the related development Trach Hoa, Nguyen Hong Thanh said that cost overruns have bulk pig died, I just ask Tiger village chief, Veterinary Officer, confirmed that two people present absolutely no interest.


Known, beyond approximately 90% United Trach pig farming families with more than 2,500 the number of children. Also the number of dead pigs is not clear which causes people to dispose of dozens of large construction already been infected pigs sell off from the area. If no measures are tensely prevention, disease prevention measures, the risk unwind in translation can easily occur here.

Vietnam Department of Animal Health

.., said blue ear epidemic has spread in area in the Central Highlands province of Dac Lac, Dac Nong, Lam Dong, Kon Tum and Gia Lai to 202 communes of 27 districts, towns, in which more than 120 thousand pigs were infected.
In Gia Lai, pigs infected with 2236, which was destroyed in 498 children. Gia Lai Provincial People's Committee has just decided to support 16,000 VND per kg of live pigs destroyed. According to the Veterinary Department of Kon Tum province, now there are 2000 infected children, in 1424 it destroyed me. PPC has supported farmers 20,000 VND per kg pigs were destroyed. In Lam Dong, has more than 20,000 of the nearly 2,000 pig farmers in Cat Tien commune blue ear disease and the overall number of severely ill and dying pigs were destroyed. Also in Dac Nong province has more than 2800 infected pigs, in which nearly 1100 children have been destroyed. In the province of Dac Lac has had nearly 100,000 pigs infected with blue ear in 14 districts. Particularly in the district had 10/13 M'Drak communes and towns with blue ear epidemic raging, with the 1592 human disease, in which 669 children died.
According to the Veterinary Department of Bac Lieu, to 20-9, blue ear epidemic has spread over 100 villages, of the 29 communes of the province with more than 1,600 infected pigs were culled. It is worth saying that many districts have blue ear epidemic has generated over 10 days, but then broke again. Animal Health Department directed the districts to strengthen the inspection diseases; Statistical Forum, held disinfect disinfectant, cleaning cages. People's Committee of Huong Hoa commune, Tuyen Hoa district (Quang Binh), said mouth outbreak of foot, mouth disease broke out in a village with over 40 Tan Duc buffaloes and cows were infected. Currently, veterinary forces and local authorities are implementing measures to put out the translation.


In Quang Ngai is a lot going on outbreak of cattle and poultry, in which the most dangerous bird flu more than three thousand chickens and ducks have died, nine blue ear pig disease, and 64 foot-mouth cattle disease , long nails. In addition to direct local development for prevention, criticized the fund raising to support the destruction of poultry, swine diseases, PPC has set up three checkpoints transport of livestock and poultry in Sa Huynh, and Ba To Binh Son.

35 Vietnamese people die of rabies

Over 35 deaths have been reported in Vietnam in first six months of the year due to rabies, according to a health official.

Rabies cases have increased in recent years in the country, said the Director of the National Institute of Hygiene and Epidemiology, Nguyen Tran Hien.

From 2001-2003, around 30 people died resulting from the dangerous disease; however, in 2007, 131 fatalities have been reported; it is 91 and 64 in 2008 and 2009 respectively.

-snip-

In successive years, all health forces concentrated on eradicate these fresh diseases including SARS, influenza H5N1 and H1N1, acute diarrhea, people neglected the dangerous disease commonly caused by dogs.

Quang Ngai appear more bird flu outbreak

09/20/2010 9:58


(TNO) 20.9 morning, DARD of Quang Ngai, said in the past 10 days, in the village of Hoa Binh, Hoa Nghia, Nghia H.; Rural Da Ngoc, Hanh Thien commune, Nghia Hanh H.; Rural Peace Noi, Binh Chanh, Binh Son appeared ducks died in a series, with up to 1132 the number of children.
Veterinary Medicine Department of Quang Ngai 9 samples taken at the outbreak of the posts of Veterinary IV Danang tests were positive for the H5N1 virus.

Department collaborated with the local destruction of the entire conduct of poultry in outbreak numbers than 2800 ducks and concurrently implementing emergency prevention measures such as localized outbreaks, close monitoring of poultry flocks, environmental disinfection, vaccination enclosure, not for the widespread epidemic.

As known, in Quang Ngai have also appeared blue ear pig.

NDM-1: New Route, Same Destination – Untreatable Infections

September 17th, 2010 3:24 pm ET -
Author – Brandi Limbago, PhD

You’ve likely seen the news over the last couple of weeks warning people about “The [so-called] New Superbug NDM-1,” a newly discovered gene that makes bacteria resistant to last-resort antibiotics called beta-lactams or carbapenems. NDM stands for New Delhi Metallo-beta-lactamase, and in this case the NDM gene rendered antibiotics useless in three cases of infection with carbapenem-resistant Enterobacteriaceae (CRE). CDC discovered NDM-1 in the United States this year and reported it through the MMWR in June. Is it concerning? Absolutely; and we are working closely with healthcare providers and health departments to stop transmission of these bacteria.

That said, I’d like to point out that the story shouldn’t be solely about these bacteria being new or imported from other countries; the story should be about the whole group of CRE and untreatable infections they cause. In reality, these are not the first CRE cases we’ve seen in the United States. Not even close. NDM-1 is actually just one type of CRE and represents a larger antibiotic resistance issue that we already have, right now, in this country. CDC has been working with partners to prevent a type of CRE known as KPCs (carbapenemase-producing Klebsiella pneumonia). The KPC gene also makes Enterobacteriaceae bacteria resistant to beta-lactam/carbapenem antibiotics, just in a different way than NDM-1. KPCs have been reported in about 35 states and are associated with high mortality – 40 percent in one report. It may be in the other 15 states as well, but has not been reported to CDC. So, let’s not wait for NDM-1 in order to take action.

What exactly is happening with these Enterobacteriaceae? They are Gram-negative bacteria that normally live in our intestines. When not held in check by our body’s normal defenses, these same bacteria can cause serious infections, especially in hospitalized patients with medical devices such as catheters or ventilators. These infections are typically treated with beta-lactams, but when a resistance gene such as NDM-1 or KPC get into the bacteria, the result is a multi-drug resistant organism (MDRO) that can be very difficult to treat.

The good news is that we know strategies to prevent transmission of CRE infections, but more needs to be done. CDC issued guidance in 2009 about CRE transmission prevention, regardless of whether they’re NDM- or KPC-producers. We also have several guidelines on MDRO and other healthcare-associated infection prevention. The challenge now is motivating the healthcare community to take action, including using antibiotics wisely, following transmission prevention guidelines, and implementing overall infection prevention recommendations.

So while I think that all the attention to NDM-1 has raised awareness about the broader CRE problem, which is good, we need providers to take the recommended steps towards prevention. Patients’ lives could depend on it.

Quang Ngai: Appeared HPAI

Hai Yen (09/17/2010 09:25)

In those days, his flock of 350 children in the village of Binh An Nguyen Ly Noi, Binh Chanh, Binh Son district (Quang Ngai) occurs already dead ducks scattered, families were reported to veterinary cooperative.

Morning 15 / 9, Quang Ngai Department of Animal Health has taken three samples sent for testing. On 16 / 9, IV regional veterinary agency responded that the test results, all three samples were taken from the flock on Mr Li's family has given positive results for H5N1.

It is known that, from 2008 to present in this locality has ever happened to bird flu.

Anthrax virus hits Dhaka suburb

by Salah Uddin Shoaib Choudhury
September 17, 2010

Click Image to Enlarge

At least two people are already detected to have been infected Anthrax virus in Gazipur district, just two kilometers from the capital city in Bangladesh.

According to Bangladeshi health officials, more than 508 people have so far been infected by Anthrax as a major outbreak of the disease spreads through Bangladesh's dairy belt. Hundreds of cows have died causing severe panic amongst the farmers in the country.

In most of the Anthrax affected areas in Bangladesh, farmers are throwing Anthrax infected dead cows, which may cause another serious hazard for fish in the rivers and large water bases. An unconfirmed source claims that, anthrax infected fish was already identified in Sirajganj district.

Anthrax is a potentially lethal bacterium that exists naturally in the soil and commonly infects livestock which ingest or inhale its spores while grazing. It can be transmitted to humans who handle or eat infected animals. Anthrax germs are also reportedly produced by various terrorist groups in the world. Anthrax spores can be produced in vitro and used as a biological weapon.

Like many other members of the genus Bacillus, Bacillus Anthracis can form dormant spores that are able to survive in harsh conditions for extremely long periods of time—even decades or centuries. Such spores can be found on all continents, even Antarctica. When spores are inhaled, ingested, or come into contact with a skin lesion on a host they may reactivate and multiply rapidly.

I already wrote in another piece on Anthrax that this virus might have been intentionally spread in Bangladesh my terrorist or Islamist groups, which are now facing tremendous offensives from the government. Current government in Bangladesh, under the leadership of Prime Minister Sheikh Hasina is continuing massive offensives against terrorists and Islamist militants since it came in power in January 2009. There had been numerous attempts on the life of the Prime Minister.

Meanwhile, local and international chain fast food stores in Bangladesh are continuing to sell beef based items such as pizza, burger, rolls etc without verifying the meat. It is feared that people as well as expatriates in Bangladesh may get infected to Anthrax virus from these foodstuff. In hundreds of local restaurants in the country, un-inspected beef are being openly sold as curry or other dishes to customers. There is no monitoring on the quality of meet used in fast food or other food items in Bangladesh, which are made of beef. Local and international hotels in Dhaka and Chittagong are also reportedly buying un-inspected beef from the local suppliers.

According to experts, people aware of this lethal infection should not only refrain from buying and consuming fast food and other food items made of beef, they also should refrain from buying any other food item from various fast food shops or restaurants in the country. They [experts] opined that, though people may refrain from buying and consuming beef based items, it should also be noted that, the fast food shops and restaurants are preparing other food items in the same pan or woven, which again remains as a matter of great concern.

A senior health official in Dhaka said, though the government has engaged experts from health department in inspecting cows before slaughtering in Bangladesh, most of the butchers are obtaining a certificate from those officials in exchange of bribe. In this case, even if any cow meat is sold in the market with certificate issued by the health department, it cannot be totally trusted.

The source further said that, in Pabna [northern district in Bangladesh] two people got infected to Anthrax germs even after consuming beef, which were certified by the health department to be free from germs.

Considering current situation, Bangladesh government has already issued red alert throughout the country. Fisheries and Livestock minister Abdul Latif Biswas announced the red alert in the country on Wednesday.

Initially the outbreak of Anthrax was reported in Sirajganj on August 20, in Pabna on August 22, Tangail on August 31, Kushtia on September 1, Meherpur and Chuadanga on September 4, Gopalganj and Faridpur on September 7 and lately in Gazipur on September 16.

On possible spread of Anthrax germs by terrorists and Islamists in Bangladesh, counter-terrorism specialists said, foreign missions in Dhaka, especially those of Western and developed countries need to take extra-precaution while receiving any document or mail sent via postal or courier service. Special monitoring should also be immediately enforced to check the visa seekers, if any of them bearing Anthrax infection enters the foreign mission compound.

The experts said, terrorists and Islamists may attempt to send Anthrax germ infected mails in the form of newspapers, letters of documents to the foreign missions in Bangladesh with ulterior motive. Though a very few foreign missions in Dhaka are already using necessary methods of scanning every incoming mails and parcels, there is no such vigilance in at least couple of dozens of foreign missions in Bangladesh. Experts suggested similar precautions in United Nation's Organizations as well as elite for Rapid Action Battalion [RAB] units in the country. It also said, judiciaries in Bangladesh are also required to take certain immediate measures in scanning each of the incoming mails and parcels.

Vietnam to destroy expired Tamiflu amid controversy

[Finally, a story in English on the Vietnam Tamiflu. I guess we'll never know how much Tamiflu they used.....isn't that always the way.......]


Last updated: 9/13/2010 14:10

The Ministry of Health has ordered the destruction of a controversial reserve of over 9.7 million capsules of Oseltamivir (aka Tamiflu), Tuoi Tre reported Monday.

The reserve is estimated to be worth some VND280 billion (US$14.3 million) in total.

According to the local newspaper, news of the edict came from an unnamed source from the ministry.

Four local manufacturers began producing the capsules at the ministry's request, starting in 2006.

Since then, a mere 100,000 capsules have been distributed to cities and towns throughout the country. It is unclear whether or not the distributed capsules were ever used, Tuoi Tre reported.

Following the drug cache's expiration in February, 2008 the ministry extended the date.

The reserve was ordered and purchased as part of a VND562-billion ($28.8 million) project to build up a reserve of 20 million Tamiflu capsules to battle the avian flu epidemic in Vietnam in 2005-2006.

Last week, the apparent boondoggle grabbed headlines when government inspectors accused that the ministry and four local drug makers of wasting financial resources.

In a report published prior to the dust-up, government inspectors accused the Ministry of deliberately overestimating the need for the medicine in a proposal it sumbitted to the government in November 2005. At that time, Vietnam had only recorded 91 cases of influenza A (H5N1) virus between 2003-2005.

The ministry didn’t stipulate a maximum price for the raw materials placing orders with the drugs companies, the inspectors charged. Instead, the domestic drug firms were left to buy materials from India at $17,500-18,000 per kilogram --nearly 50 percent more than offered by a Swiss company.

Investigators also accused the companies of receiving over $6 million in questionable reiumbursements from their suppliers, and failing to report the exchange to the government.

Tran Thi Trung Chien, the former Minister of Health who nominaly oversaw the project, responded that the investigation was incomplete and failed to demonstrate corruption and/or violations of purchasing procedures.

The four local drug manufacturers also denied the inspectors’ accusations, saying that the re-imbursements did not amount to kickbacks and were, instead, a legitimate part of an extended payment plan.

Two new antibiotic-resistant superbugs turn up, take off

Saturday, Sept. 11, 2010

By MINORU MATSUTANI

Staff writer

Two antibiotic-resistant superbugs have recently emerged in Japan.

In Tokyo, dozens of patients, mostly elderly, have been infected with Acinetobacter, and at least 12 deaths have been reported. On the other hand, thankfully, no deaths have yet been reported from infection with E. coli with the NDM-1 gene.

Following are questions and answers on the recent superbug cases:

What is the difference between the two superbugs?

Acinetobacter is a bacteria resistant to most antibiotics. Dozens of infections have been found at Teikyo University Hospital, Yurin Hospital, Tokyo Metropolitan Geriatric Hospital and other hospitals.

NDM-1 makes a bacterium resistant to most antibiotics. So far it has turned up in only one man in Japan, a patient in his 50s at Dokkyo Medical University Hospital in Tochigi Prefecture, according to the Health, Labor and Welfare Ministry. Outside Japan, NDM-1 has occurred in pneumobacillus, a germ that causes pneumonia, and other germs, ministry official Shuichiro Hayashi said.

Acinetobacter is commonly found in soil and water and easily survives on various surfaces, so hand-washing is recommended to prevent infections.

The NDM-1 gene was only recently discovered. The first infection was confirmed in April 2008 in an Indian person living in Sweden, according to Infectious Disease Surveillance Center spokesman Masaaki Nishikawa.

After the British medical journal The Lancet published an article about the increasing number of NDM-1 cases last month, the health ministry called on hospitals to investigate, leading to the discovery at Dokkyo Medical University Hospital, a ministry official said.

People from Britain, the Netherlands, Belgium, Australia and America were reportedly infected with germs containing the NDM-1 gene. The origin is thought to be India and Pakistan, where many of the patients had reportedly undergone cosmetic surgery. The infected Japanese man had reportedly been to India.

What are the symptoms?

It depends on what part of the body the bacteria enter. If Acinetobacter enters the lungs, patients may contract pneumonia, Hayashi said, adding that it generally sickens people with pre-existing diseases while healthy people will not have notable symptoms. Symptoms of E. coli with NDM-1 are the same as with regular E. coli, such as vomiting, diarrhea and fever that are typical in food-poisoning cases.

How are people infected?

Contact infection and droplet infection. Thus, a tiny drop of saliva released while talking can transmit Acinetobacter and E. coli. In the recent cases, the Acinetobacter infections are thought to have occurred in hospitals. Police are reportedly investigating hospitals on possible charges of negligence for failing to maintain a sufficiently clean environment.

Avoiding travel to India and Pakistan appears to be the most realistic option for avoiding infection with germs containing NDM-1.

What's the cure for Acinetobacter infection?

For healthy people carrying the bacteria and showing no symptoms, no treatment is necessary. Otherwise, antibiotics will be administered, though it's unclear which kind and in what amount, the Infectious Disease Surveillance Center says on its website. The treatment for infection with germs containing NDM-1 is also uncertain. The infected man has since recovered.

NDM-1 (Superflu) Commentary

The following are excerpts from various articles posted here in the past 24 hours.

Common symptoms: Urinary tract infections, blood infections, diarrhea

E. Coli: NDM-1 gene has been found inside the E. Coli bacteria.

Klebsiella Pneumoniae: Known as a bacteria hosting NDM-1

The majority of the patients treated to date who are positive for NDM-1 were those with urinary tract infections, bacteremia, or pneumonia.

The Lancet Infectious Diseases: The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.


CDC:
The Centers for Disease Control (CDC) said Tuesday that it is planning to list a new superbug NDM-1 as a communicable disease...
The CDC advises any hospitals that find such cases to put the patient in medical isolation, check the patient's close contacts for possible infection, and look for more infections in the hospital. Any case "should raise an alarm," Limbago said.

KPC (carbapenem-resistant carbapenemase):
Dr. Alexander J. Kallen, a medical epidemiologist and outbreak response coordinator with the U.S. Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion: In the United States, carbapenem-resistant bacteria -- designated carbapenem-resistant carbapenemase (KPC) -- are usually transmitted in health-care facilities such as hospitals and nursing homes, and are typically spread from patient to patient from contaminated surfaces and hands, he said.
How dangerous NDM-1 will become isn't known, Kallen said. But some studies have found the death rate from KPC [the North American bacterium] to be as high as 40 percent, he said.



U.S.A.
The American cases occurred in 2010 in people from California, Massachusetts, and Illinois, said Brandi Limbago, a lab chief at the CDC.
3 different bacteria were involved, and different mechanisms let the gene become part of them.
The American patients were not related.
The California woman needed hospital care after being in a car accident in India.
The Illinois man had pre-existing medical problems and a urinary catheter, and is thought to have contracted an infection with the gene while traveling in India.
The case from Massachusetts involved a woman from India who had surgery and chemotherapy for cancer there and then traveled to the USA.

Japan:
Thursday (September 9), Taiwan declared that NDM-1 had been classified as a category-four communicable disease, Tamil News Network (TNN) said. A category four means that hospitals and clinics will have to immediately report any suspected cases.

Shuhei Fujimoto, a professor at Tokai University's Department of Bacteriology and Bacterial Infection: ""Although the battle with multidrug-resistant bacteria has long been buttressed by developments of new antibiotics, we are in a critical situation at present,"...
E. coli with the gene to produce the NDM-1 enzyme that makes bacteria resistant to most antibiotics was reported for the first time in Japan last week.
Japan has confirmed another 5 cases of infection with _Acinetobacter_, an antibiotic-resistant bacterium, carrying what is formally know as "New Delhi metallo-beta-lactamase-1 enzyme (NDM-1)".

The cases from Teikyo University Hospital have brought the total number of people infected with the bug to 58 in the country. Of the 58 people, 32 have died,
including 9 whose deaths were likely caused directly by the infection, the Xinhua news agency reports.


China:
China's Ministry of Health has established a monitoring network nationwide for NDM-1 (New Delhi metallo-beta-lactamase), which is code for an enzyme that makes bacteria resistant to antibiotics, and selected 19 hospitals in major cities such as Beijing and Shanghai as sentinel hospitals in order to cope with potential threats, reporters learned on Sept. 14.

Thailand has not revealed cases of HIV "super bug ND M

Reported that, at present, Britain has more than 70 people infected with the NDM-1 "super bacteria", the number of infections in India and Pakistan and more than 170 people.

Canada also appears 2 infection "superbugs" cases...
One case was in Alberta, the other in British Columbia. Both patients had medical emergencies while traveling in India.

Although only 50 cases have been noted in the United Kingdom...The Department of Health in the UK, on the advice of the Health Protection Agency, has issued a National Resistance Alert 3 notice.

Australia
Dr M Lindsay Grayson, director of infectious diseases at the University of Melbourne in Australia. "It's just a matter of time" until the gene spreads more widely person-to-person, he said.

NDM-1 Map

Located on the right side-bar, this map will be updated periodically. It will contain cases and deaths (cases/deaths).

Thailand has revealed no bacteria were found resistant "super bug ND m - day".

Thailand has not revealed cases of HIV "super bug ND M - The" new drug-resistant bacteria. The only common but serious infection resistant to antibiotics work better. Warning people do not buy antibiotics, treat yourself. Patients should seek medical attention. And when to eat and then need to take to complete the doctor ordered.

3 U.S. states and Canada a "super bacteria"

According to reports, the United States within the three states found three cases of infection. It is reported that three patients had been to India, where 2 people in the local medical services, and the remaining 1 is itself sick, to rely on the catheter. Three patients are not life threatening, but unknown what kind of treatment they received.

Canada also appears 2 infection "superbugs" cases, doctors use a mixture of antibiotics.

Reported that, at present, Britain has more than 70 people infected with the NDM-1 "super bacteria", the number of infections in India and Pakistan and more than 170 people. (New), Chengdu Evening News reported on the 13th, according to U.S. media reports, three states recently discovered in the United States infected with the new "superbugs," the patients, their body variant of the "super bacteria" almost all antibiotics are "bulletproof."

..A pandemic is only a matter of time

Recently several patients in the treatment of the United States, doctors found that antibiotics can not kill the normal bacteria in their bodies, even those "last resort at the last moment before a doctor may prescribe antibiotics that have a strong effect", also on the human body bacteria helpless. Eventually, doctors discovered that the bacteria in their bodies are "superbugs" by the "infection" will become so powerful.

Scientists say the ability of drug-resistant bacteria has been enhanced, and human aspects of the discovery of more antibiotics has been no breakthrough, "superbugs," a pandemic is only a matter of time. For the growing "superbug" crisis, the medical profession has not developed the fundamental methods of treatment can only remind people wash their hands frequently engage in health, but also to remind doctors and patients to the proper use of antibiotics, the condition of patients given appropriate doses and types of antibiotics, do not abuse antibiotics.

Blue ear pig renewed outbreak in Quang Ngai

Pm 15 / 9, People's Committee of Binh Son District, Quang Ngai confirmed: blue ear disease has appeared in more than 22 pig breeding farms Do In, Giao Thuy village, Binh Thoi, Binh Son, Quang Ngai.


In it he says the number of pigs of all families with children is 24. About a week ago with symptoms of pigs stop eating, mild fever, paralysis and then sprout two stud pigs died.

After receiving information, SDAH Quang Ngai had serum samples sent veterinary offices IV tests.

The result is a herd infected with PRRS virus positive animal health agencies should have carried out the destruction of all pigs on.

Thus far Quang Ngai province is the 30th in the country have blue ear pig.

Dong Nai: making a human H1N1 death

RFA 15.09.2010

Information from the Center for Preventive Medicine of Dong Nai Province said a patient recently died of H1N1 infection. The patient was a 28-month-old girl in the city. Bien Hoa, Dong Nai province with manifest disease was originally diagnosed with bronchitis.

Meanwhile, blue ear pig continued expansion of the past few days. According to DAH, now has 29 provinces and cities have blue ear pig 21 days and the service continues to arise in many new areas in the provinces. Vinh Long province alone, the total number of infected pigs had up to 350 children, including 11 dead and destroyed. Long An province with 420 infected pigs, in which 70 children died and destroyed. In addition, there were about 180 pigs have been destroyed earlier in the districts in these provinces.

NDM-1 Facts and Symptoms

NDM-1 Facts


* Questions and Answers: For Q&As related to NDM-1 visit Mahalo Health Answers http://www.health-qna.com/1
* E. Coli: NDM-1 gene has been found inside the E. Coli bacteria http://www.medpagetoday.com/InfectiousDi...2
* Klebsiella Pneumoniae: Known as a bacteria hosting NDM-1 http://www.medpagetoday.com/InfectiousDi...3
* Common symptoms: Urinary tract infections, blood infections, diarrhea
* Bacteremia: Means bacteria in blood, may lead to blood infections or sepsis. http://www.medicinenet.com/sepsis/articl...4



NDM-1 is the gene responsible for the newest superbug. NDM-1 genes can live inside different bacteria and is resistant to currently available antibiotics.
http://omniphysicians.com/2010/08/10/ndm-1-a-new-global-threat/5 NDM-1 stands for New Delhi metallo-beta-lactamase-1.http://news.yahoo.com/s/afp/20100811/wl_uk_afp/healthdiseasebacteriaantibioticstravelindiapakistan6

NDM-1 symptoms are reported to be associated with the bacteria it attaches to. The currently known bacterias hosting this gene are E.Coli and Klebsiella pneumoniae. The majority of the patients treated to date who are positive for NDM-1 were those with urinary tract infections, bacteremia, or pneumonia.
http://www.medpagetoday.com/InfectiousDisease/PublicHealth/216367


Although only 50 cases have been noted in the United Kingdom, it is feared the spread will be global as the superbug has been associated with travel to India and Pakistan. Many travel to these counties for tourism as well as for low cost cosmetic procedures.
http://omniphysicians.com/2010/08/10/ndm-1-a-new-global-threat/8 In the U.S. none of the three known cases of NDM-1 bacteria were associated with the medical cosmetic travel seen in the UK.http://www.webmd.com/news/20100810/extremely-drug-resistant-infections-spreading-fast?page=29


There is a fear that the NDM-1 could jump to even more bacteria that are already resistant to even more antibiotics, making the NDM-1 affected bacteria impossible to kill by known methods. Drug resistance is transferred from one bacteria to another by plasmids, genetic material that move from one organism to another and reproduces, passing along the resistance. The NDM-1 is resistant to the number one antibiotic used for hard to treat infections and emergencies, the Carbapenems. The key aspects of containment by the Health Protection Agency include isolation of the sources and increased screening.
http://www.hpa.org.uk/hpr/archives/2009/news2609.htm10


A new study of NDM-1 by Dr David Livermore, director of antibiotic resistance monitoring at HPA, notes that the NDM-1 gene is wide spread in India.
http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2010PressReleases/100811resistance/11

The researchers noted that the popular press in the UK has made calls to the population to have corrective surgery done in India to decrease costs; however, doing this may be both life threatening as well as increasing costs in the long run. As a result of this study Dr. Livermore sees the NDM-1 gene as a potential worldwide health threat.
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2810%2970143-2/abstract12

He also recommends a coordinated international surveillance.
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2810%2970143-2/abstract13


The Department of Health in the UK, on the advice of the Health Protection Agency, has issued a National Resistance Alert 3 notice. They recommend that microbiologists be suspicious of isolates with resistance or reduced susceptibility to carbapenems and suspect isolates should be sent to ARMRL for further investigation.
http://www.hpa.org.uk/hpr/archives/2009/news0409.htm#enterora14

PloS ONE: Social Network Sensors for Early Detection of Contagious Outbreaks

Nicholas A. Christakis^1,2*, James H. Fowler^3,4

1 Faculty of Arts & Sciences, Harvard University, Boston, Massachusetts, United States of America, 2 Health Care Policy Department, Harvard Medical School, Boston, Massachusetts, United States of America, 3 School of Medicine, University of California San Diego, La Jolla, California, United States of America, 4 Division of Social Sciences, University of California San Diego, La Jolla, California, United States of America

Abstract

Current methods for the detection of contagious outbreaks give contemporaneous information about the course of an epidemic at best. It is known that individuals near the center of a social network are likely to be infected sooner during the course of an outbreak, on average, than those at the periphery. Unfortunately, mapping a whole network to identify central individuals who might be monitored for infection is typically very difficult. We propose an alternative strategy that does not require ascertainment of global network structure, namely, simply monitoring the friends of randomly selected individuals. Such individuals are known to be more central. To evaluate whether such a friend group could indeed provide early detection, we studied a flu outbreak at Harvard College in late 2009. We followed 744 students who were either members of a group of randomly chosen individuals or a group of their friends. Based on clinical diagnoses, the progression of the epidemic in the friend group occurred 13.9 days (95% C.I. 9.9–16.6) in advance of the randomly chosen group (i.e., the population as a whole). The friend group also showed a significant lead time (p>

Citation: Christakis NA, Fowler JH (2010) Social Network Sensors for Early Detection of Contagious Outbreaks. PLoS ONE 5(9): e12948. doi:10.1371/journal.pone.0012948

Editor: Olaf Sporns, Indiana University, United States of America

Received: June 22, 2010; Accepted: August 13, 2010; Published: September 15, 2010

Lancet Study on NDM-1

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

The Lancet Infectious Diseases, Volume 10, Issue 9, Pages 597 - 602, September 2010

doi:10.1016/S1473-3099(10)70143-2

Published Online: 11 August 2010

Summary

Background

Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.

Methods

Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene blaNDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan.

Findings

We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries.

Interpretation

The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.

Funding

European Union, Wellcome Trust, and Wyeth.

"Super bacteria" hundreds of people worldwide infected with the spread of

Out of China:

PRC "super bacteria" NDM-1 has spread worldwide trend, the United States three states and Canada have emerged infection.

医学界表示，细菌正在蔓延，但未知蔓延速度有多快，呼吁各国设立监控系统，检测入院人士，合力追踪病菌蔓延情况，并呼吁民众注意个人卫生，不要滥用抗生素。

Medical profession that the bacteria is spreading, but unknown how quickly spread, calls upon States to establish monitoring systems to detect people who admitted to jointly track the spread of the disease and urge people pay attention to personal hygiene, do not abuse antibiotics.

据报道，美国在境内3个州发现3名感染病例。

It is reported that within the three states in the United States found that three cases of infection. 据悉，这3名患者都曾到过印度，其中2人在当地接受医疗服务，余下1人则本身患病，需依赖导尿管。

It is reported that three patients had been to India, of which 2 were in the local medical services, and the remaining 1 is itself sick, to rely on the catheter.

3名患者目前没有生命危险，但未知他们接受了何种治疗。

Three patients are not life-threatening, but unknown what treatment they received.

加拿大也出现2宗感染“超级细菌”的个案，医生采用了混合抗生素治疗。

Canada also appeared two infections "super bacteria" cases, doctors use a hybrid antibiotics.

报道指出，目前，英国有超过70人感染这种NDM-1“超级细菌”，印度和巴基斯坦的感染人数则超过170人。

Reported that, at present, the United Kingdom more than 70 people infected with the NDM-1 "super bacteria", the number of infections in India and Pakistan more than 170.

（中新） (New)

No antibiotic candidates emerge to stem superbugs

From The Japan Times
Thursday, Sept. 16, 2010

Kyodo News

Japan's pharmaceutical industry doesn't have even a single candidate for new antibiotics to counter multidrug-resistant superbugs such as some types of Acinetobacter and E. coli bacteria, according to an expert reporting the situation to the government.

Shuhei Fujimoto, a professor at Tokai University's Department of Bacteriology and Bacterial Infection, said he alerted the Health, Labor and Welfare Ministry's study group on superbugs to the lack of new antibiotics indispensable to treat people infected with such bacteria.

"Although the battle with multidrug-resistant bacteria has long been buttressed by developments of new antibiotics, we are in a critical situation at present," he said.

Low profitability of antibiotics appears to be a factor behind pharmaceutical manufacturers' reluctance to make developmental efforts for new antibiotics, he said.

A total of 58 people have been infected with multidrug-resistant Acinetobacter in Teikyo University Hospital since last year, including some who have died. E. coli with the gene to produce the NDM-1 enzyme that makes bacteria resistant to most antibiotics was reported for the first time in Japan last week.

Fujimoto said he has told the ministry's study group that low profitability stems from the fact that a bacterium capable of resisting a new antibiotic is detected and reported in only four years on average after the antibiotic debuts, although new antibiotics development requires huge costs.

The medical community overseas faces a similar situation under which the number of newly developed antibiotics in the 2000s has plunged to less than one-fourth the corresponding number in the 1980s, he said.

In Japan, there were some years during the 1980s when the annual number of newly released antibiotics exceeded five. But no antibiotic promising enough to lead a drugmaker to release it on the market has been found since 2000.

19 hospitals in China's major cities prepare superbug NDM-1 prevention

September 15, 2010

China's Ministry of Health has established a monitoring network nationwide for NDM-1 (New Delhi metallo-beta-lactamase), which is code for an enzyme that makes bacteria resistant to antibiotics, and selected 19 hospitals in major cities such as Beijing and Shanghai as sentinel hospitals in order to cope with potential threats, reporters learned on Sept. 14.
　　
It's said that entrusted by the health ministry, the Institute of Clinical Pharmacology under Peking University formulated a monitoring plan targeting the super bacteria NDM-1 at the end of August that includes identification, verification and quarantine measures. The plan is currently pending the review and approval of the health ministry and will be publicized in the near future.

"The departments have responded rapidly by conducting proactive monitoring rather than passive defenses," said Li Geng, director of the Antibiotics Office in the Institute of Clinical Pharmacology under Peking University.

To better monitor and identify NDM-1, the health ministry designated 19 hospitals in Shanghai, Beijing, Tianjin, Liaoning and Jiangsu as sentinel hospitals. These hospitals must be equipped with necessary equipment and professional personnel in order to monitor and check patients with low immunity and critical illness, emergency patients as well as those from the South Asian subcontinent.

The Peking Union Medical College Hospital and the Peking University First Hospital in Beijing are among the sentinel hospitals. The Beijing Municipal Health Bureau said that the city's own bacterial resistant monitoring network to be established by the end of 2010 will focus on monitoring the superbug NDM-1 .

The monitoring plan requires that if any medical institution across the country finds positive drug-resistant Enterobacteria that has similar drug resistance features to NDM-1 during examinations, and does not have laboratory testing conditions, they must immediately send the bacterial strains to the nearest sentinel hospital. Furthermore, they should also report related information to the national drug-resistant bacteria monitoring network within 12 hours in order to get final confirmation by the Institute of Clinical Pharmacology under Peking University.

One day needed to identify super bacteria

The public can rest assured that China has techniques to easily detect and identify super bacteria. Li said that qualified hospitals will conduct both enzyme production experiments and genetic testing after receiving suspected bacterial strains.

"As the enzyme produced needs an overnight culture, an enzyme production experiment takes one day. Therefore, although the genetic testing only takes half a day, it will still take at least one day to identify super bacteria."

Once suspected bacteria are detected, the bacteria carrier should be immediately quarantined when researchers try to identify the bacteria in order to prevent the further spread.

Almost 100 percent accurate artificial gene

Health Ministry spokesman Deng Haihua said on Sept. 10 that China has not found any cases of the super bacteria so far, but a multi-layered defense system has been basically established.

A person in charge of the super-bacteria-related tasks at the Institute of Clinical Pharmacology of Peking University First Hospital said that based on the publicly available gene sequence of the super bacteria in question, China’s health authorities have synthesized a gene, which is almost 100 percent the same as the bacteria’s real gene, so as to examine whether a suspected strain of bacteria is genuine super bacteria or not. Therefore, super bacteria can be identified in time by using the synthesized gene before the standard gene is introduced to China.

Meanwhile, in order to solve the predicament that no drugs can kill the super bacteria, Guangzhou Pharmaceutical Holdings Limited and other scientific research institutions have already launched an anti-super bacteria drug R&D project, striving to achieve substantive results within five years.

By People's Daily Online

CDC to list new superbug NDM-1 as communicable disease

Taipei, Sept. 7 (CNA) The Centers for Disease Control (CDC) said Tuesday that it is planning to list a new superbug NDM-1 as a communicable disease and that hospitals should immediately report any suspected cases, especially those in which the patient has received medical treatment in India or Pakistan.

-snip-

China decoding bug bites virus transmission to humans

[Out of Vietnam]
Tuoi Tre Online - Tuesday, 14 / 9

TT-- Chinese researchers have discovered a new virus from patients with insect bites in Henan Province. Information on the virus data is a "family" most deadly virus but the good news is this kind of a "kind word" most.

CE Professor Yuan, an epidemiologist at the University of Beijing at the same time as the team members sick on China's Health Ministry, said after morphological analysis showed that this virus is a member belong to the Bunyaviridae.

Bunyaviridae has hundreds of members and growing rapidly with all the different names according to geographical aspects such as the Andes, Seoul, Amur River, Blue River and Lake Bloodland.

A member of the family Bunyaviridae viruses known and most thoroughly studied is the hantavirus.

Hantavirus is harmless in mice. But the reasons that science can not explain, once people get into, it became the "killer," brutally attacked the RNA (ribonucleic acid), specific molecules responsible platelet production. Patients will be high fever, vomiting, terrible pain, and kidney damage if not emergency in 72 hours will die from blood loss.

Mortality due to hantavirus infection than 50% in North America in the 90s but today it dropped to about 10%.

According to Professor Tu Yuan Xiaoping, because patients in Henan Province have symptoms similar to hantavirus infection should the team fear that this type of defendant brought the deadly virus. The discovery of new viruses as they Bunyaviridae reinforce this concern.

However, when they breathe a little more careful analysis of the nucleic acid of the virus suggests this virus have different structures with hantavirus. In fact, it is very much different than "members" have their virus known Bunyaviridae.

CE Raw said: "This is the most gentle member of the family Bunyaviridae that we are known. The death rate so far only about 3%. "

CE Professor Nguyen concluded: "We can see clearly now this is not a disease. Virus does not seem likely to spread from person to person. In such cases, it is not too dangerous and controlling it is easier than seasonal flu. "

PRO/EDR> NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan (02)

14-SEP-2010
ProMED-mail is a program of the International Society for Infectious Diseases

In this posting: [1] North America [2] Japan

[1] North America Date: Mon 13 Sep 2010 Source: Google news, Associated Press (AP) report [edited] An infectious-disease nightmare is unfolding: a new gene that can turn many types of bacteria into superbugs resistant to nearly all antibiotics has sickened people in 3 states and is popping up all over the world, health officials reported Mon 13 Sep 2010.

The USA cases and 2 others in Canada all involve people who had recently received medical care in India, where the problem is widespread.

A British medical journal revealed the risk in August 2010 in an article describing dozens of cases in Britain in people who had gone to India for medical procedures. How many deaths the gene may have caused is unknown; there is no central tracking of such cases.

So far, the gene has mostly been found in bacteria that cause gut or urinary infections. Scientists have long feared this, a very adaptable gene that hitches onto many types of common germs and confers broad drug resistance. "It's a great concern," because drug resistance has been rising and few new antibiotics are in development, said Dr M Lindsay Grayson, director of infectious diseases at the University of Melbourne in Australia. "It's just a matter of time" until the gene spreads more widely person-to-person, he said.

The American cases occurred in 2010 in people from California, Massachusetts, and Illinois, said Brandi Limbago, a lab chief at the CDC. 3 different bacteria were involved, and different mechanisms let the gene become part of them. "We want physicians to look for it," especially in patients who have traveled recently to India or Pakistan, she said.

The gene can spread hand-to-mouth, which makes good hygiene very important. It's also why health officials are so concerned about where the threat is coming from, said Dr Patrice Nordmann, a microbiology professor at South-Paris Medical School. India is an overpopulated country that overuses antibiotics and has widespread diarrheal disease and many people without clean water. "The ingredients are there" for widespread transmission, he said. "It's going to spread by plane all over the world."

The American patients were not related. The California woman needed hospital care after being in a car accident in India. The Illinois man had pre-existing medical problems and a urinary catheter, and is thought to have contracted an infection with the gene while traveling in India. The case from Massachusetts involved a woman from India who had surgery and chemotherapy for cancer there and then traveled to the USA.

Lab tests showed their germs were not killed by the types of drugs normally used to treat drug-resistant infections, including "the last-resort class of antibiotics that physicians go to," Limbago said. She did not know how the 3 patients were treated, but all survived.

Doctors have tried treating some of these cases with combinations of antibiotics, hoping that will be more effective than individual ones are. Some have resorted to using polymyxins, antibiotics used in the 1950s and '60s that were unpopular because they can harm the kidneys.

The 2 Canadian cases were treated with a combination of antibiotics, said Dr Johann Pitout of the University of Calgary in Alberta, Canada. One case was in Alberta, the other in British Columbia. Both patients had medical emergencies while traveling in India. They developed urinary infections that were discovered to have the resistance gene once they returned home to Canada, Pitout said.

The CDC advises any hospitals that find such cases to put the patient in medical isolation, check the patient's close contacts for possible infection, and look for more infections in the hospital. Any case "should raise an alarm," Limbago said. http://news.oneindia.in/2010/09/11/japanconfirms-five-more-cases-of-new-delhi-superbug.html

Japan has confirmed another 5 cases of infection with _Acinetobacter_, an antibiotic-resistant bacterium, carrying what is formally know as "New Delhi metallo-beta-lactamase-1 enzyme (NDM-1)".

The cases from Teikyo University Hospital have brought the total number of people infected with the bug to 58 in the country. Of the 58 people, 32 have died, including 9 whose deaths were likely caused directly by the infection, the Xinhua news agency reports.

NDM-1 is a type of bacteria resistant to carbapenems, one of the antibiotics of last resort for many bacterial infections. The bug is formally named after New Delhi, as it was reportedly discovered in the Indian capital. According to reports, it has spread to Britain and the USA through travelers who had surgery in India.

hat-tip Anne (Flutrackers.com)