The Observatory

July 22, 2015


MERS cases continue to increase in South Korean outbreak. As this issue of MLO goes to press, 122 cases of Middle Eastern respiratory syndrome (MERS) had been reported in South Korea, and 10 deaths of the disease, in an outbreak that began in May. It is the most extensive outbreak that has occurred outside of the Middle East since the disease originated in Saudi Arabia in 2012. Some 25 nations have reported cases of MERS.

The South Korean government has taken steps to forestall public panic, including releasing information about which hospitals have admitted confirmed cases; there had been some criticism that by not doing so, authorities might be increasing anxiety. Monitoring of patient contacts is ongoing. Many schools have been closed, however, and many public events have been cancelled; sales of masks and hand sanitizer have been brisk.

The World Health Organization (WHO) has expressed confidence in highly developed South Korea’s public health system, and for the most part neighboring nations in East Asia are adopting a wait-and-see attitude. Ports of entry into Hong Kong, however, have adopted more stringent entry controls, and the Hong Kong Center for Health Protection has urged citizens to “avoid unnecessary travel” to South Korea.

Pentagon gives update on live anthrax shipments. As this issue of MLO goes to press, the Department of Defense is reporting that the number of labs known to have received live anthrax samples has risen to 66, in 19 states as well as Australia, South Korea, and Canada. The recipient labs included governmental, academic, and private facilities which had expected inactivated bacteria for research purposes but been sent the live samples by mistake. Authorities stressed that there is no evidence to suggest that the transfer of the live pathogen was deliberate, and that there is no indication that anyone has been put at risk of infection. They also stressed that the spore concentrations were not high enough to infect healthy persons, and that an examination of procedures for the inactivation of the bacterium via gamma ray irradiation was underway. A Pentagon spokesman, Col. Steve Warren, said, “There is no known risk to the general public, and there are no suspected or confirmed cases of anthrax infection in potentially exposed lab workers.”


Certain preoperative tests are still commonly ordered in the United States despite low value and high costs. Professional physician associations consider certain routine tests before elective surgery to be of low value and high cost, and have sought to discourage their utilization. Nonetheless, a new national study by researchers at NYU Langone Medical Center found that despite these peer-reviewed recommendations, no significant changes in the rates of several kinds of these pre-operative tests have occurred over a 14-year period.

In their review of the effect of specific professional guidelines across a diverse range of tests and surgery types, the researchers saw no significant decline in the use of plain radiography, or x-rays done without contrast; hematocrit, or the measurement of the percentage of red blood cells; urinalysis; and cardiac stress testing. The costs of such tests may be considerable, given that 30 million Americans undergo surgery each year, and 60 percent of patients undergo ambulatory procedures, which are performed on an outpatient basis.

The researchers analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1997 through 2010. These surveys, conducted annually by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics, examine pre-operative visits at office-based physician practices, hospital-based outpatient clinics, and emergency departments.

They discovered that while overall rates of routine testing declined across several categories during the 14-year period, after accounting for overall changes in physicians’ ordering practices, the declines were not statistically significant.

Antibiotic Resistance

Antibiotic use can be cut dramatically for abdominal infections, major trial shows. In a finding that is considered important for preventing the development of antibiotic-resistant superbugs, researchers at the University of Virginia School of Medicine and 22 other institutions have determined that the duration of antibiotic treatment for complicated abdominal infections can be cut by half and remain equally effective.

The researchers, led by the UVA team, looked at the treatment of infections after the source of the infection was addressed, such as the removal of an inflamed appendix. They found that administering antibiotics for only four days was as effective as treatments spanning eight days.

The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial was launched to provide the clarity doctors need. The trial looked at 517 patients in the U.S. and Canada who were suffering from an abdominal infection and agreed to participate. After their source infections were addressed, half were given antibiotics until their symptoms had been gone for two days, while the other half were given antibiotics for only four days. The outcomes were similar.

New Assays

Your viral infection history in a single drop of blood? Howard Hughes Medical Institute (HHMI) researchers are claiming that new technology makes it possible to test for current and past infections with any known human virus by analyzing a single drop of a person’s blood. The method, called VirScan, is being touted as an efficient alternative to existing diagnostics that test for specific viruses one at a time.

With VirScan, scientists can run a single test to determine which viruses have infected an individual, rather than limiting their analysis to particular viruses. That unbiased approach could uncover unexpected factors affecting individual patients’ health, and also expands opportunities to analyze and compare viral infections in large populations.

Stephen Elledge, an HHMI investigator at Brigham and Women’s Hospital, led the development of VirScan. “We’ve developed a screening methodology to basically look back in time in people’s sera and see what viruses they have experienced,” he says. “Instead of testing for one individual virus at a time, which is labor-intensive, we can assay all of these at once.” VirScan screens for antibodies against any of the 206 species of viruses known to infect humans.

Elledge and colleagues have already used VirScan to screen the blood of 569 people in the United States, South Africa, Thailand, and Peru. The scientists described the new technology and report their findings in a recent issue of the journal Science.


Post-operative elevations of two kidney biomarkers predict increased risk of acute kidney injury. An intervention known as remote ischemic preconditioning (RIPC) significantly reduced the occurrence of acute kidney injury (AKI) in cardiac surgery patients and confirmed that post-operative elevations of two kidney biomarkers act as an alarm for risk of AKI, according to a study published online in the Journal of the American Medical Association (JAMA).

Investigators in the study used Astute Medical, Inc.’s NephroCheck Test to obtain measurements of the two biomarkers, tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP-7). In addition to confirming that post-operative elevations of the biomarkers indicate risk for AKI, results of the study suggest that such testing could someday play a role in the optimization of preventative therapies for AKI.

A blood test to detect traumatic brain injury could reduce unnecessary CT scans. New study results show that a simple blood test to measure brain-specific proteins released after a person suffers a traumatic brain injury (TBI) can reliably predict both evidence of TBI on radiographic imaging and injury severity. The potential benefit of adding detection of glial fibrillary acidic protein breakdown products (GFAP-BDP) to clinical screening with computed tomography (CT) and magnetic resonance imaging (MRI) is described in an article published in the Journal of Neurotrauma.

Paul McMahon, MD, University of Pittsburgh Medical Center, and a team of international researchers analyzed blood levels of GFAP-BDP from patients ages 16 to 93 years treated at multiple trauma centers for suspected TBI. They evaluated the ability of the blood-based biomarker to predict intracranial injury as compared to the findings on an admission CT and a delayed MRI scan. The authors reported a net benefit for the use of GFAP-BDP above imaging-based screening alone and a net reduction in unnecessary scans by 12 percent to 30 percent.

Infectious Disease

As the Ebola epidemic comes to an end, Liberia is battling an older enemy: measles. Liberia has emerged from the devastating Ebola epidemic; the country has been declared Ebola-free. Public health officials have hardly had time to celebrate, however, as another disease has taken advantage of the turmoil caused by Ebola to make a comeback. The Ebola outbreak led to the collapse of most health services in Liberia, including routine vaccinations. A measles campaign scheduled for 2014 was suspended, leaving thousands of children susceptible. The immunity gap has led to Liberia’s worst measles outbreak in years.

The Liberian government moved swiftly this spring to organize a countrywide vaccination campaign with the help of the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, and other partners. For the organizers, it was a race against time to start the campaign before the onset of the rainy season, when roads become impassable and prevent vaccines from reaching outlying districts. In May, vaccination teams fanned out across the country, immunizing hundreds of thousands of children under age five against measles and polio. The campaign quickly and significantly helped slow the outbreak, but new cases are still emerging.

Most parents are eager to have their children protected against measles, but fear of a reintroduction of the Ebola virus runs high, and many still worry about bringing their children to health centers that cared for Ebola patients. This remains a significant challenge for healthcare personnel.

WHO member nations agree on strategy to reduce malaria by 90 percent by 2030. World Health Organization member states have agreed on a new global malaria strategy for 2016-2030. The strategy aims to reduce the global disease burden by 40 percent by 2020, and by at least 90 percent by 2030. It also aims to eliminate malaria in at least 35 countries by 2030.

Between 2000 and 2013, the global malaria mortality rate dropped by 47 percent. A major expansion of the WHO-recommended core package of measures—vector control, chemoprevention, diagnostic testing, and treatment—has proved to be both cost-effective and efficient. Nevertheless, millions of people are still unable to access malaria prevention and treatment, and most cases and deaths continue to go unregistered and unreported. In 2013, malaria killed an estimated 584 000 people worldwide.

The new strategy aims to build on recent successes in an effort to radically reduce this figure. The strategy provides a comprehensive framework so countries can develop tailored programs that will sustain and accelerate progress toward malaria elimination. It is comprised of three key elements: ensuring universal access to malaria prevention, diagnosis, and treatment; accelerating efforts toward elimination and attainment of malaria-free status; and strengthening malaria surveillance.

Industry News

The 2015 AACC Annual Meeting and Clinical Lab Expo will be held July 26 through July 30 at the Georgia World Conference Center in Atlanta, GA. The conference will include more than 400 educational sessions, “covering subjects from personalized medicine and infectious diseases to point of care and laboratory-developed tests” (AACC website). Daily plenary sessions will cover such topics as nucleic acids in plasma, gene discovery and novel therapeutics, and new approaches to managing HIV. The Clinical Lab Expo, which will debut more than 200 products, will host more than 700 exhibitors—including MLO. Come see us at Booth 4551.