H5N1

CIDRAP: News scan for March 28

Via CIDRAP: NEWS SCAN: Injection-related anthrax, drug-resistant gonorrhea, post-pandemic illness, imported rubella, polio vaccine deal. Excerpt:

A German analysis of patients hospitalized with 2009 H1N1 (pH1N1) flu during the pandemic year and the first post-pandemic year found that severe illnesses and deaths jumped dramatically the year after the pandemic. 

Researchers who conducted a retrospective study on patients hospitalized with lab-confirmed flu at University Hospital Heidelberg during the two seasons published their findings yesterday in Emerging Infectious Diseases. 

They identified 102 patients with pH1N1 infections during the 2009-10 season and 76 in the first post-pandemic season. The proportion of severe illnesses rose from 14% the first year to 46% the second year, and the mortality rate rose from 5% to 12%. Patients hospitalized during the post-pandemic season were older, at an average age of 38 compared with age 18 during the pandemic year. Those hospitalized during the second year were also more likely to have an underlying medical condition. 

Researchers noted that there weren't any virus changes that were known to account for the change in clinical pattern and that it's not unusual for trends to change from a pandemic season to the following one. They suggested that the increase in severity could reflect the effects of pH1N1 on remaining susceptible adults and risk groups.

Eurosurveillance: Anthrax among European heroin users

Via Eurosurveillance: Anthrax among heroin users in Europe possibly caused by same bacillus anthracis strain since 2000. The abstract:

Injection anthrax was described first in 2000 in a heroin-injecting drug user in Norway. New anthrax cases among heroin consumers were detected in the United Kingdom (52 cases) and Germany (3 cases) in 2009-10. In June 2012, a fatal case occurred in Regensburg, Bavaria. As of December 2012, 13 cases had been reported in this new outbreak from Germany, Denmark, France and the United Kingdom. 

We analysed isolates from 2009-10 and 2012 as well as from the first injection anthrax case in Norway in 2000 by comparative molecular typing using a high resolution 31 marker multilocus variable-number tandem repeat analysis (MLVA) and a broad single nucleotide polymorphism (SNP) analysis. 

Our results show that all cases may be traced back to the same outbreak strain. They also indicate the probability of a single source contaminating heroin and that the outbreak could have lasted for at least a decade. 

However, an additional serological pilot study in two German regions conducted in 2011 failed to discover additional anthrax cases among 288 heroin users. 

ECDC: Communicable disease threats report for week 11

ECDC has published Communicable disease threats report, 10-16 March 2013, week 11. Click through for the full report. The summary:

From 10 to 16 March 2013, ECDC monitored several on-going public health threats within and outside the European Union. 

Anthrax infections amongst people who inject drugs 

Health Protection Scotland in the UK reported a new fatal case of anthrax in Glasgow in a person who injects drugs. The incident, reported on 14 March, follows a similar one reported on 8 March in Suffolk, England and is the fifteenth such case in Europe since July 2012. This outbreak is the most significant of its types since the 2009/2010 outbreak in Scotland (with cases also reported from Germany and England). 

An update to the joint Rapid risk assessment by ECDC and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was issued in July 2012. One of its conclusions was that further reports of people who inject drugs being infected with anthrax could be expected. The conclusions of the Rapid risk assessment update remain valid, in particular, people who inject drugs remain at risk as contaminated heroin is still circulating in Europe. 

ECDC and EMCDDA are working together to develop guidance on the prevention of anthrax amongst people who inject drugs. 

Novel coronavirus 

On 12 March 2013, the World Health Organization (WHO) reported an additional case of novel coronavirus (NCoV) infection. The patient first developed symptoms on 24 February, was hospitalised on 28 February but subsequently died on 2 March in Saudi Arabia. The patient had no known contact with any of the other previously confirmed cases. There have been 15 confirmed cases of NCoV infection worldwide, nine of whom have died.

UK: Glasgow drug user is sixth anthrax death

Via Daily Record: A Glasgow drug user has died after injecting heroin which contained anthrax health officials have confirmed. Excerpt:

An injecting drug user who died earlier this week has tested positive for anthrax, health officials have said. 

The middle-aged man died in Glasgow on Sunday. 

Contaminated heroin, or a contaminated cutting agent mixed with the drug, may have been responsible for his death, officials said. 

NHS Greater Glasgow and Clyde said it was an isolated case in the city, and police are now investigating. 

The death was confirmed by the health board's Public Health Protection Unit (PHPU). 

Public health consultant Dr Syed Ahmed said: "This is an isolated case in Glasgow and there have been other sporadic cases in the UK and Europe in recent months. We are working with other services and colleagues to be on the lookout for any other possible cases, especially amongst other injecting drug users.

"Drug injecting is extremely risky and dangerous. I urge all drug-injecting heroin users to be extremely alert and to seek urgent medical advice if they experience an infection at the site of injection." 

Anthrax is a bacterial infection and is primarily a disease of herbivorous mammals, though other animals and some birds can also get infected. Drug users can be exposed when heroin is contaminated with anthrax spores. 

While injecting drug users need to be on their guard, the risk to the rest of the population is negligible, officials said. 

It is rare for anthrax to be spread from person to person and there is said to be no significant risk of airborne transmission from one person to another. 

The PHPU is now working with Strathclyde Police to identify a possible source of the infection.

ECDC: Communicable disease threats report for week 10

ECDC has published Communicable disease threats report, 3-9 March 2013, week 10. Click through to download the full report as a PDF. The summary:

From 3 to 9 March 2013, ECDC monitored several on-going public health threats within and outside the European Union.   

On 8 March 2013, the Health Protection Agency in the United Kingdom reported an additional fatal case of anthrax in Suffolk, England.   

Influenza activity remained substantial across Europe but an increasing number of countries reported indications of declining transmission.   

The Swedish Institute for Infectious Disease Control (SMI) reported about two on-going measles outbreaks in two counties in Sweden, Uppsala and Stockholm. In the United Kingdom, the Health Protection Agency reported about a measles outbreak in the North-East of England.   

On 6 March 2013, the Ministry of Health in Saudi Arabia informed the World Health Organization (WHO) about a new confirmed case of novel coronavirus (NCoV) infection. This brings the number of confirmed cases of NCoV infections to 14 globally, including eight deaths.   

The ECDC communicable disease threats report is a weekly bulletin intended for epidemiologists and health professionals in the area of communicable disease prevention and control.

ECDC on the latest anthrax death

ECDC has published an Epidemiological update: anthrax cases among people who inject drugs. Click through for several important links. The summary:

On 8 March, the Health Protection Agency in the United Kingdom reported an additional fatal case of anthrax in Suffolk, England. It concerns a person who injected heroine. This brings the number of anthrax cases among injecting drug users (IDU) in the EU since June 2012 to 14: four in Germany, two in Denmark, one in France, and seven in the UK (one in Scotland, five in England and one in Wales). Six of these cases were fatal. 

These 14 cases follow an outbreak of anthrax in 2009 and 2010 involving 127 injecting drug users in the UK (England and Scotland with five and 119 cases respectively) and Germany (three cases). 

This additional case is not unexpected and does not change the risk assessment made by ECDC and EMCCDDA published on 16 July 2012. The reporting of cases of anthrax among IDU in several countries over a long period of time suggests that contaminated heroin is still circulating in Europe. People who inject heroin in Europe are still at risk of exposure to anthrax. 

The two organisations are working together to produce a joint guidance document on the prevention of anthrax among IDU.

UK: Heroin user dies of anthrax

Via the Health Protection Agency: Suffolk patient with anthrax takes total in England to five cases. Excerpt:

The Health Protection Agency (HPA) is aware that a person who injected heroin has been diagnosed with anthrax infection in Suffolk and has died. 

There is an ongoing outbreak of anthrax among people who inject drugs in a number of countries in Europe with 13 cases now identified since early June 2012. The latest case in Suffolk brings the total number affected in the UK to seven – five in England (including four fatalities), one in Scotland and one in Wales. The source is presumed to be contaminated heroin. 

It is unclear as yet whether these recent cases are linked to the cases in Europe (four in Germany, two in Denmark and one in France) but the HPA is continuing to monitor the situation. 

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have concluded that heroin users in Europe are still at risk of exposure to anthrax. 

Dr Chris Williams, Consultant in Communicable Disease Control at the HPA (Norfolk, Suffolk and Cambridgeshire) said: 

“Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to be alert to the possibility of anthrax infection in heroin users presenting with signs and symptoms – which include severe soft tissue infections or blood poisoning – to prevent any delays in providing treatment. 

“It is possible that further cases may be seen in people who inject heroin. People who use drugs may become infected with anthrax when the heroin they use is contaminated with anthrax spores. This could be a source of infection if injected, smoked or snorted - there is no safe route for consuming heroin or other drugs that may be contaminated with anthrax spores.”

Namibia: Two die of anthrax in Oshikoto

Via allAfrica.com, a report from The Namibian: Namibia: Two Die of Anthrax in Oshikoto. Excerpt:

The director of health in the Oshikoto Region, Peter Angala, has confirmed that two people from villages in the Oniipa constituency have died after eating beef from cattle infected with anthrax, while more than eight villagers had to be treated at the Onandjokwe Lutheran Hospital. 

Some of the sick people have been transferred to the Oshakati State Hospital. 

Villagers affected the most, Angala said, are those from Omadhiya and Omulonga villages. 

Angala said the Onandjokwe Lutheran Hospital was overcrowded by the affected people. 

He said since anthrax can spread fast among people, medical personnel had been dispatched to the affected villages to treat people who might have eaten meat from the infected cattle. 

Among the villagers was a student from the University of Namibia campus in Windhoek, and health authorities are searching for him so that he can be treated. 

Angala told The Namibian yesterday that the outbreak would be discussed with veterinarians from the Ministry of Agriculture so that a mass immunisation campaign for animals, especially cattle from Omadhiya and Omulonga villages, can be undertaken. 

Measures have also been put in place at the Onandjokwe Hospital to isolate suspected cases and those already diagnosed with anthrax. 

According to Angala, the disease can be transmitted to human beings if a person with broken skin comes in contact with an infected animal or if a person eats the meat of an infected animal.

Now, where did I put that Ebola?

Via Nature News Blog: Now, where did I put that Ebola? Excerpt:

In the first study of its kind, the US Centers for Disease Control and Prevention unveiled statistics on problems related to the handling of hazardous biological agents, such as Ebola, SARS, and anthrax, at hundreds of academic and government research centres. 

Laboratories that work with biological select agents and toxins—materials highly regulated for their potential to cause human disease—reported that pathogens were inadvertantly released 639 times between 2004 and 2010. During the same period, laboratories also reported losing 88 samples, although bookkeeping errors accounted for all but one. The remaining lost sample was accidentally destroyed by a commercial courier. 

The study, which published in the current issue of Applied Biosafety, says that no occurrences of theft were reported. 

Over the 7-year period, laboratories reported 11 lab-acquired infections, at an average annual rate of 1.6 per 10,000 authorised workers. Ten of the infections were traced to bacterial sources, and one was due to fungal exposure. None of the infections were fatal, and none were reported to have spread to other people. 

The infections could not be linked to obvious breaches in personal protection, such as torn gloves or cuts from sharp objects. Instead, the authors suggest that workers likely acquired infections from the release of aerosols containing the harmful agents. The team says it is continuing to analyse reports of pathogen releases and lab-acquired infections to identify possible gaps in safety procedures.

I would link to the study, but it's available only to members of the American Biological Safety Association.

UK: Case of anthrax in Medway

Via the Health Protection Agency: Case of anthrax in Medway.

The Health Protection Agency (HPA) is aware that a person who injected heroin has been diagnosed with anthrax infection in Medway and has died. 

There is an ongoing outbreak of anthrax among people who inject drugs in a number of countries in Europe with 13 cases now identified since early June. The latest case in Medway brings the total number affected in the UK to six – four in England (including three fatalities), one in Scotland and one in Wales. The source is presumed to be contaminated heroin. 

It is unclear as yet whether these recent cases are linked to the cases in Europe (four in Germany, two in Denmark and one in France) but the HPA is continuing to monitor the situation. 

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have concluded that heroin users in Europe are still at risk of exposure to anthrax. 

Dr Fortune Ncube, an expert in infections among people who inject drugs at the HPA, said: “Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to be alert to the possibility of anthrax infection in heroin users presenting with signs and symptoms – which include severe soft tissue infections or blood poisoning – to prevent any delays in providing treatment. 

“It is possible that further cases may be seen in people who inject heroin. People who use drugs may become infected with anthrax when the heroin they use is contaminated with anthrax spores. This could be a source of infection if injected, smoked or snorted - there is no safe route for consuming heroin or other drugs that may be contaminated with anthrax spores.”