H5N1

CIDRAP: News scan for August 31

Via CIDRAP: NEWS SCAN: Cholera in Africa, C diff in chicken, contaminated hospital uniforms, rural dengue, HFMD hits football team. Excerpt:

Almost two thirds of hospital physicians and nurses tested had potentially pathogenic organisms on their uniforms, even though 59% said they changed their uniforms daily, according to a study by Israeli researchers in the American Journal of Infection Control (AJIC), published by the Association for Professionals in Infection Control and Epidemiology (APIC). 

The research team used a convenience sample of 135 healthcare workers (HCWs) during a particular shift of a 550-bed university hospital, with less than 5% of available staff not participating. They sampled abdominal, sleeve, and pocket areas of uniforms but did not specify at what time during the shift samples were taken. 

The team found that 85 workers (63%) had positive samples, with no significant difference between physicians and nurses. Of the 238 samples obtained, 119 (50%) tested positive for at least one pathogen, with 79% of them testing positive for only one pathogen. 

The most common organisms were Acinetobacter, found in 89 samples, Staphylococcus aureus, in 32 samples, and Enterobacteriaceae, in 18 samples. Twenty-seven cultures contained drug-resistant pathogens, including eight that grew methicillin-resistant S aureus (MRSA). 

In a press release today from publishing house Elsevier, APIC President Russell Olmsted, MPH, said, "It is important to put these study results into perspective. Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene." 

The authors also listed some study limitations, such as relying on self-reporting of uniform changes and having a control group of only four laundered uniforms.

Katia expected to become a hurricane in Atlantic

Via Reuters AlertNet: Katia expected to become a hurricane in Atlantic. Excerpt:

Tropical Storm Katia was expected to strengthen into a hurricane over the open Atlantic on Wednesday while another mass of thunderstorms in the western Caribbean was headed for Mexico's Yucatan Peninsula, forecasters said. 

Katia had sustained winds of 65 miles per hour (100 km per hour) and would become the second hurricane of the June-through-November Atlantic hurricane season if those winds reach 74 mph (119 kph). 

"Strengthening is forecast during the next day or two and Katia will probably become a hurricane today," forecasters at the U.S. National Hurricane Center in Miami said. 

It was forecast to become a major hurricane with winds over 111 mph (178 kph) on Sunday but it was still too early to tell whether it would threaten land. 

At 11 a.m. EDT (1500 GMT), Katia was about 1,100 miles (1,765 km) west of the Cape Verde Islands. It was moving rapidly west-northwest and was forecast to turn northwest in a couple of days on a course that would keep it away from the Caribbean islands.

Bird flu deaths in Asia prompt call for scrutiny

Via Reuters, a report by Tan Ee Lyn, a veteran flu reporter: Bird flu deaths in Asia prompt call for scrutiny. Excerpt:

Virologists warned on Tuesday that there was no vaccine against a mutant strain of H5N1 bird flu now spreading in China and Vietnam and called for closer monitoring of the disease in poultry and wild birds to stop it spreading to people. 

The call came after the U.N. Food and Agriculture Organization (FAO) warned on Monday of a possible resurgence of bird flu and said a mutant strain of the H5N1 was spreading in Asia and beyond. 

While scientists are uncertain if this new strain -- called H5N1-2.3.2.1 -- is more virulent in people, they said it was different enough from its predecessor to escape a human H5N1 vaccine that can tackle the parent strain. 

"There is a human H5N1 vaccine candidate that is a (WHO) recommended vaccine ... But it doesn't confer full protection against the (new variant)," said leading virologist Malik Peiris at the University of Hong Kong. 

"But that is not unusual. H5 viruses keep changing and we have to change the vaccine strain."

Brazil: Rio declares dengue state of alert

Via Correio do Brasil: Prefeito do Rio decreta estado de alerta por causa da dengue. [Rio Prefect declares state of alert over dengue] Excerpt, with my translation:

O prefeito do Rio Eduardo Paes decretou nesta quarta-feira estado de alerta por causa da dengue. O anúncio foi feito diante da possibilidade de aumento significativo do número de casos da doença no verão de 2012. 

The Prefect of Rio, Eduardo Paes, today decreed a state of alert over dengue. The announcement was made given the likelihood of a significant increase in the number of dengue cases in the [austral] summer of 2012.

Segundo Paes,”infelizmente a evolução da dengue na cidade mostra que poderemos ter no verão a maior das epidemias da história, mas, felizmente, há luz no fim do túnel”.

According to Paes, "Unhappily the development of dengue in the city shows that this coming summer we could have the worst epidemic in history, but happily there is light at the end of the tunnel."

Hong Kong: Suspected case of scarlet fever with septic shock

Via Hong Kong's Centre for Health Protection: Suspected case of scarlet fever with septic shock. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is investigating a suspected case of scarlet fever complicated with septic shock involving a 15-month-old girl. 

Since August 22, the child presented with fever, chickenpox and sandpaper rash. She was admitted to Princess Margaret Hospital on August 29. As she developed tachycardia, she was today transferred to the Paediatric Intensive Care Unit of the hospital. 

The child is now in serious condition. Her clinical diagnosis was scarlet fever complicated with septic shock. 

Results of throat swab and blood culture are pending. The CHP's investigation revealed that the patient has no recent travel history. Her home contacts are asymptomatic.

Fukushima nuke plant workers irradiated on job ignored alarm: TEPCO

Via The Mainichi Daily News: Fukushima nuke plant workers irradiated on job ignored alarm: TEPCO. Excerpt:

Two workers exposed to high doses of beta radiation at the crisis-stricken Fukushima No. 1 Nuclear Power Plant on Aug. 28 were ignoring their dosimeter readings, plant operator Tokyo Electric Power Co. (TEPCO) announced on Aug. 30. 

The two men were both blasted with beta radiation while they and one other worker were replacing filters on a water decontamination system at the plant -- a task that requires pulling components out of the water. 

TEPCO stated that they ignored the radiation count on their dosimeters and continued to do the filter replacement despite absorbing radiation doses of 23.4 and 17.1 millisieverts respectively, exceeding the 15-millisievert limit for the operation. 

According to TEPCO, the men's radiation alarms sounded when their doses exceeded the 15-millisievert maximum, but they decided to complete the task with the help of the third worker as they had very little left to do. 

The utility also said the men's radiation control manager was not present at the time. Testing revealed the third worker absorbed a 1.1-millisievert dose.

India prepared to deal with bird flu: Government

Via Daily News & Analysis.com: India prepared to deal with bird flu: Government. Excerpt:

In the wake of the international agriculture monitoring and research body Food and Agriculture Organisation (FAO) issuing an alert for bird flu, the Indian government on Wednesday said it is prepared to handle any situation. 

"A few reports have come out in the press mentioning an FAO alert against a new and deadly mutant strain of avian influenza, popularly known as bird flu. The government has taken note of the FAO’s alert and is prepared for any eventuality," an agriculture ministry statement said. 

FAO, in a statement issued on August 29, has "urged heightened readiness and surveillance against a possible major resurgence of the H5N1 Highly Pathogenic Avian Influenza amid signs that a mutant strain of the deadly Bird Flu virus is spreading in Asia and beyond, with unpredictable risks to human health". 

The agriculture ministry statement sought to allay the fears, saying a standard procedure was followed when ever any case was reported and this has so far kept the situation in control. 

"Outbreaks of avian influenza have occurred in several countries in Asia for some time now. India has successfully handled all outbreaks in the country ever since the first outbreak of avian influenza in February 2006." 

According to the government, the last outbreak of bird flu which hit the northeastern India in February this year was controlled effectively. 

"The last outbreak took place during February-March, 2011, in Tripura. After following prescribed control and containment procedures the country was declared free from the disease with effect from July 4, 2011”.

Who gets dengue?

Via PLoS Medicine: Population Density, Water Supply, and the Risk of Dengue Fever in Vietnam: Cohort Study and Spatial Analysis. The abstract:

Background 

Aedes aegypti, the major vector of dengue viruses, often breeds in water storage containers used by households without tap water supply, and occurs in high numbers even in dense urban areas. We analysed the interaction between human population density and lack of tap water as a cause of dengue fever outbreaks with the aim of identifying geographic areas at highest risk. 

Methods and Findings 

We conducted an individual-level cohort study in a population of 75,000 geo-referenced households in Vietnam over the course of two epidemics, on the basis of dengue hospital admissions (n = 3,013). We applied space-time scan statistics and mathematical models to confirm the findings. 

We identified a surprisingly narrow range of critical human population densities between around 3,000 to 7,000 people/km2 prone to dengue outbreaks. In the study area, this population density was typical of villages and some peri-urban areas. Scan statistics showed that areas with a high population density or adequate water supply did not experience severe outbreaks. 

The risk of dengue was higher in rural than in urban areas, largely explained by lack of piped water supply, and in human population densities more often falling within the critical range. Mathematical modeling suggests that simple assumptions regarding area-level vector/host ratios may explain the occurrence of outbreaks. 

Conclusions 

Rural areas may contribute at least as much to the dissemination of dengue fever as cities. Improving water supply and vector control in areas with a human population density critical for dengue transmission could increase the efficiency of control efforts.

Will Haiti's biggest hospital be closed?

Via HaitiLibre.com: The strikers of the HUEH demonstrated yesterday in Port-au-Prince. Excerpt:

The striking employees of the Hospital of the State University of Haiti (HUEH) demonstrated yesterday in the capital, following a persistent rumor on the closing of the General Hospital, the largest hospital in the country, for a period of two years. A decision that would have been taken at the level of the Ministry of Public Health... 

The protesters have paralyzed traffic by lying on the floor, on the rue Saint Honoré at the level of Ministry of Health to protest against this possibility. 

The Director General of the HUEH, Dr. Alix Lassègue has not been able to clarify this rumor, "I can neither confirm nor deny this information. It does not fall under, in any case, the general hospital [...] So I can not provide any details for now..."

WHO on the "new" H5N1 strain

WHO has published a statement: Evolution of H5N1 avian influenza virus does not increase risk to public health.

WHO closely monitors the evolution of influenza viruses and is aware of recent reports of an H5N1 virus (described as H5N1 clade 2.3.2.1) circulating in poultry in parts of Asia. 

Based on available information, this evolution of the H5N1 virus poses no increased risk to public health. It is not considered unusual because influenza viruses are constantly evolving, especially in areas where they circulate regularly in poultry. 

The WHO Global Influenza Surveillance and Response System, the group of experts that studies animal and human influenza viruses that may impact human health, recognized this new clade in February 2011. 

WHO also routinely assesses the public health risk from all animal influenza viruses. Based on available information, the identification of this newly-reported H5N1 virus clade does not change the current public health implications of the H5N1 avian influenza viruses for humans. 

Human cases of H5N1 infection remain rare and sporadic events, occurring mostly in areas where H5N1 viruses circulate regularly in poultry. Human cases could occur wherever the viruses are present in poultry and when humans might be exposed to infected birds or contaminated environments.