H5N1

Random Analytics: MERS-CoV infographic update for October 1

Shane Granger at Random Analytics has updated his QuikStats: MERS-CoV (September 2013) infographic to include the latest cases. It's a good way to see, literally at a glance, the scope of MERS so far.

South Sudan: Three new polio cases

Via ProMED-mail, a news release from the South Sudan Ministry of Health: Poliomyelitis update (22): South Sudan, Global. Excerpt:

The Government of South Sudan is treating as an utmost priority an outbreak of polio in South Sudan. 3 children have been confirmed with the infection, 2 in Northern Bahr el Ghazal State and another in Eastern Equatoria State. 

"We consider this a national health emergency," the Honourable Dr Riek Gai, Minister of Health, said on Monday [30 Sep 2013] morning. We are mobilizing from the highest level of Government to every community in the country in order to stop this disease. 

"We are also working closely with WHO, UNICEF, and other key partners around the world and here in South Sudan to ensure the most effective response. Together, we will stop the spread of polio in South Sudan," the Minister added. 

Two girls, aged 2 and 8, living in Aweil South County, Northern Bahr el Ghazal State and a 2-year-old girl in Ikotos county, Eastern Equatoria State, were confirmed on 26 Sep 2013 as having polio. The status of the 3 girls is being followed closely. The cases were confirmed by the Kenya Medical Research Institute in Nairobi. 

South Sudan had been polio-free since June 2009. 

Since the polio outbreak in Somalia was confirmed in May [2013], quickly followed by its spread to Kenya and Ethiopia, medical authorities across South Sudan have been on high alert to look for any possible cases in this country. The Ministry of Health and its partners conducted additional polio vaccination campaigns in August [2013] in the States considered most at risk from the outbreak in the affected countries on its borders. Those States were Upper Nile, Jonglei, Eastern Equatoria, and Central Equatoria. Pariang County in Unity State was also included in that vaccination campaign. 

Immediately following the confirmation of the 3 polio cases, the Government and partners responded with emergency vaccinations in the areas where the virus was detected. The emergency "mop-up" campaign, in Aweil South County in Northern Bahr el Ghazal State, and Gogrial West county in Warrap State and Ikotos and Budi counties in Eastern Equatoria State will continue through 4 Oct [2013]. This "mop-up" campaign is designed to stop the spread of the virus quickly.

CIDRAP: Saudis report more MERS-CoV cases; serologic study draws blank

Via CIDRAP, a report by Robert Roos: Saudis report more MERS-CoV cases; serologic study draws blank. Excerpt:

Saudi Arabia reported three more Middle East respiratory syndrome coronavirus (MERS-CoV) cases today, while a serologic study of 268 children and men in eastern Saudi Arabia found that none had antibodies suggesting past exposure to the virus. 

The Saudi Ministry of Health (MOH) said the three new cases involve an 87-year-old woman, a 53-year-old woman, and a 63-year-old man, all of them Saudi citizens and all being treated in hospital intensive care units. The statement was dated Sep 27 but was posted online today. 

The MOH said all three patients had other diseases—chronic in two cases—before they were found to have MERS. The statement did not list their home cities or give any other details. The MOH now shows a national total of 114 MERS-CoV cases, with 49 deaths. 

The serologic study, released Sep 27 by Emerging Infectious Diseases, suggests that the virus was not widespread among men in Saudi Arabia's Eastern province late last year. However, an expert who was not involved in the study noted that no serologic tests for the virus have been fully validated, leaving some uncertainty about the findings. 

Few MERS-CoV seroprevalence studies have been conducted, leaving it unclear whether many infections have gone undetected because they caused no or only mild symptoms. 

In the study, German and Saudi researchers analyzed samples collected from two sets of patients at King Fahd Hospital of the University of Alkhobar, Saudi Arabia: children hospitalized for lower respiratory infections from May 2010 through May 2011, and men who donated blood in December 2012. Collection of samples from the children predated the emergence of MERS-CoV in April 2012. 

The children had a mean age of 11.6 months (range, 7.3 months to 9 years), while the men's median age was 28 years (range, 19 to 52). 

The test used was a lentivirus vector that incorporates the spike (S) protein of MERS-CoV. The test "mimics key aspects of MERS-CoV cellular entry and enables sensitive and quantitative detection of neutralizing antibodies," the report says. 

By examining the lentivirus vector's effect on target cells, the researchers determined that none of the samples contained neutralizing antibodies against MERS-S.

Yang: Are bats carrying the next plague?

Via The Star, Jennifer Yang writes: Are bats carrying the next plague? Excerpt:

The first time Jon Epstein tried to catch a bat, things went awry. 

It was the summer of 1998 in Australia, and a grey-headed flying fox had just flown into Epstein’s net. The 24-year-old veterinary student was going through the motions — controlling the bat’s feet and wings, gently securing the jaw — when he suddenly lost his grip. Chomp. 

Epstein jerked his arm and the bat “pancaked” on the ground, startled but unhurt. Flustered, he scrambled to pick it up. 

“Then, when I looked at his mouth, it turned out it didn’t have any teeth,” Epstein recalls today from New York. “As a first time getting bitten, that was probably the best way it could have happened: a toothless old bat.”

Fifteen years and thousands of bats later, Epstein has perfected his technique, having gone on bat-trapping expeditions everywhere from the suburbs of Australia to Malaysia’s mangrove forests. 

The wildlife veterinary epidemiologist is part of a fast-growing cohort of international scientists studying not only bats but also the viruses they carry. Bat research is booming and scientific publications have doubled in the last decade alone, says virologist Linfa Wang with Duke-NUS graduate medical school in Singapore. 

“Without exaggeration, every month there is a new paper describing bat viruses,” says Wang, often dubbed the “bat man” by colleagues. “My lab — we’re sitting on 60 new viruses we (found in bats but) haven’t yet published.” 

Why the surging interest in bat viruses? One good reason is Ebola. Another is SARS. Then there is Marburg, Hendra, Nipah and, most recently, MERS, plus several other nasty diseases contributing toward a growing body count around the world. 

All are viruses that are particularly deadly to humans. All have emerged in the last few decades. 

And all of these viruses, it would appear, have come from bats.

Report calls for hepatitis C testing of Canadian boomers

Via The Globe and Mail: Report calls for hepatitis C testing of Canadian boomers. The CMAJ article mentioned is behind a paywall. Excerpt:

A team of liver specialists joined the chorus of Canadian experts calling for a national strategy to diagnose and treat hepatitis C in Canada’s baby-boomer population, in a report published Monday in the Canadian Medical Association Journal. 

“Hepatitis C is clearly underdiagnosed and undertreated throughout North America,” said co-author Dr. Jordan Feld, a hepatologist at the Toronto Western Hospital Liver Centre. “This is a curable infection,” he added, “but most people don’t know they have it.” 

Individuals with hepatitis C typically show no symptoms until they develop advanced liver disease – usually decades after they are infected. By that stage, Feld said, “sometimes the only option is a liver transplant.” 

If the virus is detected early, current treatments can cure about 60 per cent of patients diagnosed with hepatitis C. But Feld predicts that better treatments with an estimated cure rate of at least 90 per cent will be available by the end of 2014. Drug treatments are far more cost-effective than liver transplants over the long term, he added: “We’re just at the cusp of having all these new therapies, so it makes sense to start treating people now.” 

As the Globe and Mail reported in September, an estimated one in 33 baby boomers in Canada is infected with hepatitis C. Due to high infection rates in boomers as well as immigrants, the Canadian Liver Foundation recommended in 2012 that all Canadians born between 1945 and 1975 be tested for the virus.

India: Medical test for zoo staff following leptospirosis threat

Via The Times of India: Medical test for zoo staff following leptospirosis threat. Excerpt:

KANPUR: To rule out the infection of any zoonotic disease including leptospirosis in zoo staff, the blood samples of all the employees are being collected for pathological test these days. This is for the first time that a medical test is being conducted for the zoo staff on such a large scale. The drive was started following the threat from leptospirosis as it is a zoonotic disease and is highly communicable. 

The drive kickstarted after it was detected that the lioness Lakshmi was suffering from the disease leptospirosis caused by the bacteria leptospira. Though, earlier it had been planned to conduct pathological examinations and complete medical checkup of the entire zoo staff including zoo officials and veterinarians but the lioness' ailment added to the seriousness of the issue. 

Every day a group of eight zoo employees are sent to a renowned diagnostic centre where their blood samples are taken. Pathological test will be conducted on as many as 92 staff members and a sum of Rs 5.5 lakhs [US$8,788] will be incurred in carrying out all the tests. The funds for this purpose have been roped in from the Kanpur Prani Udayan Evam Vikas Society. 

Talking to TOI, Kanpur zoo director, Kuruvilla Thomas said the approval for conducting medical test for entire zoo staff was sought from the Kanpur Prani Udayan Evam Vikas Society. A sum of Rs 6,000 [US$95] per person would be incurred on these tests, he added.

US: McKay on shutting down the CDC

Via the Wall Street Journal, a disturbing report from Betsy McKay: CDC Shutdown: No In-Depth Investigations of Outbreaks. Excerpt:

Better hope for no big outbreaks of hepatitis A, salmonella, or flu if the federal government shuts down. 

A government shutdown will furlough 68% of staff – meaning 8,754 people — at the Centers for Disease Control and Prevention, according to a fiscal year 2014 “Contingency Staffing Plan for Operations in the Absence of Enacted Annual Appropriations” on the Department of Health and Human Services’ website. 

That means no in-depth investigations to identify and link outbreaks that may be occurring simultaneously in multiple states, according to a CDC spokeswoman. While state public health investigators may detect outbreaks on their own territory, “we won’t be doing the cross-state consultation and laboratory work to link outbreaks that might cross state borders,” such as a hepatitis A outbreak earlier this year that sickened 162 people in 10 states, spokeswoman Barbara Reynolds said in an email. The CDC investigation helped link the infections to pomegranate seeds from Turkey. 

Nor will CDC have staff or funding to fight measles outbreaks or monitor seasonal flu activity, she said. Surveillance for emerging diseases like MERS, the deadly virus that has sickened more than 130 people and killed 58, mostly in Saudi Arabia, will be limited, she said.

Talk about politics as medicine on a large scale! Ironically the CDC's own website has a big feature on its website about its Epidemic Intelligence Service—but no mention of the staff furloughs.

Mexico: Cholera cases in Hidalgo rise to 44

Muchísimas gracias a Vicente Lozada in Mexico City for tweeting about this story. Via Excelsior: Se eleva a 44 la cifra de casos de cólera en Hidalgo.[Cholera cases in Hidalgo rise to 44] Excerpt, with my translation:

La Secretaría de Salud federal confirmó 44 casos de cólera en el estado de Hidalgo. De acuerdo con la dependencia, en la entidad hay 33 casos más en estudio; 10 personas de éstas están, de hecho, hospitalizadas. 

The federal Secretariat of Health has confirmed 44 cholera cases in the state of Hidalgo. According to the Secretariat, 33 more cases are under study; 10 of these are hospitalized.

En conferencia de prensa, la secretaria de Salud, Mercedes Juan López, advirtió del riesgo de que esta situación se pueda ampliar al resto del país, “pudiera llegar a pasar, pero por todo lo que se está haciendo lo que pensamos es que no va a pasar hacia otros estados; entonces, hasta este momento, solamente está en el estado de Hidalgo el ‘Vibrio cholerae’, que es el que también está en otros países como Haití, República Dominicana y Cuba”. 

In a press conference, Health Secretary Mercedes Juan López, warned about the risk of the situation spreading across the country: "It could happen, but given all that's being done we don't think the disease will move into other states. So at the moment only the state of Hidalgo has the Vibrio cholerae, the same as in other countries like Haiti, Dominican Republic, and Cuba."

Hasta el momento, sin embargo, la funcionaria federal descartó que exista brote o epidemia por cólera en el país. 

For now, nevertheless, the federal official denied that there is an outbreak or epidemic of cholera in the country.

Hay que recordar que esta enfermedad causó la primera defunción en más de una década de no registrase. La víctima fue una mujer de 61 años que sufría insuficiencia renal crónica, diabetes y obesidad.

It should be mentioned that this disease has caused the first death after over a decade without one. The victim was a woman of 61 who suffered chronic renal insufficiency, diabetes, and obesity.

Note that the Health Secretary very matter-of-factly mentions Cuban cholera. I take this and other reports to mean that everyone in Latin America is aware of the Cuban outbreak, even if the Pan American Health Organization doesn't mention it. And while Mexico and Cuba have good relations, the secretary clearly doesn't care if her remark annoys the Cuban government.

Mexico: Enough medicine available to deal with cholera

Via El Universal: Garantizan abasto de medicina para cólera.[Sufficient medicine for cholera is guaranteed] Excerpt, with my translation:

La subsecretaria de Salud en Hidalgo, Ana María Tavares, informó que se encuentra garantizado el abasto de medicamentos para atender la contingencia por cólera en el estado, la cual originó que se decretará una alerta epidemiológica en los 84 municipios de la entidad.

Hidalgo state Subsecretary of Health Ana María Tavares, said sufficient medications are guaranteed for dealing with cholera in the state, where an epidemiological alert has been declared in the states's 84 municipalities.

La semana pasada se dio a conocer la confirmación de siete casos positivos de este padecimiento, así como y un fallecimiento; los casos se han registrado en los municipios de Huejutla, Pachuca, Tula, Ajacuba y San Agustín Tlaxiaca; además, hay al menos unas 40 muestras en el laboratorio por casos sospechosos.

Last week it was reported that 7 cases had been confirmed, as well as a death. Cases have been recorded in Huejutla, Pachuca, Tula, Ajacuba, and San Agustín Tlaxiaca. As well, at least 40 samples from suspected cases are being tested.

ECDC: Monitoring current health threats, week 39

On September 27, ECDC published Monitoring current health threats, week 39/2013: measles and possible polio re-emergence in focus. Click through to download the full report and use the many links. The summary:

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. Some of the diseases included in this week’s report are: 

West Nile fever 

The current West Nile fever (WNF) season is progressing comparable to previous years both within the European Union (EU) and its neighbouring countries. In the week up till 27 September 2013, 20 new cases were detected in the EU: 3 from Greece, 13 from Italy and 4 from Romania. Serbia reported 28 new cases. This brings the number of reported cases to 187 in the EU and 464 in EU neighbouring countries since the beginning of the 2013 transmission season. See also the latest update on ECDC’s weekly West Nile fever maps. 

Poliovirus 

Wild-type polio virus 1 (WPV1) has been isolated in sewage and in the faeces of asymptomatic carriers in Israel in samples collected from 3 February to 25 August 2013. However, no cases of paralytic polio have been reported in Israel, the West Bank or Gaza. During the week leading up to 26 September 2013, no new positive poliovirus samples have been detected. 

ECDC’s risk assessment on the situation concludes that there is the possibility that poliovirus may be imported and re-established in the countries of the EU and European Economic Area.  

Measles 

The transmission season for measles persists in Europe with on-going outbreaks in the Netherlands and Germany. Dutch authorities have reported 1 540 measles cases since May 2013. The actual number of cases is estimated to be much higher. According to the German Federal Ministry of Health, the number of reported measles cases has been nearly ten times higher than the complete number of infections in 2012. As of 11 September 2013, 1 520 cases have been notified, most of them reported in Bavaria, followed by Berlin and North Rhine and Westphalia. 

The target year for measles elimination in Europe is 2015. The current outbreaks suggest that endemic measles transmission continues in many EU Member States and the prospect of achieving the 2015 objective is diminishing. During the period August 2012-July 2013, 11 of the 30 EU/EEA countries met the elimination target of less than one case of measles per million population. In the EU neighbouring countries, measles outbreaks are on-going in the Russian federation, Turkey and Georgia.   

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) 

Between 19 and 26 September 2013, 3 new MERS-CoV cases, including 2 deaths, have been reported by the national health authorities of the Kingdom of Saudi Arabia. The World Health Organization (WHO) has confirmed a death of a previously reported patient from Qatar. Two secondary cases in Italy are now re-classified as probable cases. WHO’s Emergency Committee has concluded on 25 September 2013 that "conditions for a Public Health Emergency of International Concern have not at present been met".