H5N1

'Powerful piece of circumstantial evidence' that virus causes paralyzing illness in kids

Via CBC News, an AP report: 'Powerful piece of circumstantial evidence' that virus causes paralyzing illness in kids. Excerpt:

Scientists have found the strongest evidence yet that a virus is to blame for a mysterious illness that can start like the sniffles but quickly paralyze children.  

The poliolike syndrome, called acute flaccid myelitis or AFM, is very rare. Since the first reports from California in 2012, the U.S. has experienced an increasingly bigger outbreak every other year, from late summer into fall.  

Doctors have a chief suspect but proof that it's the culprit germ has been frustratingly elusive. 

So researchers tried a new trick: They checked patients' spinal fluid for signs the immune system had fought an invading virus. Sure enough, kids who got sick harboured antibodies that target enteroviruses, just the viral family specialists believe is to blame. 

"This is circumstantial evidence that this is what's going on, but it's a powerful piece of circumstantial evidence," said Dr. Michael Wilson of the University of California, San Francisco, who helped lead the research. His team reported the findings Monday in Nature Medicine. 

Nailing down a suspect is key to better diagnosis and eventually finding a way to prevent or treat the illness, said study co-author Dr. Riley Bove, a neurologist at the university whose own son developed AFM at age 4. 

"If you don't have a cause, you can't have a vaccine," Bove noted. Wilson developed "a good enough microscope, in a sense, to find things they suspected were there."  

Some 590 cases of the ailment have been confirmed in the U.S. since the Centers for Disease Control and Prevention began counting in 2014. Cases spiked that year and in 2016 and last year, with just a few in the intervening years. So far, there have been 22 this year.  

As of June 6, four cases of AFM have been reported in Canada, compared with 59 last year.

Increased detection of enterovirus A71 infections, Germany, 2019

Eurosurveillance has published Increased detection of enterovirus A71 infections, Germany, 2019. The introduction:

In Europe, enterovirus A71 (EV-A71) has mainly been detected sporadically in patients with neurological disorders. C2 has been the predominant sub-genogroup during the last decade. A multi-recombinant C1 lineage (C1-like) emerged in 2015 in Germany. Since then, it was detected in sporadic cases with severe neurological disease in several European countries, as well as in an outbreak in Catalonia, Spain in 2016. In south-eastern Asia, EV-A71, sub-genogroup C4 strains have been mainly associated with severe and even fatal courses of hand, foot and mouth disease (HFMD) in children. 

Here we report on an increase of EV-A71 C1-like strains in Germany in 2019 and first detections of EV-A71 C4 strains in patients with neurological disease and HFMD.

Hong Kong: CHP investigates hand, foot and mouth disease outbreaks in three schools

Via the Centre for Health Protection: CHP investigates hand, foot and mouth disease outbreaks in three schools. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (December 17) investigating outbreaks of hand, foot and mouth disease (HFMD) in two secondary schools and one primary school, and again urged the public, schools and institutions to maintain strict hand, personal and environmental hygiene.      

The first outbreak affected four male and 16 female students aged 12 to 17 at a secondary school in Sha Tin. They have developed oral ulcers, rash and vesicles on hands or feet, and fever, since November 2. All of them sought medical attention but none required hospitalisation.        

The second outbreak was at a secondary school in Kwai Chung, affecting 16 male and three female students aged 16 to 18, as well as one female staff member. They have developed oral ulcers, rash over hands or feet and fever since December 7. All of them sought medical attention and one required hospitalisation.        

The third outbreak affected 18 male and two female students aged 6 to 10 at a primary school in Wan Chai. They have developed fever, rash over hands or feet and oral ulcers since November 24. All of them sought medical attention but none required hospitalisation.       

All patients of the above outbreaks are now in a stable condition.      

Officers of the CHP have conducted site visits to the schools and advised the management on necessary infection control and preventive measures. The schools have been put under medical surveillance. Investigations are ongoing.

Acute flaccid paralysis (AFP) surveillance: Challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015

Via Eurosurveillance: Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015. The abstract:

Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. 

The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000–0.78/100,000). Two periods (P) are described: P1 (1998–2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007–2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. 

Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain–Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. 

AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.

ECDC: CDTR, July 29-August 4

ECDC has published Communicable disease threats report, 29 July-4 August 2018. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 29 July-4 August 2018 and includes updates on poliomyelitis, dengue, Vibrio growth in the Baltic Sea, West Nile virus, Enterovirus detections and Ebola virus disease.

Peru: Hospitals on alert for Guillain-Barré syndrome

A May 8 news release from the Ministry of Health: .Hospitales del país en alerta por Sindrome de Guillain-Barré. Excerpt, with my translation:

Frente al brote de más de 15 casos sospechosos de Síndrome de Guillain Barré en La Libertad y 4 en Lima, el Ministerio de Salud (Minsa) declaró la alerta epidemiológica nacional, a fin de que todos los establecimientos asistenciales del país refuercen sus acciones de vigilancia y bioseguridad en sus servicios, de manera tal que de presentarse otros casos similares los notifiquen de inmediato al Sistema Nacional de Salud. 

Facing an outbreak of over 15 suspected cases of Guillain-Barré syndrome in La Libertad and four more in Lima, the Ministry of Health has declared a national epidemiological alert. The purpose is ensure that all health services in the country reinforce their surveillance and biosecurity so that they can immediately notify the National Health System if they encounter similar cases.

La Viceministra de Salud Pública del Minsa, María del Carmen Calle, precisó que desde el primer momento su Sector tomó las acciones necesarias para atender oportunamente a los pacientes que presentan síntomas relacionados con síndrome de Guillain Barré, así como para dar inicio a las investigaciones científicas que logren establecer un diagnóstico certero de los casos presentados en las últimas semanas.  

Vice-Minister of Public Health María del Carmen Calle said that from the first moment her sector took needed actions to attend promptly to patients presenting symptoms of Guillain-Barré syndrome, and launched scientific investigations to establish a reliable diagnosis of the cases presented in recent weeks.

En conferencia de prensa, la viceministra Calle, sostuvo que los pacientes con síntomas compatibles a esta enfermedad inmunológica vienen recibiendo el tratamiento adecuado en base al suministro del medicamento inmunoglobulina, solo 4 personas reciben respiración asistida, señaló. 

In a news conference, Vice-Minister Calle said the patients with symptoms compatible with this immunologic illness continue to receive adequate treatment based on the supply of immunoglobulin. Only four persons are on assisted respiration, she said.

A la fecha, los estudios de laboratorio realizados a muestras de secreciones, sangre, heces y orina, identificaron un probable tipo de enterovirus, que ataca al intestino vía fecal e ingresa por la boca o aparato respiratorio por falta de higiene luego de ir al baño. Este microorganismo suele producir síntomas como resfrío, vómitos, diarreas y frecuentemente dolores ascendentes y descendentes en las extremidades. 

To date, lab tests on samples of secretions, blood, stool and urine have identified a probably enterovirus that attacks the intestine through fecal matter received orally or nasally due to poor hygiene after going to the bathroom. This micro-organism usually causes symptoms such as chills, vomiting, diarrhea, and often pains going up and down the extremities.

Por su parte, el jefe del Instituto Nacional de Salud (INS), Hans Vásquez, explicó que su institución ha detectado de manera preliminar la presencia de un enterovirus en muestras de secreción de líquido cefalorraquídeo y heces de pacientes con problemas neurológicos y “en los próximos días se espera tener la identificación exacta tras un proceso de genotipificación de algunos exámenes adicionales que se están realizando”.

For his part, the chief of the National Health Institute, Hans Vásquez, explained that his institution has preliminary evidence of an enterovirus in samples of cerebrospinal fluid and stools of patients with neurological problems: "In the coming days we hope to have an exact identification after a genotyping process for some additional tests being conducted."

Brazil: More on 'black urine' disease

Oddly enough, this report appeared in O Globo yesterday, a day before the Globo report just below, which doesn't say anything about its possibly being caused by an enterovirus or parechovirus: Doença que torna urina preta tem semelhanças com surtos na Europa. [Disease that turns urine black has resemblances to outbreaks in Europe] Edited excerpt from the Google translation:

RIO - Researchers at the Federal University of Bahia (UFBA) are analyzing material samples from patients who may have contracted a mysterious disease that causes intense muscle pain and leaves the urine black. The 52 suspected cases first emerged in December.

 

According to the State Department of Health (Sesab), a man who died on the 31st of March presented the symptoms, but it cannot be said that the unknown disease killed him, since he suffered from other health problems, such as hypertension.

 

According to researcher Gubbio Soares, from the Laboratory of Virology of UFBA, the team can't identify the disease and its origin until next week. But tests of feces and urine indicate that the disease can be caused by a virus of the genus Enterovirus or the genus Parechovirus. Although not fatal, these viruses can lead to kidney failure if not treated properly. The Oswaldo Cruz Foundation (Fiocruz) is also analyzing material samples.

 

The cases are concentrated in the region of Salvador. The onset of symptoms is similar to small outbreaks, such as in Japan, between 2008 and 2014, in France between 2008 and 2010, and in Denmark in 2014.

 

"We have identified the family of the virus, and we are sequencing the genetic material. It is not a fatal virus, but it can lead to kidney failure. It is very important to seek medical attention if symptoms develop. The person should not, for example, take anti-inflammatory drugs at all," explains Soares.

ECDC: CDTR, week 44

ECDC has published Summary of Public health threats, CDTR week 44/2016. Click or tap through to download the full report and use the links. The summary:

​The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period 30 October to 5 November 2016 and includes updates on West Nile virus, enteroviruses and influenza. 

West Nile virus 

This week, one new case of West Nile fever has been reported from Bucharest, Romania.   

During the June-to-November transmission season, ECDC monitors the situation in EU Member States and neighbouring countries in order to inform the blood safety authorities of areas affected by West Nile fever and changes in the epidemiology of the disease.  

Enteroviruses 

In early November, Sweden confirmed eight cases with symptoms similar to acute flaccid myelitis whereof 4 with confirmed enterovirus D68.   

Since April 2016, Denmark, the Netherlands, Spain, Sweden and United Kingdom (Wales) have reported various severe Enterovirus infections and some have also increased enterovirus detections (the Netherlands and Germany) compared to previous years. The increased detections of enteroviruses associated with neurological symptoms in EU/EEA countries are notable in terms of the severity of symptoms of the reported cases.   

ECDC published a rapid risk assessment on 8 August 2016.   

Influenza 

Activity remained low in the region, with few samples testing positive for influenza viruses (2% of sentinel samples). Levels are similar to those observed for the same period in recent seasons.   

Influenza transmission in Europe shows a seasonal pattern, with peak activity during winter months. ECDC monitors influenza activity in Europe during the winter season.   

ECDC publishes its weekly report on the Flu News Europe website.

US: Rare, polio-like illness suspected in Bellingham child’s death

As a polio survivor (class of 1948), I take reports like this very seriously. Via The Seattle Times: Rare, polio-like illness suspected in Bellingham child’s death. Excerpt:

A 6-year-old Bellingham boy who was among eight children hospitalized this fall with a mysterious, polio-like illness has died, family and health officials said.  

Jonathan Daniel Ramirez Porter, known as Daniel, was on life support for several days before his death Monday, according to his grandmother, Mitzie De Guzman, of Bellingham. 

The child fell ill on Oct. 15 with vomiting, a high fever and other symptoms. He was taken to a hospital in Bellingham and flown to Seattle Children’s, where his condition worsened. 

“It was just all of a sudden, out of nowhere,” De Guzman said. 

Daniel was one of three children who remained hospitalized at Seattle Children’s with neurological symptoms. All of the children, who ranged in age from 3 to 14, were suspected to have acute flaccid myelitis, or AFM, a neurological illness that causes a range of problems, including paralyzed limbs. However, none of the children, including Daniel, have been confirmed to have AFM.  

The children came from King, Pierce, Franklin and Whatcom counties, health officials said. The first case was seen in mid-September and the most recent was in mid-October. 

AFM is a mysterious illness that appears to target the spinal cord. It has been associated with various viruses, including enteroviruses, both polio and non-polio types. It has also been associated with West Nile virus and the viruses that cause the common cold.  

The key symptom is the sudden onset of weakness in legs or arms, though neck stiffness is also reported. Facial drooping or trouble swallowing and speaking also have been reported.  

There has been an uptick in cases of AFM nationwide, according to the Centers for Disease Control and Prevention (CDC). Cases spiked in 2014, with 120 in 34 states. Just 21 cases were reported in 2015. As of August, 50 people in 24 states were confirmed to have AFM this year, the CDC said. Still, it remains quite rare, with fewer than one in every million people affected.  

In Washington, five children affected this fall have been released from the hospital and are recovering. Two remain at Seattle Children’s. Hospital officials said those families declined to discuss the situation.

Upsurge of enterovirus D68, the Netherlands, 2016

Via Emerging Infectious Diseases: Ahead of Print -Upsurge of Enterovirus D68, the Netherlands, 2016. The abstract:

In June and July 2016, we identified 8 adults and 17 children with respiratory enterovirus D68 infections. Thirteen children required intensive care unit admission because of respiratory insufficiency, and 1 had concomitant acute flaccid myelitis. Phylogenetic analysis showed that all of 20 sequences obtained belong to the recently described clade B3.