H5N1

Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016

Eurosurveillance has published Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016. The abstract:

Introduction 

Enterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions. 

Aim 

Our objective was to investigate the epidemiology and clinical characteristics of the outbreak.  

Methods 

We carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3’-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries. 

Results 

Most EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported. 

Conclusion 

An emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.

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.

Hong Kong: CHP investigates case of severe enterovirus 71 infection

Via the Hong Kong Centre for Health Protection: CHP investigates case of severe enterovirus 71 infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (July 5) investigating a case of severe enterovirus (EV) 71 infection, and again urged the public and institutions to maintain strict hand, personal and environmental hygiene.      

A girl, aged 17 with good past health, has presented with fever, rashes and vesicles over hands and feet, oral ulcer and sore throat since June 28. Subsequently, she developed headache, neck pain, drowsiness and confusion, and was admitted to United Christian Hospital for treatment on July 1. She was transferred to the Paediatric Intensive Care Unit for further management on July 4. The patient is now in a stable condition.      

Her rectal swab specimen tested positive for EV71 upon laboratory testing. The clinical diagnosis was EV71 infection complicated with encephalitis.      

Initial enquiries revealed that the patient had no travel history during the incubation period and her home contacts have remained asymptomatic.        

Separately, the CHP's epidemiological investigations also revealed that there is a hand, foot and mouth disease (HFMD) outbreak in the secondary school, Chinese Foundation Secondary School in Siu Sai Wan, where the patient attended. Apart from the patient, two girls aged 14 and 17 have developed HFMD symptoms since June 28. Both sought medical attention and no hospitalisation was required. They are now in a stable condition.        

Officers of the CHP have conducted a site visit to the school and advised the management on necessary infection control and preventive measures. The school has been put under medical surveillance. As a precautionary measure, the school was advised to suspend the two affected classes.     

The CHP's investigations are ongoing.      

"EV71 is one of the causative agents for HFMD. The infection is transmitted from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. Good personal and environmental hygiene are the most important measures to prevent EV71 infection," a spokesman for the CHP said.

ECDC: CDTR, week 24

ECDC has published Summary of Public health threats, CDTR week 24/2016. Click or tap through for many related links. 

​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 12 – 18 June 2016, and includes updates on the Enterovirus A-71 outbreak, Measles, Zika virus infection, the yellow fever outbreak in Africa and Plasmid-mediated colistin resistance mechanism MCR-1 in Gram-negative.   

Enterovirus A-71 – Catalonia, Spain 

An outbreak of enterovirus with neurological complications has been ongoing in Catalonia since mid-April 2016, mostly affecting children. The causative agent has been identified as enterovirus A71. 

As of 14 June, 91 probable cases have been detected and most have recovered. The cases are widespread in Catalonia. No cases have been reported from other regions in Spain.   

Measles – multistate 

Measles, a highly transmissible vaccine-preventable disease, is still endemic in some EU countries where vaccination uptake remains below the level required to interrupt the transmission cycle. Elimination of measles requires consistent vaccination uptake above 95% with two doses of measles vaccine in all population groups, strong surveillance and effective outbreak control measures.   

In 2014, 16 EU/EEA countries were above the measles vaccination coverage target of 95% for the first dose, and six countries for the second dose. Fourteen countries in the EU have coverage rates of <95% for the first dose and 20 countries for the second dose.   

During the past month, ongoing measles outbreaks were detected in Ireland, Germany, Russia, New Zealand, the United States of America, Mali and the Democratic Republic of Congo.  

Zika virus infection 

As of 15 June 2016, WHO reports 60 countries and territories with continuing mosquito-borne transmission. Of these, 52 countries and territories have reported autochthonous cases of Zika virus infection during the past nine months. Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route.   

An article on the Zika outbreak in Colombia was published in NEJM on 16 June 2016. Preliminary findings included:  

• Overall Zika incidence in women was twice that of men, which reflects factors such as increased testing in reproductive-age women because of the microcephaly threat or the role of sexual transmission. 

• More than 90% of mothers who were infected during their third trimesters had given birth, and no infants with microcephaly or brain abnormalities were found. 

• Four infants with laboratory evidence of congenital Zika virus disease were born to asymptomatic mothers.  

Yellow fever outbreak – Africa 

An outbreak of yellow fever in Angola started in December 2015 in the municipality of Viana, Luanda province and spread to all the 18 provinces of Angola.   

The neighbouring Democratic Republic of Congo (DRC) reports both imported and autochthonous cases of yellow fever. An outbreak of yellow fever, not linked to the outbreak in Angola, has been reported in several districts in Uganda.   

Another unrelated outbreak of yellow fever is reported in Peru.   

Plasmid-mediated colistin resistance mechanism MCR-1 in Gram-negative bacteria - Multistate (world) 

The recent discovery of the mcr-1 gene, which encodes the first transferable resistance mechanism to colistin (a last-resort antimicrobial agent for infections caused by multidrug-resistant (MDR) gram-negative bacteria) raised widespread concern that its dissemination within the human microbiome could lead to nosocomial outbreaks of virtually untreatable infections. 

Follow-up reports have revealed worldwide spread of the mcr-1 gene by plasmid transfer to diverse species and strains of Enterobacteriaceae, including MDR strains. In May 2016, the US CDC reported the first human mcr-1 positive E. coli isolate detected in the United States.

ECDC: Outbreak of enterovirus A71 in Catalonia, Spain

ECDC has published Outbreak of enterovirus A71 in Catalonia, Spain - rapid risk assessment. Excerpt from the summary:

​ECDC has published a rapid risk assessment due to a localised outbreak of neurological symptoms associated with enterovirus A71 (EV-A71) in Catalonia, Spain.  

Most EV infections, including EV-A71, result in asymptomatic infection. Most symptomatic EV-A71 infections manifest as a self-limiting hand, foot and mouth disease and only a very small proportion of patients develop severe and life-threatening disease. The current outbreak is notable in terms of its magnitude and the severity of symptoms of the reported cases. 

The outbreak with neurological complications caused by enterovirus has been ongoing in Catalonia since mid-April 2016, affecting children up to ten years of age. As of 7 June, 87 cases of enterovirus infection with neurological complications have been reported, most of which have evolved favourably, but 22 of the cases remain in hospital, including seven in intensive care units. According to the information received from regional authorities, there are no deaths related to this outbreak. The cases are widespread in Catalonia. 

Other EU Member States have not reported concomitant enterovirus outbreaks and ECDC is not aware of signals of other unusual enterovirus outbreaks in the EU. 

There is evidence to suggest that the epidemiological pattern of EV-A71 in Europe is going through a change, both due to virus molecular evolution, as well as an increasing likelihood of importation of new virus strains from outside the EU. 

The full characterisation of the isolates from the Spanish outbreak, and comparison of these to virus sequences from other countries and continents, should contribute to a better understanding of the changing pattern of EV-A71 epidemiology in Europe.

ECDC: CDTR, week 22

ECDC has published Summary of Public health threats, CDTR week 22/2016. Click or tap through for links.

​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 29 May to 4 June 2016 and includes updates on Enterovirus A71, colistin resistance mechanism MCR-1, and West Nile virus in Europe.   

Enterovirus A71, Catalonia, Spain 

An outbreak of enterovirus with neurological complications caused by enterovirus A71 has been ongoing in Catalonia since mid April 2016. As of 31 May, 73 cases of enterovirus infection with neurological complications have been reported, most of which have evolved favourably. The cases are widespread in Catalonia. No cases have been identified from other areas in Spain so far. Enterovirus A71 is a major cause of hand, foot and mouth disease and is particularly prevalent in parts of Southeast Asia, affecting thousands of children and infants each year.   

Colistin resistance mechanism MCR-1 

Plasmid-mediated colistin resistance mechanism MCR-1 in gram-negative bacteria The first detection of plasmid-mediated resistance to polymyxins (MCR-1) in China was reported in an article in Lancet Infectious Diseases on 18 November 2015.   

On 26 May 2016, the Journal of Antimicrobial Agents and Chemotherapy published the first report of detection of the mcr-1 gene from a human sample in the United States. The mcr-1 and ESBL-carrying Escherichia coli isolate was cultured from the urine sample of a 49 year-old female patient who presented to a clinic in Pennsylvania with symptoms of a urinary tract infection. 

Colistin is primarily used to treat multidrug-resistant Gram-negative infections, and development of colistin resistance will further severely limit treatment options, and even potentially result in untreatable infections. In the six months since its description in November 2015, the mcr-1 gene has already been detected in human, animal, food and environmental samples from multiple countries.   

West Nile virus in Europe 

As every year, ECDC monitors the West Nile virus transmission season (June to November) in EU Member States and neighbouring countries in order to inform blood safety authorities of affected areas and identify significant changes in the epidemiology of the disease.   

This week ECDC started the seasonal monitoring of West Nile fever. As of 2 June, no human cases of West Nile fever have been reported in the EU and neighbouring countries.