H5N1

UK: Two children from same family die after contracting E coli

Via The Guardian: Two children from same family die after contracting E coli. Excerpt:

Two children from the same family have died after contracting E coli, Public Health England (PHE) has said. 

The health body has not confirmed the ages of the children or where they are from, but said PHE East Midlands had been working closely with environmental health colleagues from Charnwood borough council following the confirmation of two cases of haemolytic uraemic syndrome (HUS) in two siblings.  

Dr Lauren Ahyow, a consultant in communicable disease control at PHE East Midlands, said: “E coli is an infection that causes a spectrum of illness ranging from mild through to severe bloody diarrhoea, mostly without fever.  

“Sometimes the infection can cause a condition called haemolytic uraemic syndrome (HUS), which affects the kidneys and can be very serious. Young children and elderly people are more prone to development of complications associated with E coli. 

“E coli can be acquired through a number of routes including contaminated food, contact with farm animals and infected water. PHE are working with partners to investigate further to try and determine a source of infection.”

WHO: Enterohemorrhagic Escherischia coli – United Kingdom

WHO has published Enterohaemorrhagic Escherischia coli – United Kingdom. Excerpt:

On 1 July 2016, the National IHR Focal Point for the United Kingdom notified WHO of an outbreak of Enterohaemorrhagic Shiga toxin-producing Escherischia coli (STEC) O157 PT34 in England and Wales. 

 The increase in the notifications of E. coli O157 cases was first observed by the South West Public Health England (PHE) Centre on 21 June. An outbreak control team was convened on 22 June to investigate this increase and, on 24 June, the first samples associated with this increase were confirmed as STEC serogroup O157 phage type 34, positive for the eae (intimin) and verocytotoxin 2 genes but negative for the verocytotoxin 1 gene (hereafter referred to as 'the outbreak strain').  

On 27 June, a significant increase in the number of cases with the outbreak strain was observed nationally, and the incident was declared and managed as a national outbreak. Analysis of whole genome sequencing data confirmed that the isolates fall within the same cluster. The outbreak strain is not related to strains currently circulating amongst the UK bovine reservoir but rather closely related to sequences identified in people reporting recent travel to the Mediterranean region. This suggests that the outbreak strain is likely to be imported. 

As of 14 July, 158 cases had been identified, of which 105 had been classified as confirmed cases and 53 as probable. Four of these patients remain in hospital. Features of haemolytic uraemic syndrome (HUS) have been reported in seven cases. Two cases have died, both of whom have E. coli infection listed as a causative factor. 

Cases are distributed throughout the UK, with the majority (91%) residing in England. The outbreak is characterised by multiple small clusters linked to catering and residential care premises. The proportion of hospitalised cases is high (40%). Cases are predominantly female (75%) and over the age of 18 (91%) – the age range is between 1 and 98 years. Onset dates for cases range from 31 May 2016 to 5 July 2016.  

Multiple analytical studies have provided evidence that consumption of mixed salad leaves, particularly from catering establishments such as cafes and restaurants, is associated with the infection. Sampling and microbiological examination of salad products is continuing although all results to date have been negative for STEC O157.

ECDC: CDTR, week 14

ECDC has published Summary of public health threats, CDTR week 14/2016. Click or tap through to download the full CDTR and to use other 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 of 3 to 9 April 2016 and includes updates on seasonal influenza in Europe, haemolytic uraemic syndrome (HUS) cases in Romania and Italy, outbreak of yellow fever in Angola and other threats.  

Seasonal influenza in Europe 

Despite decreasing trends being reported by 27 countries influenza was reported as widespread, largely in the south-western part of the Region. The number of cases of severe disease was lower than in previous weeks but varied between countries. Most severe cases were associated with A(H1N1)pdm09 infection and were in people aged 15–64 years.   

ECDC publishes joint weekly updates on seasonal influenza on Flu News Europe.   

Haemolytic uraemic syndrome (HUS) cases in Romania and Italy 

Twenty five cases have been identified as associated with an outbreak of Shiga toxin-producing Escherichia coli (STEC) O26 in Romania (24) and in Italy (1). Of these 25 cases, 19 were hospitalised for haemolytic uraemic syndrome (HUS), and three of the cases died.   

A joint rapid outbreak assessment with the European Food Safety Authority (EFSA) has been published.    

Outbreak of yellow fever in Angola 

Since the initial cases were detected in Luanda province, there has been a rapid increase in the number of suspected cases recorded since mid-January 2016. Local transmission is no longer restricted to Luanda. As of 30 March, 16 of 18 provinces across the country have reported suspected cases. A mass vaccination campaign has been ongoing since February aiming to immunise 6.7 million people in Luanda province.   

ECDC published a rapid risk assessment on 25 March and an epidemiological update on 1 April.

ECDC on STEC, HUS outbreaks in Romania and Italy

ECDC has published Joint ECDC/EFSA rapid outbreak assessment: multi-country outbreak of Shiga toxin-producing Escherichia coli infection associated with haemolytic uraemic syndrome in Romand and Italy. Click or tap through to download the RRA. The summary:

​An outbreak of Shiga toxin-producing Escherichia coli (STEC) infection associated with haemolytic uraemic syndrome (HUS) and affecting mostly young children has been reported in February and March in Romania. Italy reported one HUS case with an epidemiological link to Romania on 21 March 2016. Overall, 25 cases have been identified as associated with this multi-country outbreak, of which 19 developed HUS and three of these died. 

Information collected from patients points towards a milk processing establishment in Romania as a possible source of infection. Several strains of STEC have been identified so far, and it is possible that multiple sources of contamination have contributed to this outbreak. 

The recall of suspected food products has been undertaken by food safety authorities in Romania, Italy and other countries who have imported the suspected food items. However, potentially contaminated items could still be present in households. Since the precise source of contamination has not yet been identified, cases possibly linked to the this outbreak may occur in Romania and in those EU countries to which the implicated food products have been distributed.   

To minimise the further spread of the infection and investigate possible new cases promptly, ECDC and EFSA recommend EU Member States to consider enhancing monitoring for HUS and STEC cases. In addition, if new cases possibly linked to the outbreak are identified, these should be reported to the Epidemic Intelligence Information System for food- and waterborne diseases (EPIS-FWD). 

The investigation of the European dimension of this multi-country foodborne outbreak has demonstrated the added value of collaboration between Romanian and Italian public health and food authorities as well as ECDC and EFSA in enabling appropriate risk assessment and response.

ECDC: CDTR, week 11

ECDC has published Communicable disease threats report, 13-19 March 2016, week 11. Click or tap through to download the PDF. The abstract:

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 13-19 March 2016 and includes updates on Zika virus, haemolytic uraemic syndrome in Romania and seasonal influenza.

The report also mentions a fatal case of diphtheria in an unvaccinated Belgian child, Lassa in Germany, yellow fever in Angola, and the public health risks faced by refugees in Europe, Ebola's return to Guinea, and polio in Pakistan.

Eurosurveillance: Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016

Via Eurosurveillance: Measles outbreak in a refugee settlement in Calais, France: January to February 2016. The abstract:

As at 29 February 2016, 15 cases of haemolytic uraemic syndrome with onset between 25 January and 22 February were reported among children between five and 38 months in Romania, and three of them died. Cases were mostly from southern Romania. Six cases tested positive for Escherichia coli O26 by serology. Fruits, vegetables, meat and dairy products were among the possible common food exposures. Investigations are ongoing in Romania to control the outbreak.

ECDC: CDTR, week 10

ECDC has published Summary of public health threats, CDTR week 10/2016. Click or tap through to download the full report. 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 6 to 12 March 2016 and includes updates on seasonal influenza, Haemolytic uraemic syndrome (HUS) in Romania and Zika. 

Seasonal influenza - Europe 

Of 44 countries that reported on qualitative influenza indicators in the WHO European Region, 25 reported widespread influenza activity and 28 reported medium intensity of influenza activity. Influenza B virus constituted 55% of influenza virus detections in sentinel samples compared with 47% for the previous week, indicating a gradual shift towards influenza B over the last few weeks. 

The number of cases of severe disease was fewer compared to previous weeks, but most cases continued to be associated with A(H1N1)pdm09 virus infection and were in people aged 15–64 years. 

Haemolytic uraemic syndrome (HUS) cases in young children – Romania 

Since January 2016, the Ministry of Health in Romania has reported that 15 children aged 5 to 38 months have been hospitalised in Bucharest and Iasi with haemolytic uraemic syndrome (HUS). In addition, two cases without HUS tested positive for VTEC O26. This is an outbreak of VTEC O26 confirmed through serology. The epidemiological investigation suggests a single source.   

Following initial environmental investigations, E. coli O26 was identified in soft cheese samples produced by a local company that sells traditional dairy items in Arges district. The factory has been closed and the product is no longer available on the market.   

Zika virus infection – multistate 

During the last week, the Philippines and Fiji confirmed the first autochthonous cases of Zika virus transmission in 2016. As of 4 March 2016, 41 countries and territories have reported autochthonous cases of Zika virus infection in the past nine months. Links between Zika virus infection in pregnancy and microcephaly of the foetus have been under investigation since October 2015.   

Thirty EU/EEA countries have issued travel advice for people travelling to Zika-affected areas. Of these, 28 have advised pregnant women to consider postponing travel to countries affected by the Zika epidemic.

ECDC: CDTR, week 9

ECDC has published Summary of Public health threats, CDTR week 9/2016. Click or tap through to download the full report and use other 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 28 February to 5 March 2016 and includes updates on Haemolytic uraemic syndrome (HUS) in Romania and seasonal influenza.   

Haemolytic uraemic syndrome (HUS) cases in young children –Romania 

Following initial environmental investigations, E. coli O26 has been identified in a soft cheese sample produced by a local company that sells traditional dairy items in the affected Arges district. The cheese was prepared from unpasteurised milk. The factory has been closed and the product is no longer available on the market.   

The Ministry of Health in Romania reports that 15 children aged 5 to 38 months were hospitalised in Bucharest and Pitesti between 29 January and 24 February with symptoms of vomiting and diarrhoea and suspected haemolytic uraemic syndrome (HUS). 

Seasonal influenza 

During week 8/2016, 25 out of 45 Member States in the WHO European Region reported widespread influenza activity. As only five countries reported high-intensity activity, influenza may have peaked in some parts of the region, as indicated by reports of decreasing or stable trends in 33 countries.  

Thirty-six countries reported influenza virus detections in 47% of specimens from sentinel sources, which is similar to previous weeks. Influenza B virus constituted 47% of influenza virus detections in sentinel samples, indicating a gradual shift towards influenza B. 

Influenza A(H1N1)pdm09 viruses remained the predominant virus detected through sentinel surveillance, accounting for 85% of the A viruses subtyped. Cases of severe disease were fewer than in previous weeks, but varied between countries.

ECDC: CDTR, week 7

ECDC has published Summary of public health threats, CDTR week 7/2016.Click or tap throughto use the links and to download the full report. 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 14–20 February 2016, and includes updates on Zika virus infection, seasonal influenza in Europe and suspected haemolytic uraemic syndrome (HUS) cases in Romania. 

Zika – Multistate (world) 

Zika virus infections continue to spread to previously unaffected areas of the world. Several countries in the Americas, Caribbean and the Pacific continue to report an increase in autochthonous cases of Zika virus infection. In the past week, four additional countries or territories have reported laboratory-confirmed autochthonous transmission: Aruba, Bonaire, Marshall Islands and Trinidad and Tobago. 

Possible links between Zika virus infection in pregnancy and microcephaly of the foetus have been under investigation since October 2015. The magnitude of the risk that Zika virus infection during pregnancy will result in malformations in the foetus remains unknown at present. However, considering the growing body of evidence of adverse pregnancy outcomes associated with Zika virus infection, ECDC recommends that pregnant women should consider postponing non-essential travel to Zika affected areas.

Influenza - Multistate (Europe) - Monitoring 2015–2016 season 

During the past week, increasing rates of influenza-like illness (ILI) and acute respiratory infection (ARI) were reported from 21 of 46 countries in the WHO European Region. Belarus, Finland, Greece, Ireland and Switzerland indicated high-intensity influenza activity. Most of the viruses characterised so far have been similar to the strains recommended for inclusion in this winter’s trivalent or quadrivalent vaccines for the northern hemisphere. 

Haemolytic uraemic syndrome (HUS) cases in young children –Romania 

Twelve children aged between 5 and 16 months have been hospitalised in Bucharest and Craiova due to suspected haemolytic uraemic syndrome (HUS). No causative agent has been identified yet. According to the Ministry of Health in Romania, they presented with symptoms of vomiting and diarrhoea, with or without dehydration between 25 January and 9 February. Three of the cases died, three are under dialysis in an intensive care unit, five are admitted in a nephrology ward and one has been discharged. 

Two ECDC experts and one EPIET fellow have been deployed to support the outbreak investigation upon request from the Romanian Ministry of Health.

Finland: E. coli outbreak in Oulu

Via Yle Uutiset: Friday's papers: Last-minute preparations in Sochi, neo-pagan religion becomes official and an E.coli outbreak in Oulu. Oulu is a city of 192,000 at the 65th parallel with a thriving high-tech industry and a couple of big universities. Excerpt:

Kaleva reports that even more children have fallen ill with an E. coli infection in the Oulu region. Most of the seriously affected children are being treated in the Oulu University Hospital. Eight different cases of the food-borne disease Enterohaemorrhagic E. coli (EHEC) were reported after December 13, all in children between the ages of 4 and 10. 

“Five of them have symptoms of the life-threatening haemolytic uraemic syndrome (HUS)”, says Epidemiologist Ruska Rimhanen-Finne of the National Institute for Health and Welfare. 

In addition, two children have become ill with HUS with no clinical confirmation of an E. coli infection. Doctor of paediatric infections at the Oulu University Hospital Terhi Tapiainen says they still don’t know what caused the epidemic, but warns children to avoid raw ground beef and unpasteurised milk. 

“Some restaurants offer their customers hamburgers that are cooked medium. Hamburger patties should always be cooked all the way through to avoid bacterial infection,” she says.