H5N1

MMWR: Noncongenital Zika virus disease cases — 50 US states and the District of Columbia, 2016

Via MMWR: Update: Noncongenital Zika Virus Disease Cases — 50 U.S. States and the District of Columbia, 2016. The summary:

What is already known about this topic?  

Zika virus disease is an arboviral disease usually causing mild illness; however, congenital infection is associated with microcephaly and other birth defects. Although most cases in residents of U.S. states were travel-associated, local transmission has been reported. 

What is added by this report?  

In 2016, a total of 5,168 confirmed or probable cases of noncongenital Zika virus disease with symptom onset during January 1–December 31, 2016, were reported to ArboNET from U.S. states and the District of Columbia. Most (95%) cases were travel-associated. Locally acquired disease accounted for 4% of cases, with transmission occurring in Florida (218) and Texas (six). Forty-seven cases (1%) were acquired through other routes, including sexual transmission (45), laboratory transmission (one), and person-to-person through an unknown route (one).  

What are the implications for public health practice? 

CDC recommends that health care providers continue to test patients with a clinically compatible illness who live in or recently traveled to areas with ongoing Zika virus transmission or had unprotected sex with someone who lives in or traveled to those areas (https://www.cdc.gov/zika/hc-providers/testing-guidance.html). Although the risk for travel-associated Zika virus disease appears to be decreasing, it is important that persons traveling to areas with a risk for Zika virus transmission continue to take precautions, including using strategies to prevent mosquito bites and sexual transmission.

Gone or forgotten? The rise and fall of Zika virus

Via The Lancet Public Health: Gone or forgotten? The rise and fall of Zika virus. Excerpt:

The rise of Zika virus, from a little known pathogen to an internationally recognised cause of birth defects, was swift and devastating. Not present in the western hemisphere before 2015, over 800 000 people have since been reported to be infected with Zika virus in the region; however, this number is most likely an underestimate since the infection typically causes a mild febrile illness in less than 20% of patients. 

Moreover, the Asian lineage of Zika virus, which is responsible for the 2015–16 epidemic, has been associated with severe congenital defects in children born to women infected during pregnancy, leading to thousands of children with congenital Zika syndrome. Furthermore, the combination of asymptomatic infection, the potential for extended latent seminal and sexual transmission, and a predilection to cause birth defects has presented substantial challenges to disease control for inhabitants of endemic regions and travellers. 

As the scale of the epidemic and its complications came into focus, the public health community developed a multipronged response that included WHO declaring a public health emergency of international concern to encourage the development of surveillance networks, diagnostics, risk communication strategies, and vector-control measures. 

Yet, even before a substantial response was realised, the incidence of Zika virus infections in the western hemisphere began to fall almost as fast as it had risen. Seasonal variation was not to blame. Most of Latin America and the Caribbean had a massive decline in cases in 2017 compared with similar periods in 2016. Birth defects associated with Zika virus also declined by over 50%. Before the end of 2016, WHO called an end to the international Zika emergency. 

So, what is to be made of these sizeable fluctuations in the epidemiology of Zika virus disease? And how should the public—most notably women of childbearing age—and public health planners prepare for the future? The best predictors of the future course of Zika virus disease will most likely include: the duration of protective immunity after infection, and the potential effect of non-neutralising, cross-reactive antibodies to co-circulating flaviviruses, such as dengue virus. 

Regarding protective immunity, early data suggest that Zika virus infection induces serological protection from reinfection; although, the duration of such protection remains unknown. Zika virus vaccination studies have also shown the production of neutralising antibodies that appear to be protective both in vitro and in mouse models. 

Zika virus shares substantial genetic homology, structural features, and cross-reactive antibodies with dengue virus and other flaviviruses. The immune responses in people infected at some point by more than one of these viruses is not yet fully understood. 

Might some cross-protection exist? Does the order of infection matter? Might priming with one virus actually make congenital or other outcomes more or less likely? In the best case scenario, Zika virus infection will induce lifelong immunity independent of dengue virus infection, which would greatly increase the likelihood that the western hemisphere epidemic will protect much of the current population from local reinfection and provide herd immunity to others.

As Zika fades from public consciousness, scientists continue to pursue the virus

Via The Washington Post: As Zika fades from public consciousness, scientists continue to pursue the virus. Excerpt:

While the Zika virus mostly faded from the public’s consciousness last year, it’s still a hot topic among scientists — and for good reasons. 

After Zika emerged in the Western Hemisphere, it shook the Americas as reports of infections and devastating birth defects swept through Brazil and Colombia, eventually reaching the United States in 2016. In a welcome turn, the number of Zika cases in the hemisphere last year dropped dramatically in the hardest-hit areas. 

But few scientists are naive enough to think we’ve seen the last of Zika. “The clock is ticking for when we will see another outbreak,” says Andrew Haddow, a medical entomologist at the U.S. Army Medical Research Institute of Infectious Diseases in Frederick, Md. 

Researchers’ to-do list for tackling this once-unfamiliar virus is daunting. But progress has been made, especially in learning more about Zika’s biology and interactions with its hosts, and in developing a safe and effective vaccine. 

In 2017, the epidemic lost steam because many areas have probably developed herd immunity to the virus. Zika infected a large number of people, who are now presumably immune, and those exposed provide indirect protection to people who haven’t yet encountered Zika. If the mosquito-borne virus can’t find enough people to infect, it can’t easily spread.  

But Zika doesn’t rely only on mosquitoes to get around. Last year, researchers learned more about how the virus spreads through sexual intercourse.  

In humans, Zika can persist in semen for close to three months, researchers learned. And Haddow and colleagues reported in the August issue of Emerging Infectious Diseases that four of eight macaques exposed to the virus vaginally developed infections, as did seven of eight macaques that received the virus via the rectum. 

In the wild, animals can act as reservoirs for Zika between human outbreaks. A small number of black-striped capuchin monkeys and common marmosets in a region of Brazil with high numbers of human cases were found to carry the virus already, the first such report among Western Hemisphere monkeys.  

But there’s still a lot to learn about how the virus is maintained long-term in nature, Haddow says. Convinced that Zika is here to stay and especially concerned about its effects during pregnancy, researchers have rushed to develop vaccines.  

In its first test in humans, reported online Oct. 4 in the New England Journal of Medicine, one vaccine based on DNA from the virus elicited an immune response, with 100 percent of participants developing antibodies after a three-dose regimen. Another DNA vaccine, developed by the National Institute of Allergy and Infectious Diseases, is in a second round of human testing.

Madagascar: Over 1,000 new HIV cases identified

Via L'Express de Madagascar: Health - A thousand seropositives screened. The edited Google translation:

The figures on HIV / AIDS send shivers down the back. The Ministry of Public Health's STD / HIV control team identified more than 1,000 HIV-positive people between January 2016 and September 2017. 

Five hundred and seventy-nine tested positive out of three hundred and fifty thousand screened, from the beginning of the year until September. In 2016, eight hundred and twenty HIV-positive people were included in the list of people to be monitored and cared for. These numbers will certainly increase by the end of the year. 

The completeness of the current data is only 66.8%, according to a source with the Executive Secretary of the national committee against AIDS (SE / CNS), yesterday. 

These new HIV-positive people are distributed in the major cities of Madagascar where there is a large influx of tourists, as in Antananarivo-city, Toamasina, Antsiranana, Mahajanga, or Morondava. 

A 23-year-old man living in Antananarivo-ville recently became part of new people to know their HIV status. 

"He could not believe it, he did not know where he caught the virus," said the doctor who was instructed to announce this bad news. 

Twenty years is currently the average age of HIV-positive people. "We have noticed that new HIV-positive people are getting younger. They are between 20 and 24 years old, and the majority are men. Anal sex practice promotes transmission of the virus, "says Dr. Miaro-Zo Andrianoelina, project manager at CNLS. Heterosexuals who do this sexual practice are not spared.  

HIV-positive children 

The victims also include 13- and 15-year-olds. "They caught the disease at first intercourse," says Dr. Miaro-Zo Hanoa Andrianoelina. 

The 23-year-old was shocked by the result of his rapid test. He is no longer sure of his future. Some testimonials of HIV positive confirm, however, that one can live normally with the virus. 

"It's been 10 years since I learned about my illness. I take pills every day and I live like any other healthy person. I even was able to give birth to a non-HIV positive child," said an HIV-positive person. 

Patients who do not follow treatment are not so lucky. Until September, the Ministry of Public Health has registered forty-five HIV-positive deaths, against fifty in 2016. 

The doctors recommend everyone to carry out the screening to know in time, their state of health. A delay in care could be fatal.

ECDC: HIV/AIDS surveillance in Europe 2017 - 2016 data

ECDC has published HIV/AIDS surveillance in Europe 2017 - 2016 data. The executive summary:

Similar to recent years, the highest proportion of HIV diagnoses (40%) was reported to be in men who have sex with men (MSM). However, for the first time in a number of years, several countries reported a decline in new HIV diagnoses, even after adjusting for reporting delay. 

While the data in this year’s report indicate alarming rates and increases in new diagnoses in some parts of eastern and central Europe over the last decade, at the same time there has been a tendency towards stabilising or even decreasing rates in some EU/EEA countries.  

Trends by transmission mode, for example, show that the number of HIV diagnoses among MSM in the EU/EEA decreased slightly in 2016 and the number of heterosexually acquired cases has decreased steadily over the last decade. 

Moreover, in the EU/EEA, the number of AIDS cases, and the number of AIDS-related deaths, has consistently declined since the mid-1990s.

See also this news release from ECDC and WHO Europe.

Can active case finding help reduce communicable diseases in prisons?

Via ECDC: ECDC-EMCDDA review: Can active case finding help reduce communicable diseases in prisons? Excerpt:

ECDC and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have systematically retrieved and assessed evidence on active case findings for blood-borne viruses like HIV, hepatitis B and C, sexually transmitted infections as well as tuberculosis in prison settings in the EU/EEA. 

Compared with the general public, people in prison have a higher prevalence of infection with HIV, hepatitis B, hepatitis C, syphilis, gonorrhoea, chlamydia and tuberculosis. Such increased prevalence of diseases among people in prisons is recognised as a major risk for the health of both people living and working in prison settings and for the general population, as the vast majority of people in prisons return to their communities after less than 24 months of incarceration. 

According to the principle of equivalence of care, people in prison should enjoy an equivalent standard of care as in the community. Yet, their health needs tend to be greater. Incarceration may thus represent a unique opportunity to make adequate healthcare services available to people and target groups that usually are hard to reach.  

Active case finding to promote early diagnosis is a key measure to prevent onward transmission of communicable diseases and allow entry into care to individuals in need. As its broader implementation may be particularly relevant for prison settings, the available evidence was assessed in a systematic literature review, performed by ECDC and EMCDDA.     

Despite some limitations, the findings provide a valid argument to strengthen case finding initiatives in prison settings. They also show that, in such settings, the way testing is organized and offered to people in detention, influences the uptake of tests for communicable diseases. 

For example, the available evidence suggests that the active offer of tests by health care provider yields a higher uptake compared with people in prison having to ask for test themselves. However, due to lack of research, current evidence does not provide a clear indication on the most effective timing and optimal testing modalities for these diseases in prison settings.   

This systematic review highlights important knowledge gaps. More operational research is needed to assess the effectiveness of interventions to increase the offer and uptake of testing in prison settings.

Zika: An ongoing threat to women and infants

Via bioRxiv: Zika: An ongoing threat to women and infants. The abstract:

Recent data from Rio de Janeiro shows a sharp drop in the number of notified cases of Zika in the summer of 2016-17, compared to the previous summer. This is probably due to herd immunity built up after the previous year's epidemic. 

There is still a much higher incidence among women than men, almost certainly due to sexual transmission. An unexpected feature of the new data is that there are proportionally far more cases in children under 15 months than in older age classes. 

By comparing the incidence for 2016-17 with that of 2015-16, we can deduce the proportion of reported cases for men and women, and also verify that the disparity of incidence between them is still present. 

Women and children still represent risk groups with regard to Zika infection, even during a non-epidemic season.

Zika virus in French Polynesia 2013–14: Anatomy of a completed outbreak

Via The Lancet: Zika virus in French Polynesia 2013–14: anatomy of a completed outbreak. The summary:

The Zika virus crisis exemplified the risk associated with emerging pathogens and was a reminder that preparedness for the worst-case scenario, although challenging, is needed. Herein, we review all data reported during the unexpected emergence of Zika virus in French Polynesia in late 2013. 

We focus on the new findings reported during this outbreak, especially the first description of severe neurological complications in adults and the retrospective description of CNS malformations in neonates, the isolation of Zika virus in semen, the potential for blood-transfusion transmission, mother-to-child transmission, and the development of new diagnostic assays. 

We describe the effect of this outbreak on health systems, the implementation of vector-borne control strategies, and the line of communication used to alert the international community of the new risk associated with Zika virus. 

This outbreak highlighted the need for careful monitoring of all unexpected events that occur during an emergence, to implement surveillance and research programmes in parallel to management of cases, and to be prepared for the worst-case scenario.

Ceftriaxone-resistant Neisseria gonorrhoeae, Canada, 2017

Via Emerging Infectious Diseases: Ahead of Print -Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017. The abstract:

We identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in a patient in Canada. This isolate carried the penA-60 allele, which differs substantially from its closest relative, mosaic penA XXVII (80% nucleotide identity). Epidemiologic and genomic data suggest spread from Asia. Antimicrobial susceptibility surveillance helps prevent spread of highly resistant N. gonorrhoeae strains.

Multidrug-resistant Neisseria gonorrhoeae infection, Denmark, 2017

Via Eurosurveillance: Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017. The abstract:

We describe a multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. 

Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.