NEWS SCAN: Raw milk Campylobacter outbreak, malaria deaths. yellow fever in Africa, chikungunya diagnosis, cell-based flu vaccine

Feb 3, 2012

Raw milk Campylobacter outbreak grows to 38 cases in 4 states
Fifteen more patients have been sickened in a Campylobacter outbreak linked to a Pennsylvania dairy's raw milk, pushing the total to 38, spokeswoman Holli Senior from the Pennsylvania Department of Health told CIDRAP News. The new total includes 31 from Pennsylvania, 4 from Maryland, 2 from West Virginia, and 1 from New Jersey, raising the number of affected states to four. No deaths have been reported. Pennsylvania's 31 cases are from eight different counties, with 18 of them from Franklin County. Senior said the latest illness onset was Jan 27, and 18 (47%) of the case-patients are younger than 18. On Feb 1 the Maryland Department of Health and Mental Hygiene announced that it found the outbreak strain of Campylobacter in two unopened containers of unpasteurized milk from The Family Cow farm in Chambersburg, Pa. Senior said the investigation is continuing and more confirmed cases are expected.
Feb 2 CIDRAP News Scan "Outbreak Campylobacter found in raw milk on Pennsylvania farm"

New malaria mortality estimate casts light on adult deaths
A new estimate of the world's malaria burden found twice as many deaths as previously thought, though public health measures such as treated bed nets are driving yearly declines in the disease's death toll, researchers reported today in The Lancet. They found that about 1.2 million people died from the disease in 2010, nearly twice the number reflected by the World Health Organization (WHO). Christopher Murray, MD, DPhil, lead author from the University of Washington, said in a Lancet podcast that the study group found higher numbers, because it included causes of death data, rather than using just statistical models to calculate the death rate. The team also used "verbal autopsies" to make their estimates, which involved interviewing relatives about the cause of death. He said researchers found a higher-than-expected number of deaths in older children. The review of global mortality rates from 1980 to 2010 found that malaria deaths peaked in 2004, with a decline that coincided with a ramp-up in public health measures that also included artemisinin-combination treatments to battle drug resistance. Murray told the Lancet that the findings could help target resources. In an editorial, The Lancet predicted that experts will debate the reliability of the findings, and they noted that the authors will need to make their methods available to others who want to reproduce the calculations. The journal urged the WHO's new malaria advisory committee to involve a broader group of experts to review the new data and the policy implications.
Feb 4 Lancet abstract
Feb 2 EurekAlert press release
Lancet podcast
Feb 4 Lancet editorial

WHO reports yellow fever outbreaks in Cameroon, Ghana
The World Health Organization (WHO) today reported outbreaks of yellow fever in Cameroon and Ghana totaling 26 cases, 9 of them fatal. Ghana reported 23 of those cases, according to a WHO alert, including 7 deaths, from October through December 2011. The cases, in Guider, Bibemi, Gaschiga, Lagdo, Mayo Oulo, and Golombe districts, were identified in routine surveillance. At least 13 of the cases are laboratory confirmed, and a mass vaccination campaign is under way, aimed at reaching 1.2 million people.
Feb 3 WHO notice on Cameroon
Ghana reported three lab-confirmed cases during roughly the same period, two of them fatal. They occurred in three districts: Builsa, Kassena-Nankana-West, and Kitampo-South. A campaign is set to begin Feb 6 to vaccinate more than 235,000 people in the three districts. In November officials vaccinated 5.8 million people in 40 districts. Another phase later this year will target an additional 1.7 million people in 17 districts.
Feb 3 WHO notice on Ghana

Study: Chikungunya may be overdiagnosed in dengue-endemic areas
Overdiagnosis of chikungunya is common during a chikungunya outbreak in a dengue-endemic area because clinical signs and symptoms are similar, according to a Thai study. Researchers analyzed data from 50 children suspected of having chikungunya in southern Thailand during an outbreak from April to July 2009. Of the cases, 32 (64%) were confirmed as chikungunya, 10 (20%) had dengue only, 1 (2%) had chikungunya and dengue, and 7 had a different, unspecified febrile disease. The team determined that the specificity and positive predictive value of fever and arthralgia together to diagnose chikungunya were 47.1% and 74.2%, compared with 70.6% and 83.3% for fever, arthralgia, and rash. They conclude that a rash during fever combined with a white blood cell count of 5,000 cells per cubic millimeter can be helpful in differentiating chikungunya from dengue.
Feb 1 Ped Infect Dis J abstract

Cell-based flu vaccine shown safe, immunogenic in children
In a finding that may help pave the way for approval in European children, a study in The Pediatric Infectious Disease Journal found the cell-culture-based Optaflu flu vaccine from Novartis about as safe and immunogenic as the egg-derived version. European and US researchers randomized 3,604 children to receive two doses of Optaflu, made by Novartis, or conventional trivalent influenza vaccine (TIV) in those 3 to 8 years old (2,630 patients) or one dose in those 9 to 17 (974 patients). They then measured antibody levels on days 1, 28, and 50 by hemagglutination inhibition (HI) assay. They determined that Optaflu was "noninferior" to TIV and met all three European immunogenicity criteria for H1N1 and H3N2 strains in the younger age-group, which was the primary objective of the study. In the older group, the antibody responses met European criteria for all three flu strains (H1N1, H3N2, and B). Optaflu was approved for adults in Europe in 2007.
Feb 1 Ped Infect Dis J abstract

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