NEWS SCAN: Maryland flu cluster reviewed, flu vaccine priorities, dengue in Brazil, Rickettsia in Vietnam

Apr 26, 2012

CDC says Maryland severe flu cluster involved six cases
A recent family cluster of severe influenza cases in Maryland, some complicated by a resistant bacterial infection, involved six patients, one more than reported previously, the Centers for Disease Control and Prevention (CDC) reported today. Previous news reports said the infections were fatal in three patients—an 81-year-old woman and two of her children—and that a sister and another daughter of the elderly woman were hospitalized. The CDC reviewed the episode in an article released today in Morbidity and Mortality Weekly Report (MMWR). The elderly woman fell ill at the end of February and died at home 4 days later. Three days after her death, two of her children were hospitalized, and they died the day after admission. All three patients tested positive for seasonal H3N2 infections, and the two children were found to have co-infections with methicillin-resistant Staphylococcus aureus (MRSA) strain USA300. Also in early March, three more members of the family were found to have flu, the report says, without identifying relationships. Two of these tested positive for H3N2 and were hospitalized, but none of the three had pneumonia or a MRSA infection. The report also says some other family members were sick as well, but they either tested negative for flu or were not tested. The CDC said the rapid deterioration in the two patients with MRSA suggested that the flu and MRSA infections were simultaneous rather than sequential. The report notes that two of the three patients who died had multiple preexisting conditions, and two had received seasonal flu shots. The cases show the importance of using empiric antibiotic treatment when a bacterial co-infection is suspected in a flu patient, the CDC commented.
Apr 27 MMWR article
Mar 19 CIDRAP News story
Mar 8 CIDRAP News story

WHO's SAGE cites pregnant women as top flu-vaccine priority group
The World Health Organization's (WHO's) Strategic Advisory Group of Experts (SAGE) on Immunization today released preliminary recommendations after its April meeting, highlighting pregnant women as the most important target group for seasonal flu vaccine. The panel also listed, in no particular order, healthcare workers, children 6 to 59 months old, the elderly, and those with high-risk conditions as other targeted populations. SAGE members said countries currently targeting any of these groups should continue to do so and those not targeting these populations "should decide which other risk groups to prioritize for vaccination based on burden of disease, cost-effectiveness, feasibility, and other appropriate considerations." The full SAGE meeting report will be published in the WHO's Weekly Epidemiological Record on May 25.
Apr 26 WHO update

Rio dengue epidemic tops 50,000 cases
Officials in Rio de Janeiro have confirmed more than 50,000 cases of dengue this year and have declared a dengue epidemic, Agence France-Presse (AFP) reported yesterday. The state of Rio de Janeiro has confirmed 64,423 cases and 13 deaths, 12 of them in the city. The case count is ahead of last year's pace, which totaled 168,242 for the entire year, but 2011 dengue deaths totaled 140. "We have a plan focused on the epidemic and we continue to be in a state of alert," said Hans Dohmann, health secretary for the city.
Apr 25 AFP story

Rickettsia pinpointed as cause of Vietnamese skin disease
A mysterious skin ailment that has killed 19 people in Vietnam has been determined to be caused by Rickettsia bacteria, provincial health officials said, according to Xinhua, China's state news agency. The Quang Ngai provincial health department reported that 14 of 26 blood samples from patients tested positive for Rickettsia after 172 people became infected, the story said. The health department has asked for financial assistance for necessary blood filters and medicine, and the WHO said it would respond if necessary. The disease was first noticed in the central Vietnamese province last year, Xinhua reported. Rickettsia pathogens are typically transmitted to humans via fleas, lice, ticks, and mites, according to the CDC.
Apr 25 Xinhua report
CDC travel information on Rickettsia

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