News Scan for Aug 20, 2013

MERS in Qatar
Cyclospora update
H7N9, H5N1 compared
Obesity-flu link
H5N1 outbreak in Cambodia

MERS-CoV case reported in Qatar

A 59-year-old man in Qatar is sick with a MERS-CoV (Middle East respiratory syndrome coronavirus) infection, according to an Agence France-Presse (AFP) report today, marking what appears to be the Persian Gulf country's third case.

The man is in stable condition, the story said, but it gave no other details. The case has not yet been noted by the World Health Organization (WHO), and it is not mentioned on the English language Web site of Qatar's Supreme Council of Health.

Two previous MERS cases have been reported in residents of Qatar, which borders Saudi Arabia, site of the majority of cases. Last September a 49-year-old Qatari man who had traveled to Saudi Arabia fell ill with the virus and was flown to London, where he remained hospitalized until he died on Jun 28, according to previous reports.

His case was one of the first two MERS cases that came to light, the other being that of a 60-year-old Saudi man. Both cases were announced in late September, though the Saudi man died in June.

The other Qatari case involved a patient who was treated in Germany in October and eventually recovered.

The new case raises the unofficial global total of MERS cases to 97, including 47 deaths. Yesterday a machine-translated statement from Saudi Arabia's Ministry of Health reported two new cases in that country, but they have not yet been noted by the WHO.
Jul 3 CIDRAP News story on death of previous Qatari patient
March 25 CIDRAP News story noting Qatari who was treated in Germany
Sep 24, 2012 CIDRAP News story about first two MERS cases identified


CDC reports 7 more Cyclospora infections

The US Centers for Disease Control and Prevention (CDC) reported seven more Cyclospora infections today, boosting its outbreak total to 593. The number of affected states held steady at 20, with the latest illness onset listed as Jul 31. In its update the CDC said most of the cases were reported from mid June through mid July.

Texas, which has the most cases, reported 267 cases in its latest update, which is 20 more than the CDC's tally for the state. Adding those cases to the CDC total would put the national total at 613.

Cyclospora cases in Iowa and Nebraska have been linked to a bagged lettuce mix from a producer in Mexico, but it's still not clear if cases in other states are part of the same outbreak.
Aug 20 CDC outbreak update
Aug 20 Texas Department of State Health Services update


Scientists cite parallels, differences in emergence of H7N9 and H5N1

In a lengthy perspective article in Lancet Infectious Diseases, Chinese scientists find many parallels between the human outbreak of H7N9 avian influenza in China this year and H5N1 avian flu as it emerged in Hong Kong in 1997, but also some major differences.

The Hong Kong H5N1 outbreak involved 18 cases with 6 deaths. So far this year, there have been 135 H7N9 cases, including 43 deaths. H5N1 reemerged in 2003 and has caused 633 human illnesses with 377 deaths since then, according to the World Health Organization.

Both viruses showed a predilection for infecting the lower respiratory tract, caused severe pneumonia with high mortality, and involved primarily poultry-to-human transmission, says the report by researchers from Hong Kong and Hangzhou. Also, both pathogens cropped up in growing megacities (Shanghai and Hong Kong) that lie on migratory bird flyways with major river deltas and many poultry farms in the vicinity.

Genetically, both viruses are reassortants that have internal genes from H9N2 viruses found in Asian poultry, and both have genetic markers of mammalian adaptation in their hemagglutinin and polymerase PB2 segments, the report says.

Among the differences, the researchers note that the H7N9 cases were not preceded by poultry outbreaks, unlike the H5N1 emergence. Also, H7N9 patients on average were much older and were more likely to be male than those in the 1997 event.

Noting that the rapid increase in human H7N9 infections from March to May of this year is unprecedented for avian flu viruses, the authors comment, "Why H7N9 seems to be more readily transmitted from poultry to people than H5N1 is still unclear."

In other observations, they predict that stringent measures to control H7N9 in poultry will stop the human epidemic, but caution that increasing problems with avian flu are expected as poultry consumption rises in China and demand increases. Also, they write that further research is needed on whether the widespread use of H5N1 poultry vaccines in East Asia, along with lax biosecurity measures in the poultry industry, contributed to the emergence of H7N9.
Lancet Infect Dis abstract


Study finds obesity link to seasonal and pandemic flu

Obesity has a small-to-moderate association with hospitalization for flu-like illness, according to a new study that explored the link for both seasonal flu and the recent pandemic H1N1 virus.

A team from Massachusetts reported its findings today in the latest online edition of Influenza and Other Respiratory Diseases. They based their findings on data from electronic health records from patients who received care at a large multispecialty practice. Besides the 2009 H1N1 pandemic waves, they looked at the 2003-04 season, which was relatively severe and was dominated by H3N2, and the 2004-05 season, which was also dominated by H3N2 but had a higher percentage of influenza B.

Over the three seasons there were 471 cases of severe flu-like illness and 6,127 mild cases. The researchers found an association between obesity and severe illness for adults aged 20 to 59 years but not for patients 60 or older. The link was similar but smaller between obesity and mild flu-like illness that was treated in outpatient settings.

The strength of the association varied by flu season and age-group. The authors said their results support earlier findings of an association between obesity and flu, first observed during the 2009 H1N1 pandemic, and also suggest that obesity may be an independent risk factor for flu hospitalization in nonpandemic years, especially in healthy young adults.

They said that other recent studies on the link between flu and obesity have yielded mixed results but said their findings are somewhat comparable to a Canadian study that looked at the link over 12 flu seasons. The investigators noted that while their sample size was large, the study was based on diagnostic codes rather than lab-confirmed flu.
Aug 20 Influenza Other Respi Viruses abstract


H5N1 in Cambodian backyard chickens

An outbreak of H5N1 avian flu in backyard chickens has been identified in the Cambodian village of Damnak Dangkor in Battambang, the same northwestern province where a boy's death from the disease was reported yesterday.

The outbreak was discovered by a veterinary team sent to sample local chickens after a 7-year-old girl there was reported to have H5N1 earlier this month, according to a notice yesterday from the World Organization for Animal Health (OIE).

The number of chickens considered susceptible is reported at 2,000, of which 1,346 have died, for a mortality rate of 67.3%.
Aug 19 OIE report
Aug 19 CIDRAP News scan on Cambodian boy's death

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