News Scan for Oct 01, 2013

More Saudi MERS cases
Boston BSL-4 lab clears hurdle
Colorado TB investigation
Hepatitis C screening
Polio in South Sudan

Saudi Arabia announces three more MERS cases

Saudi Arabia has reported three more Middle East Respiratory syndrome coronavirus (MERS-CoV) cases, according to a machine-translated Saudi government statement posted on disease-tracking Web sites.

The brief statement from the Saudi Ministry of Health says the cases involve a 79-year-old, a 45-year-old, and a 14-year-old, according to a translation on the FluTrackers message board. The two older patients are said to have chronic diseases.

Although the translated statement is somewhat unclear, it appears that all the patients are contacts of confirmed case-patients. The 14-year-old is described as being in stable condition, while the 45-year-old is receiving "intensive treatment." The statement says the patients are from Riyadh.

If confirmed, the cases would raise Saudi Arabia's MERS-CoV tally to 117 cases with 49 deaths. The latest cases follow a report of three cases announced Sep 27, though the MOH provided no English-language statement on them until yesterday.
Oct 1 FluTrackers post
Oct 1 Avian Flu Diary post with translated statement
Saudi MOH MERS-CoV media statements


Boston BSL-4 lab clears judicial hurdle

A federal judge has ruled that a final risk assessment by the National Institutes of Health of Boston University's National Emerging Infectious Diseases Laboratories (NEIDL) adequately analyzes associated risks, which moves the lab closer to full operation, according to a story today in BU Today, the campus newspaper.

The risk assessment examined a series of potential consequences of procedural failure, including containment failures, and terrorist acts for the facility, which was completed in 2008 for research on pathogens at biosafety-level 3 (BSL-3) and 4 (BSL-4)—the highest safety level. It has not opened, however, because of controversy and litigation.

The latest ruling comes after the NIH risk assessment was challenged in court by Boston residents and the Boston-based Conservation Law Foundation. In her opinion, US District Court Chief Judge Patti Saris said, "The NIH provides sufficient scientific support for its ultimate conclusions that the risks to the public are extremely low to not reasonably foreseeable, and the differences between the Boston location and the suburban and rural sites are not significant."

"The court is saying that it's reasonable for the NIH to determine that research using these types of pathogens can be done safely at the NEIDL," said NEIDL Interim Director John R. Murphy. "This is one more step to the opening of the lab."

Murphy said that one additional judicial hurdle, a similar lawsuit filed in state court, will be heard later this year.

Boston University has also asked the Boston Public Health Commission for required permits to operate the NEIDL as a BSL-3 lab and will soon submit required BSL-4 documents, the story said.
Oct 1 BU Today story


Report: Officials successfully stem Colorado TB school outbreak

Prompt institution of tuberculosis (TB) screening and preventive treatment in a Colorado high school that had a TB-infected patient late in 2011 resulted in effective curtailment of transmission after four additional cases were discovered, reports the Centers for Disease Control and Prevention (CDC) in today's Morbidity Mortality Weekly Report (MMWR). (Note: The MMWR issue scheduled for Oct 4 was released early this week because of the government shutdown that began today.)

The index patient, who was US-born but had lived abroad from ages 8 to 10, was hospitalized in December 2011 after 2 month of coughing, fever, and night sweats. The student's chest film showed a pulmonary cavity, and a sputum smear showed acid-fast bacilli, both markers for potential contagiousness. Standard four-drug TB treatment through September 2012 was effective.

Among the student's family of five, one member was found to have genitourinary TB disease and the other four to have latent Mycobacterium tuberculosis infection (LTBI).

Screening of students and school personnel was done in stages, with people sharing at least two classes with the index patient tested first; 10 of 19 (53%) were found to have LTBI. Next screened were those sharing one class; 49 (35%) of 140 tested positive for LTBI. In total, 1,249 (90.4%) of the school's 1,381 students and school personnel were tested. One person was found to have pulmonary TB disease and 162 (13%) to have LTBI.

Of the 159 LTBI people who started either self-supervised daily isoniazid for 9 months or rifampin for 4 months, or school-supervised weekly isoniazid and rifapentine for 9 months, 153 (96%) completed treatment.

Two non-school contacts also had TB diagnosed after the school investigation, the authors said.

The local health department received help from county and state health workers to deal with the excessive workload posed by the screening and treatment. Public informational meetings were held to correct misinformation, answer concerns, and report on progress of the investigation.

"An emergency plan for focusing widespread resources, an integral public communications strategy, and new, efficient interventions should be considered in other large TB contact investigations," states the article.
Oct 4 MMWR article


Canadian physicians recommend 'Baby Boomer' screening for hepatitis C

A group of liver experts in Canada has raised arguments in a Canadian Medical Association Journal (CMAJ) analysis for a national screening program for hepatitis C among people born between 1945 and 1975, particularly because most people infected with the disease are asymptomatic and unaware of it until its later stages.

The disease, say the authors, is curable if caught early but, according to a University Health Network press release, "causes more years of life lost than any other infectious disease in Ontario, and likely, Canada, and is the leading indication for liver transplantation." So-called Baby Boomers account for 75% of hepatitis C cases in the United States, the authors point out, and have a 3.6% prevalence of the disease compared with a 1.6% rate in the overall population.

At present, people in Canada are generally tested for hepatitis C only if they have risk factors, including injection drug use, blood transfusions or blood products before 1992, piercings or tattoos done in questionable environments with nonsterile tools, exposure to infected blood, or having medical procedures or shots in areas where the disease is common (eg, Egypt, southern Italy, Eastern Europe, Central and Southeast Asia).

The authors point out that up to 30% of hepatitis C patients have no risk factors. Broadened screening would better identify these persons, they say, but should not replace risk factor–based programs.

The proposed screening program, say the authors, would be expensive but would save future healthcare costs because of reduced morbidity and mortality.

"This silent epidemic can be prevented and many more lives could be saved with Baby Boomer screening, follow-up treatment and a major education campaign," said Jordan Feld, MD, MPH, one of the authors.
Sep 30 CMAJ article (early access limited to subscribers)
Sep 30 University Health Network press release


South Sudan investigates suspected polio cases

Health authorities are investigating three suspected wild poliovirus type 1 (WPV 1) infections in South Sudan, an area considered at high risk due to an ongoing outbreak in the Horn of Africa, the World Health Organization (WHO) said today in a statement.

The patients are three girls who came down with paralysis symptoms from Aug 15 to Aug 24.They include a pair of 2-year-olds and an 8-year-old. Two are from North Bahr El Ghazal state, near the border with Sudan, and the other is from Eastern Equatoria state, close to the Kenya and Uganda borders.

Genetic sequencing tests are under way to confirm initial lab findings and to pinpoint the source of the virus. All three of the girls had previously received the oral polio vaccine.

So far 208 polio cases have been reported in three Horn of Africa countries: 191 in Somalia, 14 in Kenya, and 3 in Ethiopia. Given South Sudan's risk of reinfection, health officials conducted immunization campaigns in March, April, and August, and additional activities are planned for November and December, according to the WHO. Response plans  include further immunization efforts in areas where cases were detected. An international team of experts is being deployed to help local officials.

The latest outbreak is South Sudan's first since 2009, Voice of America (VOA) reported yesterday.
Oct 1 WHO statement
Sep 30 VOA report

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