Flu Scan for Dec 19, 2013

News brief

WHO confirms H10N8 avian flu in Chinese woman

The World Health Organization (WHO) today confirmed that the H10N8 avian flu death in a woman from Jiangxi province, China, reported 2 days ago by Chinese officials is indeed the first human case involving that strain, and it provided some new details.

In a statement, the WHO said the 73-year-old woman visited a live-bird market 4 days before onset of symptoms. As previously reported, she was immunocompromised because of underlying medical conditions, was hospitalized Nov 30, and died Dec 6.

"The fact that the virus was isolated from a patient and reported through active surveillance by the Chinese health authorities is a sign that the surveillance system is working well," the WHO said.

"The specific source of the infection is unknown. As wild birds/poultry have been known to carry this virus, further sporadic cases may be detected."

The agency said contact tracing is ongoing, and so far there is no evidence of human-to-human transmission. The statement called for vigilance and close monitoring.

As reported previously, H10N8 has been detected in birds in China before. But the WHO added that, since 1965, it has also been detected in birds in the United States, Canada, Italy, Sweden, South Korea, and Japan.

The WHO said it is closely monitoring the situation and facilitating information sharing with member states. It added that it is collaborating with animal health professionals to identify a possible animal source and assess health risks.
Dec 19 WHO statement
Dec 17 CIDRAP News story on the case

 

Immune study yields clues in H1N1 vaccine-related narcolepsy

In an ongoing effort to unravel why some European children experienced narcolepsy after receiving the Pandemrix 2009 H1N1 vaccine, an international research team led by scientists at Stanford University found that an immune response to a protein on the virus may provide a clue. The team published its report yesterday in Science Translational Medicine.

They examined CD4+ T-cell activity in 39 narcoleptic children, plus their siblings who were also vaccinated but did not develop narcolepsy. The study included identical twins for four of the cases.

In youngsters with narcolepsy, CD4+ cells reacted to both hypocretin, a neurotransmitter that carries a "waking" signal, and the hemagglutinin surface protein on the 2009 H1N1 virus. The researchers said the findings suggest that immunity to the 2009 H1N1 virus protein, from the vaccine or from the virus itself, affected hypocretin production, and that the adjuvant in the vaccine doesn't appear to have contributed to the problem, aside from boosting the immune response.
Dec 18 Sci Transl Med abstract

In a related development, researchers from Oxford University who reviewed the vaccine safety response in the cases of narcolepsy in kids who received the 2009 H1N1 vaccine wrote that the experience yielded valuable lessons. The report appears today in Lancet Infectious Diseases.

According to the report, as of June more than 900 cases of narcolepsy had been reported in those who received Pandemrix, a GlaxoSmithKline vaccine that included the AS03 adjuvant. Countries reporting cases include Finland, Sweden, England, Ireland, France, and Norway.

Their review concluded that the rare occurrence was flagged by existing surveillance strategies, triggered by clinicians' spontaneous reports, and that the events were followed by appropriate investigations and timely interventions. However, they noted that the delayed onset of narcolepsy meant that some pandemic-related pharmacovigilance strategies could not have detected the signal, because their work had already been completed.
Dec 19 Lancet Infect Dis abstract

News Scan for Dec 19, 2013

News brief

Foster Farms–linked Salmonella case count rises to 416

The multistate outbreak of Salmonella Heidelberg linked to chicken from producer Foster Farms in California has now sickened 416 people in 23 states and Puerto Rico, according to an update today from the Centers for Disease Control and Prevention (CDC). The last-reported case count was 389 on Nov 19.

The majority of cases (74%) have occurred in California. Of the 27 newly reported cases, 22 have been from California, followed by Arizona and Colorado with 2 each and Washington with 1.

Illness-onset dates for patients with information available range from Mar 1 to Dec 1 of this year. Patient ages range from 1 to 93 years, with a median of 19. Hospitalization has been necessary in 39% of 340 cases with information available, and there have been no deaths.

The three Foster Farms facilities made substantive changes in slaughter and processing methods after the outbreak began that allowed them to continue operations, according to an Oct 17 notice from the US Department of Agriculture.

The CDC notes that illnesses occurring after Nov 17 may not have been reported yet because of lag time between onset and reporting. The agency also cautions that more cases may occur because consumers purchased the tainted chicken and froze it for later use.
Dec 19 CDC update
Last CIDRAP News scan (Nov 20) on the outbreak

 

Botulism cases in Texas linked to fermented vegetables

Four cases of botulism in Amarillo, Tex., have been linked to homemade turshi, a traditional Middle Eastern dish made of fermented vegetables, according to Amarillo city officials.

All four patients were hospitalized, but two have been released, the city said in a Dec 17 press release. The identification of the first case on Dec 9 sparked an investigation by city health and environmental officials, the Texas Department of State Health Services, and the CDC.

Investigators learned that two patients from each of two households had eaten turshi over several weeks and that the dish had been prepared in one of the households, according to the release.

"Investigators believe that during the fermentation phase of preparation lasting several weeks, conditions were ideal for bacteria growth and botulinum toxin production," the release said. "Because the food was consumed weeks ago, none of the turshi was available for testing. No commercial food product or restaurant has been linked to the outbreak."

Officials said no commercially available turshi was implicated in the outbreak and there was no indication of a threat to the public.

The statement also said that tests of clinical and environmental samples in the investigation were negative, but testing was continuing.

Deree Duke, head of the city's Department of Environmental Health, told the Amarillo Globe-News that the cases were clinically confirmed. He said low levels of botulinum toxin can be hard to detect, especially when there is a considerable delay between onset of symptoms and testing.
Dec 17 City of Amarillo press release
Dec 17 Amarillo Globe-News story

 

Multistate 2011 Q fever outbreak had high rate of symptomatic cases

The first reported US multistate outbreak of Q fever, in 2011, involved 21 people, with an unusually high percentage of them having symptoms, according to results of a cross-sectional investigation published yesterday in Vector-Borne and Zoonotic Diseases.

Investigators queried people associated with the index goat farm in Washington state as well as 16 other farms that bought goats from the index farm or housed goats at the index farm for breeding.

Of 109 people contacted, 21 (19%) from Washington or Montana met the outbreak case definition and had a Coxiella burnetii phase 2 immunoglobulin G titer of 1:128 or greater by immunofluorescence assay. Of the case-patients, 15 (71%) were symptomatic. The authors said a typical symptomatic rate is about half of patients.

Evidence of C burnetii infection was detected in all 17 goat herds sampled (13 in Washington, 3 in Montana, and 1 in Oregon) by polymerase chain reaction, enzyme-linked immunosorbent assay, or both.

Goat-specific Q fever risk factors included direct contact with a newborn goat, exposure to a dead or weak newborn, living on a property with goats, and direct contact with "birth/afterbirth products."

The authors said that after their investigation Washington and Montana implemented a herd management plan to encourage best disease-control practices, reduce the possibility of future outbreaks, and promote communication between public health and agriculture officials.
Dec 18 Vector Borne Zoonotic Dis abstract


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