News Scan for Oct 02, 2014

More US chikungunya cases
More EV-D68 cases
Antimicrobials in animals
Typhoid fever control gaps

US chikungunya cases reach 1,200

As of Sep 30, 86 new cases of chikungunya were brought into the United States by travelers, most of them visiting or coming from the Caribbean, according to this week's update from the Centers for Disease Control and Prevention (CDC).

This brings the total count of imported cases to 1,200. Additionally, Florida has reported 11 locally acquired cases, a number that held steady since last week.

Cases reported from US territories number 496, 4 more than last week. Most of those cases have been locally acquired—421 in Puerto Rico and 45 in the US Virgin Islands.

Chikungunya, a mosquito-borne disease that until this year was mainly limited to Africa and South Asia, has spread widely in the Caribbean and the Americas during 2014. Overall numbers for suspected and confirmed cases in the current outbreak stand at about 750,000.
Oct 1 CDC update
Most recent (Sep 29) CIDRAP News scan on chikungunya


CDC tally of EV-D68 cases rises to 514 in 43 states

Another 14 enterovirus D68 (EV-D68) infections have been confirmed, raising the nationwide count to 514 cases in 43 states and Washington, DC, according to a CDC update today.

A CDC map shows that Vermont joined the list of affected states today. Almost all of the respiratory disease cases have been in children.

The virus, which was uncommon in the United States until recently, usually causes cold-like symptoms, but it can lead to breathing difficulty in some cases, especially in children who have asthma.

The CDC reported yesterday that four patients who recently died were infected with EV-D68, but it said the virus's contribution to the deaths was not yet clear. Today's update provided no new information about those cases.

The CDC and several state health departments are also investigating several cases of polio-like illnesses, with limb weakness or partial paralysis, that may be associated with the virus, but the CDC update offered no new findings on that topic.
CDC's EV-D68 2014 page
CDC list and map of affected states

FDA notes mixed findings regarding antibiotic use in animals

The fourth annual summary report on sales and distribution of antimicrobials for use in food-producing animals, covering data for 2012, was issued today by the US Food and Drug Administration (FDA) and noted mixed findings.

Among trends noted for medically important antimicrobials for use in US food-producing animals from 2009 through 2012 are:

  • The total quantity sold and distributed increased by 16%.
  • The percentage of domestic sales and distribution of agents with an approved indication for production use or with approval for both production and therapeutic use decreased by 4 percentage points, from 72% to 68%, a decrease that does not reflect drugs labeled solely for production. The percentage for products labeled solely for therapeutic indications increased 4 percentage points, from 28% to 32%.
  • The percentage of sales and distribution of over-the-counter agents decreased from 98% to 97%, a nonappreciable difference.

The report points out that the animal drug sales data represent the volume of product distributed or sold by manufacturers to outlets for ultimate sale to end-users, not the volume bought by end-users for use in animals.

It also notes that the 2012 data do not reflect the FDA's action in December 2013 calling for removal from product labels any indications for growth promotion in animals. Also, as of December 2016 it will be illegal to use antimicrobials in animals without veterinary oversight.
Oct 2 FDA story
2012 FDA annual report


Study: Typhoid fever still a neglected disease in many Asian countries

Despite 2008 revised World Health Organization (WHO) recommendations for tracking and vaccinating against typhoid fever in endemic areas, control efforts still lag in many parts of Asia and Western Pacific where the disease is endemic, an international group of researchers reported today in Morbidity and Mortality Weekly Report (MMWR).

They reported that infections with Salmonella enterica Typhi, transmitted through the fecal-oral route in settings that lack safe drinking water and proper sanitation sicken about 22 million people each year and lead to 216,500 deaths.

The group's analysis is based on surveillance and vaccine-use data for 48 countries in the WHO's Southeast Asia and Western Pacific regions during a 5-year period, from 2009 through 2013.

Fewer than half of the countries do culture-based surveillance, and even though some countries established vaccination programs before 2008, since that time only two—China and Vietnam—do large-scale typhoid vaccination. The investigators noted that one factor that might contribute to lack of vaccine use is lack of specific data in many countries to support their use.

The authors concluded that, despite the heavy burden, typhoid fever is still a neglected disease in the two regions and that more action is needed to craft prevention and control steps, especially in the hardest-hit countries.
Oct 3 MMWR report

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