News Scan for Oct 07, 2014

EV-D68 cases top 600
;
Dengue in India, China
;
Two MERS cases in Saudi Arabia
;
Flu ebbs in Southern Hemisphere

Enterovirus D68 count reaches 628 cases in 44 states

Another 34 patients have tested positive for enterovirus D68 (EV-D68), raising the US total to 628 cases, and Florida has recorded its first confirmed case, according to today's update from the Centers for Disease Control and Prevention (CDC).

Cases have now been confirmed in 44 states, the CDC reported. The only states with no confirmed cases are Oregon, Nevada, Arizona, Tennessee, Alaska, and Hawaii.

Florida's first case involves a 10-year-old girl in Hillsborough County (the Tampa area) who is recovering, according to an Associated Press (AP) report today.

EV-D68, previously uncommon in the United States, typically causes only cold-like symptoms, but in some children it can cause a severe illness that leaves them struggling to breathe.

Almost all the illnesses have been in children, many of whom have asthma or a history of wheezing. The virus is believed to spread via coughs, sneezes, and contact with contaminated surfaces.

The CDC says that four patients who died were infected with the virus, but the role it played in their deaths is unclear and still under investigation. Yesterday, however, health officials in New Jersey said the virus caused the death of a 4-year-old boy who died in his sleep.

EV-D68 is also suspected of being a factor in a mysterious polio-like illness that has struck a number of children in several states, including at least 10 in Colorado. Four of the Colorado children, who had partial paralysis and limb weakness, tested positive for the virus.

Keith Van Haren, MD, who has researched the polio-like cases in California, said he thinks EV-D68 will be identified as a factor in the cases, according to a Bloomberg News story today. "As a member of the clinical community, I think it is just a matter of time before we establish a definitive link between EV-D68 and this polio-like illness that follows," he said.
CDC enterovirus page
CDC list and map of
affected states
Oct 7
AP story
Oct 7
Bloomberg story

 

Study: India's dengue cases, costs greatly underestimated

India's official disease burden from dengue woefully understates the actual situation, with true case numbers standing nearly 300 times higher than the officially reported ones, says a study yesterday in the American Journal of Tropical Medicine and Hygiene. The cost burden of the disease amounts to $1.1 billion per year in the country, the authors estimate.

Reported cases of dengue in India, the country thought to have the most such infections worldwide, averaged 20,474 annually from 2006 to 2012, says the study by US and Indian researchers. Using an adjustment factor arrived at through an empirical case study in the Madurai district in the state of Tamil Nadu as well as expert opinion and a retrospective study at 10 medical colleges across the country, the authors estimated the true annual number of cases at 5,778,406, which is 282 times the official number.

To estimate the direct medical cost of dengue in India, average costs for treating a hospitalized dengue patient and a patient seen in the ambulatory setting were multiplied by the proportion of the population thought to be treated in each of these settings (67% and 33%, respectively), resulting in a total of $548 million. When indirect costs such as lost wages and the costs of travel to and from treatment are added, the total economic burden is $1.1 billion, the authors say.

Mosquito-borne dengue is thought to infect from 50 to 390 million people worldwide each year from more than 100 countries, with 20,000 fatalities.

The authors conclude, "With India's increasing role in international travel and the global economy, the need for additional dengue control and prevention strategies when available, such as vaccine and innovative vector control measures, becomes increasingly strong."
Oct 6 Am J Trop Med Hyg
abstract

In other dengue news, BBC News reported today that the southern Chinese province of Guangdong is experiencing the worst dengue outbreak in 20 years, with more than 23,000 cases so far, 6 of them fatal.

Wet weather and high temperatures, with a fivefold increase in the mosquito population, are to blame, say Chinese officials. Also contributing to the increased caseload is the week-long China National Day holiday that is now wrapping up, during which 1,000 new infections have been occurring per day, says the story.

Widespread pesticide spraying is being carried out, and free mosquito repellant is being offered.

Other countries are experiencing increases in dengue as well, including Malaysia, with deaths from the disease tripling in 2014, and Japan, which is seeing its first outbreak in 70 years, BBC reports.
Oct 7 BBC News story

 

Saudi Arabia reports two more MERS cases

Saudi Arabia reported two more MERS-CoV cases today, one of them fatal, extending a string of cases that began in late August after an early-summer hiatus in the virus's spread.

The Saudi Ministry of Health (MOH) reported a fatal case in a 51-year-old Saudi man in Hofuf who was not a healthcare worker. It said he had a preexisting illness and had been exposed to camels.

The other case involves a 77-year-old Saudi man in Taif, Mecca province, who has a preexisting disease and is in a hospital intensive care unit. He is not a health worker and was not exposed to animals, the MOH said.

His case is the eighth MERS-CoV (Middle East respiratory syndrome coronavirus) illness reported in Taif since Sep 12. The previous patients included two health workers, whose illnesses were reported on Sep 22 and 28. Taif, a city of half a million, is about 62 miles southeast of Mecca.

The new cases raise Saudi Arabia's MERS tally to 759 cases, including 323 deaths. Nine patients are still under treatment, and 427 have recovered, according to the MOH.

Also today, the World Health Organization's Eastern Mediterranean Regional Office (WHO EMRO) said no MERS cases have been reported so far in pilgrims participating in the Hajj, the annual Muslim pilgrimage to holy sites in Saudi Arabia. The Hajj is now coming to an end.

In response to a Saudi MOH request, EMRO sent a four-member technical team to Mina, Saudi Arabia, to oversee MERS-CoV–related precautions during the Hajj, according to the EMRO statement.
Oct 7 Saudi MOH statement
Oct 7 WHO EMRO statement on Hajj precautions

 

WHO notes declining Southern Hemisphere flu season

The Southern Hemisphere flu season is winding down, but influenza activity continues at high levels in Australia and Oceania, the WHO reported in its weekly update yesterday.

Influenza activity decreased in "most countries" in the Southern Hemisphere, the agency reported. Influenza-like illness (ILI) activity decreased in South America and was mostly associated with respiratory syncytial virus. Flu activity is also low in Africa.

In Australia and New Caledonia, however, the flu season continued, with high activity associated with 2009 H1N1 and H3N2 viruses. ILI activity also increased in several Pacific islands.

Flu  remained at inter-seasonal levels in North America and Europe as well as in western Asia. Influenza circulation remained low in eastern Asia after some H3N2 activity in August and September.

As of Oct 2, 1,540 of 21,796 respiratory specimens, or 7.0%, tested positive for influenza. Of those, 1,049 (68.1%) were influenza A and 491 (31.9%) influenza B. Among influenza A samples that were subtyped, 454 (61.1%) were H3N2 and 289 (38.9%) were 2009 H1N1. All but 2 of the 54 "B" strains subtyped belong to the Yamagata lineage.
Oct 6 WHO weekly update

 

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