News Scan for Nov 20, 2014

MERS case, death
More chikungunya cases
H10N7 in seals
Polio eradication in Africa

Fourth MERS case in Al-Kharj in a week, 1 death in Taif

Saudi Arabia's Ministry of Health (MOH) today reported another MERS-CoV case in the city of Al-Kharj, the fourth there in a week, as well a fatality in Taif, a city with a spate of cases over the fall season.

The new reports bring the total case count from MERS-CoV (Middle East respiratory syndrome coronavirus) since June 2012 to 808 and the deaths to 346. Twelve cases remain active, with the remaining 450 case-patients recovered.

The new case is in a 48-year-old Al-Kharj woman who is not a healthcare worker. She had preexisting disease and was symptomatic upon presentation. She is listed as being in stable condition and as having had exposure to a suspected or confirmed MERS-CoV patient in the community setting but no animal exposure.

The death occurred in a 70-year-old woman in Taif whose case was previously reported. She had preexisting disease and was not a healthcare worker.
Nov 20 MOH update

In other MERS-CoV news, Saudi Arabia now has a specialized medical laboratory with the latest technology to help in the country's struggle against the growing disease, according to Xinhua, China's news agency, reporting today on an Arab News story.

The lab, in Medina, can identify samples within 6 hours as well as provide comprehensive examination of MERS-CoV and other respiratory viruses. Such testing previously could take 24 hours because samples had to be sent to Jeddah, 330 kilometers away. The lab also processes samples from patients with suspected hepatitis and HIV.
Nov 20 Xinhua story


Caribbean chikunguyna outbreak nears 900,000 cases

The Pan American Health Organization (PAHO) reported 7,743 more cases of chikungunya in the Caribbean and Americas yesterday, bringing the outbreak total to 896,549.

The total includes 878,745 suspected and 15,793 confirmed locally acquired chikungunya cases, as well as 2,011 imported cases. The report also said the death toll has increased by 1, to 154.

Colombia reported the largest increase in cases since the previous report on Nov 7—2,601—bringing its total to 22,398 cases so far. Puerto Rico was next, with 1,081 new cases (20,104 total). And St. Lucia had 562 new cases (896 total), while St. Kitts and Nevis reported 400 new cases (459 total).

The report is dated Nov 14 but was not posted on the PAHO site till yesterday. The previous update reported an increase of more than 95,000 cases after weeks of increases of well under 10,000 cases per week.

In related news, a chikungunya vaccine candidate was shown to be safe and immunogenic in a phase 1 trial involving 42 people, Medical Xpress reported today. Trial results of the vaccine candidate, produced by Themis Bioscience GmbH of Vienna and the Pasteur Institute in Paris, were presented at two international conferences.
Nov 14 PAHO update (posted Nov 19)
Nov 20 Medical Xpress story


H10N7 detected in massive harbor seal die-off

H10N7 avian flu has been implicated in a massive die-off of harbor seals this year on the west coast of Sweden, according to a report in Eurosurveillance today. The subtype has not been reported before in seals, nor has influenza A of any type been reported in European seals, the authors say.

A team of Swedish scientists wrote than 425 dead, stranded harbor seals were counted along the coast from March through October. Typically 30 to 40 are found dead in the area each year.

Lung samples from two of the seals tested positive by polymerase chain reaction for H10N7. Phylogenetic analysis showed the strain to be closely related to other avian flu strains in wild and domestic birds in Europe.

Samples were collected 4.5 months apart, showing the virus had been circulating in the area for some time, the authors noted. They did not specify whether other seals were tested.

The researchers conclude, "From a public health perspective, extended circulation within a mammalian host not only demonstrates that this strain is capable of infecting and circulating in mammals, but it increases the opportunity for mutations to occur that may facilitate human infection."
Nov 20 Eurosurveillance report


Nigeria nears goal of polio eradication with large decrease in cases

If Nigeria can continue on its path of a low and fading number of polio cases, Africa is on target to soon be free of the disease, says an article today in Morbidity and Mortality Weekly Report (MMWR).

The report provides a summary of polio in the country from January 2013 through September 2014. Only two other countries worldwide, Afghanistan and Pakistan, continue to see circulation of wild poliovirus (WPV).

Through September 1, Nigeria has seen only 6 cases of WPV infection this year, down from 53 total (49 in the same period) in 2013, which in turn was down from 122 total in 2012. Five of this year's cases were in the Kano transmission area and one in the Borno/Yobe area, all in northern Nigeria. Supplemental immunization activities (SIAs) in these areas in June through August reached an estimated 1.7 children, and further SIAs there are planned before the end of the year.

Credit for the continuing decrease goes to innovations in the national vaccination program for successful campaigns in underserved and hard-to-reach areas. Among new strategies are responding to each WPV case as if it were an outbreak, holding "vaccination camps" for transient populations, and engaging "permanent health teams," which are typically women who vaccinate in homes in their own communities.

Routine immunization in Nigeria consists of trivalent oral polio vaccine at birth and at ages 6, 10, and 14 weeks.

No WPV3 cases or environmental isolates have been identified in Nigeria over the past 2 years, indicating possible interruption of this strain.

One of the main objectives of the Global Polio Eradication Initiative's Polio Eradication and Endgame Strategic Plan for 2013-2018 is eradication of WPV1 from Nigeria by the end of 2014.
Nov 21 MMWR article
Nov 13 CIDRAP News scan on WPV3


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