News Scan for Mar 09, 2015

News brief

US measles total rises to 173

The US Centers for Disease Control and Prevention (CDC) received reports of 3 more measles cases last week, nudging the national total to 173 so far this year, a large chunk of them part of an ongoing multistate outbreak linked to Disneyland in California, according to an update today. The pace of the increase seems to have slowed, compared with the 16-case increase the CDC reported last week.

The number of states reporting measles cases remained at 17, and most of the cases are associated with four outbreaks, the largest being the Disney outbreak. Illinois, Nevada, and Washington are battling smaller outbreaks.

Two more infections have been connected to the Disney outbreak, which started in late December, boosting that total to 142, the CDC said. Measles infections in seven states have been traced to the Disney outbreak, with 126 of them in California.

The California Department of Public Health (CDPH) said in a Mar 6 update that it has detected 132 confirmed measles cases in state residents since December. It said 40 visited Disneyland in mid December, 30 were contacts, 11 were exposed in a community setting where a confirmed case had been present, and 48 had an unknown exposure source but are linked to the outbreak due to epidemiologic factors or strain typing.

The CDPH said 3 case-patients have a different genotype from the B3 outbreak strain.

The CDC has said that most people sickened by measles this year were unvaccinated, and it warned that measles is still common in many parts of the world. The strain involved in the Disney outbreak is the same one that fueled a large outbreak in the Philippines in 2014.
Mar 9 CDC measles update on 2015 cases
Mar 9 CDC update on Disney-linked cases since December
Mar 6 CDPH statement

Chikungunya cases in the Americas rise by more than 9,000

The number of chikungunya cases in the Americas has grown by 9,038, to 1,259,933, the Pan American Health Organization (PAHO) said in its weekly update late last week. The increase was just 2,802 cases the week before.

The total includes 1,231,077 suspected, 25,353 confirmed, and 3,503 imported cases, with most of the imported ones in the United States.

Colombia had the highest increase, accounting for the vast majority of new cases, with 7,848. It now has 185,035 suspected and confirmed cases. Other areas with a substantial increase were Puerto Rico, with 418 new cases and 31,165 total, and El Salvador, with 331 new cases and 143,503 in all.

The United States reported no new cases, remaining at 11 locally transmitted ones—all in Florida—and 2,874 imported cases. The death toll linked to the mosquito-borne disease also stayed the same, at 183.
Mar 6 PAHO update
Mar 2 CIDRAP News story on previous week's numbers

Flu Scan for Mar 09, 2015

News brief

Nineteen more H7N9 cases reported in China

Nineteen new H7N9 avian influenza cases have been reported in seven of China's provinces over the past 3 days, though basic epidemiologic details are known for only six of them, according to official reports, including health department notices translated and posted by FluTrackers, an infectious disease news message board.

Nine of the cases are from Zhejiang province. Three of the case-patients are a 57-year-old man in Changshan County and two men, 49 and 76, from Jinhua. The illness in the older man was first reported in the Chinese media in late February; he has now died from his infection.

Six other H7N9 infections in Zhejiang province were noted in an update today from Hong Kong's Centre for Health Protection (CHP), though no other details were available other than that the illness onsets for a batch of 19 cases, some previously known, occurred in the past 5 weeks.

Today's CHP report—based on information from mainland health authorities—also included six other H7N9 cases that hadn't been reported before, though no epidemiologic information was included. They included 3 cases from Jiangsu province, 2 cases from Hunan province, and 1 case from Guizhou province.

In separate reports, Guangdong province on Mar 7 reported 2 more H7N9 infections, Shandong province yesterday reported 1 illness, and Fujian province today reported 1 new case. The two patients from Guangdong province are a 62-year-old man from Foshan who is hospitalized in critical condition and a 57-year-old man from Jiangmen who has a history of lung cancer and is hospitalized in serious condition.

Meanwhile, Shandong officials said yesterday that the virus infected a 58-year-old man from Tai'an who is being treated for his illness. No details were available in the translated statement from Fujian province on the 1 new case, but it also mentions 3 deaths in previously reported H7N9 patients.

The 19 cases boost the global H7N9 total to 643 cases, according to a case list maintained by FluTrackers.
Mar 8 FluTrackers thread on 1 Zhejiang case
Mar 8 FluTrackers thread on 2 Zhejiang cases
Mar 9 CHP statement
Mar 7 FluTrackers thread on Guangdong cases
Mar 8 FluTrackers thread on Shandong case
Mar 9 FluTrackers thread on Fujian case
FluTrackers H7N9 case list

Egypt reports 5 H5N1 cases, 2 deaths

Two women from northern Egypt have died of H5N1 avian flu and three other people have contracted the disease, The Cairo Post reported yesterday, citing a health ministry statement.

The women are from Monufia and Sharqia governorates, both of which are in the Nile delta region. The story included no further details on the women. It also said that a 2-year-old from Cairo and two men in their 40s in the delta region have tested positive for the virus and are hospitalized.

A case list maintained by FluTrackers—which doesn't appear to include any of the five new cases—lists 82 H5N1 infections in Egypt this year, including 23 deaths.
Mar 8 Cairo Post story
FluTrackers H5N1 case list

Meta-analysis finds no harmful effect of flu vaccine during pregnancy

A 19-study meta-analysis on the effects of influenza vaccines on pregnant women found no elevated risk of adverse effects on pregnancy-related or birth outcomes.

Australian researchers examined 19 studies that included a total of 114,863 women and 384,239 unvaccinated controls. They found that fetal death for women in later pregnancy ranged from an odds ratio (OR) of 0.34 to 2.95, miscarriage at less than 24 weeks ranged from a hazard ratio (HR) of 0.45 to an OR of 1.23, and congenital malformations for women vaccinated during their first trimester ranged from an OR of 0.67 to 2.18.

None of these findings indicates an elevated risk, though the investigators add, "Statistical imprecision and clinical and methodological heterogeneity of the observational studies mean it is not possible to totally exclude adverse effects."

The authors say their review contains more recent studies than the most recent Cochrane review and is the most up-to-date systematic review published on fetal death and congenital malformations. They also write that theirs is the only systematic review that analyzes first-trimester immunization effects on congenital malformations.
Mar 8 Vaccine study