News Scan for Mar 23, 2015

Three MERS cases
;
Chikungunya uptick
;
H5N1 cases in China, Egypt
;
More US measles
;
Climate change and vectors

Three MERS cases in Saudi-Arabia end 3-day quiet spell

Saudi Arabia ended a 3-day stretch without any new MERS-CoV cases by reporting one on Mar 21 and two more yesterday, while news of findings from an unpublished study suggested that undetected cases may be much more numerous than previously supposed.

The new MERS-CoV (Middle East respiratory syndrome coronavirus) cases all involved male expatriates who are in stable condition, according to the Saudi Ministry of Health (MOH). The patients are a 60-year-old in Jeddah, a 54-year-old in Riyadh, and a 60-year-old in Najran.

The Riyadh and Najran patients both had contact with other MERS-CoV patients in the community, the MOH said. The ministry said the Jeddah patient had no contact with patients in the community, but it listed no other exposure information, saying it would provide more in its weekly MERS update.

The MOH's Mar 21 update also noted the recovery of three previously reported patients, all in Riyadh, including two healthcare workers.

The latest cases raised Saudi Arabia's cumulative MERS count to 961 cases, with 418 deaths, 522 patients recovered, and 21 still under treatment or in home isolation.
Mar 22 MOH statement
Mar 21
MOH statement

In another development, a news story in Science said findings in a not-yet-published serologic study suggest that thousands of MERS cases may go undetected in Saudi Arabia.

According to the story, researchers ran serologic tests on a representative sample of more than 10,000 Saudis in 2012 and 2013 and found MERS-CoV antibodies in 15 people, most of them from rural provinces. Researcher Christian Drosten, MD, of the University of Bonn said the finding suggests that more than 40,000 people in the country had a recent infection, though he called the extrapolation "a bit risky."

Drosten said the finding indicates that the vast bulk of infections go undetected and, further, that patients who report no exposure to camels (which often harbor the virus) probably caught the virus from others with a mild infection, according to the story. Another implication is that the case-fatality rate is much lower than the roughly 40% seen in known cases, he said.
Mar 20 Science story

 

PAHO reports more than 28,000 new chikungunya cases

Cases of chikungunya disease in the Americas have now reached 1,310,868, with 28,768 new illnesses reported, the Pan American Health Organization (PAHO) noted late last week. The previous week saw a 22,237-case increase.

The cases include 1,280,953 suspected, 26,391 confirmed, and 3,524 imported cases. The vast majority of imported cases have been in the United States, which has 2,886 such cases. PAHO reported no new US cases last week.

A sizable portion of the new infections were in Colombia, which logged 14,638, and Honduras, which had 11,265. Colombia now has 220,088 total chikungunya cases, while Honduras more than doubled its total, from 6,908 to 18,173. Brazil had 1,339 new infections, raising its total to 5,455.

Outbreak-related deaths increased by 1, to 184, with a newly confirmed fatality in French Guiana, the country's second chikungunya death.
Mar 20 PAHO update

 

China, Egypt confirm H5N1 cases

One new H5N1 avian flu case was reported in both China and Egypt, according to health department statements today and yesterday.

The case in China involves a 34-year-old man in Yunnan province, Hong Kong's Centre for Health Protection (CHP) reported today. He is from Kunming and had been exposed to poultry, the CHP said. He developed a fever Mar 13, was hospitalized on Mar 15, and is currently listed in serious condition.

The case in Egypt involved a 4-year-old child in Sharqia governorate, according to a statement from the country's Ministry of Health that was translated by FluTrackers, an infectious disease news message board. The statement also said that four adults recently recovered from the disease, three in Sharqia and one in Kafr-El-Shaikh governorate.

Egypt has now confirmed 104 H5N1 cases this year, according to a list compiled by FluTrackers, but the new case is its first reported since Mar 16.
Mar 23 CHP statement
Mar 22 FluTrackers post
FluTrackers Egypt H5N1 case list

 

CDC: 2 more measles cases bring 2015 total to 178

The United States has now confirmed 178 cases of measles this year, 2 more than reported last week, the Centers for Disease Control and Prevention (CDC) said in an update today.

The cases have occurred in 17 states and the District of Columbia, the same as in the previous week. About three fourths of cases—131—have been linked to Disneyland in California. And 120 of the cases (67%) have been in California.

Since Disney-related cases were first confirmed in December, that outbreak has involved 146 cases, 130 of which involved people in California. The Montreal area has had at least 188 Disney-linked measles cases, according to previous reports.

In addition to the Disney-linked outbreak, the United States has had unrelated outbreaks in Illinois, Nevada, and Washington state. The four outbreaks represent 89% of total cases this year, the CDC said in its update.
Mar 23 CDC update on cases this year
Mar 23 CDC update on Disney-related cases
Mar 12 CIDRAP News scan on Montreal outbreak

 

Review notes UK risk of vector-borne diseases affected by climate change

Unprecedented change in the status of vector-borne disease has occurred across Europe and threatens to affect the United Kingdom, in part because of climate change, according to an assessment published today in Lancet Infectious Diseases.

Public Health England scientists Jolyon M. Medlock, PhD, and Steve A. Leach, PhD, reviewed the literature and analyzed the risks posed by mosquito-borne diseases like chikungunya and dengue fever, West Nile and other arbovirus infections, tick-borne disease, and sandfly disease. They write that the broadening of vectors' ranges into Europe and the lessons learned from West Nile and chikungunya outbreaks in the Americas emphasize the need to stay alert for similar UK incursions.

They recommend bolstering UK surveillance for endemic and non-native vectors, learning more about the effect of climate-change adaptation strategies on vectors and vector-borne diseases, continuing collaborations across Europe, and developing strategies to address changing public health risks in a changing environment.
Mar 19 Lancet Infect Dis article

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