Flu Scan for Dec 01, 2015

News brief

WHO flu profile shows low activity

Overall flu activity has remained low, with hot spots in only a few areas, such as some Middle Eastern countries including Bahrain, Oman, and Qatar, which are reporting that the 2009 H1N1 virus is the dominant strain, the World Health Organization (WHO) said yesterday in its regular update.

Other exceptions are Cuba and parts of tropical Asia, notably the southern and southeast part of the region. Those countries include India, Laos, and Thailand.

Testing of flu virus specimens at WHO-affiliated laboratories during the first half of November revealed that 67.6% were influenza A and 32.4% were influenza B. Of the subtyped influenza A viruses, 51.5% were H3N2 and 48.5% were 2009 H1N1.
Nov 30 WHO global flu update

Vietnam, Italy, and France report avian influenza outbreaks

Vietnam has reported two more highly pathogenic H5N6 outbreaks in poultry over the last few days, one in Lai Chau province in the far northern part of the country, and one in Nghe An province, in the north central region. Agriculture ministry officials detailed the outbreaks—both of which involved backyard poultry— in two separate reports to the World Organization for Animal Health (OIE), one on Nov 28 and the other yesterday.

The event in Lai Chau province started on Nov 19 and killed 600 of 3,604 of the birds. Meanwhile, Nghe An's outbreak began on Nov 26 and was lethal to 121 of the village's 2,250 birds. In both outbreaks, authorities destroyed the remaining poultry to control the spread of the virus.

In 2014, H5N6 outbreaks surfaced in China, then spread to a handful of other Asian countries, including Vietnam. The developments prompted the United Nations Food and Agriculture Organization (FAO) last fall to warn of the potential impacts of the H5N6 virus on animal and human health.
Nov 28 OIE report
Nov 30 OIE report

Elsewhere, Italy's animal health ministry today announced a low pathogenic H5N2 outbreak at a turkey farm in Emilia-Romagna region, located in the northern part of the country, according to a statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The report said poultry movement restrictions and other steps have been ordered, including checks at nearby facilities.
Dec 1 AFD post

French veterinary teams have detected avian flu at two more farms near a site of a recent H5N1 outbreak, the country's first in about 8 years. The outbreaks were noted yesterday in a statement from France's agriculture ministry that was translated and posted by AFD. Few details were available about the strain involved in the two additional detections.

The initial outbreak in France was reported on Nov 25, affecting backyard birds in the Perigord region of southwestern France, known for its poultry and foie gras. UK officials recently announced that preliminary sequencing of the virus detected in the outbreak suggests that it is a mutated strain closely related to European low pathogenic avian influenza strains.
Nov 30 AFD post

News Scan for Dec 01, 2015

News brief

Saudi Arabia reports Riyadh MERS case

Saudi Arabia's Ministry of Health (MOH) reported a new MERS-CoV case today in the capital city of Riyadh.

The case involves a 21-year-old Saudi woman who is in critical condition with a MERS-CoV (Middle East respiratory syndrome coronavirus) infection. She is not a healthcare worker and was not exposed to other MERS patients, the agency said. No other risk factors were noted.

Saudi Arabia has now has 1,278 MERS cases since the outbreak began in 2012, the MOH said. Of the total number, 728 (57%) have recovered, 549 (42.8%) have died, and two people remain under treatment.
Dec 1 MOH update

Hawaii dengue fever cluster tops 100 cases

The Hawaii Department of Health (HDOH) said yesterday that the number of locally acquired dengue fever cases has risen by 20 within the last week, for a total of 112 cases.

Of the confirmed cases of dengue fever, 98 are in Hawaii residents, and 14 are in visitors. Most of the total cases (77%, or 86) have occurred in adults, while 26 cases (23%) involve children. Illness onset occurred between Sep 11 and Nov 20.

The HDOH has excluded 262 potential cases due to negative test results or failure to meet case criteria.

High- and moderate-risk areas for dengue fever currently lie along the western and eastern coasts of the Big Island. State health officials continue to conduct vector control activities and monitor for imported cases.
Nov 30 HDOH update

Young immunocompromised have 18-fold risk of invasive pneumonia

Young people with immunocompromised or chronic health conditions have the highest risk of invasive pneumococcal disease (IPD) due to Streptococcus pneumoniae, according to findings published Nov 29 in Vaccine.

A team of Dutch researchers analyzed national IPD surveillance data and primary care data on chronic conditions in The Netherlands between 2008 and 2012. The high-risk group included people with an immunocompromised state due to HIV/AIDS, chronic renal disease, lymphoma, and other conditions. Medium-risk people included those with chronic lung disease, cardiovascular disease, and diabetes; normal-risk people had no comorbidities.

Of the 960 IPD cases that occurred in people ages18-64, 149 (16%) occurred in high-risk people, and 363 (38%) occurred in medium-risk people. Those with a high-risk condition had an 18-fold higher risk (95% confidence interval [CI], 15.6-21.2) for IPD, with a rate of 89 per 100,000 population compared to 5 per 100,000 in the normal-risk group. Those with a medium-risk condition had a 5-fold higher risk (95% CI, 4.3-5.7) of IPD, with a rate of 25 per 100,000.

People ages 18-64 with HIV/AIDS had a 61-fold higher risk (95% CI, 40.7-92.3) for IPD, with a rate of 308 per 100,000.

Of the 1,264 IPD cases that occurred in people 65 years and older, 175 (14%) occurred in high-risk people, and 888 (70%) occurred in medium-risk people. Older people with a high-risk condition had a 3-fold higher risk (95% CI, 2.6-3.9) of IPD, with a rate of 82 per 100,000 population compared to 25 per 100,000 in the normal-risk elderly age group. Those with a medium risk condition had a 2-fold higher risk (95% CI, 1.9-2.6), with a rate of 57 per 100,000.

High- and medium-risk people in all age groups had higher case fatality rates. High-risk people experienced a 2-fold higher risk of death from IPD (95% CI, 1.5-3.5), while medium-risk people had a 1.4 fold higher risk (95% CI, 1.0-2.1).

Researchers also found that four serotypes (6A, 6B, 23A, and 23B) caused a greater likelihood of IPD in high-risk people, indicating that these serotypes may have relevance for pneumococcal vaccine manufacturing.
Nov 29 Vaccine study

MRSA carriage associated with livestock, healthcare exposure

Carriage of MRSA strains among Dutch and German outpatients was significantly associated with proximity to livestock in a primary care population and with healthcare exposure in a urology population, according to a study yesterday in PLoS One.

A team of Dutch and German researchers evaluated carriage of methicillin-resistant Staphylococcus aureus (MRSA) between Nov 2011 and Jun 2012 among outpatients who had been prescribed antibiotics within the previous 3 months and lived in livestock farming regions along the Dutch-German border. Included were 513 patients from 12 Dutch general practitioners (GPs), 261 patients from 7 German GPs, and 200 patients from 2 German outpatient urology clinics.

Prevalence of MRSA carriage in the Dutch and German GP outpatients was 0.8% and 1.1%, respectively. Testing revealed that all S aureus protein A (spa) types were livestock-associated MRSA, and MRSA in Dutch and German outpatients was associated with proximity to a livestock farm. Of Dutch GP outpatients, 11.5% (3 of 26) of MRSA carriers lived on or near a farm; 10% (2 of 20) of German GP outpatients lived on or near a farm.

German urology patients had a higher prevalence (2%) of MRSA carriage. All spa types in the urology population were associated with healthcare exposure, and 30% of the urology outpatients had been hospitalized in the previous 6 months.

Though MRSA carriage rates on the Dutch-German border are within expected ranges, the researchers recommended that greater attention be paid to MRSA strain similarities and prevalence among people living near livestock.
Nov 30 PLoS One study