News Scan for Feb 12, 2016

US flu ramps up
Two Saudi MERS cases
Yellow fever in Angola
DRC monkeypox outbreak
Global vaccine-derived polio
Harmless E coli in cheese

CDC: Slow flu rise seasoned by pockets of high activity

The US Centers for Disease Control and Prevention (CDC) saw localized pockets of high flu activity last week, but for the nation as a whole, the levels rose only slightly again, according to today's weekly update.

The percentage of respiratory specimens that tested positive for flu registered a modest bump, increasing from 6.8% to 9.1% last week, with the 2009 H1N1 virus holding onto its spot as the predominant strain.

Also, the percentage of clinic visits for flu-like illness rose slightly to 2.4%, keeping it above the national baseline of 2.1%. Seven of the CDC's 10 regions are above their region-specific baselines for that marker.

The system that tracks flu hospitalizations reported that the cumulative number reached 3.2 per 100,000 population last week, up from 2.6 per 100,000 the previous week. The highest rates were in seniors (65 and older), young children up to age 4, and adults 50 to 64 years old. More than two-thirds of hospitalizations were linked to influenza A, and of the subtyped influenza A viruses, nearly 84% were the 2009 H1N1 virus.

Two more pediatric flu deaths were reported, lifting the season's total to 11. Overall deaths from pneumonia and flu were below the seasonal baselines for two systems the CDC uses to track that indicator.

Puerto Rico and Arizona were the only areas to report high flu activity as indicated by clinic visits for flu. Wide geographic spread of flu was reported by Puerto Rico and seven states: Arizona, California, Connecticut, Iowa, Kentucky, Massachusetts, and New York.
Feb 12 CDC FluView report
Feb 12 CDC flu
situation update


Saudi Arabia reports two more MERS cases, one fatal

Saudi Arabia today reported two more MERS-CoV cases, one of them fatal, marking the country’s first new cases since Feb 3.

The man who died was a 34-year-old foreigner living in the southern city of Najran, the Ministry of Health (MOH) reported. He was not a healthcare worker, and the source of his infection is under investigation.

The other patient is a 41-year-old Saudi man in Al-Kharj, a city in the central part of the country, who is in stable condition. He is not a healthcare worker, but he had household contact with another MERS-CoV (Middle East respiratory syndrome coronavirus) patient and indirect contact with camels, according to the MOH.

The last MERS-CoV case in Al-Kharj apparently was that of a 47-year-old man who had frequent contact with camels and contracted the disease in late January, as noted by the World Health Organization on Feb 2.

Saudi Arabia’s cumulative total of MERS cases has reached 1,294, including 552 deaths, 739 recoveries, and 3 patients still under treatment, the MOH said.
 Feb 12 MOH MERS update
Feb 2 WHO statement

Yellow fever outbreak in Angola triggers vaccination campaign

A yellow fever outbreak in Angola that began in early December with a few cases in one province has now spread to five more provinces, totaling 164 suspected cases and 37 deaths as of Feb 8, the World Health Organization (WHO) said today in a statement.

The outbreak began in the northwestern province of Luanda, where 138 cases have been reported. Other affected provinces are Cabinda, Cuanza Sul, Huambo, Huila, and Uige.

The WHO said Luanda has a high density of Aedes aegypti mosquitoes, the main yellow fever vector, posing a high risk of spread to other areas, especially given the high proportion of susceptible people. The only vaccinated people are those with international vaccination cards and children who have been immunized since 2008. The WHO said an immunization campaign was launched on Feb 2, targeting about 1.5 million people in the worst-affected part of Luanda.

The WHO said Angola has activated a task force to respond to the outbreak, that it has deployed three experts to help, and that suspected cases are being tested to rule out other illnesses and cross-reactions with yellow fever.

Elsewhere in Africa, yellow fever has been circulating in Mali and Ghana since the last half of 2015.
Feb 12 WHO statement


More than 50 monkeypox cases reported in DRC

Reports of 51 recent cases of monkeypox, including two related deaths, have emerged from the Democratic Republic of the Congo (DRC).

The outbreak occurred in the Bas Uele District of DRC's northern Orientale Province in the first week of February, according to a Feb 11 news report translated and posted yesterday on Avian Flu Diary, an infectious disease blog.

Dr. Innocent Akonda, a medical officer in Bas Uele's Aketi territory, reported that the latest cases bring the region's monkeypox total over the past few weeks to 195 cases and 8 deaths, according to The Observer, a DRC newspaper. Monkeypox is a viral illness endemic in monkeys and rodents that can be transmitted between humans or by eating undercooked bushmeat.

Akonda attributed the severity of the recent outbreak to a lack of qualified nursing staff in the region and the propensity of ill people to seek help from traditional healers and delay medical care.

In January, Avian Flu Diary reported a small outbreak of monkeypox in the Central African Republic's Bangassou District, which lies on the border with DRC. DRC also reported 20 cases of monkeypox in the central Tshuapa District in Sept 2015.
 Feb 10 Avian Flu Diary post
Feb 11 Observer story


Recent vaccine-derived polio outbreaks affect five countries

The Centers for Disease Control and Prevention (CDC) today said that a number of cases of circulating types 1 and 2 vaccine-derived poliovirus were reported during 2015, with some outbreaks ongoing, in Madagascar, Ukraine, Guinea, Laos, and Myanmar.

Although Afghanistan and Pakistan are currently the only countries where transmission of wild poliovirus occurs, cases of paralysis from circulating vaccine-derived poliovirus (cVDPV) occasionally are diagnosed in countries that use live, attenuated oral poliovirus vaccine (OPV) and have low vaccination coverage, the CDC noted in today’s Morbidity and Mortality Weekly Report (MMWR).

The cVDPV outbreak in Madagascar began Sept 29, 2014, and has comprised 11 cases of poliovirus type 1 cVDPV (cVDPV1), with the most recent case reported on Aug 22, 2015, in Sud-Ouest Province. Two cases of cVDPV1 were reported in Ukraine's Zakarpattya Oblast in summer 2015, with symptom onset occurring Jun 30 and Jul 7. Both Ukrainian case-patients fully recovered.

Although testing of suspected VDPV samples stopped in Guinea during the Ebola outbreak, two linked cases of type 2 polio cVDPV (VDPV2) were identified in August 2014 and July 2015. Guinea has reported three cVDPV cases since testing resumed, with the latest case-patient falling ill on Oct 2, 2015.

Nine cVDPV1 cases occurred in Laos between Sept 7, 2015, and Jan 11, 2016, the latest identified in Ventiane Province. Myanmar reported two linked cases of cVDPV2 in Rakhine Province in 2015 with symptom onsets on Apr 16 and Oct 5.

The CDC also noted that single cases of non-circulating VDPV2 occurred during 2015 in the Democratic Republic of the Congo, Nigeria, Pakistan, and South Sudan.

In April 2016, countries will discontinue the type 2 Sabin OPV, which is thought to be responsible for more than 90% of all cVDPVs, and switch to a bivalent types 1 and 3 OPV. The CDC recommends greater global focus on routine polio immunization and supplemental immunization activities to encourage higher OPV coverage.
 Feb 11 MMWR updat 


FDA suspends testing cheese for non-toxigenic E coli pending review

The US Food and Drug Administration (FDA) said recently it is taking a break from testing cheese for non-toxigenic (non-pathogenic) Escherichia coli, partly in response to concerns from raw-milk cheese producers who contend that the testing limits production without improving public health.

In a Feb 8 statement, the FDA noted that it, like other health agencies, tests cheese for non-toxigenic E coli because at certain levels it may indicate fecal contamination and unsanitary conditions in a processing plant.

"Our surveillance sampling shows that the vast majority of domestic and imported raw milk cheeses are meeting the established criteria," the agency said.

In response to producers’ concerns, the FDA said it respects the work of artisan cheesemakers who make a wide variety of raw-milk cheeses and appreciates "the great care that many take" to provide safe products. "We understand the concerns expressed by some cheesemakers, as well as lawmakers, and intend to engage in a scientific dialogue on these issues."

The agency noted that the Preventive Controls for Human Food rule under the 2011 Food Safety Modernization Act became final in September. With the rule in place, the statement said, "We will be taking another look at what role non-toxigenic E coli should have in identifying and preventing insanitary conditions and food safety hazards for both domestic and foreign cheese producers."

The FDA said it would also "consider and update, as appropriate, the 2010 Compliance Policy Guide, which outlines safety criteria," considering such issues as the use of a single bacterial criterion for both pasteurized and raw-milk cheese and the use of non-toxigenic E coli as an indicator organism.

A story in Food Safety News today said the 2010 policy guide reduced by 90% the amount of non-toxigenic E coli permitted in a product. The limit is now 10 MPN (most probable number) of organisms per gram in 2 or more of 5 samples.

The FDA said it will continue to inspect cheese-making plants and test for pathogens in domestic and imported cheese.
 Feb 8 FDA statement
Feb 12 Food Safety News story

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