News Scan for Mar 24, 2016

More nutrition powder Salmonella
Dengue burden in kids
H5N1 in Nigeria
HPV risk in mid-adult women

Salmonella outbreak tied to nutritional powder grows to 27 cases

The Centers for Disease Control and Prevention (CDC) today reported that 9 more people have been sickened with Salmonella Virchow associated with recalled RAW Meal Organic Shake and Meal powders, bringing the outbreak total to 27 cases.

The new cases were reported in eight states, five of which (Alabama, California, Hawaii, Michigan, and West Virginia) had not previously reported outbreak illnesses. The 27 cases are from 20 states, and 5 of 19 people with available information were hospitalized, the CDC said. No deaths have been reported. Patients range in age from younger than 1 to 84 years.

The outbreak strain has been linked to RAW Meal nutritional powders manufactured by Garden of Life, LLC in West Palm Beach, Fla. The company voluntarily recalled the powders on Jan 29 and Feb 12, though the CDC notes that the products have a long shelf life and may still be in people's homes.

Salmonella cases linked to the nutritional powders have occurred between Dec 5 and Mar 13, though the CDC said that illnesses occurring after Feb 28 may not have yet been reported. Previous news reports have identified the Salmonella-contaminated ingredient as moringa leaf powder.
Mar 24 CDC update
Feb 19 CIDRAP News item on the outbreak


Study suggests annual dengue incidence of 2.9% to 4.6% in children

Recent studies conducted in several Latin American and Southeast Asian countries suggest that the annual incidence of dengue virus infection in children ranges from about 2.9% to 4.6%, with a heavier burden in Asia, according to a report today in the New England Journal of Medicine.

The findings come from the monitoring of control groups in two phase 3 trials of dengue vaccines, sponsored by Sanofi Pasteur. The groups were monitored for acute febrile illness and virologically confirmed dengue.

In the Asian trial, the control group consisted of 3,424 healthy children from ages 2 through 16 in Indonesia, Malaysia, the Philippines, Thailand, and Vietnam, who were monitored from June 2011 through December 2013. The Latin American group included 6,939 children from 9 through 18 years old in Brazil, Colombia, Honduras, Mexico, and Puerto Rico. They were monitored from June 2011 through April 2014.

About 10% of the febrile illnesses in each group were found to be dengue infections, according to the report. The Asian group had 319 confirmed dengue episodes, or 4.6 per 100 person-years, while the Latin American group had 389 episodes, or 2.9 per 100 person-years. The incidence did not appear to vary by age.

The Asian children who contracted dengue were more likely to need hospitalization than their Latin American counterparts, with respective hospitalization rates of 19.1% and 11.1%, the researchers found. The incidence of dengue hemorrhagic fever, the most serious form of the disease, was less than 0.3 cases per 100 person-years in both groups.

"In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America," the report says.

The researchers concluded that the dengue burdens were "substantial" in both regions and all age-groups. "Burdens varied widely according to country, but the rates were generally higher and the disease more frequently severe in Asian countries than in Latin American countries," they wrote.
Mar 24 N Engl J Med abstract


Nigeria hit by 22 more H5N1 outbreaks

Outbreaks of H5N1 avian flu occurred at 22 more sites in Nigeria in mid-March, according to reports filed by Nigerian government officials with the World Organization for Animal Health (OIE) on Mar 20.

The latest outbreaks, which began from Mar 10 to 18, hit 20 farms and two backyard flocks. Poultry on affected farms included layer chickens, broilers, and pullets, and flock sizes ranged from 531 to 61,000 chickens. Backyard flocks comprised geese, ducks, and other poultry, with one flock of 10 birds and the other of 152.

Outbreak sites were scattered among seven states (Kano, 9; Edo, 4; Plateau, 3; Katsina, 2; Sokoto, 2; Bauchi, 1; and Zamfara, 1), all in northern Nigeria, except for Edo province in the southwestern part of the country.

The disease killed 8,717 of 176,431 birds at the 22 locations, and the rest were culled to prevent further outbreaks, according to the OIE reports. As with other recent Nigerian reports, these listed "poor farm biosecurity" as a contributing factor.

Nigeria is the hardest hit of several African countries that have suffered a resurgence of H5N1 outbreaks in the past year.
Mar 20 OIE report on outbreaks in northern provinces
Mar 20 OIE
report on Edo outbreaks


Number of sex partners, hormonal contraceptives associated with HPV risk

New detections of human papillomavirus (HPV) in mid-adult women are associated with recent high-risk sexual behavior, lifetime number of male sex partners, and hormonal contraceptive use, according to findings yesterday in The Journal of Infectious Diseases.

From 2007 through 2010, researchers from the University of Washington studied a convenience sample of 420 female online daters ages 25 to 65. One fourth of participants, on average, had new HPV detections each year, and 64.4% of HPV detections during the entire study were new cases, indicating that women acquired those infections from recent sexual partners.

In multivariate analyses, women who reported multiple, new, or casual male sexual partners in the past 6 months were 2.81 times more likely to have a new HPV detection. Risk factors for new HPV detections that remained consistent across the analysis included a lifetime number of nine or more male sex partners (hazard ratio [HR], 2.56) and current hormonal contraceptive use (HR, 1.82), the authors said.

The authors identified several limitations to the study, including their use of a non-representative convenience sample of online daters. The effect of hormonal contraceptive use on HPV incidence risk is unknown, though it could suppress persistent infection, making it difficult to distinguish new versus persistent infections, the authors said.

In a related commentary, Kenneth H. Fife, MD, PhD, and Aaron C. Ermel, MD, of the Indiana University School of Medicine, discuss the difficulty in distinguishing true incident cases from re-detection of prior HPV infection, noting that a third of women in the study had HPV detections not attributable to new sexual partners.

The commentary authors suggest that mid-adult women should receive episodic testing for new and persistent HPV infections, colposcopy for women with diagnoses of high-risk HPV-16 or HPV-18, and consideration for HPV vaccination past age 26.
Mar 23 J Infect Dis study
Mar 23 J Infect Dis commentary

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