News Scan for Apr 07, 2016

Third Ebola case in Liberia
;
Fatal Saudi MERS case
;
Flu vaccine gap in Denmark
;
Africa polio surveillance

Liberia's Ebola cluster grows to 3, linked to fatal case in Guinea

Two Ebola case-patients, both children, and one fatality in Liberia have been linked to a fatal Ebola infection in Guinea's ongoing flare-up, the World Health Organization (WHO) announced today, increasing the number of recent cases in Liberia to three.

The Liberian fatal case involves the wife of a deceased Ebola patient in Guinea's Macenta prefecture. She and her three children traveled to Monrovia, Liberia, following the man's death, where she developed symptoms of Ebola and died on Mar 31.

Two of her sons have tested positive for Ebola and are receiving treatment in a Monrovia hospital, the WHO said. More than 100 of the family's Liberian contacts are being monitored for signs of infection.

Blood tests have confirmed that the Ebola recurrence in Guinea and Liberia can be traced to one known survivor, and small flare-ups or clusters are likely to continue due to viral persistence in people who have recovered, the WHO said.

Liberia has instituted infection control measures and is preparing to vaccinate contacts of the deceased woman and her children, the WHO said. Guinea, where nine Ebola cases have been confirmed since late February, has already vaccinated 1,400 identified contacts to halt transmission.
Apr 7 WHO update
Apr 4 CIDRAP News story on Liberian cases

 

Saudi Arabia reports fatal MERS case

Saudi Arabia's Ministry of Health (MOH) today confirmed a new MERS-CoV infection that led to the death of a man in Abha.

The fatal MERS-CoV (Middle East respiratory syndrome coronavirus) case involved a 70-year-old Saudi man in the southwestern city of Abha. He had no exposure to camels, and his infection is listed as "primary," meaning he did not contract the disease from another person. He was not a healthcare worker and had an underlying medical condition, the MOH said.

His infection and death bring the Saudi MERS total since the outbreak began in 2012 to 1,369 cases, including 585 deaths. Ten cases remain active, the MOH said.
Apr 7 MOH report

 

Vaccine gave elderly Danes little protection against influenza B this year

The seasonal influenza vaccine has not been effective in protecting elderly people in Denmark against influenza B during the flu season now ending, probably because of a vaccine mismatch with the viruses in circulation, and effectiveness against 2009 H1N1 was low as well in that age-group, according to a report today from Danish authorities in Eurosurveillance.

The two strains have been dominant in the country this year. The authors used the test-negative case-control design to assess vaccine effectiveness (VE) in patients 65 and older who were tested for flu during the season.

As of 9 Mar 9, 3,831 elderly patients had been tested for flu, with 291 patients positive for type B and 177 positive for H1N1. (Only a handful of H3N2 infections were identified.) Vaccine coverage was 37.8% in those infected with H1N1 and 46.4% in those who had type B viruses.

The adjusted VE against influenza B was a nonsignificant 4.1% (95% confidence interval [CI], −22.0% to 24.7%), while VE for H1N1 was calculated at a "moderate to low" 35.0% (95% CI, 11.1% to 52.4%).

Subtyping of 350 type B isolates revealed that 88% belonged to the Victoria lineage and only 12% to the Yamagata lineage, the one included in the trivalent vaccine used in Denmark. The researchers said the vaccine mismatch with circulating viruses can explain the low VE for influenza B, although some VE studies from previous seasons have suggested cross-protection between type B lineages.

The authors said the VE of 35% for H1N1 was similar to the 31.0% (95% CI, −0.7 to 52.7) against H1N1 reported in Denmark in the 2014-15 flu season, even though sequencing of the hemagglutinin gene of 62 of the 2015-16 H1N1 showed that most belonged to a new subgroup called subclade 6B.1.

"This is reassuring as the WHO recommendations for the [H1N1] component in the 2016/17 vaccine for the northern hemisphere remained the same as in previous years, while the influenza B component changed from Yamagata to Victoria," the report concludes.
Apr 7 Eurosurveillance report

 

Ten African countries falling short on polio surveillance, report says

Although Africa had no reported cases of wild poliovirus (WPV) disease in 2015, 10 countries did not meet surveillance standards that are considered essential for tracking and certifying polio elimination, according to a report today from the US Centers for Disease Control and Prevention (CDC) and the WHO.

The article, published in Morbidity and Mortality Weekly Report (MMWR), outlines polio surveillance data for 2014 and 2015 from the 20 African countries and 6 countries in the WHO's Eastern Mediterranean Region that reported a WPV or circulating vaccine-derived poliovirus (cVDPV) case between 2011 and 2015.

In the WHO African Region, WPV type 1 cases dropped from 17 in four countries in 2015 to none in 2015, the last case having occurred in Nigeria in July 2014. The count of cVDPV cases dropped from 34 in four countries in 2014 to 18 in three countries last year.

In the Eastern Mediterranean, the number of WPV1 cases declined from 342 in five countries in 2014 to 74 in two countries—Afghanistan (20 cases) and Pakistan (54 cases)—in 2015. The latter are the only countries where polio is still endemic, since Nigeria was dropped from the list last September.

The WHO uses two criteria to assess the quality of polio surveillance: the number of nonpolio acute flaccid paralysis (AFP) cases detected and the rate of collection of adequate stool specimens from AFP patients. Ten of the 20 African countries met both standards last year, while all six Eastern Mediterranean countries met both.

Of the three countries hit by Ebola over the past 3 years, Guinea and Liberia missed one of the surveillance standards and Sierra Leone missed both in 2015, the report says. Noting that health systems were severely disrupted by the Ebola epidemic, it says urgent efforts are needed to improve AFP surveillance in all three countries.

The Eastern Mediterranean countries all met the AFP surveillance standards, but sewage testing results point to continued surveillance gaps in Afghanistan and Pakistan, the report says. It also notes that the surveillance indicators do not fully reflect security-related problems.
Apr 8 MMWR article

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