News Scan for Jun 07, 2016

Zika emergency panel
Hospital MERS study
Ebola secondary spread
Childhood vaccines and seizures
H5N1 hits Nigeria again

WHO Zika emergency committee to meet June 14

The World Health Organization (WHO) said today that its Zika emergency committee will meet for the third time on Jun 14, according to a notice e-mailed to journalists. It said experts will review the implementation and impact of the recommendations it made as part of their declaration of a Public Health Emergency of International Concern (PHEIC).

Representatives from affected countries will address the group, and experts will present the latest information on the disease and its complications, with an eye toward weighing whether the situation still warrants a PHEIC and if any changes to the recommendations are needed.

The 12-member group will meet by teleconference, and the WHO said results will be shared with the media shortly afterward.

According to earlier reports, one of the topics the emergency committee will consider is the upcoming Summer Olympic Games in Rio de Janeiro, Brazil. The WHO has rejected calls to recommend postponing or moving the games, but a recent letter from US Sen Jeanne Shaheen, D-N.H., to WHO Director-General Margaret Chan, MD, MPH, prompted a reply from Chan that the emergency committee would look at the issue.

Today's media note didn't mention the Olympics, but WHO spokesman Christian Lindmeier said at a news briefing that the committee would look at evidence regarding the Olympics and review related travel guidance, Reuters reported today.

The Zika emergency committee's last meeting was on Mar 8. In late January at its first meeting it said complications from the virus warranted a PHEIC.
Jun 6 CIDRAP News story "WHO committee to weigh Zika Olympic threat"


Study: Hospital MERS outbreak in Korea stemmed from 3 patients

Contact tracing and exposure monitoring were the most effective strategies in addressing a 2015 outbreak of MERS at a Korean hospital, according to findings today in the Annals of Internal Medicine.

Researchers affiliated with Samsung Medical Center (SMC), a tertiary care university hospital in Seoul, evaluated the facility's response to an outbreak of MERS-CoV (Middle East respiratory syndrome coronavirus), during which 9,793 people were exposed to the virus and 92 people were diagnosed as having MERS from May 20 to Jul 20, 2015.

All MERS-CoV transmission in the hospital originated from three patients who had pneumonia and productive cough: an index patient with a history of travel to the Arabian peninsula; a secondary case-patient who had previous contact with the index patient, was hospitalized in the emergency department for 3 days before diagnosis, and spread the disease to 82 people; and an emergency department security guard who was diagnosed on Jun 11, 2015, and spread the virus to three healthcare workers, the authors said.

SMC set up a scaled response to in-hospital transmission, which included quarantining 1,603 people and actively monitoring 8,220 contacts. Other control measures included implementing real-time testing in the hospital's laboratory, requiring healthcare workers to report body temperature and symptoms twice daily, and using chest radiographs to diagnose potential patients.

Because most cases were associated with exposure to one "superspreader," early detection and contact tracing were the most effective means of preventing further spread, the researchers said. "To make control measures more effective, patients who might have high infectivity must be recognized and resources must be concentrated on exposures with high transmission potential," they added.
Jun 7 Ann Intern Med study


Rural home deaths associated with secondary Ebola infections

More secondary Ebola infections stemmed from people who died at home in rural Liberian and Guinean communities than from people admitted to Ebola treatment units (ETUs), according to a study today in Emerging Infectious Diseases.

A research team led by the US Centers for Disease Control and Prevention (CDC) evaluated case records for 347 people with Ebola virus disease from Liberia and Guinea, 157 (45%) of whom died at home. Among the 317 infected people with outcome data available, 99 (31%) were the source of at least one secondary infection, and 82 of those source patients died at home, the authors said.

The mean number of secondary infections was significantly higher for people who died at home than for people who were admitted to an ETU (1.8 cases vs. 0.2 cases), the authors said. Patients who died at home presented a transmission risk for an average of 6.8 days.

Though circumstances surrounding death and burial are considered to be risk factors for secondary transmission in rural areas, data from Guinea found little difference in average numbers of secondary cases associated with unsafe (1.8 cases) versus safe (1.2) burial, the authors said.

Secondary transmission appeared to be driven by contact with patients in rural areas, and isolation before death was associated with an 88% drop in secondary infections. Though the WHO advocates equal treatment of all Ebola patient contacts, the authors write, "Classifying contacts of persons who died of EVD at home in the community as high-risk, regardless of whether they were reported to have received a safe burial, is an evidence-based approach to prioritizing those persons who should receive more rigorous monitoring."
Jun 7 Emerg Infect Dis study


Flu vaccine given with 2 other vaccines boosts short-term seizure risk in young kids

Children 6 to 23 months old face an increased short-term risk of febrile seizures if they receive an inactivated influenza vaccine on the same day as a pneumococcal conjugate vaccine (PCV) or diphtheria-tetanus-acellular pertussis (DTaP) vaccine, according to a study published in Pediatrics.

The report says previous research revealed an increased risk of fever and febrile seizures in small children when trivalent inactivated flu vaccine (TIV) and PCV13 were given the same day. The authors sought to find out if concomitant administration of TIV and any other childhood vaccines increased this risk.

They used data from the Vaccine Safety Datalink (VSD) to look at postvaccination seizures in 6- to 23-month-olds during 5 years that included the flu seasons from 2005-06 through 2010-11. The VSD is a collaboration of the Centers for Disease Control and Prevention (CDC) with ten healthcare organizations that have a total membership of about 9.8 million.

The team identified the incidence of febrile seizures on the day of and the day after vaccination and compared it with the incidence in the same children between 14 and 20 days after vaccination.

The only vaccine that independently increased the seizure risk was seven-valent PCV (PCV7), with an incident rate ratio (IRR) of 1.98 (95% confidence interval [CI], 1.00 to 3.91). The risk rose when TIV was given with PCV (IRR, 3.50; 95% CI, 1.13 to 10.85) or with DTaP (IRR, 3.50; 95% CI, 1.52 to 8.07).

When all three vaccines were given the same day, the increase in risk was higher still, with an IRR of 5.00 (95% CI, 2.53 to 9.90). There was no increase in risk when PCV and DTaP were given together but without TIV.

The authors calculated that the increased risk tied to concomitant administration of the three vaccines represents 30 additional febrile seizures per 100,000 children, which they described as small.

The risk of febrile seizures, the team concluded, must be weighed against the benefits of timely vaccination as recommended by the CDC. "[TIV] PCV, and DTaP vaccines each have the potential to prevent multiple episodes of infection, including fevers and FS caused by those infections," they wrote. "Over the long-term, vaccination might reduce the risk of FS, though additional study would be needed to quantify this for each type of vaccine."
Jun 2 Pediatrics report


Two more H5N1 outbreaks cause loss of 35,000 chickens in Nigeria

Nigerian poultry farmers have lost another 35,000 chickens as a result of H5N1 avian flu outbreaks at two sites, continuing a string of outbreaks that started last September, Nigerian officials told the World Organization for Animal Health (OIE).

Both of the affected farms are in Kaduna state in the north-central part of the country, according to the OIE report. At one of the farms, the outbreak began Apr 2 and killed 6,000 of 30,000 layer chickens of unknown age; the rest of them were destroyed to stop the virus's spread.

The second outbreak started May 28. The virus killed 1,053 of 5,000 19-week-old layers on the farm, and the rest were culled as a control measure, the report said.

As in many previous reports of Nigerian outbreaks, officials said the source of the virus was unknown and that poor biosecurity contributed to the problem.
Jun 6 OIE report

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