News Scan for Oct 24, 2016

New Saudi MERS cases
Avian flu in India, Bhutan
Imported malaria profile

MERS-CoV infects 3 more in Saudi Arabia, 1 fatally

Saudi Arabia reported three more MERS-CoV cases yesterday and today, one of them a fatal case that is linked to what appears to be a hospital-related outbreak in Hofuf.

Yesterday the Saudi Ministry of Health (MOH) said MERS-CoV (Middle East respiratory syndrome coronavirus) infected two male foreigners, including a 58-year-old from Arar in the far northern part of the country who had primary exposure, meaning he wasn't infected by another patient. He is hospitalized in critical condition.

The other man is a 55-year-old from Hofuf who died from his illness after contracting the virus from another patient in a healthcare setting. The MOH said the man had an underlying illness.

In a statement today the MOH announced an infection in a 46-year-old foreign man from Hofuf who had contact with camels before he became ill. He is listed in stable condition.

Since Oct 15 Saudi Arabia has reported five MERS-CoV cases in Hofuf. The first involved a man who had been exposed to camels and later died. The others were in a healthcare worker with an asymptomatic infection and a 61-year-old man who was infected while he was a patient in a hospital setting.

On Oct 22 the MOH also announced a death in a previously reported case involving a 53-year-old Saudi man from Abha who had a preexisting illness.

The developments over the past 3 days push Saudi Arabia's MERS-CoV total to 1,467, including 614 deaths. Seven people are still being treated for their infections.
Oct 23 Saudi MOH statement
Oct 24 Saudi MOH statement
Oct 22 Saudi MOH statement


H5N8 strikes 2 more Indian zoos; Bhutan reports H5N1 outbreak

Animal health officials in India recently announced that an avian influenza outbreak at a large zoo in New Delhi was caused by the highly pathogenic H5N8 strain, not H5N1 as originally thought. The news follows reports from the Indian media that H5N8 has struck two more zoos, one in Madya Pradesh state, about 100 miles southeast of the city, according to reports gathered and posted by Avian Flu Diary.

On Oct 21 a scientist from the National Institute for High Security Animal Disease in a post to ProMED Mail clarified that H5N8 was involved in the New Delhi zoo outbreak strain and that further investigation was under way. ProMED Mail is the online reporting system of the International Society for Infectious Diseases.

The following day, Indian media reports—citing officials in the Madya Pradesh city of Gwalior—said H5N8 had been detected in two samples from 15 painted storks who died at a local zoo. Yesterday media outlets reported that H5N8 struck ducks at a second zoo in New Delhi, Hauz Hass Deer Park, located about 5 miles from the earlier zoo outbreak in the city.

The trio of zoo outbreaks are the first involving H5N8 in India and come in the wake of a warning from the United Nations Food and Agriculture Organization (FAO) in September for several nations in Central Asia, the Caucasus, the Middle East, Europe, and West Africa to be alert for a highly pathogenic H5N8 clade that had been detected in June in Russian waterfowl.
Oct 22 Avian Flu Diary post on H5N8 at Madhya Pradesh zoo
Oct 23 Avian Flu Diary post on H5N8 at second New Delhi zoo
Oct 19 CIDRAP News scan "New reports of avian flu in Taipei, India, and Germany"
Oct 21 ProMED Mail post

In other developments, Bhutan's agriculture ministry today reported a highly pathogenic H5N1 outbreak in backyard birds in Chhukha district, located in the southwestern part of the country, according to a report to the World Organization for Animal Health (OIE).

Of 3,000 susceptible birds, the virus killed 13, and an investigation revealed that only an isolated pocket was affected. Sixty-one birds were culled, other control steps such as disinfection and surveillance are under way, and officials are still investigating the source of the outbreak.

The outbreak began on Oct 10 and is Bhutan's first since November 2015.
Oct 24 OIE report


Data reveal global picture of imported malaria cases

France and the United Kingdom receive the highest numbers of imported malaria cases, and illnesses exported from West Africa account for 56% of all malaria exported to non-endemic countries, according to an analysis of a decade's worth of malaria statistics. An international research team based at Oxford University reported its findings Oct 21 in The Lancet Infectious Diseases.

To get a better idea of patterns of spread, the investigators analyzed malaria data from 40 countries where the disease isn't endemic from 2005 to 2015, which spanned about 50,000 imported infections.

They found that infections were strongly influenced by a small number of high-traffic routes, with historical ties, traveler demographics, and malaria parasite species transmission also influencing imported malaria patterns. For example, France's high number of Plasmodium falciparum cases was related to its close ties with West African countries. Relationship emerged that seem to fuel secondary transmission, such as immigrant labor in the Middle East or Chinese workers returning from Africa.

Other factors, such as diagnostic capacity and prophylaxis compliance, are likely to play a role as drivers of exported cases and should be investigated in further studies, the group noted.

In a commentary in the same issue, two experts said it is important to understand importation patterns to prioritize mitigation strategies. The two added that while the findings of the study are intuitive, the authors used robust methods to provide a contemporary view of malaria importation. The authors are Karin Leder, MBBS, PhD, MPH, an infectious disease expert at Monash University in Victoria, Australia, and Lin Chen, MD, with Harvard Medical School in Boston.

They wrote that using country data, as the authors did, and other information from various sources, such as a specific traveler surveillance network, can help provide information about disease activity in destination countries and can be used to refine pretravel advice and screening protocols for sick travelers.
Oct 21 Lancet Infect Dis abstract
Oct 21 Lancet Infect Dis commentary

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