News Scan for Aug 29, 2017

Turtle-linked Salmonella
;
More Cyclospora illness
;
Avian flu outbreaks
;
Adverse vaccine events in kids
;
Water inequality

Turtle-linked Salmonella outbreak sickens 37 in 13 states

The US Centers for Disease Control and Prevention (CDC) today said a Salmonella outbreak linked to pet turtles has sickened 37 people in 13 states, about one third of them children younger than 5 years.

In its outbreak announcement, the CDC said the outbreak strain is Salmonella Ambani, which was also implicated in illnesses in 2015 that were connected to turtles from a street vendor, based on tests on Salmonella samples from patients and turtles that showed a close genetic match.

In the latest outbreak, illness onsets range from Mar 1 to Aug 3, and of 33 people with available information, 16 (48%) were hospitalized. No deaths have been reported. Eleven of the cases are from New York, with most affected states hailing from Middle Atlantic, Southeast, and Western regions.

Interviews with 33 of the patients about contact they may have had with animals found that 15 (45%) had contact with turtles or their environments before they got sick. In interviews with 9 people who had turtles, 6 had bought them from a flea market or street vendor or had received the turtle as a gift.

In 1975, the Food and Drug Administration banned the sale and distribution of turtle with shells less than 4 inches long because of the risk of salmonellosis, especially in young children. However, outbreaks continue to occur. In 2015, four outbreaks linked to three different Salmonella subtypes sickened at least 133 people in 26 states.
Aug 29 CDC outbreak announcement

 

170 more Cyclospora cases confirmed in multistate outbreak

Yesterday the CDC reported 170 more cases of Cyclospora infection since its previous outbreak report released on Aug 18. The CDC said it is still not known if cases in different states are related to each other, nor has the food source for the pathogen been identified.

As of Aug 25, officials have reported 882 lab-confirmed cases of the intestinal infection caused by the single-celled parasite, Cyclospora cayetanensis. At least 478 cases (54%) are in people who did not report international travel and were likely infected within the United States. A total of 34 states have reported cases in people with no international travel history; Texas (151 cases), Florida (61), North Carolina (36) New York City (2), and Connecticut (20) have reported the most locally acquired cases.

"At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing," the CDC said. Previous US Cyclospora outbreaks have been tied to imported fresh produce, including basil, cilantro, mesclun lettuce, raspberries, and snow peas.

Cyclospora infections are common among international travelers, but this summer has seen a spike in domestic cases, prompting the CDC to issue a warning about the trend to healthcare providers on Aug 7. The main symptoms of Cylcospora illness are watery, profuse diarrhea, fatigue, muscle pain, and low-grade fever.
Aug 28 CDC
update

 

Vietnam, Germany, China report more avian flu outbreaks

Vietnam yesterday reported a highly pathogenic H5N1 avian flu outbreak in Bac Lieu province, according to a notification from the World Organization for Animal Health (OIE).

The event began on Aug 24, killing 600 of 3,200 backyard birds at the location. Bac Lieu is in far southern Vietnam. Remaining birds were culled as one of the outbreak response steps, which also included controlling poultry movement, vaccination, enhanced surveillance, and disinfection.

The country continues to report sporadic H5N1 outbreaks; it reported its last one in July.
Aug 28 OIE report on H5N1 in Vietnam

In outbreaks involving other strains, Germany reported another H5N8 avian flu detection in wild birds, and China announced a major culling operation in Anhui province following poultry deaths related to H7N9.

In Germany, H5N8 was detected in wild swans found dead or sick in Saxony-Anhalt state in the north central part of the country. The outbreak began on Aug 22 when two swans were found dead; authorities culled a third sick one.

Germany and several other European countries had several H5N8 outbreaks in wild birds and poultry over the past winter and spring, and though most of the activity has tapered off, some locations continue to report sporadic outbreaks.

China's agriculture ministry said yesterday that authorities are culling more than 74,000 chickens at a poultry farm in China's Anhui province after hundreds of poultry deaths were reported and tests recently confirmed H7N9, according to a ministry statement translated and posted by FluTrackers, an infectious disease news message board.

The outbreak started in the middle of August at a farm in Chuzhou. The report didn't detail the pathogenicity of the virus, but mass poultry deaths are a hallmark of the highly pathogenic form of the virus that emerged in China over the winter months.
Aug 29 OIE report on H5N8 in Germany
Aug 25 FluTrackers thread

 

Study finds low risk of repeat adverse events after childhood vaccination

A meta-analysis assessing the risk of repeat adverse events in children who have had an initial episode following routine vaccination found that reimmunization is usually safe, researchers from Canada reported yesterday in Pediatrics.

For their review, they included 29 studies that estimated the risk of recurrence in at least five patients that were published before October 2016. In patients with a history of vaccine-related hypotonic hyporesponsive episode (HHE), anaphylaxis, or seizures, recurrence ranged from 0% to 8%. Allergy-type events recurred in 30 of 594 reimmunized patients, and fever occurred again in 0% to 84% of 836 patients after repeat vaccination. The authors are Sean O'Leary, MD, MPH, from Children's Hospital Colorado in Denver, and Yvonne Maldonado, MD, with Stanford University.

In children who experienced limb swelling after the fourth dose of acellular diphtheria, tetanus, and pertussis vaccine, recurrence was higher when the fifth dose contained full antigen, compared with the reduced-antigen formulation.

The study team included a caveat that many studies had few patients and that patients with severe adverse reactions often weren't reimmunized.

In a commentary in the same journal, two pediatric infectious disease specialists wrote that the new study provides welcome reassurance to doctors and parents who are faced with deciding to vaccinate again after a child has had an adverse event such as a febrile seizure or HHE after vaccination.

Before the new study, estimates of HHE risk, for example, were lacking. Estimates from the Canadian group put the risk of HHE recurrence at less than 1%, allowing pediatricians and parents to be more comfortable with the decision to vaccinate.

"This article also reinforces what vaccinologists and pediatricians have known for many years: vaccines are incredibly safe," they wrote, noting that even if the study doesn't address the risk of all known adverse events, especially rare ones, it is comprehensive and will be a useful resource for many years to come.
Aug 28 Pediatrics abstract
Aug 28 Pediatrics commentary

 

World Bank: $150 billion a year needed to reach clean water goals

A report yesterday by the World Bank said countries will need to spend $150 billion annually on clean water initiatives in order to reach the Sustainable Development Goals (SDG) by 2030. The amount represents a fourfold increase in in water supply, sanitation, and hygiene (WASH) investments, compared to what is spent today.

The figures are published in the World Bank's World Water Week report.

"Millions are currently trapped in poverty by poor water supply and sanitation, which contributes to childhood stunting and debilitating diseases such as diarrhea," says Guangzhe Chen, senior director of the Water Global Practice of the World Bank, in a press release. "More resources, targeted to areas of high vulnerability and low access, are needed to close the gaps and improve poor water and sanitation services. This report provides a roadmap for closing that gap."

The report describes stark differences between urban and rural regions around the world. In the 18 countries profiled, 75% of people who lack improved sanitation live in rural areas, with only 20% of rural inhabitants accessing improved water. For example, in Nigeria, 60% of the rural population lives 30 or more minutes away from working water sources. In Ecuador, 24% of the rural population drinks contaminated water.

World Water Week events are taking place in Stockholm and end on Sep 1.
Aug 28 World Bank press release

Aug 23 World Bank report

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