News Scan for Aug 31, 2017

Fatal yellow fever cases
Indoor mosquito spraying
Early sepsis detection
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Fatal yellow fever in French Guiana woman and in New York traveler

The World Health Organization (WHO) yesterday said French officials have notified it of a fatal yellow fever case in a 43-year-old Brazilian woman in French Guiana whose vaccination status isn't known.

In a statement, the WHO said the woman was hospitalized on Aug 7 and died 2 days later. An investigation found that she may have visited a gold mining area in the northern part of the country, and officials are still trying to pinpoint the woman's travel route.

Though yellow fever is endemic in French Guiana, the woman's illness is the first case confirmed there since 1998. Vaccination against the disease is mandatory, and coverage is considered good in French Guiana, but the WHO said there may be gaps in some populations, such as illegal workers.

Vaccination catch-up is planned for legal and illegal gold prospecting areas of French Guiana, the WHO said.
Aug 30 WHO statement

In other yellow fever developments, health officials from New York and the US Centers for Disease Control and Prevention (CDC) today described a fatal yellow fever case in a 74-year-old man who returned to the United States from a trip to Peru in 2016.

Writing in today's issue of Morbidity and Mortality Weekly Report (MMWR), they said the New York resident got sick while traveling in Peru, 3 days after visiting the northern Amazon area. He was initially hospitalized in Peru where he was treated for amebiasis, after which he returned to New York and immediately sought emergency department care.

His condition worsened, and he died 3 days after hospital admission.

Serum tests collected 7 days after illness onset were positive for yellow fever. Postmortem investigation found that the man had not been vaccinated.

The researchers noted that the last yellow fever case diagnosed in a US traveler was in 2002. They added that, following large outbreaks in Africa and South America in 2016 and 2017, the global number of travel-related yellow fever cases has increased substantially, including the US man who became ill while in Peru.

They said the case is a reminder that vaccination is needed for people traveling to high-risk areas and that healthcare providers should consider testing for the disease in people with characteristic symptoms who have lived in or traveled to yellow fever transmission areas.
Aug 31 MMWR report


Review finds indoor spraying may protect against Aedes mosquitoes

A meta-analysis published today in PLoS Neglected Tropical Diseases found some solid evidence for the effectiveness of indoor spraying to control Aedes mosquitoes, but the authors said more well-designed studies are needed.

An international team of investigators designed the study to assess indoor spraying as a method to control dengue, but Aedes mosquitoes also transmit other diseases, including Zika and chikungunya. The analyzed data from studies involving indoor residual spraying (IRS) and indoor space spraying (ISS). IRS involves applying long-acting insecticides on the walls and roofs of all houses and domestic animal shelters in a given area, while ISS is designed for emergency situations to suppress or prevent an epidemic and is geared toward massive, rapid destruction of mosquitoes.

Only 7 studies (of 39 assessed) fit the researchers' inclusion criteria, 3 involving IRS (2 with controls) and 4 ISS (3 with controls). Two IRS studies measuring human transmission showed a decline, while 1 IRS and all 4 ISS studies measuring adult Aedes mosquitoes showed a very good effect, up to 100%, but the effect was not sustained. Two IRS studies and 1 ISS study measuring immature mosquitoes showed mixed results.

The authors conclude, "It is evident that IRS and also ISS are effective adulticidal interventions against Aedes mosquitoes. . . . Overall, there is a paucity of studies available on these two interventions that may be promising for dengue vector control, particularly for IRS with its residual effect. . . . It is recommended to scale up the research regarding the community effectiveness of IRS and ISS, including measuring dengue transmission, particularly, for IRS with its residual effect."
Aug 31 PLoS Negl Trop Dis study


CDC launches 'Get Ahead of Sepsis' educational push

The US Centers for Disease Control and Prevention (CDC) today launched an education campaign called "Get Ahead of Sepsis" to protect people from the devastating effects of the condition. This initiative emphasizes the importance of early recognition and timely treatment of sepsis, as well as the importance of preventing infections that could lead to sepsis.

"Sepsis is the body's extreme response to an infection," the CDC said in a news release. "It is life-threatening, and without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death." Sepsis affects more than 1.5 million people and kills 250,000 in the United States each year.

Get Ahead of Sepsis encourages healthcare professionals to educate patients, prevent infections, identify sepsis early, and start treatment quickly. It also urges patients and their families to prevent infections, be alert to symptoms, and seek immediate medical care if they suspect sepsis or an infection does not improve.

"Detecting sepsis early and starting immediate treatment is often the difference between life and death," said CDC Director Brenda Fitzgerald, MD. "We created Get Ahead of Sepsis to give people the resources they need to help stop this medical emergency in its tracks."
Aug 31 CDC news release

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