News Scan for Oct 12, 2017

Florida Zika case
Low H3N2 protection in seniors
Yemen cholera cases
Africa VHF threat
Healthcare-associated infections

Florida announces its first local Zika case of the year

The Florida Department of Health (Florida Health) today reported the state's first locally acquired Zika case of the year, putting the nation's total this year at three local cases.

In a statement, Florida Health said the locally transmitted case has been confirmed in Manatee County, which wasn't one of the areas to report cases last year.

An investigation found a couple had recently traveled to Cuba, with one partner experiencing Zika symptoms shortly after returning home. Evidence suggests that the infected person was then bitten by a mosquito in or around the home, which transmitted the virus to the other partner.

Though the person who contracted Zika in Cuba wasn't tested for the virus during the symptomatic phase, a test this week found evidence of past Zika infection. The partner who was most recently symptomatic tested positive.

Florida Health said there is no evidence of ongoing local transmission, and the isolated case doesn't constitute a Zika zone. However, as part of established protocols, officials notified mosquito control, which is implementing mosquito reduction steps.

Florida has 154 travel-linked Zika cases this year, along with 32 with undetermined exposure. The state's number of local and imported cases for 2017 is much lower than the 1,122 travel-related and 296 local cases reported in 2016. Texas is the only other state to report local Zika cases this year, and both occurred in the previously affected Rio Grande Valley near the border with Mexico.
Oct 12 Florida Health statement


Study warns of possible repeat poor vaccine protection against H3N2 in seniors

Low influenza vaccine effectiveness (VE) in seniors against the H3N2 flu strain last season could show the same pattern this season, since H3N2 is still the dominant global strain and current vaccines still contain the same H3N2 component, European researchers warned today in Eurosurveillance.

After analyzing the latest report from the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) network, researchers provided final estimates against H3N2 hospitalizations for people age 65 and older for the previous season, which show overall VE of 17% in the group, which is lower than the early estimate of 23.4% reported in February. In people older than 80, VE was especially low, at 13%.

The scientists weren't able to measure VE against 2009 H1N1 and influenza B, because of the small number of cases. VE against those strains is usually reported to be higher.

When they compared findings in people who weren't vaccinated in the 2015-16 or 2016-17 seasons, vaccination in the earlier season seemed to have a modifying effect on effectiveness during the latter season. Though the authors said the results were too imprecise to be conclusive, the results suggest that patients vaccinated in both seasons benefited from residual protection from the earlier season, with no added effect from the 2016-17 vaccine.

Flu vaccine protection against H3N2 is known to be unpredictable, and the I-MOVE reserachers noted that most circulating H3N2 viruses last season were considered antigenically similar to the vaccine virus, though they underwent genetic diversification with the emergence of subclusters within clade 3C.2a and subclade 3C.2a1. In September, the World Health Organization (WHO) vaccine advisors recommended changing the H3N2 component of the Southern Hemisphere's vaccine for the 2018 season.

"Close monitoring of virological surveillance data will be required to prompt early promotion of complementary measures such as the use of antivirals or non-pharmaceutical interventions," the iMove team wrote.
Oct 12 Eurosurveill report


Yemen predicted to top 1 million cholera cases by year's end

Yemen's cholera epidemic will top 1 million cases, at least 600,000 of them in children, by Christmas, according to a new prediction made by Save the Children, a non-governmental organization.

The outbreak has now surpassed Haiti's 7-year cholera outbreak to become the world's largest. As of Oct 10, the WHO has reported 815,314 suspected cases and 2,156 deaths across Yemen since Apr 27. A total of 4,000 cases per day are still being reported. Haiti, in comparison, has had 815,000 cases since 2010.

Yemen's outbreak has been spurred by civil unrest that's led to a collapsed healthcare system with unpaid doctors, closed hospitals, and highly degraded public health infrastructure.

"There's no doubt this is a man-made crisis. Cholera only rears its head when there's a complete and total breakdown in sanitation," said Tamer Kirolos, Save the Children's country director for Yemen. "All parties to the conflict must take responsibility for the health emergency we find ourselves in."
Oct 11 Save the Children
press release


Study identifies African areas most at risk for VHF epidemics

A mapping study to identify which parts of Africa are most at risk for epidemics from four viral hemorrhagic fever (VHD) diseases identified key differences in disease spread among countries, as well as among different regions in individual countries, an international research team reported yesterday in The Lancet.

In assessing the vulnerabilities, the investigators analyzed and mapped the emergence and likely spread of Ebola, Marburg, Lassa fever, and Crimean-Congo hemorrhagic fever. All four share similar transmission patterns between animals and people.

The potential hot spots they found include areas that have already experienced outbreaks, as well as some that haven't usually been thought of as risk areas. For example, the group found that parts of Central African Republic (CAR), Chad, Somalia, and South Sudan are highly susceptible to any of the four diseases. For Ebola and Marburg, the team predicted that areas around the Congo River in the CAR would be most at risk.

According to the analysis, parts of West Africa rank highest as sources of widespread epidemics involving any of the four viruses, including Gueckedou province in Guinea, where West Africa's recent Ebola outbreak got its start.

Simon Hay, DPhil, DSc, study coauthor and director of geospatial science at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, said in an IHME press release that, as seen with West Africa, it's vital to prevent or stop epidemics at the earliest possible stage. "This study's framework provides an important tool for pinpointing where local surveillance and pre-emptive countermeasures are most needed."

The authors also said national assessments can mask important subnational differences.

Peter Piot, MD, PhD, another study coauthor and director of the London School of Hygiene and Tropical Medicine, said, "By assessing pandemic potential at these different stages, we can begin to identify locations where different interventions or prevention measures could have the greatest impact. The various stages reflect important transitions in an outbreak and influence what interventions should be prioritized in which location."

In an accompanying editorial in the same issue, two infectious disease experts said gaps and bias in surveillance limit the ability to predict zoonotic spillover, but the new risk estimates combine geographical information in index cases and viral detections in animals, relating the information to environmental drivers. They noted that the nations most vulnerable to secondary transmission are also ones that have political instability. The authors are Chikwe Ihekweazu, MD, MPH, with the Nigeria Center for Disease Control, and Ibrahim Abubakar, MBBS, PhD, with University College London.

They said point out that the study authors say the work should inform investments at each epidemic stage, but they don't say where the support will come from or which institutions should receive the resources. The two said that, in the wake of the West Africa's Ebola outbreak, more emphasis has been placed on strengthening national public health institutes, rather than depending on the World Health Organization, which they said doesn't have the resources to respond to and manage all VHF threats in an area as vast as Africa.
Oct 11 Lancet study
Oct 11 Lancet editorial
Oct 11 IHME press release


Risk factors for healthcare-related infections include ICU stay, diabetes

A systematic review involving 65 studies determined that major risk factors of healthcare-associated infections (HAIs) are reoperation, intensive care unit (ICU) admission, mechanical ventilation, diabetes, longer surgery times, and cephalosporin exposure, according to a study today in the American Journal of Infection Control.

The researchers, who are from Brazil, identified 867 studies published from 2009 to 2016 and included 65 that met their criteria in the review.

They listed the following risk factor in terms of relative risk (RR), odds ratio (OR), or mean difference (MD): reoperation (RR, 7.94), ICU admission (RR, 3.76), mechanical ventilation (OR, 12.95), cephalosporin exposure (RR, 1.77), diabetes mellitus (RR, 1.76), immunosuppression (RR, 1.24), longer surgery times (MD, 34.53), days of exposure to central venous catheter (MD, 5.20), ICU stay in days (MD, 21.30), and fever of 38.5°C (101.3°F) or higher (MD, 0.62).

The authors note that, according to the European Centre for Disease Prevention and Control, about 20% to 30% of HAIs are considered preventable through intensive hygiene and control programs in hospitals.
Oct 12 Am J Infect Control study

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