News Scan for Sep 07, 2018

More flulike illness in fliers
MERS in Saudi Arabia
More polio in Papua NG
WHO on dengue vaccination
Congo yellow fever threat

Second report of flulike illness in air travelers prompts CDC reminder

Passengers and crew on two inbound flights to Philadelphia yesterday were held for medical evaluation after some passengers were sick with flulike symptoms, the airport said yesterday in a statement.

The news came just 1 day after similar illness reports prompted an investigation into an Emirates Airline flight that landed Sep 5 in New York City, which found flu and common cold viruses in 10 sick passenger and crew members.

The US Centers for Disease Control and Prevention (CDC), which responded to the airline incidents in both cities, said in a media statement today that the events are a reminder that the US flu season is fast approaching and that people who are sick should protect themselves and others by not traveling. It also repeated its recommendation that everyone age 6 months and older be vaccinated against flu, preferably by the end of October.

In Philadelphia, the two international American Airlines flights were each carrying about 250 people plus crew. One was coming from Paris, while the other was flying from Munich.

The airport said that, as a precaution, the travelers were held for medical review and officials notified the CDC. Federal and local medical teams evaluated the passengers, and as of yesterday, 12 were found to be experiencing flu-like symptoms and the rest were in the process of being released.

According to NBC 10 News in Philadelphia, several of the sick passengers were returning from pilgrimages in Mecca, Saudi Arabia. A CDC spokesperson quoted in a story from Philadelphia's CBS affiliate said the 12 sick people reported symptoms such as sore throat and cough, and none had fever or were severely ill and that they would be released and notified of their test results within 24 hours.
Sep 6 Philadelphia International Airport statement
Sep 7 CDC media statment
Sep 6 NBC 10 News report
Sep 6 CBS 3 News report


MERS activity reported in Saudi Arabia's Qaseem region

In a response to a query posted on ProMED Mail, the online reporting system of the International Society for Infectious Diseases, a Saudi Arabian health official confirmed increased human activity of MERS-CoV (Middle East respiratory syndrome coronavirus) in the Al-Qassim region.

"Sporadic cases were reported from different hospitals in the region. They were not healthcare related and not epidemiologically linked, except one case that we think acquired MERS in a dialysis unit. This case shared one dialysis session with another case that had a respiratory illness but was MERS-negative initially and later proved to be MERS-positive," said Abdallah Assiri, MD, the assistant deputy minister for preventive health for the Saudi Arabian Ministry of Health (MOH).

The cases include a man from Al Zulfi, Riyadh region, who was 77 years-old and recorded as having recovered from MERS-CoV. The MOH also said a 66-year-old man and a 52-year-old man from Buraydah died from their infections.  Earlier this week, a 52-year-old man from Buraydah was listed in an MOH epidemiological report, but it is not clear if this is the same patient.
Sep 6 ProMED Mail post

In other MERS-CoV news, Public Health England (PHE) confirmed that a Middle Eastern man who traveled to the United Kingdom before being diagnosed as having the virus has recovered and was released from Royal Liverpool Hospital.

"To date, all contacts that have been tested as part of our follow-up have been negative for MERS-CoV and no other cases of MERS have been identified. Contacts will continue to be followed up for 14 days following last exposure, to ensure we can take necessary action if needed," said Nick Phin, MD, deputy director for PHE.

The latest illnesses from Saudi Arabia, combined with the UK travel-related case, appear to lift the global MERS-CoV total to 2,248 cases and the number of deaths from the disease to 797.
Sep 7 PHE update


Three new vaccine-derived polio cases in Papua New Guinea's outbreak

The polio outbreak in Papua New Guinea grew by 3 new cases, according to the latest update from the Global Polio Eradication Initiative (GPEI).

The new cases raise to the total number of circulating vaccine-derived poliovirus type 1 (cVDPV1) cases in this outbreak to nine. Papua New Guinea is currently in its second round of a vaccination outbreak response, with nationwide campaigns planned through November.

GPEI recorded 35 cases of cVDPV so far in 2018, and a total of 96 were reported in 2017. Before this current outbreak, Papua New Guinea hadn't reported a polio case since 1996 and the country and the rest of the WHO's Western Pacific region were certified as polio free in 2000.


In other polio news, the World Health Organization (WHO) released its statement on the 18th meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus. They noted concern with wild poliovirus detection in Afghanistan, where 11 cases have been reported so far this year compared to 6 at the same time in 2017.

The committee also expressed concern over the rising incidence of vaccine-derived polio cases, and unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC).
Sep 7 GPEI update
Aug 15 WHO statement


WHO updates position on dengue vaccine, reaffirming pre-vax screening

The WHO has published a position paper on dengue vaccination, reaffirming its recommended strategy of pre-vaccination screening for previous dengue infections for any country looking to introduce the vaccine.

"With this strategy, only persons with evidence of a past dengue infection would be vaccinated (based on an antibody test, or on a documented laboratory confirmed dengue infection in the past). If pre-vaccination screening is not feasible, vaccination without individual screening could be considered in areas with recent documentation of seroprevalence rates of at least 80% by age 9 years," the WHO said.

This position paper replaces the first position paper WHO penned on Sanofi Pasteur's Dengvaxia, the first licensed dengue vaccine approved for use in 2016. In November of 2017, results from a phase 3 clinical trial showed the vaccine could cause severe illness in recipients who were dengue-naive at the time of vaccination.

The study's release showed that in individuals who were seronegative before vaccination, the incidence of severe dengue was 4.0 per 1,000 when vaccinated and 1.7 per 1,000 when not vaccinated.

The WHO concluded that pre-vaccination screening would pose several logistical challenges.

"Communication to the public regarding the rationale for pre-vaccination screening, including blood taking, would also be complex. That vaccination is only appropriate for those who have had a past dengue infection may be counterintuitive to the general public," the WHO said.
Sep 7 WHO position paper


WHO weighs in on Congo yellow fever threat, potential urban spread

In an update today on a recent confirmation of a yellow fever case in the Republic of Congo, the WHO said the overall health risk to the country is high, given that the case was confirmed in the densely populated city of Pointe-Noire, which has a population of about 1.2 million.

It also warned that immunization coverage in the area is at suboptimal levels and that yellow fever activity poses a risk of spread within the country and to Brazzaville, the country's capital. The investigation also revealed high densities of Aedes aegypti populations in the affected area, which could fuel urban transmission and amplify the outbreak, the WHO said in an emailed statement.

On Aug 22, the Republic of Congo's health ministry declared a yellow fever outbreak in the Pointe-Noire area, following the confirmation of an illness in a 20-year-old man at a health center in the city. Two weeks before he got sick the man had traveled to two areas, one of which is a rural Pointe-Noire district located near the Angola border.

Investigators have identified 69 other suspected cases in the Pointe-Noire area, 56 of which were already in the surveillance system. Samples collected from 43 patients were all negative for yellow fever.

WHO said it is working with the country on an emergency response and officials have requested supplies for a mass yellow fever vaccination campaign that will target the Pointe-Noire area. It said the risk of regional spread is currently considered moderate, due to lack of information about the outbreak's scope. It notes, however, that Pointe-Noire is a port city and oil industry hub with an international airport and links to other large cities.
Aug 29 CIDRAP News scan "Congo government warns of growing yellow fever outbreak"

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