News Scan for Mar 08, 2019

Five new Ebola cases in DRC
True cost of not vaccinating
MERS in Saudi Arabia
Pregnancy infections and autism
New polio case in Nigeria

DRC records 5 more Ebola cases, 4 deaths; new health zone affected

A 20th health zone in the Democratic Republic of the Congo (DRC) has confirmed its first Ebola case, according to today's update from the ministry of health. A young woman who was a case-contact of patient in Butembo, refused follow-up, and died is the first case-patient recorded in Lubero.

Along with the Lubero case, the DRC recorded two cases in Katwa, and one each in Mandima and Kalunguta. The ministry of health also noted four new confirmed deaths, including community deaths in the patient from Lubero and a patient from Kalunguta.

Today's cases bring the outbreak total to 918 cases, including 578 deaths. A total of 190 suspected cases are still under investigation.

Today health workers in health zones neighboring Katwa, the current outbreak hot spot, are being immunized in an effort to prevent the spread of the disease. Since August, 86,436 people in the DRC, including 22,017 in Katwa, 20,796 in Beni, and 10,875 in Butembo, have been vaccinated with Merck's rVSV-ZEBOV vaccine.
Mar 8 DRC


Measles, tetanus cases highlight true cost of anti-vaccine movement

Writing in a commentary in the Journal of the American Medical Association (JAMA), several public health professionals enumerated the true cost of measles cases in present-day America, suggesting that responding to a single case of measles costs $142,000—among other substantial impacts.

In 2000, the United States eliminated endemic measles, but communities with unvaccinated children, who are largely so because of religious or philosophical reasons, have fueled several recent outbreaks across the country. The authors of the commentary note that, in addition to the financial costs, measles sequelae last for 2 to 3 years post-infection. On a larger scale, outbreaks greatly disrupt public health offices and clinical practices.

"Policy makers must consider the long-term immunologic effects measles infection has on the individual, the complete financial cost associated with outbreak response, and the associated strain on health system infrastructure when resources are diverted at the individual, hospital, and community level," the authors conclude.

In another example of the true cost of refusing routine immunizations, Morbidity and Mortality Weekly Report (MMWR) todaypublished a report on the first tetanus case recorded in Oregon in more than 30 years. The patient was a 6-year-old boy who contracted the bacterial infection in 2017 after suffering a laceration on his forehead. The boy had received no immunizations.

The boy suffered severe symptoms, including jaw clenching, muscles spasms, spasticity, and difficulty breathing, before he needed to be air-lifted to a hospital.

"The boy required 57 days of inpatient acute care, including 47 days in the intensive care unit. The inpatient charges totaled $811,929 (excluding air transportation, inpatient rehabilitation, and ambulatory follow-up costs)," the authors said. "Despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations."
Mar 7 JAMA commentary
Mar 8 MMWR


MERS sickens 1 more person in Wadi ad-Dawasir, Saudi Arabia

Saudi Arabia today reported one more MERS-CoV infection, which may be linked to an outbreak in Wadi ad-Dawasir that has involved both healthcare and camel-related exposures.

The patient is an 85-year-old man whose exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is under investigation, the health ministry said in an update to its week 10 epidemiologic report.

So far, Saudi Arabia has reported 95 MERS-CoV cases this year, 54 of them in Wadi ad-Dawasir.
Mar 8 MOH report


Autism, depression risk rises in kids after moms infected in pregnancy

An observational study of nearly 1.8 million Swedish children born from 1973 to 2014 found an increased risk of autism and depression in children born to women who had an infection during hospitalization during pregnancy. An international research team based at the University of Gothenburg reported its findings this week in JAMA Psychiatry.

For the study, the investigators looked at data from the Swedish Medical Birth Register, linking it to the national inpatient register, which included information on whether the mother had an infection diagnosis during hospitalization while pregnant. The researchers monitored children's mental health status until 2014.

The team saw a marked rise in a child's hospitalization in later life for autism or depression if his or her mother had an infection diagnosis during pregnancy. The risk increase was 79% for autism and 24% for depression. The researchers found an increased risk even after mild infection diagnosed in the pregnant mother during hospitalization for conditions other than infection.

They didn't, however, find an association between to other psychiatric diagnoses, bipolar disorder and psychosis, including schizophrenia.

The observational nature of the study doesn't yield any clues about a possible mechanism, but the authors wrote that others have found the inflammatory reaction in the mother may produce inflammatory proteins that could alter gene expression in fetal brain cells. They note that other research suggests maternal inflammation increases the production of serotonin in the placenta, which might affect the baby's brain development.

Verena Sengpiel, MD, study coauthor and associate professor of Obstetrics and Gynecology at the University of Gothenburg, said in a press release from the school, "The results indicate that safeguarding against and preventing infection during pregnancy as far as possible by, for instance, following flu vaccination recommendations, may be called for."
Mar 6 JAMA Psychiatry abstract
Mar 7 University of Gothenburg news release


Nigeria records first vaccine-derived poliovirus type 2 infection of year

Nigeria has recorded its first case of circulating vaccine-derived poliovirus type 2 (cVDPV2 ) in 2019, according to the latest update today from the Global Polio Eradication Initiative (GPEI). This is the first case of vaccine-derived polio noted globally in 2019.

The case-patient is from Kwara state and experienced onset of paralysis on Jan 22.

Last year, Nigeria recorded 34 cases of cVDPV2 in two separate and ongoing outbreaks in Jigawa and Sokoto states. According to GPEI, no cases of wild poliovirus type 1 (WPV1) have been reported in Nigeria since 2016.

Nigeria, along with Afghanistan and Pakistan, is one of three remaining countries with endemic polio transmission. So far in 2019, Afghanistan has recorded two cases of wild poliovirus type 1 (WPV1) infection, and Pakistan has recorded four cases of WPV1.
Mar 8 GPEI

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