News Scan for Mar 21, 2016

News brief

Guinea reports another Ebola fatality

Another fatal Ebola case has been reported in Guinea's recent Ebola cluster, involving a young girl who was hospitalized at an Ebola treatment center, Reuters reported on Mar 19, citing a spokesman for the country's Ebola coordination center.

The World Health Organization (WHO) said in a Mar 18 statement that the other confirmed cases are in two family members among a cluster of suspected infections, a mother and her 5-year-old son, who are in a treatment facility. The agency said Guinea notified it of three unexplained deaths that have occurred in recent weeks in the village of Koropara, in the southern part of the country.

The cluster was first announced on Mar 17, just after Sierra Leone was declared free of the virus, leading to a momentary Ebola-free declaration for West Africa. The Ebola source in the latest spurt of infections hasn't been identified, but 11 earlier similar illness flare-ups have been reported in the outbreak region. The WHO has warned of a small but real risk of recurrence linked to contact with survivors, given that the virus can linger in immune-protected parts of the body such as eyes and testes.

Koropara Sous prefecture, where the rural village is located, has had Ebola infections before and is home to 10 survivors, including 2 breastfeeding women who are wives of Ebola survivors, the WHO's African regional office said in a Mar 18 statement. It added that responders have noted some community resistance in the area and that the WHO has moved quickly to strengthen its local community mobilization efforts.

The WHO said it has sent a team of specialists to Nzerekore prefecture to help coordinate the epidemiologic investigation and to help with surveillance, vaccination, social mobilization, and contact tracing. Also, Guinea's health ministry, the US Centers for Disease Control and Prevention (CDC), and UNICEF have sent investigators. Guinea's National Emergency Response Centre called a meeting on Mar 18 on the rapid response to its first Ebola cluster since Ebola transmission was declared over on Dec 29, 2015.
Mar 19 Reuters story
Mar 18 WHO statement
Mar 18 WHO African regional office statement
Mar 17 CIDRAP News story "Cases in Guinea end West Africa's short-lived Ebola-free status"

Study finds equal flu virus levels in coughs, exhalation

A study by researchers from the CDC and West Virginia University (WVU) found no significant difference between the amount of influenza A virus in symptomatic patients' coughing and exhaling. The group published its findings on Mar 17 in Influenza and Other Respiratory Viruses.

During the 2014-15 influenza season, 53 college students at WVU who tested positive for virus H3N2 forcibly exhaled and coughed, three times per method, into a spirometer. Thirty seven of these students (70%) transmitted the virus through coughing, exhaling, or both, indicating that even with the low sample size available, both transmission modes could be a common way for the virus to spread, according to the study.

The team found that 53% of students had the virus in their coughs, and 42% had it in their exhalation. When the students who had the virus present in both actions are excluded from the data, 24% of students had the virus in their exhalations, and 41% had it in their coughs.

The difference between coughing and exhaling were statistically insignificant, supporting the theory that aerosols containing viable flu viruses reside more in the bronchioles and alveoli than in the upper respiratory system. The researchers also noted though flu viruses were detected slightly less often in exhalation, breathing may generate more airborne particles over time, since people breathe more often than they cough.

Because of the small sample size and other sources of error, the study was not able to quantify the amount of flu virus in each action. Additionally, because participants were told to inhale as deeply as possible and then forcibly cough or exhale, the origin of the aerosol particles and the how many were expelled may differ from natural settings.

The authors said the findings are useful for pandemic planning purposes and to help guide prevention practices.
Mar 17 Influenza Other Respir Viruses abstract

Hong Kong reports imported H7N9 case from mainland China

Hong Kong's Center for Health Protection (CHP) reported on Mar 18 an imported H7N9 avian influenza case in a resident who traveled to mainland China. The illness is Hong Kong's second imported H7N9 case this year.

The patient is an 81-year-old woman with underlying medical conditions who traveled to Kaiping in Guangdong province on Mar 5, where she visited a wet market but had no direct contact with birds. Her symptoms began on Mar 10, and she was hospitalized in Kaiping on Mar 14. The woman returned to Hong Kong Mar 17, where she was re-hospitalized with pneumonia, the CHP said.

Two of the woman's daughters have developed malaise and headache and have been hospitalized for observation. The CHP said tracing is underway for the patient's other contacts in Hong Kong.

The latest illness is Hong Kong's 15th imported H7N9 case since the virus emerged in 2013. It lifts the global total to 768, according to a case list maintained by FluTrackers, an infectious disease news message board.
Mar 18 CHP report
FluTrackers H7N9 case list

FDA approves injectable agent for anthrax under Animal Rule

A new injectable drug, obiltoxaximab (Anthim), was approved by the US Food and Drug Administration (FDA) Mar 18 for treating inhalational anthrax when alternatives are not available or appropriate, according to a press release today from the agency.

The drug, which is used along with appropriate antibacterial agents, is a monoclonal antibody that neutralizes toxins produced by Bacillus anthracis, the causal organism of anthrax.

Anthim was approved under FDA's Animal Rule, which allows results of efficacy studies in animals for support when trials in humans would not be feasible or ethical. Safety in humans was established in a trial of 320 healthy volunteers. Headache, pruritus, upper respiratory infections, cough, congestion, hives, bruising, and swelling and/or pain at the injection site were the most frequently reported side effects.

Allergic reactions, including anaphylaxis, can occur with Anthim, so it should be administered in settings where severe reactions can be monitored and treated.

Inhalational anthrax, a potential agent of bioterrorism, is caused by breathing spores of B anthracis. "As preparedness is a cornerstone of any bioterrorism response, we are pleased to see continued efforts to develop treatments for anthrax," said Edward Cox, MD, MPH, who is director of the FDA's Office of Antimicrobial Products.
Mar 21 FDA press release
FDA information on Animal Rule approval

Foodborne Disease Scan for Mar 21, 2016

News brief

CDC blames raw milk in two 2014 Listeria cases, one fatal

Two cases of listeriosis that occurred in 2014 have been linked to raw milk produced by a Pennsylvania organic arm, the Centers for Disease Control and Prevention (CDC) said today.

Two people were hospitalized with Listeria monocytogenes infections in California and Florida in 2014, the CDC said. The patients were 73 and 81 years old and had consumed raw milk before becoming ill. The Florida patient died of listeriosis.

Raw milk from Miller's Organic Farm in Bird-in-Hand, Pa., was identified as the probable source of both infections on Jan 29, following testing of samples of raw chocolate milk collected in November 2015 in Anaheim, Calif.

The CDC cautions consumers that contaminated raw milk from Miller's Organic Farm likely remains on the market and recommends that people consume only pasteurized dairy products.
Mar 18 CDC report

Cucumber-linked Salmonella outbreak grows to 907 cases, declared over

In the 2 months since a previous update, illnesses in a cucumber-linked Salmonella Poona outbreak have risen by 19 to a total of 907 cases, the CDC said in a Mar 18 update, noting that the outbreak is now considered over.

The outbreak, which was attributed to cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce, sickened people in 40 states and resulted in 6 deaths. California health officials, however, said salmonellosis was not a contributing factor in two of the three deaths reported in that state. One death each was reported in Arizona, Oklahoma, and Texas.

Of 720 patients with information available, 204 (28%) were hospitalized. Illness-onset dates range from Jul 3, 2015, to Feb 29, 2016, and patients range in age from less than 1 year to 99 years. Nearly half (49%) were children, the CDC said.

Eleven clusters in seven states led officials to determine that cucumbers from Baja California, Mexico, were the source of the outbreak. Andrew & Williamson Fresh Produce and Custom Produce Sales, both of California, recalled cucumbers in September 2015.

The CDC said that 127 illnesses began after Sep 24, when recalled cucumbers should have been unavailable or spoiled. Testing did not discover the source of these infections.

California confirmed the most Salmonella Poona outbreak cases (245), followed by Arizona (140) and Utah (62).
Mar 18 CDC update
Jan 26 CIDRAP News item on outbreak

Rules to guard against human exposure to BSE finalized by FDA

Interim rules aimed at minimizing human exposure to bovine spongiform encephalopathy (BSE), a progressive and fatal neurologic disorder of cattle, have been finalized, the US Food and Drug Administration (FDA) announced on Mar 17.

The interim rules, from 2004, 2005, and 2008, define specified risk materials (SRMs), meaning the cattle materials that pose a risk of containing so-called mad cow disease, and prohibit their use in human foods, dietary supplements, and cosmetics.

SRMs include bovine brain, skull, eyes, trigeminal ganglia, spinal cord, vertebral column with some exceptions, and dorsal root ganglia from cattle 30 months of age and older, plus the tonsils and distal ileum of all cattle. Also prohibited are the small intestine of all cattle unless the distal ileum has been properly removed, all material from nonambulatory cattle, and all material from uninspected cattle or cattle that have not passed inspection.

Milk and milk products, animal hides and products derived from hides, tallow containing 0.15% or less insoluble impurities, tallow-derived products, and gelatin are not among prohibited materials, as confirmed by the final rules.

The FDA points out that the risk of human exposure to BSE in FDA-regulated human foods and cosmetics the United States has been negligible in that the rules have been largely followed for an extended time even before their finalization.
Mar 17 FDA announcement
Mar 18 Federal Register notice of final rule