News Scan for Sep 18, 2014

News brief

EV-D68 cases increase to over 150, 7 new states see the infection

The number of confirmed enterovirus D68 (EV-D68) cases in US children has risen from 130 to 153 and the number of states affected from 12 to 18 in just the past 2 days, according to an update today from the Centers for Disease Control and Prevention (CDC). In addition, California has just announced its first confirmed cases, which are not included in the CDC update.

States previously affected were Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, New York, Oklahoma, and Pennsylvania. Now Connecticut, Minnesota, Montana, Nebraska, New Jersey, Virginia, and California join the list. Canada has seen cases as well, in Alberta.

Virginia has reported at least seven confirmed cases (cases are considered confirmed after testing at CDC or state public health labs). Well over 300 children visited the emergency department at just one hospital, St. Mary's, with 46 admitted, says an ABC News item updated today. "We've never been to this capacity. . . . There [are] a lot more patients and a lot more severely ill than we saw with H1N1," said a pediatrician at the hospital.

Connecticut reported its first confirmed case yesterday. It involved a child who was treated at and discharged from a hospital last week, says a notice from the state's department of public health (DPH). Other hospitals in the state have reported suspected cases that await confirmation.

Minnesota's department of health confirmed that state's first case of EV-D68 as well, according to a story yesterday in the Minneapolis Star Tribune. The story says that "hospitals in the Twin Cities have been flooded with children experiencing severe breathing problems over the past week" and that "the University of Minnesota Children's Hospital is seeing respiratory illnesses at a rate usually only seen during influenza season." The latter facility has confirmed 11 cases in its laboratories.

Finally, the California Department of Health (CDPH) announced confirmation of four cases there today. The notice says three are in San Diego County and one in Ventura County. Other specimens from throughout the state are undergoing testing, the CDPH says.

The EV-D68 illness that is circulating began in mid-August and has been severe, sending many children to emergency departments or hospitals with wheezing and difficulty breathing. Children with asthma seem to be particularly at risk.

The CDC notes that more states will be reporting cases in coming weeks owing to the fact that several are investigating clusters of respiratory illness and awaiting test results.
Sep 18 CDC update
Sep 18 ABC News item regarding Virginia
Sep 17 Connecticut DPH notice
Sep 18 Star Tribune article regarding Minnesota
Sep 18 CHDP press release
Most recent (Sep 16) CIDRAP News scan on the outbreak


Imported chikungunya cases in US increase by 117, to 1,043

CDC's weekly update on cases of chikungunya infection imported by travelers into the United States puts the number as of Sep 16 at 1,043, a rise of 117 since last week.

In addition to imported cases, nine US cases have been acquired locally, one more than last week and all of them in Florida. That state, with a total of 195 travel-associated cases, is second only to New York, which has reported 252 cases.

The US territories of Puerto Rico and the US Virgin Islands have also had cases, with 296 and 29, respectively. The large majority of them have been locally transmitted rather than imported (303 vs 22).

The overall sum of suspected and confirmed cases in the current outbreak in Caribbean regions and the Americas stands at well over 700,000, with more than 100 deaths.

Chikungunya, which is a mosquito-borne disease, causes fever and arthritis-like pain. Before the current outbreak, which began late last year, it was seen mainly in Africa and south Asia.
Sep 17 CDC update
Most recent (Sep 15) CIDRAP News scan on the outbreak

In related news, Brazil reported its first cases of domestically contracted chikungunya Sep 15, according to an item today from Agence France-Presse (AFP). The previously reported cases from the country since January numbered 37, with all of them imported.

The cases occurred in Oiapoque municipality, which is in the northern state of Amapa bordering French Guiana; the latter country has also had cases. Brazil's health ministry declared that it will increase control measures to ward off new infections.
Sep 17 AFP story


Study shows dose-sparing strategies may work with anthrax vaccine

Dose-sparing strategies may be possible in the event of an anthrax attack, according to a study yesterday in Vaccine.

US researchers enrolled 328 volunteers into one of four study arms (82 in each group) with the aim of assessing strategies to reduce vaccine usage to stretch supplies in an emergency. Three groups received the full 0.5-milliliter (mL) dose of BioThrax (Anthrax Vaccine Adsorbed) at (1) days 0 and 14, (2) days 0 and 28, and (3) days 0, 14, and 28, and the fourth group received a half dose (0.25 mL) at days 0, 14, and 28. All patients received a booster 6 months after the initial dose.

All doses were administered subcutaneously. The recommended schedule for that route is 0.5 mL at 0, 14, and 28 days, plus the 6-month booster, according to the US Food and Drug Administration—the regimen given to one of the study groups.

The regimens in groups that included a day-14 dose induced a fourfold or greater antibody rise in more subjects on days 21, 28, and 35 than the regimens in groups without a day-14 dose. The researchers noted, however, that schedules with a 0.5-mL day-28 dose induced higher peak levels of antibody that persisted longer. The 0.25-mL regimen did not induce as high an immune response as the full-dose regimens.

The authors concluded, "Depending on the extent of the outbreak, effectiveness of antibiotics and availability of vaccine, the full dose 0, 28 or 0, 14, 28 schedules may have advantages."
Sep 17 Vaccine abstract

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