Oklahoma reports fatal Heartland virus case

Oklahoma health officials today reported the state's first Heartland virus infection, in a Delaware County resident who died from complications from the illness.

In a statement, the Oklahoma State Department of Health (OSDH) said the patient is only the 10th person in the nation to contract the disease and the second to die from infection with the virus, which has been found in Lone Star ticks and is thought to be spread by tick bites.

The new virus, a member of the phlebovirus genus, was first detected in two Missouri men in 2009, and in 2013 researchers found the pathogen in Lone Star ticks near where the patients were infected.

The OSDH said illnesses have also been detected in Tennessee. Oklahoma's Delaware County is located in the northeastern part of the state, in an area that borders Missouri and Arkansas.

The disease is different from other tick-borne illnesses, because it is caused by a virus rather than bacterium and can't be treated with antibiotics.
May 27 OSDH statement
Mar 27 CIDRAP News scan on 6 recent cases
Jul 22, 2013, CIDRAP News story "Researchers trace novel Heartland virus to Missouri ticks"


Caribbean chikungunya outbreak tops 66,000 cases

An outbreak of the painful chikungunya disease in the Caribbean has now reached 66,220 suspected or confirmed cases, the Pan American Health Organization (PAHO) reported late last week. That number is 2,731 higher than the European Centre for Disease Prevention and Control (ECDC) reported on the same day, May 23.

Also, PAHO reported 13 outbreak-related deaths, while the ECDC reported 6.

Unlike with the ECDC's detailed report, PAHO reported case numbers for only the Dominican Republic and Haiti in its update. It reported 8,058 suspected cases in the Dominican Republic, compared with 8,017 in the ECDC update.

PAHO said Haiti now has 3,460 suspected cases, 2,225 of which are in Ouest department. The ECDC, which did not list suspected cases, said Haiti has 632 confirmed chikungunya cases.

PAHO's update also recommends control measures for the mosquito-borne disease.
May 23 PAHO update
May 23 CIDRAP News scan on ECDC update


Hepatitis B screening advised for those not vaccinated, certain others

Adults and adolescents who have not been vaccinated against hepatitis B virus (HBV) or have certain other risk factors should be screened for the infection, the US Preventive Service Task Force (PSTF) said in a final recommendation issued yesterday.

Most people born in the United States have been vaccinated against HBV, but up to 2.2 million are chronically infected, and 15% to 25% of them die of liver cirrhosis or liver cancer, the PSTF said in a press release about the recommendation.

The recommendation applies to unvaccinated, nonpregnant adolescents and adults who have no HBV symptoms. The task force previously recommended screening for all pregnant women. The new recommendation also is intended for people in several high-risk groups, even if vaccinated:

  • Those born in countries and regions in which HBV is common, such as Africa, Southeast Asia, Pacific islands, China, the Middle East, Eastern Europe, and northern South America
  • US-born persons not vaccinated as infants whose parents were born in countries where HBV is common
  • HIV-positive people, injection drug users, men who have sex with men, and those living with or having sex with someone with HBV infection
  • Patients with weakened immune systems or on hemodialysis

From its review of the quality of evidence supporting screening and treatment for HBV, the task force issued its advisory as a "Grade B" recommendation.

In a fact sheet for consumers, the group said early detection can help prevent complications and reduce the spread of HBV and that treatment with antiviral medicines may reduce the risk of liver cancer.
PSTF landing page for recommendation
Clinical summary of recommendation


WHA adopts measures on drug resistance, yellow fever vaccine

The 67th World Health Assembly (WHA) adjourned May 24 after adopting measures on drug resistance and yellow fever vaccination, among others, the World Health Organization (WHO) said in a press release.

WHA delegates approved a resolution that urges WHO member states to strengthen drug management systems, to support research to extend the lifespan of existing drugs, and to encourage the development of new diagnostics and treatment options, the WHO said. The agency will develop a draft global action plan to combat antimicrobial resistance that it will present to the WHA for approval next year.

The WHA also adopted revised provisions on yellow fever vaccination or revaccination under the International Health Regulations that include extending the validity of a certificate of vaccination against yellow fever. The revisions are based on recommendations of the WHO's Strategic Advisory Group of Experts (SAGE) on immunization.

"This has been an intense Health Assembly, with a record-breaking number of agenda items, documents and resolutions, and nearly 3,500 registered delegates," said WHO Director-General Margaret Chan, MD, MPH. "This is a reflection of the growing number [and] complexity of health issues, and your deep interest in addressing them."

The WHA approved more than 20 resolutions, the WHO said.
May 24 WHO press release

Food Outbreak Scan for May 27, 2014

News brief

Salmonella outbreak tied to Foster Farms chicken grows to 574 cases

A multistate outbreak of Salmonella infections linked to Foster Farms chicken products has grown to 574 cases, which is 50 more than previously reported, the Centers for Disease Control and Prevention (CDC) said in an update today. The number of affected states grew from 25 to 27.

Among 478 patients with available information, 178 (37%) have been hospitalized. Illness-onset dates range from Mar 1, 2013, to May 1, 2014, and patients' ages range from less than 1 year to 93 years. No deaths have been reported.

Since the CDC's last update on Apr 9, 50 new cases have been reported in eight states: 42 in California, 2 in Utah, and 1 each in Arizona, California, Georgia, Montana, Nevada, Oregon, Texas, and Utah. (See CDC map below.) Georgia and Montana confirmed their first outbreak cases.

California has accounted for 77% of all cases. Foster Farms is headquartered in Livingston, Calif.

"The outbreak strains of Salmonella Heidelberg are resistant to several commonly prescribed antibiotics," the CDC said in the update. "Although these antibiotics are not typically used to treat Salmonella bloodstream infections or other severe Salmonella infections, antibiotic resistance can be associated with increased risk of hospitalization in infected individuals."

The agency said that 13% of case-patients have developed blood infections as a result of their illness. That compares with 5% in a typical Salmonella outbreak.

No Foster Farms products have been recalled because of the outbreak. Federal officials have isolated one of the two outbreak strains from Foster Farms chicken.
May 27 CDC update


Comment period extended for final FSMA rule

The comment period for the sanitary transportation rule issued under the Food Safety Modernization Act (FSMA) has been extended to Jul 30, the US Food and Drug Administration (FDA) announced on May 23.

The comment period was originally set to end May 31 for the rule, which was proposed in late January, but the deadline has been extended to accommodate requests for additional time, the agency said in a Federal Register update.

The rule is the seventh and final FSMA rule and focuses on sanitary transportation practices for human and animal food.
May 23 Federal Register notice
Jan 31 CIDRAP News scan on rule


Study: UK Salmonella reached epidemic proportions in 1980s

Over a period of 67 years, Salmonella enterica serotype Enteritidis was responsible for more than 525,000 illnesses, 27,000 hospitalizations, and 2,000 deaths in England and Wales, causing "the largest and most persistent epidemic of foodborne infection attributable to a single subtype of any pathogen since systematic national microbiological surveillance was established," according to a study published today in Emerging Infectious Diseases.

The study's London-based authors reviewed surveillance data on lab-confirmed salmonellosis cases from 1945 through 2011. They then extracted data on S enterica by serotype and phage type, with the goal of examining features, causes, and overall effects of Salmonella Enteritidis.

The epidemiology of S enterica was found to fall into four stages. During the pre-epidemic (1945-81) and emergence (1982-87) stages, Salmonella Typhimurium was the most commonly reported serotype. However, during the emergence stage the Salmonella Enteritidis serotype rose from 9% to 33% of all cases, and in the epidemic stage (1988-98) it became the most commonly reported serotype, reaching a high of 70% in 1997. A decline stage began in 1999.

Contaminated chicken meat and eggs accounted for a large proportion of cases; indeed, the rise of human Salmonella Enteriditis cases matched a rise of the infection in chickens. With widespread vaccination of poultry flocks and institution of management standards in the 1990s, human cases linked to chicken meat eased and then plateaued.

Enhanced flock hygiene in laying chickens late in the 1990s resulted in a drop in contaminated egg–linked human cases that was even more dramatic.
May 27 Emerg Infect Dis study

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