Flu Scan for Aug 03, 2015

News brief

High path AI outbreaks in Vietnam, Taiwan

Veterinary officials in two countries reported highly pathogenic avian influenza outbreaks from different strains, H5N6 in Vietnam and H3N2 in Taiwan.

In Vietnam, the H5N6 virus struck village birds in Quang Ngai province, located on the country's central coast, according to a report today to the World Organization for Animal Health (OIE). The virus killed 115 of 1,200 susceptible birds, and the remaining 1,085 were culled to control the spread of the virus.

In late July, the same virus was responsible for an outbreak in backyard birds in Nghe An province, in northern Vietnam.

Meanwhile, Taiwan authorities reported four more H5N2 outbreaks in two different counties, two of them in Changhua and two in nearby Yunlin, according to a Jul 31 report to the OIE.

All of the occurred on commercial farms, with outbreak start dates ranging from Jul 14 though Jul 21. The events involved native chickens, turkeys, and ducks. Of 72,528 susceptible poultry, the virus killed 22,518, and the remaining 50,010 were destroyed.

Taiwan has been battling both low-pathogenic and highly pathogenic H5N2 outbreaks over the past several months, in addition to several involving highly pathogenic H5N8.
Aug 3 OIE report
Jul 31 OIE report

Flu vaccine saves healthcare costs in elderly; LAIV uptake varies in kids

Seasonal influenza vaccination was found to avert deaths and save healthcare and other costs among people 65 and older, according to a study published Jul 31 in Public Library of Science (PLoS) One.

Researchers from CDC analyzed costs associated with healthcare, productivity loss, and mortality during four influenza seasons (2005-06, 2006-07, 2007-08, and 2008-09). They found that vaccine uptake among people 65 and older was associated with cost savings during all four seasons.

Receipt of flu vaccine among the elderly saved $828 million in 2005-06, $1.02 billion in 2006-07, $388 million in 2007-08, and $994 million in 2008-09. During the 2007-08 flu season, averted deaths and other costs in the elderly group resulted in cost savings for all age groups.

Researchers estimated that flu vaccination of people 65 and older prevented 8,484 hospitalizations in this age group during the 2005-06 flu season and 20,225 hospitalizations during the 2007-08 season.

Vaccination was also associated with preventing 549,329 flu cases requiring medical attention among the elderly in 2005-06 and 549,329 cases requiring medical attention during 2007-08.

Researchers noted that consideration of influenza’s societal burden and effect on productivity losses was important to consider, as an analysis of medical costs alone did not show that the vaccine was cost-saving.

The study’s findings are limited by the fact that influenza costs vary significantly by season and the fact that researchers did not account for vaccine effectiveness or the effects of herd immunity.
July 31 PLoS One study

Another CDC study published Aug 1 in Vaccine found that receipt of live, attenuated influenza vaccine (LAIV) among children was associated with age, race, and poverty level.

Researchers analyzed data reported by parents to the National Immunization Survey-Flu (NIS-Flu) for the 2011 through 2014 flu seasons. During the 2013-14 season, 33.3% of children ages 2-17 received LAIV, and this rate was comparable to the 2012-13 (32.1%) and 2011-12 (32.2%) seasons.

Children were more likely to have received LAIV during all three seasons if they were between the ages of 2-8, identified as white, and had a family income of at least $75,000.

During the 2013-14 season, children ages 2-8 were 1.5 times more likely to receive LAIV (1.38-1.63; 95% CI). White children were 1.22 times more likely than black children to receive LAIV (1.11-1.34; 95% CI), and children living above the poverty line were 1.16 times more likely to receive LAIV (1.06-1.28; 95% CI) during the 2013-14 season.

Researchers note that further study is needed into preferences and barriers related to receipt of LAIV and inactivated (injectable) flu vaccine in various demographic groups.
Aug 1 Vaccine study

News Scan for Aug 03, 2015

News brief

MERS hospitalizes two Saudi men

Saudi Arabia's health ministry today announced two new MERS-CoV cases, both of them from Riyadh, an area that over the past several weeks has experienced a spate of hospital-linked cases.

They are the first cases to be reported after a 4-day hiatus. The patients are two men, ages 53 and 75 years old. Neither are health workers, and both are symptomatic. The younger man is in stable condition, and the investigation revealed that he had contact with a suspected or confirmed case in the community or hospital setting. The older man is in critical condition, and authorities are still exploring how he was exposed to the virus.

Today's developments lift Saudi Arabia's total from Middle East respiratory syndrome coronavirus (MERS-CoV) to 1,059 cases, which includes 467 deaths. Nine patients are still being treated, and 583 so far have recovered from their infections.
Aug 3 Saudi MOH update

Chikungunya cases rise by more than 8,000

The Pan American Health Organization (PAHO) on Jul 31 reported 8,636 new cases of chikungunya in the Caribbean and Americas, bringing the outbreak total to 1,622,954.

The new total includes 470,546 suspected and 14,706 confirmed locally acquired cases and 755 imported cases reported in 2015.

Colombia, which has reported thousands of cases per week for the past several months, reported the largest increase with 6,452 new cases, bringing its outbreak total this year to 308,522.

Brazil reported 1,299 new cases for a 2015 outbreak total of 8,378. Ecuador, which reported a substantial 5-week increase last week, experienced a case increase of 503, bringing its outbreak total to 30,548.

No new fatalities were reported, and the 2015 outbreak death total stands at 61.

The epidemic began in December 2013 with the first locally acquired chikungunya case ever reported in the Americas, on St. Martin in the Caribbean.
July 31 PAHO update

CDC announces state infectious disease funding

In an action targeted to help states and major cities battle infectious disease threats, the US Centers for Disease Control and Prevention (CDC) today announced nearly $110 million in funding through its Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (ELC). The amount represents an increase of about $13 million compared to last year, the CDC said in a statement.

ELC funds go to all 50 state health departments, six of the country's biggest local health departments, and eight territories and US affiliates. The CDC said some of the increases are going to surveillance for vaccine-preventable diseases such as measles, foodborne-disease prevention, and advanced molecular detection.

Some of the funding will also help states at the US-Mexico border prepare for and respond to possible chikungunya outbreaks. The CDC added that the ELC funding mechanism helps states counter healthcare-associated infectious and antibiotic resistance.

Beth Bell, MD, MPH, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, said in the statement, "In the last year alone, states were hit with emerging diseases, like chikungunya and respiratory infections from enterovirus D-68, while also responding to outbreaks of measles, foodborne illness, and other threats. These awards lay the foundation for those on the front lines--state and local health departments--to act quickly to prevent illness and deaths."
Aug 3 CDC press release

More Salmonella cases reported from outbreaks tied to live poultry

The Centers for Disease Control and Prevention (CDC) on Jul 31 reported an increase in Salmonella cases tied to multi-state outbreaks that have sickened 218 people, 50 of whom were hospitalized.

Since the CDC’s initial outbreak report on Jul 1, 37 new cases have been identified, and 17 additional people were hospitalized. One new case in Illinois has brought the number of states affected by the outbreak to 41.

The outbreaks have been linked to contact with chicks, ducklings, and other live poultry. Among 117 people interviewed, 84% reported having contact with live birds in the week prior to becoming ill.

The outbreaks involve four different Salmonella serotypes. New cases include 10 people infected with Salmonella Enteritidis in five states, 5 people with Salmonella Hadar in four states, 5 people with Salmonella Indiana in four states, and 17 people with Salmonella Muenchen or Salmonella Muenster in 12 states. Infections related to the Hadar subtype have been responsible for more than half (52%; n=26) of hospitalizations since the outbreaks began.

All 16 isolates tested by the CDC were susceptible to antibiotics, and testing is ongoing.

The CDC cautions live poultry suppliers and owners to provide information regarding Salmonella risk and wash hands frequently when in contact with poultry. The CDC also advises that consumers only obtain live poultry from hatcheries and suppliers that participate in the United States Department of Agriculture (USDA) Voluntary Salmonella Monitoring Program.
July 31 CDC announcement
July 2 CIDRAP News story on multi-state outbreaks