Flu Scan for Feb 11, 2015

News brief

CDC: Swollen salivary glands reported in some kids with flu

The Centers for Disease Control and Prevention (CDC) says that several states have recently reported an unusual finding in some influenza patients this season: parotitis, or swelling of the salivary glands.

The CDC reported the finding yesterday in an update of its current flu guidance for the public, titled "What You Should Know for the 2014-2015 Influenza Season."

Most of the flu cases accompanied by parotitis have occurred in children with influenza A/H3N2 infections, the CDC said, adding that most of the cases have been mild. H3N2 is the predominant flu subtype this winter.

"Parotitis is not a common symptom of influenza infection, although cases of parotitis with influenza infection have been reported in the past," the agency said. "Parotitis is much more commonly seen following infection with other pathogens such as the mumps virus. Symptoms of influenza infection include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headache, fatigue (tiredness), and sometimes vomiting and diarrhea (more common in children than adults)."

On Jan 16, as pointed out by Michael Coston on his Avian Flu Diary blog, the Chicago Department of Public Health (DPH) issued an alert to clinicians about parotitis in flu patients. It said several health departments in Midwestern states, including Illinois, had been informed of such cases. Illinois officials, the alert said, were working with the CDC and other state health departments to investigate the reports.

The notice advised healthcare providers to consider influenza in the differential diagnosis of all patients with parotitis, especially those with flu-like illness. It said providers should collect specimens for both mumps and flu testing regardless of the patient's vaccination status.
Feb 10 CDC statement
Jan 16 Chicago DPH alert

Flu activity up in Europe and Asia, with H3N2 and H1N1 circulating

The flu season in North America appears to have peaked, while Europe and Asia continue to see high levels of influenza A (H3N2 and 2009 pandemic H1N1), according to a Feb 9 World Health Organization (WHO) report.

Data from 93 countries as of Jan 25 showed that 32,188 of 135,489 specimens tested positive for influenza, with 87.4% typed as influenza A and 12.6% as influenza B. Of the flu A specimens, 92.4% were subtyped as H3N2 and 7.6% as H1N1. Subtyping of flu B specimens showed that 99% were of the Yamagata lineage, and 1% were of the Victoria lineage.

The flu season in the United States and Canada appears to have peaked, with 27.4% of specimens in Canada and 19.9% of US specimens testing positive.

Countries in central and western Europe are seeing high flu activity, with 26 countries reporting increases in flu cases. The WHO said that 87% of European specimens are flu A and 13% are flu B. Of the flu A specimens, 78% were subtyped as H3N2 and 22% as H1N1.

Flu levels have increased in much of Asia, with India reporting increases in H1N1 cases and Japan reporting a sharp increase in clinical visits (18 visits per 1,000 people) associated with circulating H3N2. Elderly populations in Hong Kong are experiencing high hospitalization rates associated with flu.

The flu season in North Africa and the Middle East appears to have peaked, with both H3N2 and flu B circulating. Algeria and Iran are seeing increases in specimens positive for H1N1. Central Africa reported circulation of H3N2 and flu B, with Rwanda detecting H1N1.

Flu levels remained low in the tropical Americas with the exception of Puerto Rico, which is seeing high activity, and Jamaica, where sentinel sites are detecting increases in severe acute respiratory infections associated with circulating H3N2.
Feb 9 WHO report

H7N9 sickens one more in China

China's Guizhou province today announced the confirmation of an H7N9 avian influenza infection in a 44-year-old man who is hospitalized, reported Xinhua, China's state news agency, today.

The case is only the second detected in Guizhou province, located in southwestern China.

Provincial health officials said the man started spiking a high fever on Feb 5 and went to a hospital in Guiyang after home treatments didn't resolve his symptoms. An investigation into the source of his illness found that he had been exposed to live poultry before he got sick and that members of his family work as poultry cullers.

The man's illness would push the global number of H7N9 infections to 585, according to a case list kept by FluTrackers, an infectious disease news message board.
Feb 11 Xinhua story
FluTrackers H7N9 case list

More avian flu detections reported in Taiwan, Bulgaria

Animal health officials in Taiwan today said 35 more poultry sites have been hit by H5N8 avian influenza, with the H5N3 virus striking 3 more locations, according to two reports to the World Organization for Animal Health (OIE). In a third report today they detailed 72 more H5N2 outbreaks.

The H5N8 outbreaks affected 34 farms and one slaughterhouse in 5 different counties as well as in the cities of Tainan and Kaohsiung. The H5N2 virus was also found on three farms. Most of the farms housed geese, but a few were raising ducks, chickens, and turkeys.

Of 121,897 affected birds, the infections killed 19,910, with the remaining ones slated for culling.

Taiwanese authorities also reported three H5N3 outbreaks on farms in two different counties, Yunlin and Pingtung. Two farms raised geese and one raised chickens. Among 16,700 birds, 2,900 deaths were reported, and the remaining poultry will be destroyed to curb the spread of the virus.

Meanwhile, the additional H5N2 outbreaks struck 70 poultry farms and 2 slaughterhouses in four different counties, plus the cities of Taoyuan, Tainan, Kaohsiung, and Taichung, affecting geese, chickens, ducks, and turkeys. Of 564,047 susceptible birds, the virus killed 142,989, and the rest were destined for culling.

Elsewhere, Bulgarian agriculture officials reported more H5N1 findings in wild birds in the southeastern province of Burgas. Other wild bird findings and an outbreak in backyard poultry have recently been reported in the same area. The OIE report said H5N1 was detected in a rock pigeon and a black-headed gull.
Feb 11 OIE report on H5N8 in Taiwan
Feb 11 OIE report on H5N3 in Taiwan
Feb 11 OIE report on H5N2 in Taiwan
Feb 11 OIE report on H5N1 in Bulgaria

News Scan for Feb 11, 2015

News brief

Philippines reports imported MERS case

Health officials in the Philippines reported a case of MERS in a Filipino nurse who recently returned from Saudi Arabia, according to a Reuters story today.

The nurse returned to the Philippines last week and presented with a fever, body pain, cough, and difficulty breathing. She was diagnosed with MERS-CoV (Middle East respiratory syndrome coronavirus) and is currently hospitalized in stable condition, the story said.

Her husband, who traveled with her from Saudi Arabia to the Philippines, tested negative for MERS-CoV. Filipino health officials are conducting contact tracing for the 225 passengers who traveled with the nurse on Saudi Airlines flight 860.

Reuters said this is the first MERS case in the Philippines, although last spring Filipino officials reported an asymptomatic MERS-CoV infection in a nurse who had recently returned from the United Arab Emirates. Saudi Arabia reported the death of a Filipino nurse in 2013.

The Philippines has expressed growing concern over MERS-CoV rates and the potential for imported cases in the many Filipino healthcare professionals working in the Persian Gulf region.

In news from Saudi Arabia, a Feb 9 Ministry of Health (MOH) report listed the recovery of a 67-year-old man who had previously been diagnosed with MERS-CoV. The man was not a healthcare worker and had an underlying medical condition.

The new recovery brings Saudi Arabia's MERS case total to 857, of whom 476 people have recovered and 366 have died. Fifteen Saudi cases remain active.
Feb 11 Reuters story
Apr 16, 2014, CIDRAP News story on asymptomatic case in Filipino nurse
Sep 17, 2013, CIDRAP News story on death of Filipino nurse in Saudi Arabia
Feb 9 MOH update

Ten measles cases in Quebec linked to Disneyland

An outbreak of 10 measles cases in Joliette, Quebec, is linked to the Disneyland-related outbreak in the United States, the Canadian Press (CP) reported today.

A statement from the Lanaudiere health authority, which covers a region northeast of Montreal, said the 10 cases are all connected, according to the story. The statement didn't name Disneyland specifically but said the first case-patients caught the virus while visiting a park in California where other cases have been reported. Officials did not reveal the patients' ages.

The count in a widespread US measles outbreak stood at 121 cases 2 days ago, with Disneyland seen as the source for most of them.

In other developments, a measles outbreak in Illinois has now reached 10 cases, with 9 of them linked to a daycare center in the Chicago suburb of Palatine, according to media reports today.

The two latest cases involve infants connected to the KinderCare Learning Center in Palatine, the Chicago Daily Herald reported yesterday. Another case is in a student at Elgin Community College in Elgin, a city 35 miles northwest of Chicago. Reports say all 10 case-patients were unvaccinated.

Meanwhile, Georgia health officials said they have identified 35 people at risk for measles following contact with a measles-infected baby from Kyrgyzstan who was treated at an Atlanta hospital, according to a story today from the Savannah (Ga.) Morning News.

The baby was admitted to Children's Healthcare of Atlanta at Egleston on Feb 6 and was discharged yesterday, the story said, citing hospital officials.

The 35 at-risk people identified by officials have not been immunized against measles or have compromised immune systems, said Patrick O'Neal, MD, director of health protection for the Georgia Department of Public Health, according to the story. He said many of them are children.
Feb 11 CP story
Feb 10 Chicago Daily Herald story
Feb 11 Savannah Morning News story