Flu Scan for May 19, 2015

News brief

H5 outbreaks strike four more Iowa farms

Iowa agriculture officials today reported four more highly pathogenic H5 avian influenza outbreaks, with testing under way to confirm that they are part of a string of H5N2 outbreaks that has now affected up to 60 of the state's farms.

The newly affected locations include a turkey farm in Buena Vista County that houses 24,000 birds, and three sites in Sioux County, the Iowa Department of Agriculture and Land Stewardship (IDALS) reported.

The Sioux County sites are a commercial egg-laying facility with 150,000 chickens, a pullet farm housing 100,000 birds, and a backyard flock of 15 chickens, the agency said.

Monitoring activities related to another outbreak detected the virus at the pullet farm, while increased mortality triggered testing and detection at the other three sites.

Confirmatory tests are being done by the US Department of Agriculture's (USDA's) National Veterinary Services Laboratory in Ames, Iowa.
May 19 IDALS press release

WHO details recent H5N1 illnesses in Egypt

The World Health Organization (WHO) today provided more details about reports of 14 H5N1 avian influenza cases it received between Apr 1 and May 1, including 13 from Egypt and 1 from China. The details were included in the WHO's monthly report on zoonotic flu infections.

Over the past several months Egypt has experienced an unprecedented gush of H5N1 infections, but the WHO said cases have declined since its last report last month. Three days ago the WHO reorted that exposure to infected poultry, lack of awareness, and prevention gaps were probably the main disease drivers, rather than changes in the virus or the epidemiology of the disease.

In the new update, posted yesterday, the WHO said the reasons for the drop in human cases in Egypt since its last update are unclear, but the decline is probably the result of multiple factors, including fewer poultry outbreaks, greater awareness, and seasonal factors.

Of the 13 patients from Egypt in the WHO report, 9 had illness onsets in March and 4 got sick in April. The people were from eight different governorates and ranged from 3 to 58 years old. Three are children younger than 10. Slightly more females were sickened by the virus than males. All were exposed to poultry before they became ill.

All but one the patient, a 43-year-old man, recovered from their infections. All of the country's patients received oseltamivir, often the day they were hospitalized. The WHO added that the proportion of fatal cases has consistently been lower in Egypt than in other countries, especially in kids.

The 14th case the WHO noted was that of a 6-year-old boy from China's Yunnan province, whose illness has already been reported. Few details were available, other than that he recovered.
May 18 WHO monthly flu at the human-animal interface report
May 15 CIDRAP News item "Global panel: H5N1 surge in Egypt likely due to more poultry contact"

WHO: Global flu levels low in lead-up to Southern Hemisphere season

The Northern Hemisphere flu season is nearing its end, with influenza B dominant as the disease makes its exit many countries, while flu activity in the Southern Hemisphere was low in the lead-up to the start of its season, the WHO said yesterday in an update.

Amid the overall decline, 2009 H1N1 detections rose in some countries, especially Jordan. Other sparks of activity were reported in Guatemala, which saw a slight increase in H3N2 detections, and some West African countries; Ivory Coast is reporting H3N2 and 2009 H1N1 activity, and Ghana is seeing all three strains cocirculate.

In the temperate Southern Hemisphere countries, South Africa is reporting a slight increase in flu, with all three strains detected. In Australia and New Zealand, however, flu levels are still below the seasonal threshold, with sporadic identification of all three strains. That region's flu season typically runs from May through October.

At the global level, among samples tested in the 2 weeks leading up to May 2, nearly 74% of positive specimens were influenza B, mostly belonging to the Yamagata lineage. Of the subtyped influenza A viruses, 54% were 2009 H1N1 and 46% were H3N2.
May 18 WHO global flu update

News Scan for May 19, 2015

News brief

Salmonella outbreak possibly tied to raw fish reaches 51 cases in 9 states

An unusual Salmonella outbreak believed to be tied to raw fish now includes 51 cases in nine states, the US Centers for Disease Control and Prevention (CDC) reported today.

CDC spokeswoman Kristen Nordlund told CIDRAP News that most of the patients are from states in the Southwest or reported travel to that region. Among 45 people with available information, 10 (22%) reported being hospitalized, but no deaths have been reported.

As reported yesterday, Arizona and New Mexico recently reported a total of 15 Salmonella Paratyphi infections that were thought to be caused by eating raw fish. Arizona officials said raw tuna in restaurant sushi was implicated in the cases. In addition, California reported 25 similar cases in April.

Nordlund said the outbreak strain is Salmonella Paratyphi B variant L(+) tartrate(+), which does not cause paratyphoid fever, enteric fever, or typhoid fever. The illness typically involves diarrhea, fever, and abdominal cramps starting 12 to 72 hours after exposure.

"The investigation has not yet conclusively identified a food source, but most ill people interviewed by local and state public health officials reported eating sushi containing raw fish in the week before becoming ill," Nordlund said via e-mail. "CDC always recommends that people at higher risk for serious foodborne illness not eat raw fish or raw shellfish, regardless of an ongoing outbreak." Those groups include children under age 5, adults over 65, pregnant women, and those with weakened immune systems.

The CDC is working with state public health officials and the Food and Drug Administration to investigate the outbreak, Nordlund said.
Related May 18 CIDRAP News item

US economic burden from foodborne illnesses estimated at $15.5 billion

Foodborne illnesses impose a significant economic burden in the United States, to the tune of an estimated $15.5 billion per year (2013 dollars), with 90% of that total attributable to illnesses caused by only five pathogens, says a new released report from the US Department of Agriculture (USDA).

The 59-page report points out that among the approximately 48 million US residents who have foodborne illnesses each year, a specific cause can be found in only about 20% (9.4 million). And just 15 pathogens were responsible for at least 95% of those.

The five most common were non-typhoidal Salmonella (accounting for 24% of the economic burden), Toxoplasma gondii (21%), Listeria monocytogenes (18%), norovirus (15%), and Campylobacter (12%). The remaining leading pathogens were Clostridium perfringens, Cryptosporidium, Cyclospora cayetanensis, Shigella, Shiga toxin–producing Escherichia coli (STEC) O157, non-O157 STEC, Vibrio vulnificus, Vibrio parahaemolyticus, non-cholera Vibrio species, and Yersinia enterocolitica.

The authors compared the economic burden among the 15 pathogens and found that it varied greatly, from $202 per case for Cyclospora cayetanensis to $3.3 million per case for Vibrio vulnificus, for example.

When looking at the health outcomes for the 15 pathogens, the authors found that deaths accounted for 83% ($12.8 billion) of the economic burden, followed by medical costs at 12% ($1.8 billion) and lost productivity at 5% ($856 million.

Included in the report are summaries of the 15 foodborne illnesses analyzed as well as educational materials for each.

The authors state that the large proportion of foodborne illnesses with no identifiable cause "indicates the need for research on the cost and value of investment in better foodborne disease surveillance."
May 2015 USDA report

Polio team attacked in Pakistan; Nigeria targets vaccine-derived polio

Militants today attacked a polio vaccination team in Pakistan's Khyber-Pakhtunkhawa province in the northwestern part of the country, injuring a female worker and a police officer, Pakistan's Express News reported today. The attack took place in the state's Mardan district. Another police team opened fire on the unidentified assailants, killing one of them.

In other polio developments, Nigeria has gone 9 months without a wild poliovirus (WPV) case and is taking extra steps to prevent circulating vaccine-derived poliovirus (cVDPV) infections, the World Health Organization's African regional office said today in a statement. It noted that the last cVDPV case was isolated 6 months ago, but it was found in environmental samples form the Kamacha River in Kaduna state in March and in Sokoto South Local Government Area in 2014.

On May 8 the two states wrapped up a combined vaccine campaign to address the cVDPV environmental detections. Children ages 0 to 59 months were targeted to receive a trivalent oral polio vaccine and a subset of those ages 3 to 59 months received inactivated polio vaccine. The WHO said the vaccine combination was designed to improve population immunity and prepare for the global switch from oral to injectable polio vaccine in 2016.
May 19 Express Tribune story
May 19 WHO African regional office statement

CDC: Fungal meningitis response probably saved 124 lives

An aggressive public health response to a 2012 fungal meningitis outbreak caused by contaminated methylprednisolone injections from the New England Compounding Center (NECC) likely prevented 153 cases of meningitis or stroke and averted 124 deaths, according to estimates from researchers at the CDC.

The team published its findings in the May 15 edition of Emerging Infectious Diseases.

To arrive at their estimates, the authors compared deaths and clinical details of patients who were diagnosed before and after Oct 4, the day news of the outbreak was widely publicized. They also examined NECC shipping records to determine the volume of contaminated injections shipped to 75 facilities and calculated the risks from each of the three recalled product lots.

The researchers wrote that 13,535 people were potentially at risk and that the outbreak could have been far worse without the response, which involved thousands of public health officials, clinicians, and medical staff. Diagnosis before the outbreak was publicized was associated with a higher 60-day case-fatality rate compared with diagnosis after that cutoff point: 28% versus 5%. They said the response probably enabled clinicians to diagnose the infections earlier and more quickly prescribe antifungal therapy.

Most of the infections involved Exserohilum rostratum, though the index case was infected with Aspergillus fumigatus. According to the CDC, the outbreak sickened 751 people, 64 of them fatally, in 20 states. The episode led to federal charges against several NECC employees and uncovered problems with Food and Drug Administration (FDA) oversight of compounding pharmacies.
May 15 Emerg Infect Dis report
CDC fungal meningitis outbreak information