Flu Scan for Nov 18, 2014

News brief

WHO: Pacific islands only area showing notable flu activity

Several Pacific Islands are the only areas of the world with noteworthy influenza activity at present, as circulation in nearly all other areas remains low, typical for this time of year, according to yesterday's World Health Organization (WHO) biweekly update .

North America is seeing slight increases, but overall activity remains low. Tropical areas of the Americas are also experiencing low activity, with most influenza-like illness (ILI) there caused by respiratory syncytial virus (RSV).

Flu News Europe, a weekly bulletin from the European Centre for Disease Prevention and Control (ECDC) and the WHO European office, reports low-intensity flu activity for week 45 (Nov 2 through 8), with no indication that the flu season has begun. Seven of the 39 reporting countries had sporadic cases, and 2 countries showed slightly increasing trends. (WHO did not report data on Europe because of temporary unavailability owing to a change in data collection forms.)

Africa, western Asia, and eastern Asia similarly are seeing low levels of activity. Tropical Asia's levels are low, with type B flu predominating in Viet Nam.

Southern Hemisphere areas generally have low activity. In the Pacific, however, flu circulation is high in American Samoa, the Federated States of Micronesia, Fiji, French Polynesia, Guam, and the Northern Mariana Islands.

Data are based on FluNet reporting from 51 countries as of Nov 14. A total of 44,937 respiratory specimens were tested, of which 1,978 were positive for flu. Of those, 72.5% were influenza A and 27.5% were influenza B. Of the 873 subtyped influenza A samples, 93.1% were H3N2 and 6.9% were 2009 H1N1. Of 90 subtyped flu B samples, 96.7% were of the Yamagata lineage and 3.3% were Victoria.
Nov 17 WHO update
FluNews Europe update

UK avian flu virus is H5N8; Dutch outbreak arrested

British authorities announced today that the avian influenza virus that hit a Yorkshire duck farm last week is the H5N8 subtype, as expected, while Dutch authorities said an H5N8 outbreak in the Netherlands has not spread beyond the original chicken farm.

The UK's animal health laboratory in Weybridge confirmed that the outbreak in East Yorkshire involves H5N8, the Department for Environment, Food & Rural Affairs (Defra) announced today. The outbreak, which began Nov 14, killed 338 ducks and prompted the culling of the rest of the 6,000-duck flock.

The British and Dutch outbreaks followed an H5N8 outbreak detected on a German turkey farm Nov 4, marking the first H5N8 incursion in Europe. The virus struck South Korea in January and forced the culling of more than 10 million poultry in the country by mid-March. Health agencies suspect that wild birds brought the virus to Europe.

In the Netherlands, authorities announced today that no signs of the virus have been found on other farms within 10 kilometers of the affected one, Agence France-Presse (AFP) reported. As a result, they lifted a temporary nationwide ban on the transport of poultry and poultry products.

No human infections with H5N8 have been reported. But AFP said the WHO is urging Europeans to avoid touching sick or dead wild birds and is advising those involved in culling to check for fever over the next 2 weeks.

Elizabeth Mumford, a WHO scientist, said she expects more avian outbreaks but judged that it's unclear whether the virus will spread to humans, according to AFP. If it did infect humans, it would be unlikely to spread from person to person, she said. She added that oseltamivir (Tamiflu) could be used to treat it, because lab tests showed the virus is susceptible to the drug.

Mumford said the virus's H (hemagglutinin) component appears similar to that found in the highly pathogenic H5N1 subtype, but the N (neuraminidase) segment is from a completely different virus with no human-adapted component, indicating it prefers to attach to birds.
Nov 18 Defra update
Nov 18 AFP story

Egypt reports additional H5N1 death

A 30-year-old woman in Egypt died of H5N1 avian flu today, according to a Reuters report that cites Al-Ahram, Egypt's state newspaper. Her death is the second H5N1 fatality reported in Egypt in 3 days.

The woman is from Minya governorate in north-central Egypt and died in a hospital in Asyut, farther south, the Reuters story said. She had contact with infected birds before falling ill.

On Nov 17 the country's Ministry of Health reported an H5N1 death in a 19-year-old woman in Asyut, as well as a nonfatal case in a 3-year-old girl in Minya. Reuters yesterday reported those cases in addition to the case in the 30-year-old, but the health ministry did not report the case in the older woman until today, according to a translated statement on the Avian Flu Diary blog.

The new cases bring the country's H5N1 total to eight, including three deaths.
Nov 18 Reuters report
Nov 18 Avian Flu Diary blog post
Nov 17 CIDRAP News scan on previous cases

Study: LAIV use increases in children during last flu season

Researchers from the US Centers for Disease Control and Prevention (CDC) found that 38% of children 2 to 8 years old received live attenuated influenza vaccine (LAIV) during the 2013-14 flu season, according to a study yesterday in Vaccine.

Study coordinators looked at vaccination records from six sentinel sites located around the country. LAIV use increased from 20.1% in that age-group during the 2008-09 flu season to 38% in the 2013-14 season, the study said.

During this period, overall vaccine coverage also increased from 29.2% to 39.9% among children ages 2 to 8. Coverage also increased in children ages 9 to 12, from 18.2% to 33.3%, the study said.

Children ages 5 to 8 had the highest use of LAIV (42.1%), and children ages 2 to 4 had the lowest (32.8%). North Dakota and Minnesota had the highest rates of LAIV uptake among children ages 2 to 8, with 55.5% and 50% of children receiving LAIV in 2013-14, respectively.

On Jun 25, 2014, the Advisory Committee on Immunization Practices (ACIP) preferentially recommended LAIV for healthy children ages 2 to 8. Although LAIV availability can be affected by cost, storage limitations, and shelf life, the study reported that its acceptance appears to be increasing in the target population.
Nov 17 Vaccine study

News Scan for Nov 18, 2014

News brief

ECDC: Increased antibiotic resistance in Europe 'truly alarming'

Effective antimicrobial treatment options for certain infections in European countries continue to narrow, according to the newly released Antimicrobial Resistance Surveillance in Europe 2013 report, issued yesterday by the European Centre for Disease Prevention and Control (ECDC).

The report, compiled from European Antimicrobial Resistance Surveillance Network (EARS-Net) data, presents resistance data from 30 countries for seven microorganisms: K pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Actinotobacter, Streptococcus pneumoniae, Staphylococcus aureus, and Enterococci.

Among the most concerning findings is increasing resistance of K pneumoniae to carbapenems, which are among the last-line agents for multidrug-resistant Gram-negative bacteria. Carbapenem resistance remains relatively low in most countries, but in mean percentage for the population-weighted European Union (EU)/European Economic Area (EEA), the resistance of K pneumoniae increased significantly, from 4.6% in 2010 to 8.3% in 2013.

Said European Commissioner for Health and Food Safety Vytenis Andriukaitis in the ECDC release, "The near doubling of resistance in a certain bacteria in three years is truly alarming, and illustrates the need to tackle the issue from all directions." He labeled antimicrobial resistance "one of the most pressing public health issues of our time."

Also of concern is that K pneumoniae showed resistance to polymyxin E (colistin), a backup drug for carbapenem-resistant K pneumoniae, for the first time, being observed in 5% of isolates. ECDC Director Marc Springer called this a "worrying development." He added, "We are gradually returning to the 'pre-antibiotic era,' when bacterial diseases could not be treated and most patients would die from their infection because there was no effective treatment."

Good news came regarding methicillin-resistant Staphylococcus aureus (MRSA). A significant decreasing trend was seen from 2010 to 2013, although it was not as large as the drop in the previous 4-year period, and the EU/EEA population-weighted mean MRSA percentage remained above 25% in 7 of the 30 reporting countries.
Nov 17 ECDC press release
ECDC full report

Saudi Arabia reports new MERS case, recoveries, and death

Saudi Arabia's Ministry of Health (MOH) today reported a new MERS-CoV case and a recovery from the disease in separate cities in Al-Kharj governorate. The MOH also reported 1 recovery yesterday and 1 death on Nov 16 in previously confirmed patients.

The case reported today involves an 84-year-old Saudi woman from Al-Kharj city who is hospitalized in critical condition. She is not a healthcare worker (HCW) and had no exposure to animals. The MOH reports that she had a preexisting medical condition and is investigating whether she had contact with suspected or confirmed MERS-CoV (Middle East respiratory syndrome coronavirus) patients.

Today the MOH noted that a 32-year-old female expatriate from Riyadh has recovered from MERS. She is an HCW and had no preexisting disease. Yesterday the agency confirmed that a 33-year-old Saudi man from Riyadh had recovered from the disease. He had an underlying medical condition and is not an HCW.

The patient whose death was reported on Nov 16 was a 57-year-old Saudi man from Riyadh. He was not an HCW and had a preexisting medical condition.

The new case, recoveries, and death bring the Saudi MERS-CoV total to 806 cases. Fourteen cases are active, 449 people have recovered, and 343 people have died.
Nov 18 Saudi MOH update
Nov 17 Saudi MOH update
Nov 16 Saudi MOH update