Study: Weakness, fever, distress common with Ebola in young children

A study published in the July issue of The Lancet Global Health notes that weakness, fever, distress, and diarrhea were common symptoms in children under the age of 5 years who were being treated for Ebola virus disease (EVD) in West Africa, and many presented without a fever. 

For the observational study, researchers used admissions data from two Medecins Sans Frontieres (MSF) Ebola management centers in Sierra Leone, collected from June to December of 2014.

Ninety-one children were included in the study. The most common symptoms observed during admission were weakness (74.7%), fever (70.8%), distress (63.7%), diarrhea (59.3%), and cough (52.7%). About 25% presented without a fever.

The recent West Africa EVD outbreak is the largest in history, with more than 11,000 deaths since early 2014. According to the World Health Organization (WHO), mortality in children under the age of 5 was as high as 80% during the outbreak.

The symptoms most associated with mortality were fever (80%), diarrhea (51.9%), and vomiting (75%). Also, hiccups, confusion, and hemorrhaging were observed only in children who died. Distress was associated with a higher survival rate.

Parents were diagnosed as the source of EVD in 47% of children under the age of 2, and 28% in children ages 2 to 5. This suggests that non-parental caregivers, neighbors, and other children are significant sources for EVD infection in this population, the authors write.

In a commentary on the study, experts from Kings College London who were not involved in the study note that the relatively high percentage of children presenting without fever is an important clinical observation. "Those without fever did not meet the WHO case definition for a suspected case, highlighting the need to reassess this definition so as not to miss significant numbers of pediatric cases during a future outbreak."
July Lancet Glob Health study
July Lancet Glob Health commentary


Chikungunya cases spike as study notes antibody levels in Nicaragua

The Pan American Health Organization (PAHO) late last week reported 21,200 new chikungunya cases, to bring the 2016 total in the Americas to 148,453 infections, while a new study notes higher antibody levels in older people compared with younger in Nicaragua.

The previous 2 weeks saw increases of 2,446 and 9,424 suspected and confirmed cases, respectively. PAHO's latest update was posted on Jun 17.

The vast majority of new cases are from Bolivia, which reported 19,329 new infections, bringing its 2016 total to 83,678. Honduras added 844 cases and now has 10,333 for the year.

PAHO reported 1 new chikungunya-related death, in Brazil, raising that number to 17 for the year.

The outbreak was first reported in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas. Since then PAHO has reported 2,028,420 suspected or confirmed cases, including 285 deaths.
Jun 17 PAHO update

In the study, published yesterday in PLoS Neglected Tropical Diseases, researchers from Nicaragua and the University of California, Berkeley, analyzed serum samples from 4,210 residents of Managua, including 3,362 who were 2 to 14 years old. Most samples were collected after chikungunya was confirmed in the country.

They found that 13.1% of people 15 and older had antibodies to chikungunya virus, while 6.1% in the younger group did, a statistically significant difference. The proportion of unapparent infections was 64.9% in the older group and 58.3% in the younger.

The investigators found that age, water availability, household size, and socioeconomic status were associated with chikungunya seropositivity.
Jun 20 PLoS Negl Trop Dis study


Egypt reports 2 more H5N1 outbreaks in poultry

Egypt reported two more H5N1 avian influenza outbreaks in poultry last week, involving ducks and chickens, according to the United Nations Food and Agriculture Organization (FAO).

One outbreak, first observed on Jun 16, sickened 4,000 ducks in Sharqia governorate, in the country's northeast, the FAO said. All the ducks were killed to stop the virus's spread. In the other episode, 10 chickens in the Cairo area were infected and were subsequently culled as a precaution. The outbreak was detected Jun 17.

The episodes were listed by the FAO's EMPRES (Global Animal Disease Information System) database, which notes cases reported by national authorities.

Egypt has had a few human H5N1 cases this year, but the number is far below the level of the first half of 2015, when there was an unprecedented surge involving at least 134 cases.
Jun 18 FAO post on Cairo outbreak
Jun 18 FAO post on Sharqia outbreak


First estimate of global HPV vaccine uptake finds wide disparities

A new pooled analysis published in The Lancet Global Health shows substantial disparities among high- and low-income countries regarding use of national human papillomavirus (HPV) immunization programs.

The authors of the study attempted to quantify global cumulative coverage of publicly funded HPV vaccination programs by analyzing data from a systematic review of the literature and official Web sites. From 2006 to 2014, 64 countries nationally, four countries sub-nationally, and 12 overseas territories had introduced the HPV vaccine into national immunization programs.

Most of these programs were in high-income and upper-middle-income countries, with Australia, Northern Europe, and New Zealand having the most comprehensive vaccination programs, the authors wrote.  School-based had the highest coverage rates.

Globally, 118 million girls and women received at least one dose of the HPV vaccine, but only 1% were from low-income nations. About 82% of targeted female patients (from 10 to 20 years old) were from developed regions, and 18% were from less-developed regions. Only 7 of 38 low-income and less-developed countries had nationalized HPV vaccination programs.

The authors of the study estimate that HPV vaccination programs target only 12% of adolescent girls worldwide. Countries without HPV vaccine programs have the highest burden of disease and would benefit the most from efforts to prevent cervical cancer, they added.

In a comment on the study, a WHO expert noted that cervical cancer is the second most common cancer (after breast cancer) in low-income and middle-income countries. Eighty-five percent of new cervical cancer cases and 88% of related deaths occur in low-income countries.
July Lancet Glob Health study
July Lancet Glob Health commentary
Jul 30, 2015, CIDRAP News story on US HPV vaccine coverage

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