News Scan for May 16, 2014

News brief

Florida reports 3 imported chikungunya cases

In a moment that health officials have anticipated, the Florida Department of Health (FDH) today reported three cases of mosquito-borne chikungunya fever, all imported from the current 45,000-plus-case outbreak in the Caribbean.

The cases all involve women: a 30-year-old from Miami–Dade County, a 29-year-old from Broward County, and a 44-year-old from Hillsborough County, the FDH said in a news release. All had recently traveled to the Caribbean, but the agency didn't specify which island or islands.

"With a large number of people travelling to and from the Caribbean in Florida we have been monitoring for possible imported cases," said Carina Blackmore, DVM, PhD, state public health veterinarian and deputy state epidemiologist. "We encourage all Floridians to practice the drain and cover method to minimize mosquito exposure."

"Aedes mosquitoes are day biters which can lay eggs in very small water containers," the FDH said in the release, referring to the type of mosquito that can transmit the disease. "Early detection of the symptoms and preventing mosquitoes from biting will help prevent the disease from spreading in the United States."

The FDH advised residents to drain or cover any standing water, which can serve as mosquito breeding grounds.
May 16 FDH news release

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China reports another H7N9 infection

The H7N9 influenza virus has sickened one more patient in China, an 86-year-old man from Guangdong province, according to a health department statement translated and posted by FluTrackers, an infectious disease news message board.

The man is hospitalized in critical condition at a hospital in Meizhou. His illness edges the overall outbreak total to 441 infections, according to a running case list kept by FluTrackers. So far 305 cases have been reported during the current second wave of infections, which have now tapered off to just a few cases a week. For comparison, 136 cases were reported during the first wave last spring.

In other developments, the World Health Organization (WHO) yesterday provided more details about five H7N9 cases in a report it received from China on May 12. Two of the patients are from Guangdong province, with the others from Jiangxi, Hunan, and Jilin provinces.

All of the patients are adults, ages 23 to 74. Illness onsets range from Apr 14 to May 2, and hospitalization dates range from Apr 27 to May 6. Two are hospitalized in mild condition, one is in severe condition, and two are listed as critical.

Four of the case-patients had been exposed to live poultry before they got sick.
May 16 FluTrackers thread
FluTrackers human H7N9 case list
May 15 WHO statement


US flu markers continue spring decline

US flu activity continued its spring exit last week, though viruses—especially influenza B—are still circulating in some parts of the country, especially in the Northeast, the Centers for Disease Control and Prevention (CDC) said today.

Two of the CDC's regions, both of them in the Northeast, reported that the percentage of clinic visits for flulike illness were above their baselines, but for the nation as a whole, the level increased just slightly, from 1.2% to 1.3%, and was well below the national baseline of 2%.

Connecticut and Texas reported low-intensity flu activity, another marker that tracks clinic visits. The number of states that reported widespread geographic spread of flu fell from four plus Guam to three (Connecticut, Massachusetts, and New York).

The percentage of overall deaths attributed to pneumonia and flu fell from 6.8% to 6.2% last week, putting it below the seasonal baseline. Three more pediatric flu deaths were reported, raising the season's total so far to 94.
May 16 CDC FluView
May 16 CDC flu situation update

In Canada, late-season flu activity is beyond its peak and the disease is at expected levels for this time of year, the Public Health Agency of Canada (PHAC) said today. Like the United States, Canada has seen a late-season surge of influenza B activity. The PHAC said influenza B activity is still circulating in several of the country's regions but is stable or declining.

Meanwhile, Europe's flu season is drawing to an end, with markers that continue to decline, the European Centre for Disease Prevention and Control (ECDC) said today. It said flu activity is declining in all reporting countries after 5 months of active transmission.
May 16 PHAC FluWatch
May 16 ECDC weekly flu update


GAO: DOD countermeasures strong, but need more prioritization

The US Department of Defense (DoD) has made progress with developing new countermeasures against biological threats, but it isn't using a process it has in place for prioritizing threats, according to a report yesterday from the Government Accountability Office (GAO).

The GAO review of the DoD's countermeasure efforts looked at the budget, its activities, and coordination with other government agencies as mandated by the federal government. The 55-page report focuses on the DoD's Chemical and Biological Defense Program. The GAO said the program is developing or has obtained Food and Drug Administration approval for countermeasures against 10 of 19 threats to military troops. It added that, of 43 countermeasures, 13 involve technologies that enable them to be used against emerging or genetically modified biological threats.

The DoD, however, doesn't use its own process for annually updating its list of biological threat priorities the GAO noted. The list was updated in 2001 and 2012, but the GAO did not get input from key stakeholders. The GAO said the annual priority review is an important part of ensuring that investments target the most important threats.

The GAO praised the DoD's increased transparency with countermeasure development and its coordination with other branches of government, such as the Department of Health and Human Services and the Department of Homeland Security.

DoD officials reviewed a draft of the GAO report and said they agreed with its conclusions. The GAO recommended that the Secretary of Defense appoint DoD officials to develop and implement a process to validate and update the DoD's list of threats or implement a process that aligns with the department's current review directives.
May 15 GAO report


Study: Early measles vaccine cuts childhood mortality in poor nations

Children in low-income countries who receive a first dose of measles vaccine at 4 to 6 months of age, when maternal antibody is still present, have a better survival rate by age 5 years than those receiving vaccine only at the recommended 9 months of age, according to an analysis published yesterday in Clinical Infectious Diseases.

Current WHO recommendations call for measles vaccination at the later age in low-income countries, a regimen based on the belief that vaccine given after maternal antibody has waned is most beneficial.

The authors, from Guinea-Bissau, Denmark, and England, reanalyzed two measles vaccine trials done in Guinea-Bissau, the first from 1993 to 1995 and the second from 2003 to 2007, to determine the effect of residual maternal measles antibody at first vaccination on overall survival. In both trials, infants had been randomized to receive vaccine only at 9 months of age or to receive an extra dose at 4 to 6 months of age.

In the first trial, the mortality rate per 1,000 person-years in infants given the extra, early dose of vaccine was 0.0, compared with 32.3 in those receiving vaccine in the absence of maternal antibody, for a mortality rate ratio (MRR) of 0.0 (95% confidence interval [CI], 0-0.52).

In the second trial, the mortality rate was 4.2 deaths per 1,000 person-years in infants receiving vaccine at 4 to 6 months of age, compared with 14.5 in those receiving it later, for an MRR of 0.29 (CI, 0.09-0.91). Potential confounding factors did not account for the differences in either trial.

The authors point out that the beneficial effect on survival of the early measles vaccine dose was nonspecific, meaning it applied to mortality from causes other than measles. "There is every reason to use the non-specific beneficial effects to reduce child mortality in high-mortality countries. We may need to give the first dose [of measles vaccine] earlier rather than later," say the authors.
May 14 Clin Infect Dis study

VHF Scan for May 16, 2014

News brief

New Ebola cases reported in Guinea outbreak

Five more cases of Ebola virus disease (EVD) in Guinea as of May 12 have been reported by that country's ministry of health, bringing the cumulative number of clinical cases in the outbreak to 248, according to an update yesterday from the World Health Organization (WHO). The number of deaths remains at 171, unchanged from the agency's May 8 update.

Confirmed cases stand at 138 with 92 deaths; probable cases at 67 with 57 deaths, and suspected cases at 43 with 22 deaths. The cities with the most cases are Guekedou, with 163, including 119 deaths, and Conakry, with 50, including 24 deaths. Other cities that have been affected are Macenta, Kissidougou, Dabola, and Djinguirae.

The WHO notes that the number of cases is subject to change owing to reclassification and consolidation of cases and data, enhanced surveillance, and contact tracing. A total of 480 contacts of patients are being monitored in Guinea, the large majority in Guekedou.

No new cases have been reported in Liberia or Sierra Leone.
May 15 WHO update


Mazambique and Tanzania see 1,000 dengue cases

A thousand cases of dengue fever have occurred in southeastern Africa since outbreaks in the countries were first reported to the WHO in late April, according to a WHO alert yesterday.

As of May 8, the Ministry of Health (MOH) in Mozambique has counted 77 confirmed and 166 suspected cases, for a total of 243, and the MOH of Tanzania has reported 460 confirmed and 297 suspected cases, for a total of 757. Tanzania has seen three deaths in the outbreak so far.

The Aedes aegypti mosquito has been identified as the main vector; the serotype of the virus causing the outbreak is not yet known but is under investigation.

Both countries have developed and implemented response plans with the support of the WHO. Activities include education and communication programs for the public, training of health workers, enhanced surveillance, use of rapid diagnostic kits, promotion of of window screen and mosquito repellent use, proper removal of solid waste, and minimization of mosquito breeding sites.
May 14 WHO alert

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