Sierra Leone reports 2 more Ebola cases, 1 fatal

Sierra Leone has reported two more Ebola cases, including a fatal one that is not part of a recent cluster in the northwestern Kambia district.

The country's National Ebola Response Center (NERC) reported another infection in a contact of a 67-year-old woman who died in late August in Sella Kafta, a village of almost 1,000 people in Kambia, Xinhua, China's state news agency, reported late last week. The cluster has now risen to six cases, including the index one.

The new case involves a relative of the older woman who took part in washing and burying her body, a NERC spokesman said. All the other contacts who tested positive for the disease were already quarantined, he added.

The Ebola-related death in the 67-year-old was reported on Aug 30, less than a week after Sierra Leone began its countdown toward being declared Ebola-free.

The other new case involves a 16-year-old girl who might have had sexual contact with an Ebola survivor, Reuters reported today. She lived in Bombali district, which had not had an Ebola case in nearly 6 months. The district lies to the east of Kambia.

The girl died yesterday at the International Medical Corps Ebola treatment unit, the story said. Emmanuel Conteh, head of Ebola response for the district, said 690 people in the girl's village will be quarantined, and 7 of her closest contacts have been taken to the Ebola treatment unit.

Sexual transmission is suspected because the girl had not traveled outside the village in year. But Conteh said, "We are baffled by that possibility because the survivor in question was discharged in March, way beyond the 90-day period within which sexual transmission is said to be possible."
Sep 11 Xinhua story
Sep 14 Reuters report


PAHO chikungunya decline holds; Senegal reports outbreak

The Pan American Health Organization for the second week in a row reported low chikungunya outbreak numbers, with only 7,156 new chikungunya cases in the Caribbean and the Americas, as Senegal reported a return of the virus.

Last week's PAHO update included only 4,857 new cases. The previous two weekly updates reported 34,866 and 27,867 new cases, respectively.

The outbreak total now stands at 1,719,103, cases, PAHO said in a Sep 11 update. The new total includes 572,334 suspected, confirmed, and imported cases in 2015. And a new chikungunya-related death occurred, raising that total to 67.

Colombia, which has reported has reported the highest case count in most recent weeks, logged 5,598 new cases, bringing its 2015 total to 330,332. Mexico had the next-highest total, with 1,152 new cases, for a total of 5,737 for the year. As in past weeks, many countries have not reported on chikungunya for weeks.

The epidemic started in December 2013 with the detection of the Americas' first locally acquired cases on St. Martin in the Caribbean.
Sep 11 PAHO update

In Senegal, samples from 10 of 14 recently suspected cases tested positive for chikungunya virus, the World Health Organization (WHO) said in an update today. The country had not seen active circulation of the virus since 2010.

The country's health ministry has taken several steps in response to the outbreak, the WHO said, including case management, information distribution, and preparing a deployment team that will spearhead response efforts.

The WHO recommends measures to protect against mosquito bites, mosquito control, community-based surveillance, and social mobilization and communication.
Sep 14 WHO statement on Senegal


Study finds age, hand hygiene tied to H7N9 death

A Chinese team has determined that age, hand hygiene practices, and peak C-reactive protein (CRP) levels are independently associated with H7N9 avian flu death, according to a report yesterday in the International Journal of Infectious Diseases.

The researchers analyzed data from 85 patients with lab-confirmed H7N9 from Mar 1, 2013, to Jun 30, 2014. Their univariate analysis found the following factors associated with H7N9 death: age 60 or older, low education level, chronic diseases, poor hand hygiene, time from illness onset to the first medical visit and to intensive care, incubation period of 5 days or less, peak CRP 120 mg/L or higher, increased initial neutrophil count, decreased initial lymphocytes count, and both lungs infected initially.

Multivariate analysis showed that age, hand hygiene, and peak CRP were all independently associated with higher death rates.

The authors conclude, "Immunity improvements, early case identification and treatment, and personal protection measures are keys to addressing the high human avian influenza A (H7N9) case fatality rates."
Sep 11 Int J Infect Dis abstract


Feds recommend renewed focus on reusable medical devices

The US Centers for the Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) said in a Sep 11 CDC Health Alert Network (HAN) advisory that hospitals and other healthcare providers need to properly maintain, clean, and disinfect or sterilize reusable medical devices.

The agencies did not say that the alert was triggered specifically to recent illnesses tied to inadequately cleaned duodenoscopes, stating only, "Recent media reports describe instances of patients being notified that they may be at increased risk for infection due to lapses in basic cleaning, disinfection, and sterilization of medical devices."

The CDC and FDA recommend that facilities appoint a professional with expertise in reuse of medical equipment to assess their procedures. The agencies recommend several steps regarding training, audit and feedback, and infection control procedures.

The HAN alert recommended mandatory training for all new hires, at least once a year, and when new devices or protocols are implemented. It also specifies that healthcare facilities regularly monitor and document adherence to cleaning, storage, and reuse protocols.
Sep 11 CDC HAN advisory
Most recent (Aug 26)
CIDRAP News scan on duodenoscope illnesses

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