News Scan for Sep 05, 2013

News brief

DHS seeks 24-hour disease notification service

The US Department of Homeland Security (DHS) is asking for bids on a 24/7 service to provide global data on disease outbreaks and other biologic threats, the agency said in a release this week.

The National Biosurveillance Integration Center within the DHS's Office of Health Affairs (OHA) "requires a real-time, open source, biosurveillance data feed to support mission objectives of providing earlier warning and enhanced situational awareness for biological threats of national concern," the solicitation notice said.

The feed will continually provide information to the DHS from at least 25,000 publicly available Web sites in at least five languages on both human and animal diseases. Content will be updated hourly, at a minimum. It will be delivered via e-mail or RSS feed, the DHS said.

The agency will award the contract for 1 year, with a possible 1-year extension.
Sep 3 DHS notice

'Bible Belt' in the Netherlands hit hard by measles

More than 1,200 cases of measles have been reported in the Netherlands since late May of this year despite overall vaccination coverage of more than 95%, says a report in today's Eurosurveillance. Most cases in the current outbreak are in orthodox Protestants, a large portion of whom reject vaccinations on religious grounds.

Of the 1,226 cases reported from May 27 to Aug 28, 176 (14.4%) involved complications, including pneumonia (90), otitis media (66), and encephalitis (1). Hospitalization was required in 82 cases (6.7%), but no patients died. Patient age ranged from under 1 year to 65 years, with a median of 10 years and a majority (717 cases [58.5%]) aged 4 to 12 years.

The large majority of cases occurred in persons who were unvaccinated (1,174 of 1,217 [96.5%] with known vaccination status).

Most patients were orthodox Protestant (1,087 of 1,145 [91.7%] with information available), a close-knit group of about 250,000 people in the country spread across the southwest-to-northeast corridor known as the Bible Belt. According to the article, refusal of vaccination in the group is based on a belief in predestination and "the idea that people should not interfere with divine providence."

The source of the infection remains unknown, with the first reported case occurring in a child who had not traveled abroad.

The Netherlands has, since 1987, offered vaccination against measles, mumps, and rubella (MMR) in a two-dose schedule given at age 14 months and 9 years. In 2012, MMR coverage overall was 96% for the first dose and 93% for the second.

The most recent large measles outbreak in the country's Bible Belt occurred in 1999-2000 and involved more than 3,200 cases. An even larger number of cases is expected in the current outbreak, especially now that the school year is beginning, according to the article.
Sep 5 Eurosurveill article

Food Outbreak Scan for Sep 05, 2013

News brief

Report details farm findings in 2011 cantaloupe Listeria outbreak

Newly installed used cleaning equipment likely played a significant role in the 2011 outbreak of listeriosis linked to Colorado cantaloupe that sickened 147 (see CDC map below) and killed 33, according to a report in today's New England Journal of Medicine (NEJM).

Scientists from the US Centers for the Disease Control and Prevention (CDC) and elsewhere provided details on the investigation of the outbreak, which ran from Aug 1 to Oct 31, 2011, and affected 28 states.

The implicated farm is called "Farm A" in today's report but was previously named by the CDC as Jensen Farms of Granada, Colo., in the Rocky Ford growing region in the southeastern part of the state. The farm had previously used recirculating chlorinated, chilled water to clean and cool cantaloupes.

In 2011, however, the farm installed washing and drying equipment that was previously used for packing "another raw agricultural commodity," the NEJM report said. Jensen's new system used municipal water that wasn't recirculated and didn't have added chlorine.

Of 39 environmental swabs taken from food-contact or adjacent surfaces on Jensen Farms, 12 yielded Listeria monocytogenes isolates matching the outbreak strain. All 12 swabs were collected either within or "immediately downstream" from the newly installed equipment, the report said.

"The findings of our investigation indicate that cantaloupe contamination most likely occurred during processing operations conducted by Farm A," the authors concluded, adding that the new washing and drying process probably promoted bacterial growth.
Sep 5 NEJM abstract
Aug 27, 2012, final CDC update on the outbreak

CDC: Recent waterborne outbreaks caused 1,000+ illnesses

Waterborne disease outbreaks in 2009 and 2010 caused 1,040 illnesses, 85 hospitalizations, and 8 deaths, with Legionella for the first time accounting for more than half the outbreaks, the CDC reported today in Morbidity and Mortality Weekly Report (MMWR).

Using data from the Waterborne Disease and Outbreak Surveillance System, CDC researchers reported 33 outbreaks related to contaminated drinking water, which was about the same as in 2007-08, when 36 such outbreaks occurred.

Legionella accounted for 58% of outbreaks and 7% of illnesses, they reported, and Campylobacter accounted for 12% of outbreaks but 78% of illnesses. The most commonly identified cause in these outbreaks was Legionella in plumbing systems (57.6%), followed by untreated groundwater (24.2%) and deficiencies in water distribution systems (12.1%).

They also reported 12 outbreaks associated with other nonrecreational water use that caused 234 illnesses, 51 hospitalizations, and 6 deaths. Legionella accounted for 58% of these outbreaks, as well as 42% of cases, 96% of hospitalizations, and all deaths.

An editorial note with the report said, "Legionella outbreaks are particularly challenging to prevent and control, in part because the organism multiplies in plumbing systems within buildings, which usually fall outside of regulatory oversight."

The note also called for full implementation of the federal Ground Water Rule to address improperly treated groundwater.
Sep 6 MMWR report