News Scan for Aug 26, 2013

News brief

Report says Qatar has another MERS case

Authorities in Qatar have reported another Middle East respiratory syndrome coronavirus (MERS-CoV) case, the country's second in a week, according to a Kuwait News Agency (KUNA) story today.

The illness is in a 29-year-old man who is in critical condition in an intensive care unit, according to the story. The nation's Supreme Council of Health reported that the case was diagnosed at the national influenza center and that samples were sent to laboratories abroad for confirmation, the report said.

On Aug 20 a media story said Qatari officials reported a MERS case in a 59-year-old man who was said to be in stable condition, and Qatari authorities issued an English-language statement about the case on Aug 21. That case has not yet been noted by the World Health Organization, which has not issued announcements about any of the new cases reported in the past week.

Two MERS cases were reported previously in Qatar. One involved a 49-year-old man who got sick last September and died in a London hospital in June; the other was in a man who recovered after treatment in Germany last October.
Aug 26 KUNA story
Aug 20 CIDRAP News item

Count of locally acquired dengue cases in Florida reaches 8

This year's count of locally acquired dengue fever cases in Florida reached eight late last week with reports of new cases in Martin County and Miami-Dade County, according to media accounts and health officials.

In Martin County, a case was reported Aug 22 in Rio, an unincorporated community, and on Aug 23, county health officials said three cases were confirmed in the Jensen Beach area, according to an Aug 24 story in the Palm Beach Post.

Those cases had been preceded the previous week by three others, two in Martin County and one in St. Lucie County, the story said.

Miami–Dade County's first locally acquired dengue case of the year was reported Aug 23 in an 18-year-old man, the Florida Department of Health announced that day.

Locally acquired infections with dengue virus, spread by mosquitoes, are rare in the United States. In Florida the disease cropped up in 2009 after being absent since 1934, according to previous reports. Since then a few cases have been reported in the state each year.

The latest cases have prompted health officials to warn residents to take steps to eliminate mosquito breeding sites and protect themselves from the insects.
Aug 24 Palm Beach Post story
May 20, 2010, CIDRAP News story on Florida cases that year

Cronut burger fingered in Canadian fair Staph outbreak

An outbreak of foodborne Staphylococcus aureus that sickened more than 150 people at the Canadian National Exhibition (CNE) in Toronto may have been caused by the pastry-hamburger combo called the cronut burger, health officials said on Aug 23.

"The cronut burger is the only food that was common to the people that became ill," said Dr. David McKeown, Toronto's medical officer of health, according to C-News.

Toronto Public Health (TPH) said that, as of the morning of Aug 23, more than 150 people had gastrointestinal symptoms after eating food at the CNE, and all 100 or so of those who were interviewed reported eating cronut burgers from Epic Burgers and Waffles at the fair.

"Early laboratory test results indicate that samples of the cronut burger were contaminated by Staphylococcus aureus toxin, which is a recognized cause of foodborne illness," McKeown said in a TPH news release. Symptoms such as nausea, vomiting, and diarrhea within 2 to 4 hours of consuming a contaminated item are common with S aureus, McKeown told C-News.

Epic said on its Facebook page that it has closed its CNE site over the outbreak. "We will await results and further information from Toronto Public Health before we re-open our operation," it added.

A cronut is a cross between a croissant and a doughnut. Food can be contaminated with S aureus by workers who carry the bacterium, which makes toxins that are not destroyed by cooking, according to the US Centers for Disease Control and Prevention.
Aug 23 C-News story
Aug 23 TPH news release
Aug 22 Epic Burgers and Waffles Facebook statement

Flu Scan for Aug 26, 2013

News brief

Analysis finds thin link to pregnancy, ethnicity and severe flu

Evidence of some risk factors such as pregnancy and ethnicity for a severe outcome in patients with seasonal and pandemic influenza is largely limited or absent, which has implications for public policies regarding prioritization of groups for vaccination programs, according to a recent meta-analysis.

Obesity and the postpartum period were potentially important risk factors that should be included in future vaccination recommendations, though others weren't backed by evidence, according to the research team, which is based at Canada's McMaster University. Their findings appeared in the Aug 23 issue of BMJ.

The researchers identified 234 articles in the literature representing 610,782 participants that met their inclusion criteria. They focused on studies reporting on at least one risk factor in patients with lab-confirmed flu or flulike illness during a period of known flu circulation.

Evidence supporting some of the risk factors for flu complications was low, and some could not be confirmed. Researchers found that many of the studies lacked sufficient power to show an association, and some didn't adjust for confounders.

Elderly people had the highest risk of death for both seasonal and pandemic flu. Pregnancy increased the risk of hospital admission but not other outcomes, although the data suggested that risk increases in the late stages of pregnancy.

Obesity (body mass index greater than 30) is an important cause of death with both seasonal and pandemic flu, they found, but the group noted that it's unclear whether the obesity itself or comorbidities associated with obesity are responsible.

No significant differences were noted in all-cause mortality between Asian, black, or native populations compared with whites, although Hispanic and black individuals as well as pregnant women were more likely to have been hospitalized during the 2009 pandemic.

Chronic illness (immunosuppression, cardiovascular disease, chronic lung disease, neuromuscular disease, neurologic disease, chronic renal disease, and metabolic diseases) increased the risk of mortality.

The analysis seems to support flu vaccination recommendations that prioritize immunizing pregnant women and older people, but the evidence didn't appear to strongly support prioritizing young children over adults.

Researchers concluded that policymakers should acknowledge the poor quality of evidence supporting flu vaccine recommendations for some risk groups and include the level of evidence in their guidance, especially when vaccine supplies are limited.

The team also noted that the quality problems they identified underscore the importance of conducting rigorous studies when exploring flu-related complications.
Aug 23 BMJ abstract

H7 outbreak hits third Italian poultry farm

Italian veterinary authorities have detected a third H7 avian influenza outbreak at a poultry farm in the country's northern Emilia-Romanga region, according to an Aug 23 report to the World Organization for Animal Health (OIE).

The virus was detected at a turkey farm in Ferrara province during surveillance activities that began at the site where the virus was first detected, a town called Ostellato, which is about 10 miles from Portomaggiore, where the turkey farm is located.

Polymerase chain reaction testing was positive for H7, and further tests are under way to determine the virus's pathogenicity and neuraminidase type, according to the OIE.

The outbreak began on Aug 21, killing 1,300 of 19,850 susceptible birds. The rest will be culled to control the spread of the disease. So far the source of the virus is unknown.

The virus was detected at the first farm in the middle of August. It turned up for a second time at a layer farm in Bologna province a few days later.

The highly pathogenic H7N7 strain has been detected sporadically in European wild birds and poultry. It sparked a 2003 outbreak in humans in the Netherlands that was linked to at least 89 mild infections and one death.
Aug 23 OIE report
Aug 21 CIDRAP News scan "Highly pathogenic H7N7 detected in Italian poultry outbreaks"