Canada reports 6 cases tied to US romaine lettuce E coli outbreak

The Public Health Agency of Canada (PHAC) yesterday confirmed that six Canadian Escherichia coli infections are tied to the 29-state US outbreak in which contaminated romaine lettuce has been implicated.

Two of the cases are in Saskatchewan, two in Ontario, and one each in British Columbia and Alberta. Genetic fingerprinting of E coli samples from the patients linked them to the US outbreak. The patients range in age from 13 to 68, and four are female. Two of the patients reported traveling to the United States before they fell ill.

The PHAC said, "In Canada, based on the current information related to the Canadian outbreak investigation, the risk to Canadians is low. The U.S. FDA has reported that romaine lettuce coming from the Yuma [Ariz.] growing region in the U.S. is no longer being produced and distributed, therefore reducing the potential for exposure to contaminated product on the marketplace given that leafy greens have a shelf-life of 21 days."

Yesterday the US Centers for Disease Control and Prevention reported 28 new cases, bringing the total number of US cases to 149.
May 9 PHAC notice
May 9 CIDRAP News scan on latest US numbers


FDA reports Burkholderia cepacia cases tied to hospital cleansing foam

The US Food and Drug Administration (FDA) has confirmed 10 Burkholderia cepacia infections likely caused by contamination in no-rinse cleansing foam used to bathe hospital patients, and the manufacturer has recalled its products.

"The FDA is advising health professionals and consumers to avoid using all lots of Medline Remedy Essentials No-Rinse Cleansing Foam, manufactured by Shadow Holdings dba Bocchi Laboratories at this time, as these products might be contaminated with several species within the bacteria, Burkholderia cepacia complex (Bcc)," the agency said in a statement.

In response to the outbreak, Shadow Holdings Bocchi Laboratories, of Santa Clarita, Calif., has recalled certain lots of the product, the agency said.

Seven of the infected patients are in Pennsylvania, two in California, and one in New Jersey. The patients were already hospitalized when they contracted B cepacia.

"State and federal health officials have collected samples of the product from multiple locations, including affected hospitals," the FDA said. "As of May 7, 2018, there have been multiple product samples that tested positive for Bcc. Isolates from these product samples match clinical strains isolated from case patients by Pulsed Field Gel Electrophoresis (PFGE). Additionally, an environmental swab collected at Shadow Holdings, dba Bocchi Laboratories during FDA's investigation has tested positive for a strain of Bcc."
May 8 FDA statement


Brazil reports more yellow fever cases and deaths

Brazil's health ministry yesterday reported four more lab-confirmed yellow fever cases, along with 15 more deaths, according to its weekly update. The ministry said health officials are still working through the process of confirming or ruling out a backlog of suspected cases.

The country has now reported 1,261 cases and 409 deaths from the disease, for a case-fatality rate of 32.4%. Most of the confirmed cases have been reported from the southeast region of Brazil.

The current outbreak is the country's biggest in decades and triggered a nationwide immunization program with full and fractioned doses of the yellow fever vaccine. Though the number of cases this season, which ends on Jun 30, has passed the previous season, the incidence is lower, because the mosquito-borne virus is circulating in areas of the country with larger populations.

So far there is no evidence that Aedes aegypti mosquitoes are involved in the current transmission cycle, with human illnesses occurring in areas were epizootics (outbreaks in animals) are occurring.
May 9 Brazilian health ministry update


China, 3 European countries report more high-path avian flu

Over the past few days, China, Finland, Germany, and Sweden reported more highly pathogenic avian flu detections involving different strains, according to recent notifications from the World Organization for Animal Health (OIE).

In China, highly pathogenic H7N9 struck a layer farm in Ningxia province in the north, the same area where an outbreak was reported at another layer farm in the middle of April. In the latest event, the outbreak began on Apr 25, killing 2,210 of 86,000 susceptible birds. Authorities culled the survivors to curb the spread of the disease.

Germany, Finland, and Sweden, meanwhile, reported new H5N6 detections in wild birds. Germany's outbreak involved a Eurasian buzzard found dead on May 5 in North Rhine-Westphalia state, Finland's involved a white-tailed eagle found dead on Apr 27 near the city of Turku on the country's southwest coast, and Sweden's involved five white-tailed eagles found dead on Apr 19 in Skane County and on Apr 26 in Kalmar County, both in southern Sweden.
May 9 OIE report on H7N9 in China
May 7 OIE report on
H5N6 in Germany
May 9 OIE report on
H5N6 in Finland
May 9 OIE report on
H5N6 in Sweden

In other avian flu developments, Denmark on May 7 reported a low-pathogenic H5 outbreak at a commercial duck farm near the city of Handbjerg in the country's northwest. The virus was found on May 5 during surveillance for avian flu. All 20,900 ducks at the facility were destroyed.
May 7 OIE report on H5 in Denmark


WHO panel extends public health emergency on polio

The World Health Organization's (WHO's) polio emergency committee met for the 17th time recently and again extended the public health emergency of international concern and the related temporary health recommendations related to the disease, the WHO said today in a statement.

The emergency committee reviewed the data on wild poliovirus type 1 (WPV1) and circulating vaccine derived polioviruses (cVDPVs) before unanimously voting to continue the emergency declaration. "Overall the Committee was encouraged by continued progress in WPV1 eradication, with the number of cases globally remaining low in 2018.  In addition, there has now been no international spread of WPV1 since October 2017," the WHO said.

The committee approved of the strong commitment seen in both Afghanistan and Pakistan to eliminate the disease, and the high level of cooperation. Efforts to stop transmission in the two current zones of transmission are a key to success in achieving eradication in both countries, the experts said, expressing concerns over stagnation in progress in remote regions, where some children have yet to be immunized.

"The Committee commended the innovations that continue to be made in Nigeria to reach children in Borno, where the number of inaccessible children has fallen from 160,000 in late 2017 to around 104,000 currently," the WHO said. "Although it is over 19 months since the last detection of WPV1 in Nigeria, the outbreak response assessment by global polio experts concluded ongoing undetected transmission could not be ruled out."

Committee members also expressed concern about recent cVDPV outbreaks in Syria, Somalia, Kenya, and Nigeria.
May 10 WHO statement

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