News Scan for Dec 17, 2019

News brief

Ebola sickens 1 more in DRC as CDC issues guidance on rapid tests

One more Ebola case has been confirmed in the Democratic Republic of the Congo (DRC) outbreak, lifting the overall outbreak total to 3,349 cases, according to numbers reflected on the World Health Organization (WHO) online Ebola dashboard. Authorities are still investigating 519 suspected cases.

Also, 1 more patient died from Ebola, putting the fatality total at 2,211.

The daily update from the DRC's Ebola technical committee (CMRE) said that both cases announced yesterday were in Mabalako, one of the few remaining hot spots.
WHO online Ebola dashboard
Dec 16 CMRE report

In other Ebola developments, the US Centers for Disease Control and Prevention (CDC) yesterday sent out a Health Alert Network (HAN) notice that covers guidance for using rapid tests for Ebola. The guidance comes in the wake of the October Food and Drug Administration approval of the OraQuick Ebola rapid antigen test, the first rapid test for the disease available in the United States.

The CDC notes that the test should be used only when more sensitive molecular testing isn't available and that all rapid-test results are considered presumptive, meaning they need to be verified with reverse-transcriptase polymerase chain reaction (RT-PCR) tests at Laboratory Response Network labs in 49 states and at the CDC.

On Dec 19 the CDC will host a Clinician Outreach and Communication Activity (COCA) call to discuss and field clinician questions about the test and guidance.
Dec 16 CDC HAN notice
Dec 19 COCA call information


Distinct enterovirus A71 clinical presentation noted in children

Children afflicted with neurologic disease caused by enterovirus A71 (EV-A71) infection showed clinical symptoms distinct from other enteroviruses, including higher rates of myoclonus (muscle twitching) and ataxia, according to a study yesterday in The Lancet Infectious Diseases. Children infected with EV-A71 were also more likely to make a full recovery.

The study was conducted during an enterovirus outbreak in 2018 at the Children's Hospital Colorado, where 74 children were found to have enterovirus-related neurologic disease. Forty-three of the 74 children were infected with EV-A71.

Of the 43 children with EV-A71, 93% had findings suggestive of meningitis, 72% showed evidence of encephalitis, and 23% of children met the hospital's case definition of acute flaccid myelitis (AFM), a polio-like illness that can cause paralysis. All children with EV-A71 disease had fever, and 42% had hand, foot, or mouth lesions at or before neurologic onset, the authors said.

"Children with EV-A71 disease were best differentiated from those with other enteroviruses (n=31) by the neurological findings of myoclonus, ataxia, weakness, and autonomic instability," the authors wrote. In AFM cases, children with EV-A71 were likely to be younger and recover more fully than children whose AFM was caused by enterovirus D68.

In a commentary, the authors suggest that "a robust enterovirus surveillance system is important to monitor neurological diseases caused by EV-A71 and EV-D68," and add that the rising profile of enterovirus diseases in the developed world may spur better vaccines and therapeutics.
Dec 16 Lancet Infect Dis study
Dec 16 Lancet Infect Dis commentary


New Jersey comes close to banning religious exemptions from vaccines

Today a New Jersey bill that bars religious exemptions from required immunizations for private and public schoolchildren, as well as children in childcare centers, is in jeopardy. 

Yesterday the law passed in the state assembly on a vote of 45 to 25. But late last night, a vote in the state senate was postponed. The New York Times reported that anti-vaccine groups called the postponement a victory for vaccine choice.

Over the last 2 years, New Jersey has recorded several measles cases as bordering New York–based Orthodox Jewish communities have battled large outbreaks. In June, New York banned most regions exemptions from immunizations. California, Maine, Mississippi, and West Virginia also require all school-age children to be immunized unless they have a medical exemption.

New Jersey is home to the nation's largest Orthodox Jewish yeshiva, or school, with 7,000 students. The bill was opposed by the ultra-orthodox group, Agudath Israel of America, whose members argued the law would take away authority from religious leaders.
Dec 17 New York Times story

CWD Scan for Dec 17, 2019

News brief

Minnesota officials call for voluntary CWD-linked limit on moving live deer

The Minnesota Board of Animal Health voted unanimously against a mandatory 30-day state lockdown that would have banned shipping deer in and out of captive deer facilities, and instead opted for a voluntary lockdown for the state's 330 deer farmers.

According to the St. Paul Pioneer Press yesterday, the lockdown was proposed after a deer in Douglas County in west central Minnesota tested positive for chronic wasting disease (CWD), a fatal neurologic prion disease. Minnesota's state veterinarian, Beth Thompson, DVM, supported the temporary ban, because the 8-year old doe found in Douglas County was not born in that county.

Deer farmers and lobbyists representing them opposed a mandatory lockdown, however, claiming it would amount to a "scarlet letter" on Minnesota farms. The voluntary lockdown prevents moving deer until Jan 15, 2020.

CWD is a prion disease that affects cervids such as deer, elk, and moose. Though the disease has not yet jumped to humans, many fear it could mimic bovine spongiform encephalopathy (mad cow disease).
Dec 16 Pioneer Press story


Wisconsin reports first CWD detection in Sheboygan County

For the first time, CWD has been detected in Sheboygan County in the far eastern part of the state, the Wisconsin Department of Natural Resources (DNR) reported late last week.

The CWD-positive deer was an adult doe harvested in Plymouth township 20 miles from Fond du Lac County during this year's archery deer season. It was tested as a part of the DNR's disease surveillance program, the agency said in a news release. Because of the finding, the DNR has renewed a 3-year ban on baiting and feeding deer in Sheboygan County and a similar 2-year ban in Fond du Lac County, as required by state law.

Larry Bonde, chair of the Wisconsin Conservation Congress, said on Facebook that the detection is more than 40 miles from the nearest positive sample, which he calls "very troubling."

Jeff Pritzl, DNR Northeast District wildlife supervisor, said in the DNR release, "We are committed to working closely with local communities, including the citizen-based County Deer Advisory Councils, as we explore future management options for this disease in Sheboygan and the surrounding counties."

The agency encourages reporting of sick deer and sampling of vehicle-killed and hunter-harvested deer. It will continue to provide CWD sampling locations during the remainder of the 2019 deer hunting season and encourage hunters to use deer carcass waste disposal stations.
Dec 13 Wisconsin DNR news release
Dec 13 Larry Bonde Facebook post

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