Officials note 1 new Ebola case but troubling developments in hot spot

Today the Democratic Republic of the Congo (DRC) confirmed one new case of Ebola in the ongoing outbreak in North Kivu and Ituri provinces, but the World Health Organization (WHO) spotlighted some troubling signs in its weeks update.

The single case raises the outbreak total to 3,228. There were 4 new fatalities also reflected today on the WHO online Ebola dashboard, which raises the total number of deaths during the 14-month outbreak to 2,157. Officials are still investigating 443 cases.

Also today, the DRC's Ebola technical committee (CMRE) provided information on three cases reported yesterday. All three were in Mandima, the current hot spot of the outbreak.

The WHO today, in its latest disease outbreak news report, noted 15 new confirmed cases reported in North Kivu and Ituri provinces during the week of Oct 7 through Oct 13. But despite the decrease in cases, Mandima and Biakato Mine health area have reported increasing cases.

In Mandima, officials have noted a decline in the proportion of confirmed cases listed as contacts (from 57% to 13%) and an increase in the proportion of cases dying outside of Ebola treatment centers (from 14% to 27%) this past week—both worrisome indications of increased transmission risk—the WHO said.

A recent qualitative investigation in Mandima and Biakato Mine Health Area also produced troubling results: Less than half of respondents said they would call a hotline if they or a member of their community were suspected to have Ebola, and less than half said they would encourage a family member to go to an Ebola treatment center.
WHO Ebola dashboard
Oct 16 CMRE report
Oct 17 WHO disease outbreak news update

MERS infects 1 more in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) today reported a new human MERS-CoV case, the seventh to be reported this month.

The patient is a 57-year-old man from the city of Uyun Al Jawa in Al Qassim region in the central part of the country. The man's contact with camels isn't known and his exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as primary, meaning he probably didn't contract the virus from another known MERS patient.

In its latest monthly update, the WHO Eastern Mediterranean regional office said 2,468 MERS-CoV cases have been reported globally as of the middle of September, with at least 850 of them fatal. The vast majority have been reported in Saudi Arabia.
Oct 17 MOH update

ECDC: Local Zika case in France poses very low transmission risk

The European Centre for Disease Prevention and Control (ECDC) yesterday posted a risk assessment for a local Zika case detected in southern France, which is thought to involve vector-borne transmission, which if confirmed would mark the first case of its kind in Europe.

On Oct 11 the ECDC noted the case in its weekly communicable disease threat report and said it would soon publish a more detailed risk assessment.

The patient is from the city of Hyeres in Var department in the country's southeast. He or she had Zika symptoms during the first half of August, and lab tests confirmed the case on Oct 1. The investigation found the patient had not traveled to any countries that have a history of Zika transmission, along with no evidence of sexual transmission. No imported infections were reported in the patient's area for 2019.

Further investigation is under way to determine how the patient contracted Zika virus, but for now, health officials suspect vector-borne transmission.

Mosquito control measures have been implemented near the patient's home, and so far, no other Zika illnesses have been detected. The ECDC noted that Aedes albopictus, one of the mosquito species capable of carrying the virus, is widely established in southern Europe. However, Ae albopictus in Europe is considered a less competent vector than its tropical and subtropical relatives.

More sporadic cases or clusters of locally acquired Zika infections are possible, especially in Mediterranean areas of Europe in the summer and early fall, so a case in southern France isn't surprising, the ECDC said. Officials assess the risk of Zika spread as very low, given the lack of evidence of a more extensive cluster and the fact that decreasing temperatures as autumn progresses aren't favorable for sustaining transmission.
Oct 16 ECDC risk assessment
Oct 11 ECDC communicable disease threat report

Survey: Most doctors do not have injectable STI antibiotics on site

According to a study yesterday in Emerging Infectious Diseases, most American office-based physicians who treat patients for sexually transmitted infections (STIs) do not have on-site access to injectable antimicrobials, the first-line treatment for uncomplicated gonorrhea and primary and secondary syphilis.

Researchers used the results of the 2016 Physician Induction File of the National Ambulatory Medical Care Survey to determine how many American physicians use injectable antimicrobials. A total of 1,030 physicians representing an estimated of 330,581 physicians in the United States, completed the survey, the authors said.

Of those physicians, 45.2% said they saw patients for STI evaluation, but 77.9% of those who saw STI patients said they did not have access to penicillin G benzathine (used for syphilis), while 56.1% said they did not have access to intramuscular ceftriaxone (used for gonorrhea).

Physicians in the South were more likely to have access to injectables, as were those in the western United States, where congenital syphilis has been most commonly observed, the authors said.

Rates of STIs are on the rise in the United States, with increased rates of gonorrhea (+75%) and syphilis (primary and secondary, +153%) cases in 2017 compared with 2013. "Mitigating the lack of medication availability to treat these infections will help public health officials stop the rise in STI disease," the authors concluded.
Oct 16 Emerg Infect Dis study