Flu Scan for Apr 04, 2014

News brief

Decline in flu activity took a break last week

US influenza activity took a break last week from its recent pattern of steady decline, at least by some measures, the Centers for Disease Control and Prevention (CDC) reported today.

Five states—New York, New Jersey, Delaware, Connecticut, and Massachusetts—reported geographically widespread flu activity last week, compared with four states the week before, the CDC said in its weekly update. And New York City reported high flu-like illness (ILI) activity last week, whereas no jurisdictions had high activity a week earlier.

The share of outpatient medical visits for ILI stayed the same as the week before, at 1.6%, which is well below the national baseline of 2.0%.

The proportion of respiratory specimens that tested positive for flu increased: 12.5% of 5,206 samples last week, up from 11.5% of 4,977 samples a week earlier, the agency said.

Three more flu-related deaths in children were reported, one fewer than the week before, raising the season's total to 82, the CDC said.

The CDC said 6.5% of deaths registered through its mortality reporting system were due to pneumonia and influenza, which was well below the epidemic threshold of 7.3%. A week earlier the figure was 7.2%.

Influenza A/H3N2 and influenza B viruses continued to account for a larger share of cases, near the end of a season in which 2009 H1N1 was mostly predominant. Influenza B accounted for about 52% of viruses that were typed. Of 158 type A viruses that were subtyped, 90 were H3N2 and 68 were H1N1.

The CDC found just one more flu isolate, a 2009 H1N1 virus, showing resistance to oseltamivir (Tamiflu), raising the season's total to 55.
Apr 4 CDC FluView report


H7N9 cases detected in China, Hong Kong

Two new H7N9 illnesses were reported today, one in China and one in Hong Kong in a man who had traveled from China.

The newest case reported from China involves a 62-year-old man from Guangdong province who is hospitalized in critical condition, according to a health department statement translated and posted by FluTrackers, an infectious disease news message board.

Meanwhile, Hong Kong's Centre for Health Protection (CHP) said today that it is investigating an imported H7N9 infection in a 65-year-old man who got sick in the Guangdong city of Shenzhen on Mar 31 and whose symptoms were detected yesterday at an entry point into Hong Kong. The man was immediately hospitalized, and his samples tested positive for H7N9 today. He is isolated in stable condition.

An investigation found that the man had recently bought slaughtered pigeons from a wet market near his home. His illness marks Hong Kong's eighth imported H7N9 case from China.

The two new cases push the outbreak's overall total to 411, according to an ongoing tally of cases kept by FluTrackers. The unofficial number of deaths remains at 124. So far 275 cases have been reported in the outbreak's second wave, compared to 136 in the first wave last spring.

In related developments, the World Health Organization (WHO) today supplied more details about two H7N9 cases reported by China yesterday, in a 28-year-old man from Jiangsu province who is in severe condition and a 68-year-old man from Guangdong who is in critical condition.

Illness onsets were Mar 23 and Mar 20, respectively. Both patients had been exposed to poultry before they got sick.

In poultry-related developments, the United Nations Food and Agriculture Organization (FAO) said yesterday that a recent meeting of experts in late March in Rome started work on creating global guidelines and tools for avian disease surveillance in live poultry markets. They noted that methodologies vary in different countries and that standardization would assist with the evaluation of surveillance systems and help in comparing disease information across borders.
Apr 4 FluTrackers thread
Apr 4 CHP statement
FluTrackers human H7N9 case list
Apr 4 WHO statement
Apr 3 FAO statement


News Scan for Apr 04, 2014

News brief

Guinea reports more Ebola illnesses, three deaths

Guinea has reported 10 more suspected or confirmed cases of Ebola virus disease (EVD), along with three more deaths. Gregory Hartl, a spokesman for the World Health Organization (WHO), said today in a Twitter post that the developments push the country's overall outbreak total to 137 illnesses, 86 of them fatal.

So far 16 of the EVD cases, 5 of them fatal, have been reported from Conakry, Guinea's capital, the WHO said today in a feature story on an isolation ward at Donka Hospital, a national teaching facility in Conakry. It said two patients were released from the unit yesterday after 7-day stays and that six people remain. Health officials will close another isolation unit there and transfer three patients to the Donka site.

Dr. Tom Fletcher, a WHO physician who is treating Ebola patients in Conakry, said, "Today’s discharge of patients shows that Ebola is not always fatal. Good, early supportive care such as hydration, nutrition and appropriate medication can have a positive impact."

In Liberia the number of suspected or confirmed EVD cases is now 14, with 7 of them fatal, Hartl said. The number is four more than what the WHO reported on Apr 2.

In other outbreak developments, Mali is reporting possible Ebola cases. Mali state television, quoting government sources, said yesterday that three people have been placed in quarantine and that their samples have been sent to the US Centers for Disease Control and Prevention (CDC), Reuters reported today. The story said Gambia recently placed two people in quarantine, but their samples tested negative for Ebola.

In France, a scare over a possible sick patient on a flight from Guinea prompted the brief quarantine of an Air France jet in Paris today, Agence France Presse (AFP) reported.

The discovery of a dirty toilet prompted the airline to screen passengers for fever. Diarrhea is one of the symptoms of Ebola infection. An Air France spokesman told AFP that tests were negative.
Gregory Hartl Twitter feed
Apr 4 WHO feature story
Apr 4 Reuters story
Apr 4 AFP story


African nations fall short of WHO goals for measles elimination

Despite substantial progress, measles pre-elimination goals for 2011-12 established by the WHO's African Region (AFR) were not met, and intensified efforts globally and nationally are needed to achieve the WHO's goal (set in 2011) of eliminating measles in Africa by 2020, according to an update from the WHO in today's Morbidity Mortality Weekly Report (MMWR).

The report notes an 88% reduction in measles mortality since 2000, indicating good progress but a failure to meet the pre-elimination goal of 98%.

Using case-based surveillance data, which was provided by 43 (93%) of member states, the confirmed incidence of measles per million population overall fell from 50.4 to 29.0 from 2011 to 2012, but only 16 of 43 states (37%) met the goal of fewer than 5 cases per million population. Using data from standardized Joint Reporting Forms (JRFs), which were provided by all states, the incidence per million fell from 223.6 in 2011 to 118.8 in 2012. The variation between the case numbers is of concern and may be due to such factors as classification and reporting errors on JRFs, say the authors.

As far as immunization, WHO–UN Children's Fund (UNICEF) estimates put first-dose measles-containing vaccine coverage at 73%; 13 (28%) states met the goal of greater than 90% coverage. Four (15%) of 27 supplemental immunization activities (SIAs) with available information met the target of greater than 95% coverage in all districts.

The report also lists several recommendations for steps to help achieve the 2020 goals.
Apr 4 MMWR article

Air-sampling techniques called effective for detecting biological agents

Detection of a biological agent released into an urban atmosphere is feasible through air sampling both during and after the release, according to results of trials carried out by the Pentagon Force Protection Agency (PFPA) and published yesterday in Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science.

Techniques currently employed for detecting aerosolized biological agents include the BioWatch system for civilian use and the Guardian system for the military. Both have been criticized for what has been called a lack of "operational data" to support their use, and many of the studies done to test their effectiveness are outdated or were carried out in nonurban settings, say the authors.

The PFPA staged deliberate releases of an organic pesticide containing Bacillus amyloliquefaciens, thought to be a reasonable surrogate for B anthracis,in 2005 and again in 2009. The Department of Homeland Security (DHS) at the same times carried out experiments to determine the effectiveness of commonly used air- and surface-sampling techniques at detecting the agent.

High-volume samplers (portable sampling units [PSUs]) were situated in the expected plume of the release, and samples were collected before, during, and after the release. In addition, environmental-surface and personal air samples near the high-volume samplers were collected after dispersal of the plumes. The Lawrence Livermore and Los Alamos National Laboratories developed five real-time TaqMan polymerase chain reaction assays for use in testing the samples.

All background samples from multiple PSU locations in both 2005 and 2009 were negative for B amyloliquefaciens. In the 2005 experiment, a sample collected 6 hours after release in a PSU placed in an adjacent subway station was positive for B amyloliquefaciens, as were 7 of 13 environmental samples collected 40 hours after release.

In 2009, positive samples were collected post-release from two PSUs nearest the release point; samples for all (four) PSUs were positive by 24 hours and for up to 72 hours (the time of last sampling) after release. Three of 36 swipe samples were positive for B amyloliquefaciens.

The authors, all from the Los Alamos lab, conclude that the results provide "operational data" applicable to the scenario of intentional release of an aerosolized biological agent. They also comment that environmental sampling used as a follow-up procedure to obtain more information on a released agent may not be necessary and that avoiding it would serve to limit risks for sampling personnel.
Apr 3 Biosecur Bioterror article abstract


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