Flu Scan for Apr 06, 2015

News brief

H7N9 hospitalizes 2 in Shanghai; study estimates transmission risk

Shanghai health officials reported two new H7N9 avian influenza cases, in a 52-year-old man and a 37-year-old woman, the first infections reported in the city since the middle of February.

Hong Kong's Centre for Health Protection (CHP) said yesterday in a statement that the man is hospitalized in stable condition. No details were available about how he may have been exposed to the virus. The agency said so far 619 human cases have been reported on China's mainland, more than half of them from Guangdong and Zhejiang provinces.

The woman's infection was reported today in a statement from Shanghai's health department that was translated and posted by FluTrackers, an infectious disease news message board. The report said the woman is from Jiangsu province and is hospitalized in critical condition.

The two illnesses appear to be the 46th and 47th cases reported from Shanghai since the virus emerged in China 2 years ago.

Though it's unclear exactly how many H7N9 infections China has had in the third wave of illnesses that began in October, a case list kept by FluTrackers, which compiles official reports, puts the global total from the disease for all three waves at 646.
Apr 5 CHP statement
Apr 6 FluTrackers thread
FluTrackers H7N9 case list

In related developments, an analysis of surveillance systems in Cambodia, Laos, Thailand, and Vietnam suggests that severe human H7N9 infections in humans hasn't likely occurred, because the virus hasn't spread to the countries or that it has a lower incidence than H5N1 avian flu. The report, by researchers from the US Centers for Disease Control and Prevention and their counterparts in the four countries, appeared today in Emerging Infectious Diseases.

Though H7N9 may have already spread from China to poultry in other countries, poultry surveillance isn't likely to detect the virus until it becomes widespread, and possibly wouldn't be detected unless a human case surfaces, the investigators noted.

The authors said all four countries have the capacity to detect H7N9, along with well-developed hospital-based surveillance systems. They added that all but Laos have passive pneumonia surveillance systems that cover a wide area, and the group pointed out that Vietnam and Cambodia have detected H5N1 in humans since H7N9 emerged, suggesting that severe H7N9 infections haven't occurred or that they are less common than H5N1.

The team concluded that sporadic travel-related human infections might crop up, but they won't likely contribute to the spread in humans, as long as person-to-person transmission remains limited. They warned, though, that vulnerabilities remain, given the growth of trade networks and economic integration.
Mar 6 Emerg Infect Dis report


Canine flu outbreak strikes Chicago area

A canine influenza outbreak under way in the Chicago area has sickened more than 1,000 dogs so far and has been linked to 5 canine deaths, the Chicago Veterinary Medical Association (CVMA) said in an Apr 3 statement. The group is urging dog owners to take steps to protect the animals from exposure to canine infectious respiratory disease (CIRD), which is responsible for an increase in severe infections.

Donna Alexander, DVM, director of Cook County Department of Animal and Rabies Control (CCDARC), said in the statement that preliminary data from local veterinarians through Mar 31 suggests that 73% of animal hospitals have reported an increase in CIRD, and though the age of the dogs varies, the most severe cases of CIRD are being reported in dogs under 1 year old and those older than 7 years old.

She added that the majority of specimens submitted have been negative, but some results are still pending. Of samples that have tested positive, 93% were positive for canine influenza, suggesting that canine influenza may be the primary cause of the increasing number of severe respiratory infections that Chicago-area veterinarians are seeing.

Canine influenza is extremely contagious, and some infected dogs show no symptoms and can transmit the disease to other dogs. The CVMA is urging owners to keep their dogs from socializing with other dogs or from participating in group training activities. Pet owners are also being urged to refrain from boarding their dogs at kennels and to avoid doggie daycare, dog parks, and grooming facilities.

The CCDARC said the CIRD outbreak could last for several weeks. It said the condition is distinguished from "kennel cough" by its severity, possible consequences, and diagnostic confirmation. Symptoms include persistent cough, lethargic behavior, poor appetite, and fever. The agency added that the disease isn't transmitted to humans or other household pets, and because the virus can live on surfaces, people can avoid passing the virus to dogs by thoroughly washing their hands after touching or petting a dog.

A vaccine for CIRD is available and can be administered by a veterinarian.

According to the American Veterinary Medical Association (AMVA), canine influenza is caused by the novel influenza A H3N8 subtype, first seen in 2004 in racing greyhounds in Florida. Since then cases have been detected in 30 states and Washington, D.C. The disease is endemic in parts of Colorado, Florida, New York, and Pennsylvania.
Apr 3 CVMA statement
CCDARC notice
AVMA background

News Scan for Apr 06, 2015

News brief

Ebola infection reported in former Sierra Leone hot spot

A 9-month boy tested positive for Ebola after he died in Sierra Leone's Kailahun district, a former hot spot for the disease that had not seen a case over the past 4 months, Reuters reported today.

Alex Bonapha, Kailahun's district council chairman, said it's not clear how the boy was infected, because his parents were healthy, according to the report. He said the boy might have been infected through a blood transfusion he received before he died, or that there may have been a problem with the sample that was tested. He said because of health system weaknesses, there is a chance that the blood the baby received wasn't the blood that his uncle had donated.

Local and foreign experts have been asked to investigate the case and the positive test result, according to Reuters.
Apr 6 Reuters story

In Ebola research developments, a German team that compared glycoprotein (GP)-mediated cell entry of Ebola Zaire viruses from 1976 and the current outbreak in West Africa found that both viruses use the same mechanism and should be susceptible to established antiviral strategies that target GP and cell entry factors. The researchers published the results of their cell-culture study late last week in the Journal of Infectious Diseases.

They said the GP of the current outbreak strain harbors eight unique substitutions, and it wasn't known if the changes would alter cell entry or contribute to resistance to inhibitors or neutralizing antibodies. The modern sample they used was from Sierra Leone.

Their comparison found no major differences in cell host entry, and GPs from both viruses were susceptible to blockade by inhibitors and antiviral host cell proteins.
Apr 2 J Infect Dis abstract


Saudi Arabia confirms 2 more MERS cases, 1 fatal

Saudi Arabia announced two more MERS-CoV cases over the weekend but none today, with the latest reports hinting at a slowdown from the rate of cases seen the past 2 months.

The new cases were reported yesterday and involved two men, a 65-year-old Saudi in Riyadh who died and a 66-year-old foreigner in Mecca who is in stable condition, the Ministry of Health (MOH) reported.

The men were not healthcare workers, and neither had had contact with other MERS-CoV (Middle East respiratory syndrome coronavirus) cases in healthcare settings or the community before they got sick. There was no information on contact with animals.

On Apr 4 the MOH announced a death in a previously reported case, that of a 60-year-old Saudi man in Jeddah.

Also noted were the recoveries of three patients in Riyadh: two men, ages 30 and 54 (Apr 4), and a 65-year-old female expatriate (Apr 5).

The two new cases bring the total for the first 6 days of April to three. For comparison, the MOH reported a total of 75 cases in February and 53 in March.

The MOH's cumulative count of MERS cases is now 976, including 424 deaths, 541 recoveries, and 11 patients still in treatment.

In other developments, the MOH today posted a weekly MERS update, but it provided little new information about recent cases. In somewhat confusing language, it indicated that 2 of the last 7 cases involved contact with camels, 2 resulted from contact with cases in the community, 2 involved healthcare workers, and 1 is still under investigation.
Apr 4 MOH statement
Apr 5 MOH statement
Apr 6 MOH weekly update


PAHO reports 13,000-case chikungunya increase

The number of chikungunya cases in the Americas increased by 13,239 last week, to 1,356,611, the Pan American Health Organization (PAHO) said in its most recent weekly update on Apr 3.

In comparison, the region saw a 32,504-case increase the week before and a 28,768-case increase the week before that. PAHO's latest count includes 1,322,693 suspected, 30,309 confirmed, and 3,609 imported cases. The wide majority of the imported cases are from the United States.

Consistent with many recent weeks, by far the largest increase was in Colombia, which reported 11,671 new cases. The largest percentage increase, though, occurred in Ecuador, which more than quintupled its case count, from 239 to 1,245—an increase of 1,006 cases.

Bolivia and Paraguay also had sizeable increases, percentagewise. Bolivia had 274 new cases—763 total—and Paraguay logged 211 new cases, for 522 total.
Apr 3 PAHO update

In related news, Brazilian researchers reported today that a 1,000-plus-case chikungunya outbreak in Feira de Santana in east-central Brazil last fall was caused by the East/Central/South African genotype rather than the Asian type that has caused almost all other cases throughout the Americas.

Writing in Emerging Infectious Diseases, the investigators noted that cases occurred in neighborhoods throughout the city of 612,000 residents, but 52% were in the same neighborhood as the index patient, who had traveled to the city from Angola.

"This epidemic had some unusual aspects," the authors wrote. "First, it was not caused by the Asian genotype circulating in affected countries of the Americas, which maintain intense tourism and trade with Brazil. Second, it occurred during the dry season, when little dengue transmission was occurring."

They noted that cases were noted elsewhere in Brazil at the same time, but they were caused by the Asian genotype.
Apr 6 Emerg Infect Dis report


Blue Bell closes Oklahoma plant tied to Listeria outbreak

Blue Bell Creameries on Apr 3 announced it had shut down its manufacturing plant in Broken Arrow, Okla., after it was implicated in a five-case listeriosis outbreak in Kansas that killed three people.

Blue Bell said in a news release that, after suspending operations, "We will then thoroughly inspect the facility for any possible problems that may have led to the contamination of some of our ice cream products in the past few weeks."

The company added, "We have notified the U.S. Food and Drug Administration of our action and we remain committed to being transparent with that federal agency. Once our investigation is complete and we have made all necessary improvements, it will return to operation."

The US Centers for Disease Control and Prevention (CDC), in an update on the same day, recommended that consumers not eat any Blue Bell products made at the plant. It said they can be identified by any of the letters "O" through "T" appearing following the "code date" on the bottom of the product packaging (see CDC image at right).

Whole-genome sequencing of Listeria monocytogenes from the implicated Blue Bell products showed they were highly related to patients' Listeria isolates, the CDC said.

All four outbreak patients with available information ate milkshakes made with Blue Bell ice cream while they were hospitalized for unrelated conditions.
Apr 3 Blue Bell news release
Apr 3 CDC
Mar 13
CIDRAP News scan on outbreak


Study: Rare norovirus variant caused many Guangdong outbreaks

Not only did a rare variant strain of norovirus surge in China this past winter, it caused 83% of the outbreaks in one province, according to a new study in Emerging Infectious Diseases.

Chinese and Australian researchers looked at 52 norovirus outbreaks in Guangdong province from January 2013 through January 2015 that had at least 20 cases. From November 2014 through January 2015, 29 outbreaks involving 2,340 cases were reported, compared with 9 outbreaks involving 949 cases in the same period in 2013-14.

The GII strain of the virus was detected in 44 of 46 outbreaks (96%) for which samples were successfully genotyped over the entire study period. From January 2013 through October 2014, the GII.4/Sydney/2012 strain was detected in 48% of outbreaks. From November 2014 through January 2015, however, the rare variant GII.17 strain was reported in 10 cities in the province and in 24 of 29 outbreaks (83%).
Apr 2 Emerg Infect Dis study

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