Flu Scan for Apr 25, 2014

News brief

US flu season winding down with influenza B wave

Most flu markers in the United States declined last week, but the Northeast is still in the grip of a wave of influenza B activity, the US Centers for Disease Control and Prevention (CDC) said today in its latest FluView report.

The agency said it's not uncommon for a second wave of flu activity involving seasonal flu viruses other than the predominant one to occur toward the end of a season and that some disease activity could continue into May.

The 2009 H1N1 virus dominated during most of the season, but this week influenza B accounted for the largest percentage of circulating viruses, with the number of H3N2 positives increasing as well.

Though the country has been below baseline for clinic visits for flulike illness, two CDC regions, both in the Northeast, are still above their baselines. The overall percentage of respiratory specimens that tested positive for flu dropped last week from 14.5% to 12%.

One state—Texas—reported moderate-intensity flu activity, and wide geographic spread was reported by Connecticut, Massachusetts, New Jersey, New York, Rhode Island, and Guam.

Three more pediatric flu deaths were reported, pushing the season's total in that age-group to 89. Overall, deaths from flu and pneumonia were 6.3% of all deaths, well below the epidemic threshold of 7.1%.

Canada, like the United States, is seeing influenza B circulate in several regions, consistent with late-season patterns for the strain and with the overall flu activity levels expected for this time of year, according to today's update from the Public Health Agency of Canada (PHAC).

In Europe, flu activity continued an overall decline, with low-intensity activity reported by 27 countries and local or sporadic activity reported by 19 of them, according to a report today from the European Centre for Disease Prevention and Control (ECDC). Poland was the only country to report an increasing trend. Of the respiratory samples that tested positive for flu, 84% were influenza A.
Apr 25 CDC FluView report
Apr 25 PHAC FluWatch report
Apr 25 ECDC weekly flu surveillance report

Taiwan detects fourth imported H7N9 case

Taiwan today reported its second imported H7N9 influenza case this week, in a 39-year-old Taiwanese resident who had traveled to two areas of eastern China before getting sick. The illness is Taiwan's fourth imported case of H7N9.

According to a machine translation of a statement from the Taiwan Center for Disease Control and Prevention, the patient traveled to China between Mar 31 and Apr 19, visiting Beijing and the city of Kushan in Jiangsu province. That province has reported several H7N9 cases, including some recent ones. A report today from China News Agency (CNA) said the patient is a businessman.

On Apr 19, the day the man returned to Taiwan, he had fever, shortness of breath, and other symptoms, which prompted him to seek medical care. He was apparently hospitalized on Apr 23 after x-rays showed pneumonia. He was treated with antivirals, and his initial throat swab tested negative for H7N9. He was re-tested because his symptoms persisted, and those samples were reported positive for H7N9 today.

The initial investigation into the source of the man's infection found no history of exposure to poultry or poultry markets. Health officials are monitoring the man's contacts, including passengers who were on his flight back to Taiwan.

The new case brings the overall H7N9 outbreak total to 432, according to a case list kept by the FluTrackers infectious disease message board. So far 296 cases have been reported in the second wave of the outbreak, compared with 136 in the first.
Apr 25 Taiwan CDC statement (in Chinese)
Apr 25 CNA story
FluTrackers human H7N9 case count

News Scan for Apr 25, 2014

News brief

WHO: Guinea Ebola outbreak situation improving

The overall epidemiologic status of Guinea's Ebola virus disease (EVD) outbreak is improving, with 4 of the 6 locations that have reported cases passing the 21-day incubation period with no new cases, according to an update from the World Health Organization (WHO) Regional Office for Africa. Two incubation periods need to pass before the outbreak can be declared over in a particular location.

Ten more cases and five more deaths have been reported in Guinea, pushing the country's outbreak total to 218 suspected or confirmed cases, 141 of them fatal. Three more cases were confirmed by lab tests, raising that total to 115.

The latest illness onset of a suspected case was Apr 23, and the isolation of the most recent confirmed case was Apr 22.

Liberia has reported one more illness clinically compatible with EVD, raising its total to 35; 6 are confirmed, 2 probable, and 27 suspected cases. The WHO said the country's health ministry is working on reconciling suspected cases with lab-confirmed cases and expects that most suspected cases will be ruled out.

Sierra Leone's health ministry is investigating three patients who have illnesses compatible with viral hemorrhagic fever for possible Lassa fever or EVD, the WHO said. So far no Ebola outbreak cases have been detected in the country.
Apr 25 WHO statement

FSIS publishes food safety guide for retail delis

Earlier this week the US Department of Agriculture's Food Safety and Inspection Service (FSIS) posted notices on controlling Listeria in retail delis and on food safety measures for poultry products. Both notices appeared in the Federal Register.

The first notice asks for comments on the document "FSIS Best Practices Guidance for Controlling Listeria monocytogenes (Lm) in Retail Delicatessens," which deals with Listeria control on deli meats, poultry products, and salads.

The guidance includes practical recommendations that deli owners can use to ensure ready-to-eat foods are handled under sanitary conditions and may help reduce other foodborne pathogens as well, the notice says. Best practices are divided into four topics: product and product handling, cleaning and sanitizing, facility and equipment controls, and employee practices.

The guidance also includes a self-assessment tool. Comments are due by Jun 20.

The second notice from FSIS concerns the "HACCP Plan Reassessment for Not-Ready-to-Eat (NRTE) Comminuted Poultry Products and Related Agency Verification Procedures," which it published Dec 6, 2012. The FSIS this week posted responses to the 22 comments it received regarding those procedures.
Apr 21 Fed Reg notice on Listeria
Apr 21 Fed Reg notice on poultry plans

WHO Europe aims for regional malaria elimination by 2015

The WHO European Region aims to eliminate malaria from the region by 2015, the agency said in a World Malaria Day press release. The agency called the goal "realistic and attainable," given recent progress.

Cases of locally acquired malaria have declined dramatically in recent years, the agency said, from 90,712 in 1995 to only 37 in 2013. The 2013 cases were reported in Greece, Tajikistan, and Turkey.

Imported cases continue to pose a problem, however, with about 5,000 reported in the region in 2013.

The WHO has published a manual to help nations assess the technical, operational, and financial feasibility of moving toward malaria elimination, according to the release.
Apr 25 WHO Europe press release

The WHO's Western Pacific Region Office (WPRO), meanwhile, said that most malaria-endemic countries in that region have reduced their malaria burden substantially since 2000, in line with global goals.

In the 10 WPRO malaria-endemic nations, malaria cases decreased from about 396,000 in 2000 to 299,000 in 2012. In the same period malaria-related deaths dropped from 2,500 in the region to 460, the agency said.
Apr 25 WPRO news release

The WHO's South-East Asia Region Office (SEARO), noted that its region has three fourths of all malaria cases, even though it is home to only one fourth of the world's population.

Although malaria decreased in the region from 2.9 million cases in 2000 to 2 million in 2012, the disease continues to have a significant impact, according to a SEARO press release today.

"We must continue surveillance for malaria. Funding needs to be increased for diagnostics, drugs, insecticide-treated mosquito nets, and research and response to drug and insecticide resistance. We need to empower communities to protect themselves," said Poonam Khetrapal Singh, PhD, WHO SEARO director. She said 1.4 billion people in the region continue to be at risk for malaria.
Apr 25 WHO SEARO press release

FDA approves new option for cervical cancer screening

The Food and Drug Administration (FDA) yesterday approved a DNA test for primary screening of women aged 25 years and older for human papilloma virus (HPV).

The test was approved previously, in 2011, but only for use in conjunction with or as follow-up to the Pap (cell cytology) test. The new approval of the HPV test alone adds a new option for primary screening.

Called the cobas HPV Test and manufactured by Roche Molecular Systems, the test is able to detect in a sample of cervical cells DNA from HPV types 16 and 18, which account for 70% of cervical cancers, as well as 12 other HPV types considered high risk.

Positive results for HPV 16 or 18 on the test indicate the need for a woman to undergo colposcopy, a procedure in which the cervix is illuminated and magnified so the physician can directly observe cervical cells.

Roche Diagnostics carried out a study of the cobas HPV Test for primary screening in 40,000 women 25 years of age or older and found it to be safe and effective.
Apr 24 FDA news release

CDC probes possible disease exposure at Arizona donation facility

The US Centers for Disease Control and Prevention (CDC) said today that it is investigating possible occupational exposure to HIV, hepatitis B and C viruses, and Mycobacterium tuberculosis in employees who handled materials at a facility in Arizona that processes donated cadavers.

The materials are used by universities, surgical instrument companies, and pharmaceutical firms for educational and research purposes and are not used in human transplants, said the CDC.

A team from the agency described the status of the investigation today in an early-release article from Morbidity and Mortality Weekly Report (MMWR). They said the center in Arizona might not have consistently followed standards set by the American Association of Tissue Banks that specify exclusion criteria for donor material, proper environmental controls, and safe work practices. The facility is now closed.

The CDC is helping Arizona officials notify former workers about the potential exposures, and Arizona is offering them free testing for and counseling about the diseases.

Barbara Reynolds, a spokeswoman for the CDC, told CIDRAP News that the CDC was brought in during the course of a criminal investigation and that so far no employee infections have been detected.

The report today highlighted safety considerations for employers and employees who work in the nontransplant anatomical donation industry. It emphasized that there are no known risks to the general public.
Apr 25 MMWR report