News Scan for Feb 05, 2015

News brief

California, Illinois officials confirm 12 new measles cases

California officials yesterday confirmed 7 new measles cases in an outbreak that began in December, bringing the case total for the state to 99, while 5 babies at a Chicago-area daycare have also been diagnosed as having the disease.

Also yesterday, the Trust for America's Health (TFAH) pointed out the states having the lowest measles vaccination coverage in toddlers.

Of the 99 California patients, 39 visited Disneyland from Dec 17 through 20, where they were presumably exposed, according to an update from the California Department of Public Health (CDPH). In addition, 23 are household contacts of those cases. Of the remaining 37, 3 were exposed in a non-Disney community setting and 34 have an unknown exposure source.

The new California cases include three in children younger than 1 year, a group that is not eligible to receive measles vaccine. Eight children in that age-group have now contracted the disease in California, or 8% of the total. That compares with 14% in children 1 to 4 years old, 18% in those 5 to 19, and 60% in adults 20 and older.

Meanwhile five children at a daycare center in the Chicago suburb of Palatine, all under 1 year, have been found to have measles, Illinois and Cook County health officials announced today, according to the Chicago Tribune. Illinois has now confirmed six cases.

Determining the outbreak total has been difficult. The US Centers for Disease Control and Prevention (CDC) has confirmed 102 cases in 14 states through Jan 30, but it does not include December cases in that total. On Feb 2 the New York Times, using CDC and state data, posted a map that details 136 cases in 14 states. The new California and Illinois cases would bring the total to at least 148.
Feb 4 CDPH update
Feb 5 Chicago Tribune story
Feb 2 New York Times map
Related Feb 2 CIDRAP News scan

In related news, TFAH noted in a press release that measles vaccination coverage in 17 US states is less than 90% for kids 19 to 35 months old. The states are Missouri, Oklahoma, Alabama, Kentucky, Kansas, Oregon, South Carolina, Michigan, New Mexico, Wyoming, Virginia, Arkansas, Louisiana, Montana, Colorado, and West Virginia. The last three are tied for the lowest coverage, at 86.0%.

New Hampshire had the highest coverage for that age-group, at 96.3%, followed by Washington, DC, North Carolina, and Massachusetts. Nationally, 91.1% of kids this age were vaccinated, compared with 94.7% of kindergartners, TFAH said.
Feb 4 TFAH news release

WHO panel again says MERS not a global health emergency

A World Health Organization (WHO) panel of experts today said that, while the MERS-CoV situation is a cause for concern, it still has not met the criteria to be declared a Public Health Emergency of International Concern (PHEIC), a distinction the WHO has given to Ebola virus disease.

Saudi Arabia, meanwhile, confirmed two more MERS-CoV (Middle East respiratory syndrome coronavirus) cases yesterday, for a total of six in 3 days.

The WHO emergency committee convened yesterday by phone. In a WHO statement today, the members said, "The Committee emphasized that although the pattern of transmission appears relatively unchanged, the overall situation and the possibility of international spread remains of concern. In addition, increased surveillance in many countries is needed to better monitor trends related to the spread of this virus."

They noted that sporadic cases are still occurring, mostly in Saudi Arabia, but without sustained human-to-human transmission. "The Committee further noted that although significant efforts have been made to strengthen infection prevention and control measures, transmission in healthcare settings is still occurring."

The experts, who met for the eighth time, unanimously agreed that the conditions for a PHEIC have not been met.
Feb 5 WHO statement

The new MERS-CoV cases in Saudi Arabia involve a 58-year-old woman and a 37-year-old man in Riyadh, the Saudi Ministry of Health (MOH) said in an update yesterday.

Both patients are non-Saudis, are hospitalized in stable condition, and had preexisting disease but no known animal or human exposures. The man is a healthcare worker.

The cases bring the MERS total in Saudi Arabia to 851, including 365 deaths, the MOH said.
Feb 4 MOH update

Margaret Hamburg to leave FDA helm in March

Margaret Hamburg, MD, will leave her position as commissioner of the US Food and Drug Administration (FDA) in March, after 6 years in which she led new initiatives on food safety and efforts to fast-track licensing of new drugs, the Washington Post reported today.

"As you can imagine, the decision was not easy," Hamburg was quoted as saying in a statement. "While there is still work ahead (and there will always be), I know that I am leaving the agency well-positioned to fulfill its responsibilities to the American public with great success."

President Barack Obama nominated Hamburg to the position in March 2009, promising that food safety would improve under her leadership. Her appointment came in the wake of a nationwide Salmonella outbreak linked to peanut products, among other foodborne outbreaks.

She had previously served as New York City health commissioner, assistant director of the National Institute of Allergy and Infectious Diseases, and an assistant secretary in President Bill Clinton's Department of Health and Human Services (HHS). Before joining the FDA, she was the senior scientist at the Nuclear Threat Initiative, a foundation dedicated to reducing threats from nuclear, chemical, and biological weapons.

The Post story noted that the FDA had its share of controversies during Hamburg's tenure, including congressional questioning in 2012 over the outbreak of fungal infections tied to contaminated steroid injections and a fight with the HHS secretary over the sale of morning-after contraceptives to young teenagers.

Hamburg's resignation comes as the FDA is working to implement the far-reaching Food Safety Modernization Act of 2011. The Post said that Stephen Ostroff, MD, the FDA's chief scientist, will lead the agency until Obama names a permanent successor to Hamburg.
Feb 5 Washington Post story
FDA biography of Hamburg
Related Mar 16, 2009, CIDRAP News story

Little progress seen in adult vaccination rates from 2012 to 2013

Adult coverage in the United States for six routinely recommended vaccines, not including influenza, remains low and increased only modestly or not at all from 2012 to 2013, according to an analysis published today in Morbidity Mortality Weekly Report of data from the 2013 National Health Interview Survey (NHIS).

Modest increases in coverage were seen for three vaccines. Tetanus and diphtheria with acellular pertussis (Tdap) vaccination in adults 19 or older increased by 2.9 percentage points, to 17.2%; herpes zoster (shingles) vaccination in adults 60 and older increased 4.1 points, to 24.2%; and human papilloma virus (HPV) vaccination among 19- to 26-year-old men rose by 3.6 points, to 5.9%. Coverage for pneumococcal disease, hepatitis A, and hepatitis B did not increase appreciably from 2012.

Racial and/or ethnic disparities in coverage persisted for all six vaccines, with higher coverage seen in whites than other groups. The largest differences were for Tdap and herpes zoster vaccination.

Coverage rates for all six vaccines are well below the goals set in the Healthy People 2020 federal initiative.

Awareness of the need for vaccines in adults is low in the general population, say the authors, with adults relying mainly on recommendations from their clinicians. For this reason, healthcare providers should assess vaccination needs, make recommendations, and offer vaccines at every clinical encounter "to improve vaccination rates and to narrow the widening racial/ethnic disparities in vaccination coverage."

Current recommended immunization schedules from the Advisory Committee on Immunization Practices (ACIP) for persons 18 and younger and those 19 and older are also included in today's MMWR.
Feb 6, 2015 MMWR article
2015 ACIP immunization schedule for persons 0-18 years old
2015 ACIP immunization schedule for persons 19 years and older

Avian Flu Scan for Feb 05, 2015

News brief

High-path avian flu outbreaks hit more farms in Taiwan, Bulgaria

Agriculture officials in Taiwan yesterday said 51 more poultry farms have been struck by H5N8 avian influenza and 108 more facilities have reported more H5N2 outbreaks, with some of the locations hit by both strains, according to two separate reports to the World Organization for Animal Health (OIE).

The new H5N8 outbreaks are concentrated on the southwestern part of the island and involve mostly goose farms, though fresh outbreaks were also reported from five duck farms and three farms that house native chickens. Of 224,963 susceptible birds, authorities reported 46,230 deaths, and the remaining birds were slated for culling.

Among the 51 farms reporting H5N8, 12 reported concurrent infection with the H5N2 strain, which is also ravaging Taiwan's poultry.

Meanwhile, most of the 108 new H5N2 outbreaks were located in southwestern Taiwan, but a few were reported on the west central and northwestern part of the island. Most of the farms housed geese, but some were raising ducks and chickens.

Of 660,131 susceptible birds, 128,132 deaths were reported, and the remaining birds were to be destroyed.

Since early January animal health officials in Taiwan have battled the two highly pathogenic viruses at hundreds of poultry farms, and they have also been grappling with a smaller number of outbreaks involving a new highly pathogenic subtype. Widespread virus activity on the farms has triggered monitoring for human infections, but none have been reported so far.
Feb 4 OIE update on H5N8 in Taiwan
Feb 4 OIE update on H5N2 in Taiwan

In another avian flu development, Bulgarian agriculture officials shared details about an outbreak in the southeastern province of Burgas that was reported in the media recently. In a report yesterday to the OIE, they said tests confirmed highly pathogenic H5N1 in samples from backyard birds and that the virus had killed 20 of 22 susceptible birds.

The source of the outbreak was probably contact with wild species. In late January the H5N1 virus was detected in a pelican found dead in the same province.
Feb 4 OIE update on H5N1 in Bulgaria

H7N9 hospitalizes two more in Guangdong province

Two more H7N9 avian influenza infections have been reported from China's Guangdong province, both men from Shenzhen, according to two separate government sources today.

One of the patients is a 77-year-old whose illness was confirmed Feb 3 and who is hospitalized, says a provincial health department statement translated and posted by FluTrackers, an infectious disease news message board.

The other man is a 51-year-old who is hospitalized in serious condition, according to a report today from Hong Kong's Centre for Health Protection (CHP), which cited the provincial health department.

In what appears to be a third wave of H7N9 infections that began in the fall, the Guangdong province city of Shenzhen has now reported 11 cases. The two new infections lift the global H7N9 total to 546, according to a case list kept by FluTrackers.
Feb 5 FluTrackers thread
Feb 5 CHP statement
FluTrackers H7N9 case list