News Scan for Sep 25, 2019

News brief

Second big measles outbreak over in New York state

Health officials in New York's Rockland County today declared the end of a 2018-2019 measles outbreak that sickened 312 people, a development that decreases the chance of the United States losing its measles elimination status on Oct 2.

A statement from Rockland County officials said the outbreak began in October 2018 and was part of New York's largest outbreak since 1992. The last rash onset was Aug 13, and two incubation periods (42 days) have passed with no new cases reported.

The vast majority (92%) of the illnesses occurred in people who didn't receive vaccine or whose vaccination status was not known. Over the course of the outbreak, the county and its partners administered 29,027 doses of measles, mumps, and rubella (MMR) vaccine.

Patricia Ruppert, DO, MPH, the county's health commissioner, said, "This outbreak involved a large amount of staff time and resources. Thanks to our highly skilled and dedicated team at the Health Department, community outreach, case investigations, and required reporting were completed competently and in a timely manner." She added that staff monitored almost 1,200 contacts to help curb the outbreak.

The US Centers for Disease Control and Prevention (CDC) said in information updated Sep 18 that the United States will lose its measles elimination status on Oct 2 if the outbreak in New York state is not stopped by that date. On Sep 3, health officials in New York City said an outbreak in Brooklyn was over a year after it began, sickening 654 people. On Sep 19 an outbreak in New York's Wyoming County was declared over.

The New York State Department of Health (NYSDH) in a statement yesterday marked the Rockland County achievement and said remaining counties reporting measles are on track in the coming days to reach similar milestones.
Sep 25 Rockland County
press release
Sep 24 NYSDH
press release
background on measles elimination


WHO updates Philippines polio situation, notes detection of 2nd strain

The World Health Organization (WHO) yesterday posted an update on the latest polio developments in the Philippines, with more details about the second circulating vaccine-derived poliovirus type 2 (cVDPV2) case and noting that another strain—vaccine-derived poliovirus type 1 (VDPV1)—has been detected in environmental samples from Manila.

Confirmed on Sep 14, the previously announced first case is in a 3-year-old girl from Lanao del Sur in the south of the country. The WHO said genetic analysis shows the VDPV2 virus is related to earlier environmental samples from Manila and Davao, indicating that it is circulating. The case marked the first polio detection of any kind in the Philippines since 2001.

The second case, confirmed on Sep 19, involves a 5-year-old boy from Laguna province, which is about 62 miles southeast of Manila. Tests are under way to further characterize the virus.

Also, VDPV1 has been found four different times between Jul 1 and Aug 27 in environmental samples collected from Manila.

The WHO said the risk of international spread from the Philippines is low, but the threat of further spread within the country is high because of limited population immunity, with bivalent oral polio vaccine coverage at 66% and inactivated polio vaccine coverage at only 41% in 2018. Also, the WHO said acute flaccid paralysis surveillance is suboptimal.
Sep 24 WHO statement


Saudi Arabia reports second MERS case this month

Saudi Arabia's health ministry today reported a new MERS-CoV case, the second for September, in Unaizah, a city in Al Qassim province.

The new MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 74 year-old man with unknown camel exposure. Health officials said his exposure to the virus is primary, meaning it's unlikely he contracted the virus from another MERS patient.

As of Sep 19, the World Health Organization's Eastern Mediterranean regional office said that, since 2012 there have been 2,468 MERS cases, at least 850 of them fatal. The vast majority of cases have been in Saudi Araba.
Sep 25 Saudi MOH statement


Study links infectious disease consult to better Candida survival

A retrospective cohort study at Washington University School of Medicine in St. Louis found that an infectious disease (ID) consultation is associated with lower mortality rates with Candida bloodstream infections, according to findings published yesterday in The Lancet Infectious Diseases.

The researchers analyzed data from 1,691 patients with Candida bloodstream infections treated at Barnes-Jewish Hospital in St. Louis from 2002 to 2015. The team looked at what steps the Washington University doctors took to treat each fungal infection, including whether they consulted with ID specialists, and compared data on fatality rates.

They found that 45.9% of the physicians who had primary responsibility for the patients consulted with ID specialists. Of the patients who were evaluated by an ID expert, 28.6% died within 90 days, compared with 50.5% of patients whose attendant had not consulted an ID specialist. Even after correcting for risk factors such as age and underlying disease, the benefit of a specialist consultation translated into a 20% lower risk of death, the authors noted.

"Candida infections are a major problem in hospitals," said senior author Andrej Spec, MD, in a Washington University news release. "Even uncomplicated versions of these infections are actually quite dangerous and require a detailed and well-thought out approach to make sure that people do well."

"Our study indicates that bringing in a specialist to consult on such infections should be the standard of care," he added. "We're taking steps to adopt this protocol for our patients."

"Washington University provides a physicians' access line, where any community physician who has any concerns about a patient can call an infectious disease doctor 24 hours a day, 365 days a year, and ask questions," Spec said.

A commentary in the same journal by Belgian experts echoed that sentiment. "We believe every hospital should have an expert management strategy addressing all individual cases of candidaemia," said Katrien Lagrou, PharmD, PhD, and Eric Van Wijngaerden, MD, PhD. "The need for such expert management should be incorporated in all future candidaemia management guidelines."
Sep 24 Lancet Infect Dis study
Sep 25 University of Washington School of Medicine news release
Sep 24 Lancet Infect Dis commentary

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