News Scan for Sep 25, 2017

News brief

Saudi Arabia identifies first new MERS cases in weeks

The Saudi Arabian Ministry of Health (MOH) reported two new cases of MERS-CoV in Al Hofuf late last week, one of which was fatal. These are the first cases reported by the MOH in 10 days.

On Sep 21, the MOH confirmed that a 48-year-old Saudi man with direct camel contact was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) infection after presenting with MERS symptoms. He is in stable condition.

In addition, a 72-year-old Saudi woman died from her MERS-CoV illlness. Her infection was listed as primary, meaning it is unlikely she contracted the virus from another person.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,723, including 698 deaths. Four patients are still being treated for the disease, according to the MOH.
Sep 21 MOH update


PAHO reports 37,000 new chikungunya cases in the Americas

Fueled almost entirely by a large increase in Brazil, chikungunya cases in the Americas jumped by more than 37,000 last week, the Pan American Health Organization (PAHO) said in its weekly update.

The 37,254 new cases lift the 2017 total in the region to 182,727, PAHO said in its Sep 22 update. The agency reported just 617 and 143 new cases in the previous 2 weeks.

Brazil reported 37,183 of the new cases, bringing its total to the year so far to 171,930, or 94% of the total. The increase covers a 2-week period. Costa Rica, El Salvador, Colombia, Peru, and Venezuela all reported small increases.

Since the Americas outbreak began in 2013 on the Caribbean island of St. Martin, the Americas region has reported 2,569,438 cases.
Sep 22 PAHO update


Researchers find post-exposure prophylaxis effective in measles outbreak

New York City health officials report that the effectiveness of the measles, mumps, and rubella MMR vaccine used as post-exposure prophylaxis (PEP) in response to a measles outbreak in 2013 was 83.4%, but immune globulin PEP effectiveness was 100%, according to a small study in Clinical Infectious Diseases.

The researchers assessed the effectiveness of PEP—which is used to prevent disease in contacts of people with measles—among 44 people who received MMR PEP and 77 who received immunoglobulin (Ig) PEP. The outbreak involved 58 cases in an Orthodox Jewish community in Brooklyn.

The investigators determined that the effectiveness of MMR PEP was 83.4% (95% confidence interval [CI], 34.4%-95.8%). Effectiveness of Ig PEP was 100% (95% CI, 56.2%-99.8%). Effectiveness of receiving any PEP (MMR or Ig) was 92.9% (95% CI, 56.2%-99.8%).

The authors conclude, "Our findings support current recommendations for administration of PEP following exposure to measles. These results highlight the importance of a rapid public health outbreak response to limit measles transmission following case identification."
Sep 23 Clin Infect Dis study


New guidelines released to prevent sport-related pediatric infections

The American Academy of Pediatrics (AAP) today released new guidelines for infectious diseases that can be transmitted during organized sports. Authors of the guidelines, published in Pediatrics, emphasized that proper hygiene is imperative in preventing sports-related skin infections and illnesses.

Outbreaks among high school rugby players and wrestlers were used to illustrate how infections of herpes virus, methicillin-resistant Staphylococcus aureus, and Tinea bacteria can travel from player to player if not quickly identified. These skin-to-skin infections require vigilance and early isolation of infected players. Identifying skin infections and lesions within 3 days is key to prevent widespread infection, the authors said.

For diseases spread via the droplet route, including measles and mumps, the authors said focusing on vaccination coverage is the most important factor in preventing an outbreak among a sports team.

In general, players' primary care providers, coaches, and parents must work together to intervene early if a pediatric athlete shows sign of a communicable disease, the AAP said.
Sep 25 Pediatrics

Flu Scan for Sep 25, 2017

News brief

Swine influenza found in more Maryland fair pigs; more human cases noted

State and county health officials in Maryland are investigating influenza in 11 pigs that were recently shown at a fair in Frederick County, the second time flu has been detected at the state's county fairs in as many weeks.

In the latest developments, preliminary tests show the pigs are infected with influenza A, but officials don't know if it's a strain that can spread to people. The Maryland Department of Agriculture (MDA) has issued a quarantine order for all pigs at the Frederick County fairgrounds until 7 days after the last pig shows signs of illness signs, the agency said in a news release.

The fair took place from Sep 15 to Sep 23. So far no human illnesses have been linked to contact with the pigs, but the local media said authorities were investigating a possible illness in a child who has a flulike illness.

On Sep 20, the state health department announced that tests had presumptively identified variant H3N2 (H3N2v) in seven Maryland resident who had close contact with pigs at the Charles County Fair. In a Sep 22 update, officials said the total of presumptive positives has risen to 10.
Sep 24 MDA press release
Sep 23 Frederick News-Post
Sep 21 CIDRAP News scan "
Seven fairgoers contract H3N2v in Maryland"


H7N9 cluster analysis finds multiple but limited human-to-human spread

A closer analysis of 21 clusters of H7N9 avian flu infections in the first three waves in China's ongoing outbreak suggests that human-to-human transmission is involved in a small fraction of cases.

Researchers from China and their collaborators at the US Centers for Disease Prevention and Control (CDC) used a simple framework to gauge the likelihood of human-to-human transmission and published their findings Sep 19 in the Journal of Infectious Diseases.

The 21 clusters with 22 infected contact cases were identified by the Chinese Center for Disease Control and Prevention from March 2013 to June 2015. The team looked at detailed epidemiologic information, including timing of contact exposures to people and poultry during the incubation period. Using a framework based on exposure timing to help distinguish person-to-person transmission from a common infectious source such as poultry, they graded the likelihood of exposure as probable, possible, or unlikely.

Probable person-to-person transmission occurred in 12 clusters, was possible in 4, and unlikely in 6. Two of the probable clusters involved nosocomial transmission. The investigators found no evidence of sustained transmission among people.

The researchers said the framework they employed could be used as a standardized tool to help quickly assess future H7N9 clusters as they occur.
Sep 19 J Infect Dis abstract


FDA approves pediatric indication for IV peramivir

The US Food and Drug Administration (FDA) has approved an expanded indication for peramivir injection (Rapivab) in children ages 2 years and older with flu, the first new influenza antiviral available for kids in more than 10 years.

A press release from BioCryst, a pharmaceutical company based in Research Triangle Park, N.C., said the new FDA indication for the intravenous neuraminidase inhibitor covers uncomplicated influenza in pediatric patients age 2 and older who have had symptoms for no longer than 2 days. The agency based its approval on the interim analysis of an ongoing clinical study, which will be presented at the ID Week meeting in San Diego in early October.

John Vanchiere, MD, PhD, chief of the section of Pediatric Infectious Diseases at LSU Health Sciences Center, said in the press release that Rapivab is a great addition to antiviral agents available for fighting flu. "It will be especially helpful for patients who cannot tolerate oral medications. In addition, the long half-life allows for one-time dosing, which will improve compliance."

The FDA in December 2014 approved the drug for adult flu patients who have difficulty taking oral or inhaled antivirals.
Sep 21 BioCryst press release


More H5N1 events linked to earlier Malaysian outbreaks

The World Organization for Animal Health (OIE), based on updates from Malaysian veterinary officials, reported 25 more highly pathogenic H5N1 avian flu outbreaks that occurred back in March, part of activity that marked the country's first resurgence of the disease in nearly a decade.

All of the events occurred in Kelantan state, with start dates from Mar 8 to Mar 26. All of the events were declared as resolved on Apr 1. Most of the newly reported outbreaks involved backyard or village poultry, including chickens, ducks, Guinea fowl, geese, turkeys, and pet birds. The virus sickened 132 of 14,924 susceptible birds, and authorities culled all of the remaining ones to help limit the spread of the virus.

In March, Malaysia reported 11 H5N1 outbreaks, all in Kelantan state, which is located in the northeastern part of the country's peninsular region.
Sep 25 OIE report
Mar 8 CIDRAP News story "
Malaysia reports first H5N1 outbreak in nearly 10 years"

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