NEWS SCAN: More cases in Cambodia, pertussis in hospital worker, solving respiratory outbreak mysteries, congenital Chagas, drive-thru immunization

Jul 6, 2012

Mystery disease cases in Cambodia climb to 74
The number of cases of an unidentified respiratory disease in Cambodian children has reached 74, 12 more than reported previously, the World Health Organization (WHO) said in a statement today. On Jul 4 the WHO reported that the disease was fatal in 61 of 62 cases. Today the agency did not list the overall death toll, but it said that 57 cases—56 of which were fatal—involved a common syndrome of fever, respiratory, and neurologic signs. Most of the case-patients were less than 3 years old and from the central and southern parts of Cambodia and were treated at Kantha Bopha Children's Hospital in Phnom Penh. "Despite all efforts, many of the children died within 24 hours of admission," the WHO said. In testing at the Institut Pasteur in Cambodia, all samples examined so far have been negative for H5N1 and other flu viruses, SARS (severe acute respiratory syndrome) virus, and Nipah virus. In a separate statement today, the European Centre for Disease Prevention and Control (ECDC) said 58 children, all under the age of 7, were hospitalized in Phnom Penh and 4 were hospitalized in Siem Reap. Out of 60 deceased patients for whom information was available, 46 died within 24 hours of hospital admission and most of the rest succumbed between 1 and 3 days after admission, the ECDC said. The Cambodian health ministry used the International Health Regulations mechanism to inform the WHO of the disease, the WHO noted.
Jul 6 WHO statement
Jul 6 ECDC statement

Staff member with pertussis stirs concern at Washington hospital
A staff member at a hospital in Everett, Wash., tested positive for pertussis this week, and hospital officials have said as many as 300 people may have been exposed to the illness, according to local media reports. The worker at Providence Regional Medical Center was sent home with a bad cough last week, and on Jul 2 he tested positive for pertussis, according to a Jul 4 report from KOMO TV News. Dr. Ahmet Tural, head of infectious diseases at the hospital, said the staffer probably had the illness for about 2 weeks before he was sent home, the report said. It said hospital officials believe at least 53 employees have been exposed to the virus, but with patients and visitors, the number could reach 300. Those who are believed to have been exposed have been put on antibiotic treatment, hospital officials said. The sick worker had been vaccinated against pertussis, but Tural noted that in 20% to 30% of cases the vaccine isn't fully effective, the story said. According to another local media report, from KING 5 News, a hospital spokeswoman said the sick worker is a nurse, but officials don't believe he came in contact with any pregnant women or infants, who are treated at a different campus of the hospital. The KOMO story noted that Washington has had nearly 3,000 pertussis cases so far this year, including about 140 in the past week.
Jul 4 KOMO story
Jul 5 KING 5 story

CDC profiles unexplained respiratory illness working group
To assist with puzzling respiratory disease outbreaks, the US Centers for Disease Control and Prevention (CDC) in 2004 formed an Unexplained Respiratory Disease Outbreak (URDO) working group of about 40 scientists. A review of the group's work from March 2007 through September 2011 found that they consulted on 57 investigations, 41 domestic and 16 international, according to a report published in today's issue of Morbidity and Mortality Weekly Report (MMWR). A cause of the outbreak was found in 29 (51%) of investigations, most commonly non–flu-related respiratory viruses, influenza, Mycoplasma pneumoniae, and pertussus. The group received notification a median of 33 days after the illness onset of the first case, which the report said could have limited the ability to collect early lab samples. Case counts ranged from 1 to 409. Of 52 investigations with available information, adults were most commonly affected, with communities and long-term care facilities the most frequent settings. In the report, URDO working group members urged healthcare providers to report outbreaks to public health officials early, and they suggested that public health officials collect clinical specimens as outbreaks evolve for possible future testing.
Jul 6 MMWR report

First confirmed US case of congenital Chagas disease reported
A boy born in Virginia in 2010 to an apparently healthy mother who had immigrated from Bolivia was determined in his second week of life to have Chagas disease. This is the first US case of congential Chagas disease confirmed by the Centers for Disease Control and Prevention (CDC), according to a case report in today's Morbidity and Mortality Weekly Report (MMWR). The boy was delivered by cesarean section at 29 weeks gestation because of fetal hydrops. Although his Apgar scores were normal, he had ascites, pleural effusion, and pericardial effusion at birth. Serologic tests for multiple diseases were negative. His clinical status improved after treatment with antibiotics. During the child's second week, the mother reported that she had been told previously that she had Chagas disease but had had no symptoms or treatment. Further tests showed that the infant was positive for Trypanosoma cruzi, the agent of Chagas disease. He was treated successfully with a 60-day course of benznidazole. Chagas disease, endemic in Mexico and Central and South America, affects 8 to 11 million persons worldwide. It is primarily transmitted by triatomine insects but can be acquired through other routes, including congenitally in 1% to 10% of infants born to infected mothers, according to MMWR. Infected persons are usually asymptomatic and unaware of their disease, although 20% to 30% eventually show signs, most commonly cardiomyopathy. It is estimated that about 300,000 people in the United States have chronic Chagas disease brought from endemic areas. The authors urge healthcare providers to be aware of the disease, particularly congenital cases, as appropriate treatment is highly effective.
Jul 6 MMWR article

Study finds good safety record for drive-through immunizations
Though fainting episodes can occur after vaccination, this doesn't appear to pose a risk for drive-through immunization programs, according to a study published recently in the Journal of Emergency Management. The researchers, in an effort to assess the risk, looked for relevant adverse events, court cases, database information, and expert communications since the University of Kentucky's program began in 1995. The authors found no adverse events linked to drive-through immunization clinics, and they calculated the risk to be 0.8% for a 2-day event giving 20,000 immunizations. Researchers suggested that warnings about fainting after immunization probably don't account for the drive-through scenario where recipients are seated and in a familiar setting. Ruth Carrico, PhD, RN, study coauthor and associate professor in the division of infectious diseases at the University of Louisville School of Medicine, asserted in a EurekAlert press release that some experts have talked about fainting risks without facts to back up the concerns. "We have created safe drive-through processes that we feel lead to safer communities," she said. "We found that a person's risk of fainting during a drive-through vaccination is less than the probability of being struck by lightning." Sometime this summer the group is planning to release a toolkit on how to develop drive-through immunization clinics.
May-Jun J Emerg Manag abstract
Jul 5 EurekAlert press release

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