News Scan for Jun 19, 2013

Foodborne illness in poor kids
HPV vaccine data
Missed fungal infections
New cyclovirus
CDC rubella alerts
Dengue in Laos
Measles in Syria

Report suggest poorer kids face greater food safety risks

Despite data collection gaps, there is strong evidence that poorer children are at greater risk for foodborne illness, according to a Jun 17 report from the Consumer Federation of America (CFA), a nonprofit advocacy group based in Washington, DC. Kids younger than 15 account for half of all foodborne illnesses, and young children are particularly vulnerable, the report said.

However, the CFA said few studies have looked at the connection between income and illness rates. For example, some have hinted that food sold in corner groceries, common in urban areas, may not always be stored at the correct temperature, which can pose illness risks.

Another challenge could be families' understanding of safe food handling procedures. One study found a connection between food establishment inspection scores and income level.

The CFA noted that one mitigating factor might be that low-income people tend to consume more processed foods and higher-risk foods, such as undercooked eggs and meat. It urged the US Centers for Disease Control and Prevention (CDC) to consider collecting income data, if possible, when foodborne illnesses are diagnosed and reported.

The 19-page report also covered unintentional injuries and was sponsored by Underwriters Laboratories.
Jun 17 CFA press release
Jun 17 CFA report

Study finds HPV vaccine associate with drop in infections for teen girls

The first study to gauge the impact of the human papillomavirus (HPV) vaccine in girls and women before and after the vaccine was introduced in 2006 showed a significant drop in vaccine-type HPV prevalence, researchers reported today in the Journal of Infectious Diseases.

Investigators compared HPV prevalence in vaginal swabs from females ages 14 to 59 from 2003 to 2006 before the vaccine launched with swab samples obtained from 2007 to 2010. They found that the prevalence decreased 56% in girls ages 14 to 19.

CDC Director Tom Frieden, MD, MPH, said in a press release that the report shows the vaccine works well and should spur the nation to protect future generations by increasing HPV vaccination rates. He noted that the vaccine showed a significant effect, despite relatively low HPV vaccine update.

Only a one third of girls ages 13 to 17 have been fully vaccinated, the CDC said.

Lauri Markowitz, MD, a study coauthor and CDC medical epidemiologist, said in the press release that the decline was higher than expected and could also be related to herd immunity, high effectiveness with less than three doses, changes in sexual behavior, or other unmeasured factors. "The decline is encouraging, given the substantial health and economic burden of HPV-associated disease," she said.

Vaccination is designed to prevent HPV-associated cancers and is recommended for girls and boys at age 11 to 12.
Jun 19 J Infect Dis abstract
Jun 19 CDC press release

Study: Some steroid-linked fungal infections may have been missed

Some patients who received injected steroids contaminated with the fungus Exserohilum rostratum in 2012 and 2013 had fungal infections even though they did not have worsening symptoms, according to a study today in the Journal of the American Medical Association (JAMA).

The Michigan researchers who conducted the study also determined that magnetic resonance imaging (MRI) can help detect the infection.

The team examined 172 patients who had received an injection of contaminated methylprednisolone from a "highly contaminated lot" from the New England Compounding Center but had not sought medical care for adverse effects. They found that 36 patients (21%) had abnormal MRIs, 35 of whom met the CDC case definition for probable (17 patients) or confirmed (18 patients) fungal spinal or paraspinal infection. Twenty-four of them required surgical debridement, and 17 of those had laboratory evidence of fungal infections, including 5 who had no symptoms.

In addition, of 115 patients who were asked about new or worsening back or neck pain, lower extremity weakness, or radiculopathy symptoms, 35 (30%) said they had had at least one symptom.
Jun 19 JAMA abstract
Jun 19 accompanying JAMA editorial

Researchers report new cyclovirus in patients with severe brain infections

Scientists have identified a new cyclovirus in Vietnamese patients with severe brain infections but are not sure if the virus is responsible for the patients' illness, according to a study yesterday in mBio.

The virus was found in 28 (4%) of 644 patients with severe brain infections but in none of the 122 patients with non-infectious brain disorders who were tested.

Rogier van Doorn, MD, of the Wellcome Trust Vietnam Research Programme and Oxford University, said in a Wellcome Trust news release, "We don't yet know whether this virus is responsible for causing the serious brain infections we see in these patients, but finding an infectious agent like this in a normally sterile environment like the fluid around the brain is extremely important."

The researchers were not able to detect the virus—which they named CyCV-VN—in blood samples from the patients, but they were able to detect it in 8 of 188 fecal samples from healthy children.

The virus was also found in more than half of fecal samples from chickens and pigs taken from the area of one of the CyCV-VN–positive patients, which may indicate an animal source.

The researchers are trying to isolate the virus in cell culture, develop a serologic assay, and determine whether it is present outside of Vietnam, according to a separate press release from the American Society for Microbiology (ASM), the publisher of mBio.
Jun 18 mBio study
Jun 18 Wellcome Trust news release
Jun 18 ASM news release

CDC issues travel alerts for rubella in Poland, Japan

The CDC today issued two travel alerts for rubella, one for Poland and the other for Japan. The yellow-colored alert is higher than the CDC's basic travel watch but is below the warning to avoid nonessential travel.

So far this year Poland has reported more than 26,000 cases of rubella, with the highest levels in the western provinces of Malopolskie and Wielkopolskie.

As of May 29, Japan has reported 8,500 lab-confirmed cases, with illnesses increasing over the past few months and expected to continue to rise, the CDC said. That number is sharply higher than the 5,442 rubella cases in the first 4 months of the year that prompted a Jun 14 report in the CDC's Morbidity and Mortality Weekly Report (MMWR).

The highest numbers of cases have been reported from Osaka, Tokyo Metropolis, Kanagawa, and Kagoshima prefectures.

For travel to both countries the CDC recommends that people stay up to date on rubella vaccination.

Pregnant women who are not protected against rubella from vaccination or previous infection should avoid travel to the two countries during the outbreaks, especially during the first 20 weeks of pregnancy, the CDC said. 

Rubella infections during early pregnancy can cause serious problems, such as miscarriage, stillbirth, or birth defects. Measles, mumps, and rubella (MMR) vaccination is contraindicated during pregnancy.
Jun 19 CDC travel alert for Poland
Jun 19 CDC travel alert of Japan
Jun 14 CIDRAP News scan "Rubella epidemic in Japan traced to female-only vaccination efforts"


Laos joins Southeast Asian countries hit hard by dengue

Dengue virus infections have sickened 7,920 people in Laos and killed 31 so far this year, and a World Health Organization (WHO) official said the numbers may soon reach epidemic proportions, according to a report today from Bernama, Malaysia's national news agency.

Liu Yungo, the WHO representative in Laos, warned of "serious economic and social consequences," including overburdened hospitals, if the country fails to take serious actions to stop the outbreaks.

Meanwhile, dengue cases continued to rise in Singapore and Thailand, which also are experiencing bad dengue years, according to The Diplomat, a current-affairs magazine covering the Asia-Pacific region. Singapore has had 10,257 cases this year, while Thailand has had 43,609, including 50 deaths, the story said.

Because of the high dengue numbers, the Association of Southeast Asian Nations (ASEAN) designated Jun 15 as ASEAN Dengue Day to promote awareness and prevention.
Jun 19 Bernama report
Jun 19 Diplomat report 
Related Jun 11 CIDRAP News item


Measles outbreak reported in northern Syria

A measles epidemic in war-torn parts of northern Syria has sickened about 7,000 people so far, worsening the country's humanitarian crisis, Doctors Without Borders (or Medecins Sans Frontieres [MSF]) said yesterday in a press release.

A collapse of the country's medical system in 2011 has disrupted regular vaccination programs, and Syria's conflict has driven people into camps, which expose them to crowded and unsanitary conditions.

Medical teams from MSF have vaccinated 75,000 children in Aleppo, Ar-Raqqah, and Idlib provinces, but conflict in the area and fear among the people are making efforts difficult, said the group, which has five field hospitals and other medical programs in northern Syria. For example, vaccination campaigns must avoid attracting long lines of people, which could attract air strikes or rocket attacks.

The group is planning a second mass vaccination campaign with a target of reaching 10,000 to 30,000 kids younger than 15 who live in Idlib province's villages and displaced-people camps.
Jun 18 MSF press release

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