News Scan for Feb 19, 2014

H5N1 case in Cambodia
Vaccinating without a cold chain
Zoonotic, foodborne agents in Europe
More polio funding

Cambodia confirms 3rd H5N1 case this year

A case of H5N1 avian flu has been confirmed in a 4-year-old Cambodian boy, bringing to three that country's cases so far this year, according to a joint press release today from Cambodia's Ministry of Health (MOH) and the World Health Organization (WHO).

The boy, from Kratie province in the northeast, played with and carried dead chickens 6 days before symptoms developed. He was hospitalized with mild symptoms—fever, runny nose, vomiting, sore throat, and cough—and given oseltamivir (Tamiflu). He is now in good condition, according to the statement.

About 350 chickens, ducks, and geese became ill and started dying in the area in January. H5N1 was not confirmed in the birds, the statement says.

The total count of H5N1 cases in Cambodia since 2005 is 50, with 34 deaths, says the statement, and 38 of the cases have been in children younger than 14 years. A nationwide public health educational radio campaign began in late January, and special efforts are ongoing in the locality where the latest case occurred.

Minister of Health Mam Bunheng said H5N1 remains a serious health threat in Cambodia, particularly for children. "I urge parents and guardians to keep children away from sick or dead poultry and . . . also make sure children thoroughly wash their hands with soap and water before eating and after any contact with poultry," he said.
Feb 19 MOH/WHO press release

Meningitis vaccination drive in Africa succeeded without refrigeration

A meningitis vaccination campaign in Africa in 2012 succeeded despite the use of a vaccine that was not refrigerated, a feat that may open the way for new immunization strategies in developing countries, according to a study published yesterday in Vaccine.

The need to keep vaccines in a "cold chain" is a major obstacle to achieving broad immunization coverage and affects the choice of vaccination strategies, especially in developing countries, the report notes.

The vaccination drive, conducted in Benin, involved the meningococcal A conjugate vaccine MenAfriVac, made in India. In 2012 the Indian government approved a label change allowing a "controlled temperature chain" (CTC) for the vaccine, which stipulated it could be left unrefrigerated for up to 4 days at up to 40°C (102.2°F).

The immunization campaign targeted Benin's Banikoara district, with a population of about 147,000. Heat-sensitive stickers were used to monitor vaccine temperatures.

The drive achieved vaccine coverage of 106%, the report says. Only 9 of about 15,000 vaccine vials were discarded because they passed the 4-day CTC limit, and none were discarded for getting too warm. No meningitis A cases were reported in Benin in 2013, and follow-up monitoring indicated the CTC approach was safe, according to a press release from the Meningitis Vaccine Project.

Nearly all vaccinators and supervisors liked the CTC approach, saying it enabled them to vaccinate more people and eliminated the need to return to health centers every night.

The study involved a collaboration of the WHO, the global health nonprofit PATH, and the Benin government.

"Finding solutions to reducing the cost and logistical challenges of reaching people living in remote areas would remove a major constraint to achieving universal coverage with vaccines beyond MenAfriVac," Michel Zaffran, coordinator of the WHO's Expanded Programme on Immunization, said in the press release. He said a similar approach is being explored with the manufacturers of other vaccines, such as those for yellow fever and cholera.
Feb 18 Vaccine report
Feb 18 Meningitis Vaccine Project press release


ECDC: Campylobacter tops zoonotic, foodborne outbreaks

Campylobacter is the leading culprit by far in zoonotic and foodborne outbreaks in Europe, but it is declining slightly, the European Centre for Disease Prevention and Control (ECDC) said in a report today. The agency also noted that Salmonella infections are also down slightly, while listeriosis is up.

Europe saw 214,268 confirmed cases of Campylobacter in 2012, the ECDC said in the annual report on such diseases, which was co-authored by the European Food Safety Authority (EFSA). Salmonella was a distant second, at 91,034, and verocytotoxigenic Escherichia coli was third, with 5,671 cases.

The most common food vehicle for disease was eggs and egg products, the report said.

Campylobacteriosis cases fell 4.3% compared with 2011, and salmonellosis was down 4.7%. Listeriosis, by contrast, was up 10.5%, to 1,642 cases in 2012. Listeria was also the fourth on the list of disease pathogens, but it caused the most deaths by a large margin, 198. The second-leading cause of death was Salmonella, at 61.

Also, the listeriosis death toll was the highest it's been in Europe since 2006, according to the report. And Listeria was associated with the highest hospitalization rate of the nine pathogens studied, at 91.6%.

Over the past 5 years, Campylobacter cases are up 12%, Salmonella cases are down 32%, and Listeria cases are up 13%.

In a report on US foodborne outbreaks released by the Centers for Disease Control and Prevention (CDC) last July, norovirus (43%) topped the list of most common causes, followed by Salmonella (18%). The most deaths were linked to Salmonella, followed by Listeria and Shiga toxin–producing E coli, but the CDC report focused exclusively on foodborne disease.
Feb 19 ECDC landing page for the report
Feb 19 ECDC/EFSA full report
Feb 19 ECDC/EFSA news release on the report
Jul 1, 2013, CIDRAP News story on CDC report


Rotary donates $36 million to help fight polio

Rotary International has donated $36 million to the Global Polio Eradication Initiative (GPEI), the organization said in a press release yesterday. GPEI aims to end the debilitating disease globally by 2018, the release said.

Funds from the philanthropic group of businesspeople include $6.8 million for Afghanistan, $7.7 million for Nigeria, and $926,000 for Pakistan—the world's three polio-endemic countries. Also, the United Nations Children's Fund (UNICEF) will use a grant of $2.73 million to bolster vaccination activities throughout the Horn of Africa to address an outbreak that began in 2013 from an imported virus from Nigeria and has now caused more than 200 cases in children.

Last summer, Rotary International said at that point it had raised $1.2 billion to fight polio.
Feb 18 Rotary press release
Jun 26, 2013, CIDRAP News scan on Rotary giving

In related news, a study in the February issue of The Lancet Global Health found that, in spite of high refusal rates, low immunization awareness, and continued polio transmission in Nigeria at the end of 2012, overall population immunity to the poliovirus had improved. The study was funded by the Bill & Melinda Gates Foundation and the Royal Society.
February Lancet Global Health study

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