News Scan for Jun 06, 2014

More West Africa Ebola
Lab-linked Salmonella outbreak
Public health at World Cup
Neglected zoonotic diseases

WHO reports 20 new Ebola cases in Guinea and Sierra Leone

West Africa's Ebola virus outbreak continues to swell, with 20 new cases and 3 additional deaths, according to an update yesterday from the World Health Organization (WHO), based on new reports the agency received on Jun 2 and 3.

Eleven of the illnesses and 3 deaths were reported from Guinea, raising the country's total to 344 cases, 215 of them fatal. So far 207 of the infections are lab confirmed. All of Guinea's new cases are from already-affected areas.

Thirty-one patients are still hospitalized, and health officials are following 987 contacts, the WHO said.

Sierra Leone reported 9 new suspected cases, pushing its Ebola virus disease (EVD) total to 81, including 6 deaths. So far 31 illnesses have been confirmed by lab tests. Eleven patients are in isolation at Kenema Hospital, which specialized in treating hemorrhagic fever illnesses.

The WHO said authorities are following 30 close contacts Sierra Leone but added that community resistance is hampering the identification and follow-up. The group said it brokered a cross-border meeting among Guinea, Sierra Leone, and Liberia to discuss efforts to harmonize surveillance and social mobilization tools to address community resistance.
Jun 6 WHO update

In a related development, an editorial today in The Lancet touched on community resistance as one of the factors that continue to fuel the outbreak. Incidents have included citizens in Guinea and Sierra Leone stoning health workers investigating the outbreak and people in Sierra Leone removing family members from health facilities.

The journal said the biggest challenge for the countries' health ministries and global health partners will be improving public awareness about a disease that is new to West Africa and building trust and confidence in the medical response.
Jun 7 Lancet editorial


Lab-linked Salmonella strain sickens 41

The US Centers for Disease Control and Prevention (CDC) announced yesterday that 41 people in 13 states have been sickened since November by a Salmonella Typhimurium strain used in labs for teaching or quality control.

Public health officials have used PulseNet, the national subtyping network, to identify illnesses that have the same genetic fingerprint. The commercially available Salmonella strain is used in several college and clinical labs associated with sick patients.

Illness onsets range from Nov 1 through May 3. Ages range from younger than 1 to 87 years. The CDC said 62% of the patients were 21 years or younger. Of 28 patients with available information, 10 were hospitalized. No deaths have been reported.

Interviews with patients about their exposures found that 18 of 21 were enrolled in a biology or microbiology course and that 15 were students and 3 were employees. Many of them reported risk behaviors including not wearing gloves or lab coats, not washing their hands, and using the same writing utensils and notebooks outside of the lab setting. Several of them did not recall receiving any safety training.

An outbreak involving the same strain in 2010 and 2011 and also linked to labs sickened 109 people in 38 states.

The latest outbreak is a reminder that bacteria in lab settings can cause illnesses, even in household contacts, including young children and others who never visited the lab.

The CDC urged labs to use nonpathogenic or attenuated strains whenever possible and for lab instructors to enhance biosafety training.
Jun 5 CDC outbreak announcement


ECDC to boost public health steps for World Cup in Brazil

To enhance early disease detection and public health response, European health officials will enhance their epidemiologic intelligence surveillance when the FIFA soccer World Cup begins next week in Brazil, the European Centre for Disease Prevention and Control (ECDC) said in a risk assessment yesterday.

The agency will use using lessons learned during the 2012 Olympic Games in London and other events to guide its public health surveillance and response. "Routine epidemic intelligence activities will be enhanced by expanding the information sources monitored, using a targeted and systematic screening approach, and tailoring tools (i.e. MediSys)," the ECDC said, referring to an information scanning tool.

Europeans who travel to World Cup matches in Brazil will be most at risk of gastrointestinal illness and vector-borne infections, the ECDC said in its assessment. They should therefore practice good hygiene and protect themselves from the bites of mosquitoes and other insects.

They should also take malaria medication and be vaccinated against yellow fever if they plan to visit risk areas. In addition to being fully vaccinated according to ECDC standards and avoiding unprotected sex, travelers should receive a hepatitis A vaccine, the ECDC said.
Jun 5 ECDC risk assessment


Study calls for more focus on anthrax, brucellosis, bovine TB

The importance of three neglected zoonotic diseases (NZDs)—anthrax, brucellosis, and bovine tuberculosis—in hard-hit countries is still underrecognized in spite of the World Health Assembly's (WHA's) action to place priority on them as early as the 1950s, a study yesterday in PLoS Neglected Tropical Diseases found.

Researchers at the University of Edinburgh reviewed the resolutions of all 66 WHA meetings since the group was formed in 1948.

They found that 21 resolutions targeted at least one of eight WHO-defined NZDs, but they represented only 4% of all resolutions on infectious diseases that the WHA passed. In addition, a 2013 WHA resolution represented a new approach that targets the NZDs as co-endemic clusters in affected countries—a positive step.

"However," they write, "three major NZDs remain outside this recent resolution: anthrax, brucellosis, and bovine TB," and they call for increased priority and funding for the trio.

Lead author Susan Welburn, PhD, said in a University of Edinburgh news release today, "It is extraordinary that in the 21st century we are failing to manage brucellosis and the other neglected zoonotic diseases that impact so severely on rural communities in developing economies when, for many of these diseases, the tools to manage them are well developed."
Jun 5 PLoS Negl Trop Dis study
Jun 6 University of Edinburgh news release

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