News Scan for Sep 15, 2014

Chikungunya spike
More EV-D68 cases
Additional MERS case
CDC animal-related safety breach
Poliovirus spill in Belgium

Chikungunya outbreak total tops 700,000 infections

Health officials reported another big spike in the Caribbean region's chikungunya outbreak, much of it due to updated surveillance information from the Dominican Republic, the hardest-hit country, according to the latest report from the Pan American Health Organization (PAHO). PAHO also reported a tripling of outbreak deaths, to 113.

Countries in the region reported 55,190 more cases than last week, lifting the overall total to 714,744 suspected and confirmed cases. Last week's increase is much larger than the 1,088 new cases reported the week before. An update from the Dominican Republic accounts for 37,628 of the new cases.

Some of the other countries reporting new cases include El Salvador, Panama, Guadeloupe, French Guiana, Martinique, Puerto Rico, Venezuela, and several islands in the area of the Caribbean where the outbreak began.

Though the disease isn't often fatal, the number of confirmed deaths jumped last week compared with the week before, from 37 to 113, an increase of 76. All but 3 of the deaths were in Guadeloupe and Martinique.

The number of imported cases in the region also saw a rise, increasing from 972 to 1,152. The United States has reported most of the imported cases.
Sep 12 PAHO update
Sep 8 CIDRAP News scan on last week's numbers

In a related development, Guatemala's health ministry reported its first eight chikungunya cases, according to a statement in Spanish that appears to suggest they are locally acquired cases. The ministry said it increased surveillance for the disease and instituted more vector-control efforts when the first cases were detected in neighboring El Salvador.

According to Telesur, a media outlet based in Venezuela, Guatemala's health minister said the cases were detected in the central city of Escuintla.
Sep 14 Telesur media report


Tally of confirmed EV-D68 cases tops 100

Recent reports from federal and New York health officials put the nationwide count of confirmed infections with enterovirus D68 (EV-D68), previously a relatively rare respiratory virus, well above 100.

In a Sep 12 notice, the Centers for Disease Control and Prevention (CDC) reported that its tally of confirmed cases was 97 in six states, which was 13 more cases than reported 2 days earlier. The number included cases in Colorado, Kansas, Iowa, Illinois, Missouri, and Kentucky.

The same day, the New York State Department of Health (NYSDH) reported "more than a dozen" confirmed cases in children, with tests under way in additional possible cases. Many suspected cases have been reported in a number of other states.

The virus causes fever, cold-like symptoms, and, in severe cases, wheezing and difficulty breathing, especially in children with asthma. There is no vaccine or specific treatment for the infection.

The initial clusters of cases in the current outbreak were reported in Kansas City (Mo.) and Chicago and exclusively involved children, a few of whom were sick enough to need mechanical ventilation. The latest CDC update does not specify if any adults have been infected.

The CDC has urged clinicians to watch for possible cases, although reporting of the illness is not required. The agency plans to present a teleconference for clinicians tomorrow at 2 p.m. EDT to describe the current EV-D68 situation, procedures for lab testing and reporting of cases, and prevention and treatment strategies.

In other developments, CBC News reported that EV-D68 is suspected in clusters of respiratory illnesses in children in Windsor, Ont., and Calgary, Alta.
CDC EV-D68 page with case numbers
Sep 12 NYSDH statement
Information on CDC teleconference for clinicians
CBC stories on possible cases in Ontario and Alberta
Related Sep 11 CIDRAP News item


Saudi Arabia reports new MERS case as Hajj nears

An additional case of MERS-CoV has been reported by Saudi Arabia's ministry of health (MOH) today, the latest in a small rash of cases recently from widely disparate areas of the country after a summer lull.

The patient is a 76-year-old man from Najran, which is in the far south of the country near the border with Yemen. He had unspecified preexisting disease and is in intensive care, says the update. He is not a healthcare worker and did not have exposure to animals.

Saudi Arabia has reported a total of 730 MERS-CoV (Middle East respiratory syndrome coronavirus) cases, 302 of them fatal, since June 2012. No new deaths were reported today.

Few Saudi MERS cases were reported over the summer, but news of three others has come in just the past 8 days in areas far flung from today's case. Of concern is that the Hajj, which is expected to bring more than 2 million people from all over the world to Mecca, begins in less than 3 weeks.

As part of a pre-Hajj campaign to raise public awareness of MERS, the MOH issued an advisory over the weekend to Saudis to be cautious about contact with camels, which have been found to play a role in transmission of the disease, according to an Arab News story yesterday.
Sep 15 Saudi MOH report
Sep 14 Arab News story


CDC rabies researcher banned for animal-related safety lapses

A CDC rabies researcher was banned from animal research this year after injecting non-human primates with non-rabies lyssaviruses without approval and not informing colleagues that he had done so, Bloomberg Businessweek reported today.

According to documents obtained by People for the Ethical Treatment of Animals (PETA) under a Freedom of Information Act request, Charles Rupprecht, VMD, PhD, the former chief of the CDC's Rabies Section, injected primates with West Caucasian bat virus and Lagos bat virus. He also failed to inform his staff about exposure risk involving the primates, including a possible "untreatable and fatal laboratory-acquired infection," the documents reveal.

The violations occurred sometime between 2006 and 2009, but the CDC did not learn of them until 2012, the story said.

Rupprecht, who resigned his post after the CDC banned him from animal research, denied the allegations, saying they resulted from a jealous boss, an insecure colleague, and supervisors who wanted to appear sensitive to animal welfare issues. "I'm not sure you have enough hours to deal with this crock of much ado about nothing!" he told Bloomberg.

CDC spokesperson Barbara Reynolds called Rupprecht's lab actions "horribly egregious," according to the story. "It's a horrible slippery slope if protocols are not submitted and followed," she added.

Without naming Rupprecht, the CDC quietly posted a summary of allegations against a "rabies researcher" in May 2013, the story said. The summary now has a "last reviewed" date of Jul 16 at the bottom, and says it was last updated on Sep 9 but does not specify what if anything was changed.

Rupprecht said the studies in question were conducted to determine if the rabies vaccine would protect against related lyssaviruses. He said the studies made clear that other investigators had done similar experiments "under similar conditions without any impact from a biosafety standpoint."

He said it was "ludicrous" to suppose that other staff members weren't aware that other lyssaviruses were used in the experiments, but noted that the double-blind nature of the experiments would preclude their knowing which exact viruses were involved.
Sep 15 Bloomberg Businessweek story
CDC notice on researcher


ECDC reports environmental spill of GSK poliovirus in Belgium

Concentrated live poliovirus solution was accidentally released into the environment by pharmaceutical company GSK in Belgium on Sep 2, according to a notice in this week's Communicable Disease Threats Report from the European Centre for Disease Prevention and Control (ECDC).

The 45-liter spill, caused by human error, occurred in Rixensart. According to the report, the liquid flowed directly to the Rosieres water-treatment plant and then, after treatment, into the river Lasne, which flows into the river Dyle, which in turn flows into the Escaut/Scheldt.

Belgium's High Council of Public Health (HCPH) conducted tests of water and mud at the treatment plant and in the Lasne and Dyle rivers and found no presence of polio virus. Personnel at the plant, considered to be at increased risk, were given medical assistance and polio vaccinations. Booster doses of vaccine were recommended for people having exposure to water in the river Lasne since Sep 2.

Although the HCPH believes the risk to the population is very low because of the high level of dilution of the contaminated water and the 95% polio vaccination coverage in the country, ECDC noted that populations with lower immunization rates reside in the southwestern part of the Netherlands, through which the Escaut/Scheldt runs before emptying into the North Sea.
Sep 13 ECDC report

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