News Scan for Oct 10, 2014

Marburg confirmed in Uganda
Novel poxvirus in US
$50 million for Haiti

Case of Marburg confirmed in Ugandan health worker

Confirmation has been received that a healthcare worker in Uganda who became ill Sep11 and died Sep 28 had Marburg virus, a relative of the Ebola virus causing havoc in several West African countries. The last Marburg outbreak in Uganda, affecting 20 people and killing 9 of them, was in 2012, according to a notice from the World Health Organization (WHO) today.

The confirmed case was in a healthcare worker in Kampala. He had no history of travel beyond his immediate area, no contact with anyone with a similar illness, and no recent exposure to bats, nor had he eaten any bush meat, all of which could be risk factors.

Health authorities have identified and are monitoring 146 so far, according to the WHO. Several have shown symptoms that could indicate Marburg, but the disease has not yet been confirmed in any of them.

Ugandan officials, supported by WHO, Doctors Without Borders, and the US Centers for Disease Control and Prevention (CDC), are investigating and instituting early responses such as training health workers on infection control practices, distributing personal protective equipment, and performing a risk assessment.
Oct 10 WHO alert
CIDRAP overview of viral hemorrhagic fever


US researchers report 2 cases of novel poxvirus infection

Researchers reported yesterday infections with a new poxvirus in two patients from Tennessee and Missouri who had contact with horses and donkeys.

Writing in Clinical Infectious Diseases, investigators from the CDC and Tennessee said the first patient was a 17-year-old girl from eastern Tennessee who in late 2012 developed itchy, painful lesions on her face and temple that did not respond to antibiotics. Physicians suspected a poxvirus and sent samples to the CDC.

The lesions were eventually excised or treated with cryotherapy.

The girl owned and cared for horses, but none had mucous membrane or skin lesions. She was taking immonsuppressive drugs following heart-transplant surgery 5 years earlier.

The second patient was a 28-year-old woman from western Missouri who had traveled to Tanzania on a mission trip and cared for donkeys there. In March 2013 she sustained a rope burn on her hand and shortly afterward retrieved a donkey from a water hole and submerged her hands in murky water. She also noted that some of the donkeys she cared for had wounds on their withers and legs.

After returning to the United States she developed a papule in the area of the rope burn that later progressed to a nodule. A dermatologist excised the legion and sent samples to the CDC. The woman owned a cat, dog, and horse, but none of them had visible lesions.

The researchers wrote, "Specimens from both human cases revealed a novel poxvirus. The agent shares 88% similarity to viruses in the Parapoxvirus genus and 78% to those in the Molluscipoxvirus genus but is sufficiently divergent to resist classification as either."

All animal and environmental samples from the patients' residences tested negative for poxvirus. The authors say the source is likely zoonotic in both cases. Both patients recovered completely.
Oct 9 Clin Infect Dis abstract


World Bank pledges $50 million to fight cholera in Haiti

Safer water and improved sanitation in Haiti are issues being supported by the World Bank Group (WBG) to the tune of a new $50 million pledge announced by the group just before the start of an international conference yesterday in Washington, DC, according to a WBG press release.

The institution's pledge will support a project intended to reach 2 million people in areas of rural Haiti considered to be hot spots for cholera, which is spread through contaminated water.

The conference, titled "Haiti: Clean Water, Improved Sanitation, Better Health," was convened by the WBG with the United Nations and was chaired by WBG President Jim Yong Kim and United Nations (UN) Secretary General Ban Ki-moon.

Estimates from the WBG and Haiti's Department of Health and National Department for Water and Sanitation put the need at $310 million over the next 3 years for preventing cholera in high-risk areas of Haiti.

"We cannot ignore this opportunity to prevent thousands more Haitian children from dying from waterborne diseases," said Kim.

Cholera began to run rampant in Haiti in the fall of 2010 after a devastating earthquake caused widespread destruction in January of that year. More than 700,000 cases with nearly 8,000 deaths have occurred. The current rate of illness is about 1,000 cases per month, and the fatality rate has dropped to 0.4%, according to the release.

The cholera epidemic is believed by some to have stemmed from water contamination from a camp set up by UN peacekeepers who arrived from Nepal after the earthquake.
Oct 9 WBG press release
Oct 9 conference paper

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