News Scan for Oct 15, 2014

Ebola in DRC
More EV-D68 cases
Jamaican chikungunya emergency
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Study: Ebola outbreak in DRC not related to West Africa epidemic

The Ebola virus responsible for an outbreak in the Democratic Republic of the Congo (DRC) that began in July bears similarities to previous outbreaks in equatorial Africa but is distinct from the virus causing the ongoing epidemic in West Africa and has a different zoonotic origin, say results of a study today in the New England Journal of Medicine.

The DRC outbreak began near the town of Boende in the Equateur province and has remained confined to that province. From Jul 26 through Oct 7, there have been a total of 69 suspected or confirmed cases, 8 of them among healthcare workers, says the study. Case numbers peaked in the second half of August and have now fallen. Forty-nine cases deaths have been reported.

The most recent Centers for Disease Control and Prevention (CDC) report on the outbreak, from Oct 9, says there have been 68 cases and 49 deaths.

The study authors say genome sequencing of samples from DRC patients revealed a local variant of Ebola Zaire as the cause. It showed 99.2% identity with the most closely related variant from a large outbreak in Kikwit, southwest of Boende, in 1995. The virus showed 96.8% identity to the strain now circulating in West Africa.

The index case was in a pregnant woman who cut up a dead monkey that her husband had discovered. She became ill and died about 2 weeks later. A doctor and three health workers who did a postmortem cesarean section on her also became ill and died. Further cases followed.

The authors speculate that among the reasons the current and past DRC Ebola outbreaks have stayed more contained than the West African outbreak is that the former have occurred in more remote areas with fewer human contacts and that the response in the DRC has been rapid, with more experience gained with each one (the DRC has had six previous Ebola outbreaks since it was first seen there in 1976).
Oct 15 N Engl J Med study
CDC Web page on DRC outbreak


US EV-D68 cases rise to 780

The CDC today confirmed 89 new cases of enterovirus D68 (EV-D68) in 46 states and the District of Columbia. The outbreak has now reached 780 cases, almost all of them in children, many of whom have asthma.

The CDC also reported that EV-D68 was detected in seven children who died, though it's unclear what role the virus played in their deaths. That number is up from five in the CDC's previous update yesterday. Health officials in New Jersey recently blamed the death of a 4-year-old boy on the pathogen.

"CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations," the agency said in the update. "CDC has prioritized testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness."

The agency also said it expects cases to decline by late fall.

In announcing the implementation of a new, faster test to detect EV-D68 yesterday, the CDC said that, as it tests specimens it has received since mid-September, "the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will not reflect changes in real time or mean that the situation is getting worse."
CDC EV-D68 outbreak page
Oct 14 CDC news release


Jamaica declares national emergency to combat chikungunya

Jamaica has declared a national emergency due to the rise in chikungunya cases over the past several weeks, the Caribbean Journal reported yesterday.

Jamaican Prime Minister Portia Simpson Miller has requested $4.5 million in national resources primarily to be used for destroying mosquito breeding areas. The Prime Minister also alluded to several members of the Jamaican parliament being out with chikungunya, the story said.

The declaration of a national emergency comes as the number of suspected chikungunya cases in the Caribbean, Americas, and Oceania approaches 760,000. On Oct 10, the Pan American Health Organization (PAHO) reported 325 suspected and 57 confirmed cases of chikungunya in Jamaica.
Oct 14 Caribbean Journal report
Oct 10 PAHO update
Oct 13 CIDRAP News scan on chikungunya case increase

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