News Scan for Oct 30, 2014

3 new Saudi MERS cases
Polio update
Leprosy in US

Saudi Arabia confirms 3 new MERS cases plus 3 deaths

After confirming six MERS-CoV cases yesterday, Saudi Arabia's Ministry of Health (MOH) reported three more cases today in various parts of the country, as well as three deaths in previously reported case-patients.

The first case is in a 65-year-old man in Taif who is hospitalized in stable condition. He had possible contact with a patient in a healthcare setting who had MERS-CoV (Middle East respiratory syndrome coronavirus), the MOH said. Since early September more than 40% of the country's MERS cases have been in Taif, which is in the southwest near Mecca.

The second patient is a 57-year-old man in Riyadh in central Saudi Arabia. He also had possible healthcare contact with a MERS patient and is in stable condition.

The third patient is a 40-year-old female healthcare worker (HCW) in Al-Jawf in the north. She had contact with a MERS patient in a hospital or clinic and is now receiving intensive care, the MOH said.

All three patients are Saudi citizens who have underlying medical conditions, and none of them reported recent contact with animals.

The MOH also reported deaths in three previously reported MERS-CoV case-patients: 45- and 77-year-old Saudi men from Taif, and a 61-year-old female expatriate in Riyadh. None were HCWs, and all had preexisting disease.

The agency also reported today that a 73-year-old female non-HCW in Riyadh has recovered from the disease. The new report pushes the Saudi MERS case count to 789 and the fatality total to 337.
Oct 30 Saudi MOH update
Oct 29 CIDRAP News scan on previous MOH update


Afghanistan launches polio vaccination; Pakistan remains a concern

Afghanistan launched a national polio vaccination campaign this week targeting 8.9 million children under 5 years of age in all 34 of the country's provinces, according to a World Health Organization (WHO) notice today.

The new campaign, announced at a ceremony by Vice President Mohammad Sarwar Danish, marks the fourth one this year. Afghan officials called for support from the public in cooperating with campaign workers.

Eradication of polio is one of the country's top health priorities, the WHO says, although conflicts in some parts of the country have interfered with reaching children with vaccine.
Oct 30 WHO notice

Meanwhile, interruption of wild poliovirus (WPV) is within reach in Afghanistan and Nigeria, two of the countries where it remains endemic, but the situation in Pakistan is far worse this year than last, says an article today in Morbidity Mortality Weekly Report (MMWR) summarizing efforts toward polio eradication from January 2013 through August of this year.

Afghanistan, which the WHO notice says has 15 confirmed cases currently, had 14 reported cases in 2013, down from 37 in 2012, says the MMWR report. Vaccination coverage in 2013 was estimated at 71%.

Pakistan has seen a fivefold increase in polio incidence this year, with 170 cases through August, compared with just 33 in the same period last year, the MMWR update says; 87% of the cases have been in the Federally Administered Tribal Areas where repeated attacks on health workers have seriously thwarted vaccination efforts.

Importation of polio from Pakistan threatens the Middle East and Asia, said the Centers for Disease Control and Prevention in a news synopsis of this week's MMWR, and the lack of progress there could undermine global efforts to wipe out the disease completely by 2018, the stated goal of the Polio Eradication and Endgame Strategic Plan.

The CDC synopsis goes on to say, "Every year that eradication is delayed could cost the world up to 1 billion dollars."
Oct 31 MMWR article
Oct 30 CDC news synopsis


Study: Occurrence of leprosy in US means clinicians should beware

Hansen's disease (HD), also known as leprosy, continues to occur in the United States, albeit rarely, but can be stopped by early diagnosis and treatment, so clinicians should become familiar with its signs and symptoms, say the authors of a separate MMWR report today.

The researchers examined yearly reports of new HD diagnoses from the National Hansen's Disease Program from 1994 to 2011, grouping case-patients as US-born or foreign-born.

They found that over the 18-year period 2,323 new cases of HD occurred, with an average annual incidence rate of 0.45 cases per million population (confidence interval [CI], 0.43-0.47). The incidence decreased overall by 17% during the period.

The average incidence over the study period was 0.13 cases per million annually for US-born people (CI, 0.12-0.14), with that number not changing appreciably from the earlier to the later years.

In foreign-born people, the average rate was 2.81 cases per million over the entire period (CI, 2.67-2.95), with the rate starting at 3.66 in 1994-96 (CI, 3.23-4.15) and falling to 2.29 by 2009-11 (CI, 2.02-2.58).

The time from symptom onset to HD diagnosis, calculated for 2,214 cases, was less than 3 years in 74% of patients. Median delay was 1 year and mean delay 2.4 years. The median delay was significantly longer in foreign-born than in US-borne patients (P < 0.001).

HD is not contagious but is thought to be transmitted through nasal secretions. It often presents as one or more chronic anesthetic macular or maculopapular skin lesions. If left untreated, it can lead to peripheral nerve damage, with sensory and motor loss, and can eventually lead to permanent disability.
Oct 31 MMWR report

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