News Scan for Nov 06, 2014

Saudi MERS cluster
H5N8 in Germany
Childhood pneumonia decline
CDC chikungunya alert

Hospital MERS cluster in Riyadh tied to patient from Taif

A hospital cluster of five confirmed MERS-CoV cases in Riyadh, Saudi Arabia, has been traced to a patient from Taif near Mecca, the country's Ministry of Health (MOH) said in a statement today.

The index MERS-CoV (Middle East syndrome coronavirus) patient traveled from Taif to the Dr. Sulaiman Al-Habib Hospital in Riyadh on Oct 18. Afterward, four other patients who had contact with the index patient tested positive for MERS-CoV at the hospital, including two healthcare workers. Two of those patients died, one recovered and was discharged, and one remains hospitalized at a MERS-CoV Center of Excellence, presumably the Prince Mohammed bin Abdulaziz Hospital.

The MOH did not specify the fate of the original patient from Taif, but he or she may be a hemodialysis patient, as the statement said such patients are at higher risk of developing more MERS complications. Dr. Abdullah Assiri, the country's assistant deputy minister for preventive health and liaison to the World Health Organization (WHO), said, "Hospitals should be very vigilant in monitoring these patients and isolating them when they develop any symptoms that may be attributed to an infection."

The MOH's Command & Control Center continues to work with the WHO to monitor the original cluster of cases in Taif, the statement said. Taif has reported almost half of recent Saudi MERS cases.

The MOH also said today that another MERS patient has recovered, a 54-year-old expatriate in Riyadh who is not a health worker. It's not known whether the patient is linked to the hospital cluster. The agency reported no new cases today, keeping the country at 796 MERS-CoV cases, 338 of which have been fatal.

The European Centre for Disease Prevention and Control (ECDC) said yesterday in an epidemiologic update that the global MERS total is 929 cases with 372 deaths. Its report does not include 3 cases from Saudi Arabia. The WHO's count as of Nov 3 is 897 cases, including 325 deaths.
Nov 6 MOH statement on Riyadh cluster
Nov 6 MOH case update
Nov 5 ECDC epidemiologic update


H5N8 strikes 31,000-bird turkey farm in Germany

H5N8 avian flu has infected 5,000 turkeys, killing 1,880 of them, at a farm in the northeastern German state of Mecklenburg–Western Pomerania, the first time the strain has been detected in Europe, according to a report filed today by German authorities with the World Organization for Animal Health (OIE).

The outbreak at the holding farm began Nov 4, and samples tested positive for H5N8 yesterday, the report said. Officials have begun culling the remainder of the 30,939-bird flock to prevent disease spread.

Workers will decontaminate the premises, and other control measures, like prevention of movement of turkeys, will be implemented. The source of the virus is unknown.

"We have to assume that every highly pathogenic virus can also represent a danger to humans," said Elke Reinking, spokeswoman for the German Veterinary Research Institute, in a Deutsche Presse-Agentur (DPA) story today.
Nov 6 OIE report
Nov 6 DPA story


Tennessee study: PCV13 brings major decline in childhood pneumonia

The incidence of hospitalization for pneumonia among young children has decreased by more than 70% in Tennessee since pneumococcal conjugate vaccine (PCV) was added to the schedule of routine infant immunizations in 2000, with roughly one third of that decline occurring since 2010, when an expanded form of PCV that protects against 13 pneumococcal serotypes (PCV13) was substituted for the original 7-valent form (PCV7), according to a study today in Morbidity and Mortality Weekly Report (MMWR).

Previous research found that the introduction of PCV7 resulted in a 43.2% decline nationwide in pneumonia hospitalization in infants from 2000 to 2009.

The current study authors, from Vanderbilt University and the Centers for Disease Control and Prevention (CDC), analyzed Tennessee hospital discharge data from 1998 through 2012 to compare hospitalizations/emergency department (ED) visits for pneumonia in children younger than 2 during three periods—pre-PCV (January 1998–December 1999), PCV7 (January 2001–June 2009), and PCV13 (July 2010–December 2012).

The annual rate of pneumonia hospitalization/ED visits decreased 71%, from 14.5 to 4.1 per 1,000 children, from the pre-PCV to the PCV13 years; the rate for the PCV13 period was 27% lower than that for the PCV7 period. There was a corresponding 83% decline in pneumonia hospitalizations coded as pneumococcal, the authors found.

Their results translate to about 1,300 fewer childhood hospitalizations annually since PVC was introduced.

"The decrease in pneumonia rates described in this report suggests substantial direct benefits of PCV13 use in the early years after its introduction," say the authors, adding that "the expanded coverage of six additional serotypes with PCV13 has also expanded the effectiveness of the U.S. PCV program against pneumonia."
Nov 7 MMWR study


CDC warns travelers of chikungunya outbreak

The CDC today warned US travelers that even if mosquitoes have subsided in their state, they need to be aware of the chikungunya outbreak still gripping the Caribbean and Central and South American nations and protect themselves from mosquito bites.

The outbreak, which began in December and is the first in the Americas, has caused at least 795,000 chikungunya fever cases in 37 countries and territories, and more than 1,600 cases in travelers returning to the United States have been reported as of Nov 4. That compares with an annual average of 38 before the outbreak.

Preventing mosquito bites is the best way to avoid chikungunya and other mosquito-borne illnesses, the CDC said, and the mosquitoes that spread chikungunya bite mostly during the daytime. The agency recommends using insect repellent and wearing long-sleeved shirts and long pants during the day and staying in air-conditioned or well-screened rooms at night.

Travelers more likely to have severe disease if they are infected include those older than 65 and those with arthritis or serious underlying medical conditions such as high blood pressure, heart disease, or diabetes. People in those groups should discuss their travel plans with their health care provider before leaving.

Chikungunya disease symptoms include fever, joint pain, muscle aches, headaches, joint swelling, and rash.
Nov 6 CDC news release

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