News Scan for Nov 21, 2014

News brief

Plague outbreak in Madagascar sickens 119, kills 40

An outbreak of plague in Madagascar comprising 119 cases with 40 deaths as of Nov 16 has spread to Antananarivo, the country's capital and largest city, greatly increasing the risk of further spread, according to an alert today from the World Health Organization (WHO).

Cases have been reported in 16 districts of seven regions. Two cases, one of them fatal, have occurred in Antananarivo. A weak healthcare system there and its high population density make for conditions where more cases are likely, says the report. It adds that a high level of resistance to the insecticide deltamethrin, which is used to control fleas, the main carriers, adds to the risk.

The large majority of cases are bubonic, a form that is treatable with antibiotics if caught early, with only 2% pneumonic at this point. The latter occurs when the causal agent, Yersinia pestis, reaches the lungs. The pneumonic form is lethal and transmissible from person to person through droplets spread by coughing.

Madagascar has activated a national task force that is receiving technical and human resources support from the WHO and other organizations as well as financial support from the African Development Bank. Control measures, including provision of personal protective equipment, insecticides, and antibiotics, are being implemented.
Nov 21 WHO alert

EV-D68 count reaches 1,121, possibly related polio-like illness adds 13

Five more cases of enterovirus D68 (EV-D68) infections associated with severe respiratory illness have occurred over the past week, bringing the total since mid-August to 1,121 in 47 states and the District of Columbia, according to a weekly update yesterday from the Centers for Disease Control and Prevention (CDC).

No new deaths associated with the virus were reported this week, keeping that total at 12.

The CDC notes that decreased EV-D68-like illness is being reported by most states over the past couple of months but added that cases could continue through late fall. EV-D68 infection has been far more common this year than is typical for the rare disease; cases have occurred almost exclusively in children and are most serious in those with asthma or a history of wheezing.

In potentially related news, 13 new cases of an acute polio-like illness of unknown cause have occurred in the past week, bringing that total to 88 since August 1, according to a separate CDC update. Three more states have been added to those affected by the illness, although they are not specified in the update.

EV-D68 was found in 4 of 10 patients with the mysterious neurologic disease in the early weeks of the outbreak, so it is one possible cause being investigated.
Nov 20 CDC EV-D68 update
Nov 20 CDC paralysis investigation update

Canadian report ranks 17 countries on food safety performance

Canada and Ireland received the highest scores when evaluated with 10 food safety performance measures, according to a report issued yesterday from the Conference Board of Canada's Centre for Food.

In collaboration with the University of Guelph's Food Institute, the Conference Board ranked 17 countries based on food safety risk assessment, risk management, and communications. All countries are members of the Organisation for Economic Cooperation and Development (OECD), and measures evaluated each nation's food safety progress since 2010.

Other countries joining Canada and Ireland in the top tier of performance included France, the United Kingdom, Norway, and the United States, the report said.

Austria, Canada, France, Ireland, Japan, the United Kingdom, and the United States all showed significant improvement in reporting the incidence of Campylobacter, Salmonella, Yersinia, Escherichia coli, and Listeria. Sweden, Norway, and Germany ranked lowest in this area, suggesting a decline in pathogen reporting within the last 5 years, the report said.

The report also looked at public trust in a country's ability to prevent and respond to food safety and allergen issues. Canada and Ireland experienced an increase in public trust, while the evaluation found that public trust had declined in Australia, France, Italy, and the United States.

Evaluators used common elements of food safety systems across all 17 countries to conduct their evaluation, while noting the need for greater consensus on multinational food safety standards.
Nov 20 Conference Board of Canada report
Nov 21 Food Safety News article on the report

Flu Scan for Nov 21, 2014

News brief

Avian flu detected on 3rd Dutch farm; H5N8 confirmed on 2nd

A third poultry farm in the Netherlands has been hit with avian flu, as Dutch authorities confirmed the H5N8 strain on the second affected farm, according to two separate Reuters stories today.

H5N8 was first confirmed in the country on Nov 17, on a farm in Utrecht province. Yesterday officials reported that an H5 strain had struck a farm of 43,000 chickens in the village of Ter Aar. Further testing revealed the strain to also be H5N8, one Reuters report and a Dutch report filed with the World Organization for Animal Health (OIE) said.

That strain led to costly outbreaks in South Korea earlier this year and in Germany and Britain in recent weeks.

The third outbreak is on a 10,000-chicken farm in the northern town of Kamperveen, meaning that 3 of the nation's 12 provinces have been affected, Reuters reported in a separate story. All birds on the farm will be culled to prevent disease spread, and a 6-mile exclusion zone has been established. Officials will inspect 32 nearby farms. The strain responsible is not yet known.

A total of 203,000 chickens have been or will be destroyed in the three outbreaks, the story said. About 2,000 businesses in the Netherlands house more than 100 million chickens and produce about 10 billion eggs each year.
Nov 21 Reuters story on H5N8 confirmation
Nov 21 OIE report
Nov 21 Reuters story on third affected farm

In related news, the head of the OIE said the Netherlands is susceptible to animal outbreaks such as these, according to yet another Reuters story.

"When there is a disease in the Netherlands, which is the country in the world where the concentration of farms is the highest, be it for poultry or pigs, it hurts," said Bernard Vallat, DVM, OIE director-general. "The Netherlands are really vulnerable because of this density [of farms]."
Nov 21 Reuters story quoting Vallat

Early CDC flu data show some H3N2 mismatch

US flu activity remains at low levels, but early testing on a small number of H3N2 viruses has shown a fair amount of divergence from the strain in the vaccine, the Centers for Disease Control and Prevention (CDC) noted in its weekly update today.

The agency said that 19 (56%) of 34 H3N2 viruses from patients tested match the H3N2 component of this season's flu vaccine, while 15 showed reduced titers with antiserum produced against the vaccine strain, called A/Texas/50/2012, indicating a mismatch. Among the 15, "the majority" were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere flu vaccine.

The Swiss strain was first detected in small numbers in the United States in March "and began to circulate in greater numbers over the spring and summer," the CDC said.

Regarding flu activity, the CDC reported that the entire nation is experiencing minimal to low activity of influenza-like illness (ILI), except for Puerto Rico, which is reporting high ILI activity. Most states are reporting sporadic or local geographic spread of influenza, with a few southern states, Massachusetts, and Puerto Rico reporting regional spread.

The agency said that 9.3% of respiratory specimens tested were positive for influenza, 88% of which were influenza A. None of the 257 influenza A viruses subtyped were 2009 H1N1; they were all H3N2.

The CDC said that deaths from pneumonia and flu were below threshold levels, as were outpatient ILI visits. No new flu-related pediatric deaths were reported.
Nov 21 CDC FluView report

Study finds mammal transmission and virulence potential in H9N2

A number of H9N2 avian influenza virus subtypes have acquired mutations that allow them to transmit between and cause disease in ferrets, according to a study published yesterday in PLoS Pathogens.

Researchers at the Chinese Academy of Agricultural Sciences' Harbin Veterinary Research Institute studied receptor binding, replication, and transmission in 35 H9N2 virus strains that represent 17 genotypes. All strains were obtained from live-poultry markets in southern China between 2009 and 2013.

Six out of 9 strains were transmitted by respiratory droplets between ferrets, and 2 of these strains were highly transmissible. Infection had a variable effect on the ferrets' lungs, ranging from severe bronchopneumonia to mild lesions.

Researchers found that the H9N2 subtypes that had infected ferrets had acquired mutations that enhanced the virus' virulence and transmissibility. When mice were inoculated with H9N2, 26 strains were able to replicate and cause virulent disease.

All 35 strains preferentially bound to human-like cell receptors, and 2 strains retained their ability to bind to avian receptors, which may enhance H9N2's transmissibility. Several strains also showed evidence of a mutation that causes resistance to amantadine and rimantadine.

Although H9N2 shows low pathogenicity in poultry, the study demonstrates that the genetic variation it has accumulated in birds may have implications for potential future transmission to and between humans.
Nov 20 PLoS Pathog study