News Scan for Feb 27, 2015

News brief

Saudi Arabia reports 3 MERS cases, 3 deaths

The ongoing string of MERS-CoV cases in Saudi Arabia continued with a report of three more late yesterday, along with three more deaths, according to the Ministry of Health (MOH).

Today the MOH reported no new cases but noted two more deaths in previous cases. The latest reports raise the total cases this month to 71, with 30 deaths.

The MOH did not release any of the details it usually includes about new cases, disclosing only their locations: Riyadh, Al Khobar, and Al Jawf. The latest deaths included one in Riyadh, two in Mecca, one in Hofuf, and one in Al-Quway'iyah.

The country's total of MERS-CoV (Middle East respiratory syndrome coronavirus) cases has reached 916, with 392 deaths, 24 patients still being treated, and 500 recoveries.
Feb 26 MOH report
Feb 27 MOH report

Meanwhile, the World Health Organization (WHO) released details yesterday on four MERS cases that the MOH had reported to the agency from Feb 20 to 22.

The patients were three men and one woman in four cities: Dammam, Al Khobar, Al-Quway'iyah, and Buraydah. The woman, a 58-year-old from Buraydah, died on Feb 21; two of the men were listed in critical condition and one was stable. The man in Al-Quway'iyah, a 51-year-old, matches the description in one of the deaths reported by the MOH today.

The Buraydah woman and the man from Al Khobar had possible exposure to MERS-CoV in hospitals, as they were treated in the same ward and by the same personnel as some previous MERS patients, the WHO said. The man from Al-Quway'iyah had drunk raw camel milk before he got sick. The fourth patient had no reported exposure risks.

The WHO also said it was informed of the deaths of four previously reported MERS patients. The agency's MERS case count has reached 1,030, with at least 381 deaths.
Feb 26 WHO statement

New bornavirus suspected in deaths of German squirrel breeders

Researchers say a newly discovered bornavirus may have been the cause of fatal encephalitis in three German men who bred exotic squirrels, the European Centre for Disease Prevention and Control (ECDC) reported today.

The three men, between the ages of 62 and 72, bred variegated squirrels, which are native to Central America and are sometimes used as pets, the ECDC said in a rapid risk assessment. The men, who knew each other but did not live close together, all died recently after illnesses that included confusion, psychomotor impairment, and ocular paresis (partial paralysis).

Veterinary investigators did a genetic analysis of tissue from a squirrel that belonged to one of the men and discovered sequences of a new type of bornavirus, a genus that can infect many species of mammals and birds, the ECDC reported. Analysis of brain tissue from the three deceased men subsequently revealed the same virus, which "is clearly different from all currently known bornaviruses."

The available evidence suggests that the virus passed from the squirrels to the men, but there is no proof yet of a direct causal relationship between the viral material in the brain and the encephalitis cases, the report said.

Additional testing of variegated squirrels from one breeder and a zoo did not detect the virus, but further investigations are under way. The role of the virus in the three cases and the identification of the virus's natural hosts, reservoirs, and transmission route all require additional research, the ECDC said.

The agency said any risk to the general population appears to be very low, but squirrel breeders and owners of pet squirrels could have an increased risk. Until the investigation is finished, the statement warned, people should avoid feeding or having director contact with variegated squirrels.
Feb 27 ECDC statement
Feb 27 ECDC rapid risk assessment

European report notes high resistance in Salmonella, Campylobacter

Multi-drug resistant isolates of Salmonella continue to spread across Europe, and some nations have reported ciprofloxacin resistance in Campylobacter isolates from both humans and animals, according to a report released yesterday by the European Food Safety Authority (EFSA) and the ECDC.

The report, based on 2013 data, reflects for the first time, the EFSA's and ECDC's use of similar criteria to interpret data, which eases comparisons among isolates from humans, animals, and foods, according to an EFSA news release.

The report found multidrug resistance levels to be 73.0% in turkeys, 56.0% in broilers, 37.9% in fattening pigs, and 31.8% in humans. Researchers also expressed concern over the continued spread of particularly multidrug-resistant clones in human, broiler, pig, and cattle isolates.

More than half of both human and broiler Campylobacter jejuni isolates (54.6% and 54.5%, respectively) were resistant to ciprofloxacin, and the level was 35.8% in cattle. Two thirds of human and broiler Campylobacter coli isolates (66.6% and 68.8%, respectively) were resistant, compared with 31.1% of pig isolates.

"The high levels of resistance to fluoroquinolones observed in Campylobacter isolates from both humans and broilers are of concern considering that a large proportion of human Campylobacter infections come from handling, preparation and consumption of broiler meat," said Mike Catchpole, PhD, chief scientist at ECDC. "Such high resistance levels reduce the effective treatment options for severe human Campylobacter infections."

The report also includes data on resistance in Escherichia coli, enterococci, and methicillin-resistant Staphylococcus aureus in animals and food.
Feb 26 EFSA/ECDC abstract and link to full report
Feb 26 EFSA press release

Study identifies Marburg antibody binding site

US researchers have determined that antibodies to Marburg virus (MARV), a close relative of Ebola, bind to the virus's glycoprotein (GP) as well as to Ebola virus glycoprotein, according to a study yesterday in Cell.

The study shows that the human immune system can effectively fight MARV infections by producing antibodies and shows how these antibodies inactivate the virus, according to a news release yesterday from the University of Texas Medical Branch at Galveston (UTMB). The findings could one day help researchers develop antibody-based treatments against both MARV and Ebola viruses, the release says.

The researchers isolated a panel of neutralizing antibodies from a Marburg survivor that bind to the virus's GP and compete for binding to a single antigenic site, which could inhibit infection. This appeared to be the same spot thought to interact with human cells targeted by the virus during the initial phase of infection, according to the release.

The authors conclude, "The data suggest that MARV-neutralizing antibodies inhibit virus by binding to infectious virions at the exposed MARV receptor-binding site, revealing a mechanism of filovirus inhibition."
Feb 26 Cell abstract
Feb 26 UTMB news release

Flu Scan for Feb 27, 2015

News brief

US flu activity continues slow fade as season lingers

Nearly all measures of seasonal flu circulation in the United States continued their slow decline last week, but they stayed above baseline levels, making the season officially longer than average, the Centers for Disease Control and Prevention (CDC) said today.

Thirteen weeks has been the average span of flu seasons over the past 13 years, and last week marked this season's 14th week, the CDC noted.

Outpatient medical visits for influenza-like illness (ILI) dropped to 3.0% of all visits last week, down from 3.2% the week before, but that level remained well above the national baseline of 2.0%, the CDC reported. Twelve states reported high ILI activity, one less than a week earlier.

Geographically widespread flu circulation was reported by 20 states, down sharply from 30 states the week before. The share of respiratory samples that tested positive for flu was down to 12.1% from 13.0% a week earlier, the CDC said.

The fraction of deaths attributed to pneumonia and flu was 7.4% last week, compared with 8.4% a week earlier, but it still hovered above the epidemic threshold of 7.2%.

The cumulative rate of flu-related hospitalizations continued to climb, reaching 51.7 per 100,000 population last week. For elderly people the hospitalization rate pushed further into record territory, reaching 258.0 per 100,000, far above the previous record of 183.0 in the 2012-13 season.

Six more flu-related deaths in children were reported, bringing the season total to 92, the CDC said. Three deaths were linked to influenza A/H3N2 viruses, one involved an influenza B virus, and the other two involved type A viruses that were not subtyped.

H3N2 viruses have been heavily dominant this season, but type B is staging a late-season surge, which is not unusual. Last week type B viruses accounted for 30.9% of specimens that were typed. For the season overall, only 6.9% of tested isolates have been type B.
Feb 27 CDC FluView summary
Feb 27 FluView report

Two elderly men latest H7N9 cases in China

Two more cases of H7N9 avian influenza have been diagnosed in China's Guangdong province, according to a press release yesterday from Hong Kong's Centre for Health Protection (CHP) and the machine translation of a report from the Ministry of Health and Family Planning Commission posted today by FluTrackers, an infectious disease news message board.

The first case-patient is a 78-year-old man from the city of Zhaoqing who was hospitalized in serious condition. No other details are provided.

The second is an 80-year-old man from the city of Shantou. He had preexisting medical disease including high blood pressure and heart failure and was hospitalized in critical condition.

These cases bring the total since 2013 to 616, according to a case listing maintained by FluTrackers. Guangdong province has seen more cases of H7N9 flu than any other, with Zhejiang province running a close second and 14 others reporting cases as well.
Feb 26 CHP press release
Feb 27 FluTrackers post
FluTrackers case listing

CDC says human risk from H5 outbreaks in birds is low

The CDC yesterday noted the recent detections of H5 highly pathogenic avian influenza (HPAI) in domestic and wild birds in western states but said the disease risk to people is low.

Since H5 was first detected in Washington state in December 2014, HPAI H5N2, H5N8, and a new H5N1 reassortant have been identified in California, Idaho, Oregon, Utah, Washington, and Nevada, the CDC said.

The agency added, however, "The risk to people from these HPAI H5 infections in U.S. birds and poultry is believed to be low at this time because these viruses do not normally infect humans easily, and even if a person is infected, the viruses do not spread easily to other people."

The CDC said it is coordinating efforts with state health departments to ensure that human health measures are in place "and is working with animal health colleagues to evaluate and minimize public health risk."

The agency concluded, "Because avian influenza A viruses have the potential to change and gain the ability to spread easily among people, monitoring for human infection and person-to-person transmission is extremely important for public health."
Feb 26 CDC statement

Evidence of H5N1 antibodies low in poultry workers: study

The level of antibodies to H5N1 avian flu in poultry workers in Bangladesh is low, according to a seroprevalence study today in Emerging Infectious Diseases.

Researchers from the CDC and Bangladesh analyzed blood samples from 404 Bangladeshi workers in live-poultry markets in which both hand washing after poultry handling and use of personal protective equipment were low. Nine of the workers (2%) were seropositive at baseline.

Of the 284 workers who completed the study and were seronegative at baseline, 6 (2%) seroconverted, for a rate of seven cases per 100 poultry worker–years. The team also determined that workers who frequently fed poultry, cleaned feces from pens, cleaned food or water containers, and did not wash hands after touching sick poultry had a 7.6 times higher risk of infection compared with workers who infrequently engaged in these behaviors.

The authors conclude, "The risk behaviors identified in our study may help public health officials explore interventions to interrupt poultry-to-human transmission of H5N1 virus and other avian influenza A viruses among the poultry workers."
Feb 27 Emerg Infect Dis study