News Scan for May 21, 2015

Details on new rabies variant
Ebola clinical symptoms
Global polio progress
Peanut butter Salmonella settlement

CDC expert: Novel New Mexico rabies strain is related to existing viruses

The novel rabies virus (RABV) variant identified this week in a rabid fox that attacked a woman in New Mexico is a close relative of well-established strains of RABV in Western Hemisphere tree bats found in the United States, a Centers for Disease Control and Prevention (CDC) scientist told CIDRAP News today.

Andres Velasco-Villa, PhD, of the CDC's Pox Rabies Branch, said the New Mexico variant, from a gray fox, "seems to be a close relative of well-established RABV variants circulating independently in different species of tree bats, such as Lasiurus cinereus, Lasiurus borealis, and Lasionycteris noctivagans, just to mention a few species."

In responding via e-mail to queries about the case, which was reported by the New Mexico Department of Health on May 19, he emphasized, "This is not a new species of lyssavirus; it is just a novel RABV variant."

Velasco-Villa said the results were determined about 3 weeks ago, and since then CDC researchers have been confirming the findings and coordinating with their colleagues in New Mexico.

"At this point," he added, "with only one isolate in our hands, it is difficult to conclude whether this rabies virus is just a dead-end spillover rabies event in this gray fox coming from a novel RABV well established in a previously unrecognized bat rabies reservoir host . . . or alternatively this RABV virus already host-shifted from bats to gray foxes and now has become established in the gray fox population of the region as an emerging rabies enzootic."

He said US researchers have noted multiple rabies outbreaks in gray foxes caused by separate introductions from bats in Oregon and Arizona, adding that scientists are concerned these viruses will shift to carnivore hosts like foxes. He added that there have been other instances of rabid gray foxes transmitting bat-related rabies to people.

Velasco-Villa said his group is conducting investigations of rabies cases in gray foxes and bats from New Mexico to see if the new RABV variant had already existed in foxes or bats and to find the primary host species if the virus is still circulating in bats.
May 20 CIDRAP News scan on New Mexico finding


Chinese team finds differences in symptoms in fatal Ebola cases

Fever isn't always present as an early Ebola symptom, and getting treatment early in the disease course can improve survival, according to a report yesterday from a Chinese medical team that treated Ebola patients at a hospital in Sierra Leone.

The team worked at the Freetown China–Sierra Leone Friendship Hospital, and they based their findings on lab-confirmed patients admitted between Oct 1 and Nov 14. They published their observations in Clinical Infectious Diseases.

Of the 61 patients studied, 42 (68.9%) died from their infections. Eleven (18%) of the people didn't have a fever when they presented at the clinic.

Fatal case-patients were more likely to be older than 30, and they found survival was better for those who had sought medical care faster after symptom onset. Clinical features that they saw more often in fatal infections included weakness, extreme fatigue, vomiting, diarrhea, mental symptoms, bleeding, and loss of appetite. Those findings varied from earlier reports that linked weakness, dizziness, and diarrhea to fatal outcomes.

They noted that the interval between symptom onset and clinic presentation was relatively longer for those over 30 years old, which might partly explain why that group had worse outcomes. The team added that bleeding was less common than reported for other Ebola outbreaks, but, as in other studies, gastrointestinal symptoms and fatigue were the most common symptoms.

They concluded that symptoms can be nonspecific and don't always involve fever, which may lead to treatment delays and that early intervention can significantly improve prognosis.
May 20 Clin Infect Dis abstract


Global polio efforts progressed in 2014, but tough challenges remain

After suffering setbacks in 2013, the global polio eradication drive made "encouraging progress" in 2014, but further progress hinges largely on overcoming barriers to reaching populations in dangerous regions, according to a CDC report today.

A total of 359 wild poliovirus (WPV) cases were identified in 2014, including 306 (85%) in Pakistan, 28 (8%) in Afghanistan, and 6 (2%) in Nigeria, the three countries where polio is still endemic, says the article in Morbidity and Mortality Weekly Report (MMWR). The numbers marked increases over 2013 for Afghanistan and Pakistan, but Nigeria's total was far below the previous year's. Polio workers in Pakistan have often been attacked by militants in recent years.

The other 19 cases in 2014 resulted from importation of polio into previously polio-free countries in Central Africa (Equatorial Guinea and Cameroon), the Horn of Africa (Somalia and Ethiopia), and the Middle East (Iraq and Syria). That number was down 93% from 2013, when there were 256 imported cases in five previously polio-free countries.

In the first 3 months of this year, 23 WPV cases were reported globally, all in Pakistan and Afghanistan, compared with 65 cases for the same months last year, the report says. Also, no cases have been reported so far this year in countries where polio is not endemic.

To build on the gains made in 2014 will require "innovative strategies to access populations during SIAs [supplemental immunization activities] in areas with complex security and political challenges, improve AFP [acute flaccid paralysis] surveillance, and strengthen routine immunization," the report states.

It concludes, "With the progress achieved in 2014 to interrupt endemic WPV transmission in Nigeria and polio outbreaks in Africa and the Middle East, permanent interruption of global poliovirus transmission appears possible in the near future, provided that similar progress can be made in Afghanistan and Pakistan."
May 22 MMWR article


ConAgra pays $11.2 million in 2007 peanut butter Salmonella settlement

ConAgra yesterday agreed to pay $11.2 million to settle federal charges related to Peter Pan peanut butter it shipped that was tainted with Salmonella, which led to a 2007 outbreak and recall, the Associated Press (AP) reported yesterday.

The outbreak sickened more than 400 people in 44 states and involved the Salmonella Tennessee subtype. The illnesses were linked to consuming Peter Pan or Great Value peanut butter produced at a single facility in Georgia.

According to the settlement, the company agreed to pay $8 million in criminal fines, which the Justice Department said is the highest such fine in a food investigation. The other $3.2 million reflects forfeitures to the government.

Al Bolles, ConAgra's chief technical and operations officer, said in a company statement yesterday that ConAgra did not and will not knowingly ship a product that is not safe for consumers. He said the company has heavily invested in leading-edge food safety technology and practices in the 8 years after the outbreak.
May 20 AP story
CDC Salmonella outbreak background
May 20 ConAgra press release

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