News Scan for Jun 24, 2015

More Korea MERS cases
Ebola's malaria impact
Cyclospora in Texas
Cholera in South Sudan

Four more cases lift Korean MERS total to 179

South Korea's health ministry reported four more MERS-CoV infections today, boosting the total to 179, and said they have identified transmission that may have occurred outside of the hospital setting, according to media reports.

One of the patients is a 50-year-old woman who was exposed to the virus in the emergency department of Samsung Medical Center in Seoul when an unknowingly infected man from the first affected hospital spent nearly 3 days there, the Korea Times reported today. Another of the patients is a 51-year-old man who was exposed during his stay on the same ward with a MERS-CoV (Middle East respiratory syndrome coronavirus) case-patient at Konkuk University Medical Center in Seoul.

Health officials are still investigating how the two other people were infected, a 29-year-old man whose father was sick with MERS-CoV and a 54-year-old female nurse who works at a hospital in Gangwon Province where three patients with the disease were treated, according to the Times. No deaths were reported today, keeping the fatality total at 27.

In another development, health authorities reported that the first transmission outside of the hospital setting appears to involve a 75-year-old man who was in home quarantine with his wife, who was later diagnosed as having a fatal case of MERS, the Korea Herald reported today. Though the man had been hospitalized in Gyeonggi province in late May for pneumonia, health officials said he was probably exposed to the virus at home by his wife, who had cared for the man during his earlier hospitalization.

Experts from the World Health Organization (WHO) have said the identification of some cases in the community wouldn't be a worrisome development, especially with the large number of contacts under monitoring. For the first time in the past few days the number of contacts under monitoring increased today, rising by 298, to 3,103.

In its update on the outbreak yesterday, the WHO said so far all cases except for the index patient—who was exposed in the Middle East—are linked to a single transmission chain involving healthcare facilities.
Jun 24 Korea Times story
Jun 24 Korea Herald story
Jun 23 WHO update


Study: Ebola-hit regions in Guinea suffered malaria lapses

Healthcare centers in Ebola-wracked Guinea treated about 74,000 fewer malaria cases in 2014 than in previous (non-Ebola) years, leading to more malaria deaths, according to a study yesterday in The Lancet Infectious Diseases.

Researchers from the United States and Guinea sampled 60 health facilities in Ebola-affected prefectures and 60 in unaffected prefectures. In Ebola-affected regions, outpatient visits dropped by 23,103, cases involving fever declined by 20,249, and the number of patients treated with either oral or injected antimalarial drugs dropped by 22,655 and 5,219, respectively.

They determined that 48% of community health workers in Ebola-affected prefectures were actively treating malaria cases, compared with 96% in unaffected prefectures. The investigators estimated that, nationwide, 74,000 fewer malaria cases were seen in healthcare centers last year.

One problem is that early symptoms of malaria—fever, headache, and body aches—mimic Ebola, said lead author Mateusz Plucinski, PhD, MPH, from the US Centers for Disease Control and Prevention, in a Lancet news release. "Malaria is one of the main causes of fever and health facilities visits in Guinea, but our data suggest that since the start of the Ebola epidemic people with fevers have avoided clinics for fear of contracting Ebola or being sent to an Ebola treatment centre."

He added, "Untreated malaria cases lead to rising malaria death rates and more cases of fever in the community. This puts extra pressure on an already overburdened health system."

In a related Lancet Infectious Diseases commentary, Dr Franco Pagnoni, MD, and Andrea Bosman, MD, PhD, of the WHO noted that WHO guidelines for malaria prevention in Ebola-affected areas recommend malaria treatment for all patients with a fever and malaria drugs for everyone in areas heavily affected by Ebola where malaria transmission is high.

They write, "Benefits of mass drug administration include a rapid reduction in the malaria burden for a certain period, and a decrease in the incidence of febrile illnesses due to malaria." They also stress other antimalarial measures, such as use of treated bed nets.
Jun 23 Lancet Infect Dis study
Jun 23 Lancet news release
Jun 23 Lancet Infect Dis commentary


Texas officials investigating 42 Cyclospora infections

Texas authorities are investigating 42 recent Cyclospora infections, including at least 15 in the Austin area, officials from the Austin/Travis County Health and Human Services Department said in a news release yesterday.

In addition to the 15 confirmed and probable cases in Travis County, the county is assessing 11 new cases. No details were provided on the 42 cases reported within the past week to the Texas Department of State Health Services.

Cyclospora is spread by ingesting food or water contaminated with feces containing the parasite. It is generally not transmitted from person to person. Leafy greens are a common vehicle, but no food item has been identified with this outbreak.

A Texas Cyclospora outbreak last year linked to cilantro grown in Mexico involved at least 126 cases.
Jun 23 Austin/Travis County news release


South Sudan reports 170-case, 18-death cholera outbreak

South Sudan's health minister announced a cholera outbreak in Juba County involving 170 suspected cases, including 18 fatalities, the WHO's Africa regional office said in a statement yesterday.

One of the cases was confirmed Jun 1, and 18 others have been confirmed via lab testing since then. Testing for 46 other patients is pending.

"The confirmation of the cases automatically triggers the activation of a full-scale response involving all relevant sectors and partners in line with International Health Regulation (IHR 2005) requirements," said Minister of Health Dr. Riek Gai Kok.
Jun 23 WHO regional office statement

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