News Scan for Jun 26, 2015

Ebola rapid test
Asymptomatic MERS in UAE
EV-C105 and flaccid paralysis
Cholera on Hispaniola

Ebola rapid test performs well in first field test

The first field trial of a rapid, point-of-care test for Ebola infection found that it was as accurate as conventional lab methods, which in outbreak settings can take days to get a result. A research team from Harvard Medical School, Partners in Health (PIH), and Boston Children's Hospital published its findings yesterday in The Lancet.

The trial took place in Sierra Leone in February, and the group used both testing methods on 106 suspected patients in two treatment centers run by the country's health ministry and PIH. The team also compared the two tests on 284 samples in the laboratory.

The rapid test (ReEBOV Antigen Rapid Test) from Denver-based Corgenix uses a drop of the patient's blood, which is placed on a test strip. The company says the test produces a result in 15 to 25 minutes. Conventional reverse-transcriptase polymerase chain reaction (RT-PCR) tests require a test tube of blood, and samples must be taken to a lab. Turnaround for conventional tests in West Africa can take days, exposing health workers and other responders to the virus.

Clinicians have hoped for a speedier diagnostic test that would allow them to more quickly separate Ebola patients from those who have conditions with similar symptoms, such as malaria. The triage step is one of the keys to limiting the spread of Ebola. In February the US Food and Drug Administration issued an emergency use authorization for the company's rapid test.

The rapid test had 100% sensitivity and 92% specificity, yielding only a few false-positives. Also, the team found that when compared with an alternative test that isn't yet available for widespread use, both failed to detect Ebola in a subset of patients who had very low levels of the virus.
Jun 25 Lancet study
Jun 25 Lancet commentary on the study
Jun 25 Harvard Medical School press release


Family MERS cluster in UAE includes 2 without symptoms

The World Health Organization (WHO) today reported two asymptomatic MERS-CoV infections in two family members who were contacts of a man in the United Arab Emirates (UAE) who has since died from his infection.

The three people in the family cluster are expatriates who are in the UAE's Eastern region. The WHO announced the 65-year-old man's MERS-CoV (Middle East respiratory syndrome coronavirus) illness on Jun 16, noting that he was hospitalized in critical condition at that point. He had an underlying medical condition but no other known risk factors.

His two family members who tested positive for the virus and are now in negative-pressure isolation are a 46-year-old woman who has a preexisting medical condition and an 11-year-old boy. Both tested positive for MERS-CoV on Jun 18 as part of the man's illness investigation. Neither the woman nor the boy has any other known risk factors.

Researchers still haven't been able to flesh out how MERS-CoV transmits, because the source of the virus is often unclear for many patients. Experts suspect that people who have asymptomatic or mild infections might be able to spread the disease to others.
Jun 26 WHO statement
Jun 16 CIDRAP News story "MERS case confirmed in UAE, death in Saudi Arabia"


Girl with flaccid paralysis had EV-C105, Virginia researchers report

The Centers for Disease Control and Prevention (CDC) has confirmed 118 cases of acute flaccid paralysis (AFP) in US kids since last August, many attributed to enterovirus-D68 (EV-D68), but a case report yesterday in Emerging Infectious Diseases noted a different enterovirus, EV-C105, in a Virginia girl last fall.

University of Virginia School of Medicine scientists reported that the 6-year-old girl was treated at the university's children's hospital in October for acute onset of weakness in her right arm. She had been ill with a mild cough and runny nose that progressed to a low-grade fever, headache, fatigue and intermittent pain in her right ear and right armpit. After other symptoms improved, she still reported right arm pain.

Tests of nasopharyngeal swabs came back positive for EV-C105. During her most recent follow-up visit, 8 months after symptom onset, the weakness in her right arm had improved, and she back at almost full forearm strength.

The enterovirus C species includes polioviruses and 11 enterovirus serotypes previously classified as coxsackie A viruses, the authors note. EV-C105 was first detected in 2010 and has been associated with AFP before.

Referring to the AFP outbreak reported by the CDC, the authors write, "As the results from this case indicate, it is possible that other viral pathogens with neurovirulence may be contributing to the outbreak."
Jun 25 Emerg Infect Dis report
CDC page on AFP outbreak


Dominican Republic, Haiti report cholera rises

Cholera activity in the Dominican Republic and Haiti is higher this year so far compared with the same period in 2014, the Pan American Health Organization (PAHO) said in a Jun 24 update.

So far this year the Dominican Republic has registered 273 suspected cases, 10 of them fatal, representing a 76% increase over the same stretch in 2014.

Similarly, Haiti's cases have increased this year compared with 2014, PAHO said. The country has reported 16,696 suspected cases so far this year, including 140 deaths. About 80% of the people sickened by the disease have been hospitalized. The agency added that, between May and June, outbreak alerts were reported in 4 of Haiti's 10 departments.

The last case linked to Cuba was reported in January and involved an infection in a Canadian who had a history of travel to Cuba, PAHO said.
Jun 24 PAHO update

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