News Scan for Jun 30, 2015

MERS death
Vaccine exemption law
Pleas for better lab safety
Global sanitation failures
More H5N1 in Ghana
Maternal HIV, syphilis

South Korea sees MERS lull, reports one more death

For the third day in a row South Korea reported no new MERS-CoV cases, but its health ministry today reported one more death, involving an 81-year-old woman who had a stoke before she was diagnosed, the Korea Times reported today. The woman was exposed to the virus while at Samsung Medical Center in Seoul.

Her death from MERS-CoV (Middle East respiratory syndrome coronavirus) pushes the fatality number to 33, with the illness total remaining at 182.

The health ministry said today that 2,638 possible contacts are still under monitoring, 44 fewer than the day before, according to the report.
Jun 30 Korea Times story

Meanwhile, two infectious disease experts from Hong Kong said that although South Korea's outbreak remains a challenge to health officials, it provides an opportunity to address some of the unanswered questions about MERS-CoV.

David Hui, MD, with Chinese University of Hong Kong and Malik Peiris, DPhil, with the University of Hong Kong, published their analysis of the outbreak events yesterday in the American Journal of Respiratory and Critical Care Medicine.

They wrote that South Korea's outbreak gives experts the chance to explore the mode of virus transmission, risk factors in health settings, pathogenesis, prognosis factors, viral infectivity kinetics, serological response, and optimal treatment, including the possible roles for convalescent serum and monoclonal antibodies.
Jun 29 Am J Respir Crit Care Med abstract

In research developments, a team from the University of Maryland and Regeneron Pharmaceuticals yesterday described two potential treatments for one day preventing and treating MERS-CoV, according to a study in the Proceedings of the National Academies of Sciences (PNAS). They reported that the two drugs are the first to show early promise in animal models.

The two antibodies, REGN3051 and REGN3058, demonstrated the ability to neutralize the virus. Researchers described the development of a humanized mouse model for MERS-CoV infection to test the therapies, as mice aren't usually susceptible to the virus. They reported that the model rapidly generated fully human antibodies against MERS-CoV.
Jun 29 PNAS abstract
Jun 29 University of Maryland press release


California ends philosophical exemptions for childhood vaccines

California Gov. Jerry Brown today signed legislation that bars parents from using their personal beliefs as grounds for exempting their children from school vaccination requirements.

Under the law, parents who don't want their children immunized can seek a medical exemption or else school them at home, according to an Associated Press (AP) story yesterday. "Otherwise, school-age children who currently claim a personal belief exemption will need to get fully vaccinated by kindergarten and seventh grade, the state's two vaccine checkpoints."

The legislation applies to public and private schools and day care facilities. It still allows exemptions on medical grounds attested by a doctor.

The bill, passed by the California Senate just yesterday, was prompted by the Disneyland-linked measles outbreak that started last December and caused at least 147 cases in the United States and Mexico, NBC News reported.

"The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases," Brown said in his signing statement. "While it's true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community."

The new law transforms California from one of the most lenient to one of the strictest states on immunization exemptions for schoolchildren, NBC News said. The only states that have equally strict vaccination requirements are Mississippi and West Virginia, the AP reported.
Jun 29 AP story
Jun 30 NBC News story
Gov. Jerry Brown's Jun 30 statement


US leaders call for action as labs sent live anthrax number 78

US senators and public health experts demanded better transparency and oversight in the wake of a USA Today investigation that uncovered widespread safety lapses and secrecy surrounding federal labs, as the number of US labs that have received live Bacillus anthracis grew to 78.

The probe uncovered hundreds of lab accidents and "near-miss" incidents that occurred in recent years in high-containment labs that work with dangerous pathogens. The investigation also found that oversight of labs is spotty and consequences for even serious safety violations are light.

The "lack of transparency and significant variability in how safety lapses are reported and reprimanded across all levels of government is very concerning," said Sen. Ron Johnson, R-Wis., chair of the Senate Committee on Homeland Security and Governmental Affairs, according to a USA Today story yesterday.

Gregory Koblentz, PhD, deputy director of the biodefense graduate program at George Mason University, added, "We really need to have a nationwide, centralized biosafety oversight system."
Jun 29 USA Today story

Meanwhile, the number of commercial companies, academic institutions, and federal labs that have received live samples of B anthracis—which causes anthrax—has grown to 78, the Department of Defense (DoD) reported yesterday. That number rose from 74 about 2 weeks ago.

The labs are in 20 states and the District of Columbia. In addition, labs in Japan, the United Kingdom, South Korea, Australia, and Canada received live samples from the Dugway Proving Ground's Life Science Test Facility in Utah after insufficient methods were used to inactivate the bacteria.

The DoD also said that 31 lab personnel are receiving post-exposure drugs as a precaution against anthrax, 23 of whom work for the DoD.
Latest DoD information on the incidents
Most recent (Jun 19) related CIDRAP News scan


UN report notes drinking water gains, sanitation failures

Lack of adequate sanitation continues to plague much of the world, with 2.4 billion people still without sanitation facilities, a fact that threatens to undermine health gains from better access to safe drinking water, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) said today in a report.

The Joint Monitoring Programme report, "Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment," compares access to drinking water and sanitation with the Millennium Development Goals (MDGs). It notes that globally 1 in 3 people, or 2.4 billion, are still without sanitation facilities—including 946 million people who defecate in the open.

"What the data really show is the need to focus on inequalities as the only way to achieve sustainable progress," said Sanjay Wijesekera, head of UNICEF's global water, sanitation and hygiene programs, in a WHO news release. "If we are to reach universal access to sanitation by 2030, we need to ensure the poorest start making progress right away."

Access to improved drinking water sources has been a major achievement, the WHO said. With some 2.6 billion people having gained access since 1990, 91% of the global population now has improved drinking water. This has led to substantial gains in child survival, with fewer than 1,000 children under 5 years dying each day from diarrhea caused by inadequate water, compared with more than 2,000 just 15 years ago, the agency said.

Progress on sanitation, however, has been hampered by inadequate investments in behavior-change campaigns, lack of affordable products for the poor, and social norms that accept or even encourage open defecation, the report said. Although some 2.1 billion people have gained access to improved sanitation since 1990, the world has missed the MDG target by nearly 700 million people. Only 68% of the world's population uses improved sanitation, well below the MDG target of 77%.
Jun 30 WHO/UNICEF report
Jun 30 WHO/UNICEF news release


Ghana reports H5N1 in flock of 1,900 hens

Ghanaian officials this week reported the nation's 10th outbreak of H5N1 avian flu this month, involving a flock of 1,948 laying hens, according to a report posted by the World Organization of Animal Health (OIE).

The latest outbreak, which began in mid-April and was confirmed on May 12, affected a farm in Ashanti region in the south-central part of Ghana. The other nine outbreaks were in Greater Accra or Volta regions farther to the southeast.

The disease killed 1,302 of the 1,948 chickens, and the rest were destroyed to contain the outbreak. Response measures such as quarantine, control of poultry movement, and disinfection of the premises have been carried out, according to the report.

Prior to this month's outbreaks, the country had not had an H5N1 outbreak in domestic birds since 2007.
Jun 28 OIE report


WHO: Cuba eliminates maternal HIV, syphilis transmission

The WHO announced today that Cuba has become the first country to receive validation that it has eliminated mother-to-child transmission of HIV and syphilis. The WHO and its partners published criteria for elimination in 2014, and an expert international mission to Cuba in March of 2015 concluded that the country had met the guidelines.

In a press release today, the WHO said the number of children born with HIV has halved since 2009, but more needs to be done to meet a 2015 goal of getting the global total of fewer than 40,000 new child infections per year. It said the 15% to 45% risk of an infected mother transmitting HIV to her baby drops to just 1% with properly timed antiretroviral therapy.

For syphilis, effective screening and treatment during pregnancy can eliminate most neonatal infections and complications. The Pan American Health Organization (PAHO) has been working with Cuba and other countries in the Americas since 2010 on regional plans to eliminate mother-to-child spread of the two diseases.

In 2013 only two babies were born with HIV in Cuba and five were born with congenital syphilis, according to the WHO. Carissa Etienne, MD, PAHO director, said universal access and coverage were some of the keys to Cuba's success and that the country's achievement is an inspiration to other countries.

Margaret Chan, MD, MPH, the WHO's director-general, said, "This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation."
Jun 30 WHO news release

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