News Scan for Sep 08, 2015

Cucumber-linked Salmonella
Source of pertussis
New chikungunya cases
Plague in Madagascar

Cucumber-linked Salmonella outbreak sickens 285 in 27 states

Federal health officials on Sep 4 announced a multistate Salmonella Poona outbreak linked to cucumbers imported from Mexico, which triggered a recall by the US-based importer that distributed the products.

The Centers for Disease Control and Prevention (CDC) said 285 illnesses in 27 states have been reported. So far 1 death has been linked to the outbreak, and 53 people have been hospitalized.

The hardest-hit states are Arizona (60 cases), California (51), and Utah (30), which account for about half of all the infections so far. Illness-onset dates range from Jul 3 to Aug 26.

Epidemiologic, trace-back, and laboratory investigations point to cucumbers imported by Andrew & Williamson Fresh Produce, based in San Diego, as the likely outbreak source.

Eleven illness clusters have been found in seven states, where interviewers found cucumbers as the common thread in people who were sick.

San Diego County authorities detected Salmonella in samples from cucumbers at the company's produce facility. Tests are under way in several states on cucumber samples collected from the homes of sick people. The CDC said the PulseNet subtyping network suggests that the outbreak involves three Salmonella Poona strains.

On the same day the CDC announced the outbreak, Andrew & Williamson recalled all cucumbers sold under its "Limited Edition" brand between Aug 1 and Sep 3. The cucumbers were distributed to 22 different states and may have been further distributed to others.

The CDC said the cucumbers are typically sold in bulk displays without packaging. They were shipped in cartons that indicated they were grown and packed by Rancho Don Juanito in Mexico.

Meanwhile, the Food and Drug Administration (FDA) said in a recall notice that the company is working with authorities to determine if its cucumbers are the source of the outbreak and is recalling the products out of an abundance of caution. In separate background information, the FDA said the cucumbers associated with the outbreak were grown in Baja, Mexico.
Sep 4 CDC outbreak announcement
Sep 4 FDA recall notice

Sep 4 FDA background information


Siblings overtake moms as main source of infant pertussis, study finds

Pertussis (whooping cough) may now be transmitted to infants more often from siblings than from mothers as had previously been the case, according to a study in Pediatrics yesterday.

Researchers from several states and the Centers for Disease Control and Prevention analyzed data from surveillance sites across the country from 2006 through 2013. Of the 1,306 infant cases identified, a source of infection was specified in 569 cases.

About two thirds (66%) of the sources were immediate family members, most often siblings (36%), mothers (21%), and fathers (10%). Mothers predominated until 2008, when that role when to siblings.

The authors conclude, "In contrast to previous studies, our data suggest that the most common source of transmission to infants is now siblings." They emphasize, though, that vaccination during pregnancy will directly boost infant protection.
Sep 7 Pediatrics abstract


PAHO reports 4,800 new cases of chikungunya

A total of only 4,857 new chikungunya cases in the Caribbean and the Americas have brought the outbreak total to 1,711,947, the Pan American Health Organization (PAHO) reported late last week.

The previous two weekly updates from PAHO reported 34,866 and 27,867 new cases, respectively.

The new total includes 546,199 suspected, 18,109 confirmed, and 870 imported cases, bringing the total for 2015 to 565,178 so far, according to a Sep 4 update. Six new chikungunya-related deaths occurred, brining that total to 66.

Colombia, which has reported by far the most cases this year, logged 2,739 new cases, bringing its 2015 total to 324,734. El Salvador accounted for most of the rest of the new cases. It reported 1,983 new cases, for a total of 36,156 for the year. As in past weeks, many countries have not reported on chikungunya for weeks.

The epidemic started in December 2013 with the detection of the Americas' first locally acquired cases on St. Martin in the Caribbean.
Sep 4 PAHO update


WHO details 14 plague cases, 10 deaths in Madagascar

A pneumonic plague outbreak in Madagascar has sickened 14 people, 10 of them fatally, the World Health Organization (WHO) said in a Sep 6 statement.

The first case was detected on Aug 17 in Moramagna district, located in the east central part of the country. No new cases have been reported since Aug 27.

The agency said Madagascar's government has activated a task force, with help from the WHO and the Pasteur Institute in Madagascar. Response steps include active case finding, surveillance, contact tracing, chemoprophylaxis, and vector control. The agency recommended that urban areas such as Antananarivo take vector prevention actions.

The plague outbreak is Madagascar's second in the past few years. An event in 2014 and 2015 peaked in November 2014, sickening 335 and killing 79.

Plague typically is spread by rodents to humans through fleas infected with Yersinia pestis. If bacteria from a flea bite reach the lungs, patients can develop pneumonia and spread the disease to others by coughing. Illness can kill quickly, in as little as 24 hours, but is treatable with early antibiotics.
Sep 6 WHO statement

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