News Scan for Oct 15, 2015

Countermeasures for emerging disease
More cuke Salmonella
H5 in Nigeria, Gaza
Invasive mosquitoes
Super-spreading events

IOM report lists priorities for emerging ID countermeasures

The Institute of Medicine (IOM) this week published a report on a 2-day medical countermeasure workshop it held in late March to discuss how to how better develop and deliver medical countermeasures (MCMs) for emerging infectious disease threats, based on challenges that flared up during West Africa's Ebola outbreak.

The workshop brought together three IOM forums: on preparedness for catastrophic events, drug discovery, and microbial threats. It also included participation from public health and private industry stakeholders. According to the 177-page report, the group examined MCM responses to other recent threats, including pandemic flu and Middle East respiratory syndrome coronavirus (MERS-CoV).

One areas of broad consensus, according to the report, was that emerging infectious disease preparedness is a US national security issue. Some participants raised concerns that an "all hazards" approach to a broad array of public health threats "dilutes" a greater focus that should be on infectious diseases.

Another theme was that discussions surrounding MCM development should include more than just traditional groups, such as economists, global risk analysts, and animal health experts.

The group grappled with financing issues and competing public health priorities, and many of the topics involved how to best involve the private sector. To help speed MCM development in an evolving situation, experts discussed the need for a more streamlined regulatory platform set up in advance and better ways of gauging when traditional public health measures aren't enough and threats warrant an MCM.
Oct 12 IOM report


Salmonella outbreak linked to cucumbers grows to 767 cases

The Centers for Disease Control and Prevention (CDC) yesterday reported that a multistate outbreak of salmonellosis linked to cucumbers imported from Mexico grew by 35 illnesses and 1 state, to 767 cases in 36 states.

Illness-onset dates range from Jul 3 to Sep 29. Although patients range in age from less than 1 to 99 years, the median age is 17, and half the patients are children. Among 561 people with available information, 157 (28%) reported being hospitalized.

One death has been reported in four states: Arizona, California, Oklahoma, and Texas. That number has not changed since the previous update.

California and Arizona have by far the most cases, at 205 and 118, respectively, followed by Utah with 53 and Wisconsin with 42. (See CDC map.) Florida reported its first case since the CDC's previous update a week ago.

The outbreak, caused by Salmonella Poona strains, has been linked to cucumbers imported from Mexico by Andrew & Williamson Fresh Produce of San Diego. The company announced a voluntary recall of its cucumbers on Sep 4.
Oct 14 CDC update


Nigeria reports 2 H5N1 outbreaks; H5 detected in Gaza Strip

Nigerian officials have reported two new outbreaks of H5N1 highly pathogenic avian influenza (HPAI) involving 3,500 poultry, while H5 HPAI has been detected in the Gaza Strip area of the Palestinian Territories, according to separate reports posted by the World Organization for Animal Health (OIE) today.

The Nigeria outbreaks involve farms holding 1,000 and 2,500 chickens in Rivers state, the region hardest hit by H5N1 outbreaks this year. The smaller farm, housing broilers, experienced 150 poultry deaths, while the larger farm, an egg-laying operation, had 50 deaths. All surviving birds on both farms were euthanized to curtail the outbreak.

The country has had 92 H5N1 outbreaks this year.
Oct 15 OIE report on Nigeria

In Gaza, little information is provided about the H5 outbreak there, other than it involved HPAI. A sample or samples tested positive for the virus at a regional reference lab on Aug 8, but no information was given about the specific H5 strain.

"The relationship between the cases could not be determined due to the situation in Gaza Strip, and no information about the population of infected birds in Gaza Strip is available due to the situation there," the report said.
Oct 15 OIE report on Gaza Strip


California warns of Aedes mosquitoes after detection in 2 more counties

The California Department of Public Health (CDPH) in a news release yesterday cautioned about invasive Aedes mosquitoes, which can transmit such diseases as dengue fever, chikungunya, and yellow fever.

Either A aegypti (the yellow fever mosquito) or A albopictus (the Asian tiger mosquito) have now been detected in 12 counties. In September A aegypti was detected for the first time in San Bernardino and Riverside counties, the CDPH said.

"It is important to know these species of mosquitoes because they are not what we're used to in California, and they can transmit diseases such as dengue fever, chikungunya and yellow fever," said CDPH Director and State Public Health Officer Karen Smith, MD, MPH. "While the risk is still low in California, infected travelers coming back to California can transmit these viruses to mosquitoes that bite them. This can lead to additional people becoming infected if they are then bitten by those mosquitoes."

The two mosquito species are known for their black-and-white stripes, for biting during the middle of the day, and for readily entering unprotected buildings. The more-familiar Culex mosquitoes bite primarily at dusk and dawn.

"It is important for everyone to take steps to keep these mosquitoes from spreading," Smith said. The CDPH release details specific steps, such as using adequate repellants and eliminating potential mosquito-breeding sites.
Oct 14 CDPH press release


Experts highlight role of super-spreaders in outbreaks

Super-spreading events have occurred with MERS-CoV and its predecessor SARS before it, as well as to a lesser extent with Ebola, according to a review article yesterday in Cell Host & Microbe that lists steps that might help reduce such events.

A Chinese team of experts noted that about 75% of the 186 MERS-CoV cases in South Korea can be traced to just three super-spreaders. With SARS (severe acute respiratory syndrome), another coronavirus disease, super-spreading events involved the index patient in Hong Kong (at least 125 secondary cases) and occurred at the the Hotel Metropole (13 cases) and the Amoy Gardens housing complex (more than 180 cases) in Hong Kong, as well as aboard an Air China flight traveling from Hong Kong to Beijing (22 cases).

The scientists say that super-spreaders also contributed to West Africa's Ebola outbreak, though to a lesser degree. They cite the example of a traditional healer who died in Sierra Leone and was shown to have directly infected 13 others and was eventually linked to more than 300 cases.

The authors say that a complex combination of factors—such as virus mutation, duration of contact with an infected person, genetic susceptibility, underlying medical conditions, air recirculation, travel and trade, and customs and beliefs—likely plays a role in super-spreading events.

They recommend animal studies to identify factors that likely contribute, as well as detailed analyses of the large amount of patient data and samples available from the recent Korean MERS-CoV and West Africa Ebola outbreaks.
Oct 14 Cell Host Microb report

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