News Scan for Nov 30, 2015

Saudi MERS case
Chikungunya complications
Celery E coli source
Cholera in Iraq and Tanzania

New Saudi MERS case, blood study in Kazakh camels

Saudi Arabia reported a new MERS-CoV infection yesterday in the city of Buraidah, while an international team of researchers found no serologic evidence that the virus is endemic in Kazakh camel herds.

The Saudi Ministry of Health (MOH) reported yesterday that a 35-year-old Saudi woman from the north-central city of Buraidah is in critical condition with a MERS-CoV (Middle East respiratory syndrome coronavirus) infection. She is not a healthcare worker and was not exposed to other MERS patients, the ministry said. No other risk factors were noted.

The woman's illness was Saudi Arabia's first case to be reported in 17 days.

Saudi Arabia has now has 1,277 MERS cases since 2012, the MOH said. Of the total number, 728 have recovered, 549 have died, and one person remains under treatment.
Nov 28 MOH update

Writing in Emerging Infectious Diseases on Nov 25, an international team of researchers found a lack of evidence for MERS-CoV infection in dromedary and Bactrian camel herds living in Kazakhstan.

Investigators conducted a seroepidemiologic study of 455 dromedary camels living in 9 herds in 4 Kazakh cities, along with 95 Bactrian camels living in 2 herds in 2 Kazakh cities. Dromedary camels are assumed to be the natural MERS-CoV host, with the virus present in herds living in the Arabian Peninsula and several African regions.

Though blood samples from 10 dromedary camels were positive for bovine coronavirus neutralizing antibodies, all camels lacked evidence of MERS-CoV infection following a validated MERS-CoV (strain EMC) spike pseudo particle neutralization test.

The researchers said that their results imply that dromedary camels may only maintain the virus, while another animal or environment likely serves as the ultimate natural reservoir for MERS-CoV.
Nov 25 Emerg Infect Dis study


Chikungunya encephalitis complications noted in infants, elderly

Infants and elderly people who experience neurologic symptoms with chikungunya virus infection may be at increased risk of encephalitis and death, according to findings published online Nov 25 in Neurology.

An international team of researchers conducted a cohort study of people affected by the 2005-06 chikungunya virus (CHIKV) outbreak on Reunion Island, which lies off the coast of Madagascar. Approximately 300,000 people were infected with CHIKV during the epidemic, and investigators monitored people reporting neurologic symptoms at disease onset for long-term central nervous system (CNS) effects until 2009.

Of the 57 people with CNS symptoms, 24 people (Incidence Rate [IR]: 8.6 per 100,000) had encephalitis associated with CHIKV infection. Infants younger than 1 year had a drastically higher incidence rate of encephalitis (187 per 100,000), as did people over the age of 65 (37 per 100,000).

During the outbreak, 16.6% of people with CHIKV-associated encephalitis died, while 30% to 45% of people with encephalitis experienced long-term disabilities, such as behavioral change and memory problems in infants and dementia in previously healthy older people.

Researchers said that the CHIKV-associated encephalitis rates during the Reunion Island outbreak were higher than encephalitis rates from all causes in the United States, calling for greater surveillance and monitoring of people presenting with CHIKV infection and CNS symptoms.
Nov 25 Neurology study


Celery from Costco chicken salad linked to 7-state E coli outbreak

A celery and onion mix used in rotisserie chicken salad sold at Costco stores has been identified as the probable source of Shiga toxin-producing Escherichia coli O157:H7 that has sickened 19 people in seven states, according to a Nov 27 announcement from the Centers for Disease Control and Prevention (CDC).

The Montana Public Health Laboratory identified E coli O157:H7 in the diced celery and onion blend, which was produced by Taylor Farms Pacific, Inc. in Tracy, Calif. The US Food and Drug Administration (FDA) reported on Nov 27 that Taylor Farms Pacific, Inc. has recalled 71 products containing celery.

As of Nov 23, the outbreak had sickened 19 people from seven states. Five people required hospitalization, and 2 became ill with hemolytic uremic syndrome associated with the E coli infection.

States affected by the outbreak include Montana (6 cases), Utah (5), Colorado (4), California (1), Missouri (1), Virginia (1), and Washington (1). Of the 16 ill people interviewed, 14 reported consuming rotisserie chicken salad purchased at Costco stores.

Costco has removed all rotisserie chicken salad sold as item number 37719 from its stores. The FDA advises consumers to discard any Costco rotisserie chicken salad or products containing celery affected by the Taylor Farms Pacific recall.
Nov 27 CDC update
Nov 27 FDA update and recall information
Nov 24 CIDRAP News scan on the outbreak


Iraq and Tanzania implement vaccination, surveillance for cholera outbreaks

Laboratory-confirmed cases of cholera caused by the outbreak strain Vibrio cholera 01 Inaba have reached 2,810 in Iraq, according to a Nov 26 World Health Organization (WHO) update. The total reflects an increase of 1,547 from a WHO update on Oct 12.

Cases have occurred in 17 Iraqi governorates, and the outbreak has significantly affected the large governorates of Baghdad (940 cases), Babylon (675), and Qadisiyyeh (442). Two deaths related to the outbreak strain have been reported. The illnesses were confirmed at the Central Public Health Laboratory in Baghdad. (A Nov 22 update from the WHO's Eastern Mediterranean Office said provincial labs had confirmed 4,858 cases.)

The Government of Iraq, along with the WHO and UNICEF, administered the first round of oral cholera vaccine to 229,000 internally displaced people and refugees in 13 governorates during the second week of October, reaching 93% of the target population. A second round of vaccine will be administered in early December.

Iraqi officials are planning water surveillance and case management activities to coincide with the pilgrimage of Arba'een on Dec 2, during which the city of Karbala will expect 10 million pilgrims.
Nov 26 WHO update on Iraq

Cholera cases in Tanzania have reached 9,871 in an outbreak that now affects 19 regions, along with 2 islands in the Zanzibar archipelago, and has caused 150 deaths, according to a Nov 26 WHO update.

The outbreak, which began in August, has significantly affected the urban center of Dar es Salaam, causing 4,482 cases in the city. The islands of Unguja and Pemba in the Zanzibar archipelago have reported 223 and 202 cases, respectively.

Tanzania's Ministry of Health and Social Welfare is conducting surveillance and water chlorination programs, while a team deployed from the International Centre for Diarrhoeal Disease Research in Bangladesh is providing emergency operations assistance within Tanzania.

Though cases are declining, the upcoming rainy season is likely to cause flooding and increased cholera transmission within affected regions.
Nov 26 WHO update on Tanzania

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