News Scan for Apr 05, 2016

Yellow fever in Angola
Finalized food transport rule
Ebola persistence in semen
Saudi MERS case
More chikungunya

Yellow fever vaccine shortage a 'ticking timebomb'

In what Director-General Margaret Chan, MD, MPH, of the World Health Organization (WHO) says is the most serious outbreak of yellow fever in Angola in 30 years, a serious global shortage of vaccine makes what is already a bad situation potentially catastrophic, sources are reporting. Dr. Chan recently visited Angola to observe the situation first-hand.

Outbreak cases, which began in December of last year, have been concentrated in urban Luanda, the country's capital, but have now spread to 6 of the country's 18 provinces, said a WHO feature story yesterday. The official outbreak total now stands at 490 cases with 198 deaths, according to the WHO, but could be far higher.

Vaccination campaigns launched in February by the WHO and partners have reached 5.7 million people in Luanda as of late March. However, the global emergency stockpile is empty, the WHO says. Only four sources of the vaccine exist worldwide, and the egg-based process of making the vaccine is slow and outdated, as explained in an Apr 4 Science news story.

Imported cases have been identified in China and three other African countries, including the Democratic Republic of Congo. Experts are particularly concerned that yellow fever, which is endemic in much of Latin America but brings the heaviest disease burden in Africa, could begin spreading in urban areas elsewhere in Africa as well as in southern China, where Aedes aegypti mosquitoes are plentiful, and other parts of Asia.

"I hate being an alarmist," said Jack Woodall, PhD, in the Science article, "but this is something I'm really panicking about." Woodall is a retired virologist from the US Centers for Disease Control and Prevention (CDC) and the WHO.

The WHO is in discussions with the vaccine's manufacturers to divert shipments of yellow fever vaccine intended for routine national immunization programs to Angola to help stem the outbreak. Officials are also being encouraged to vaccinate only in areas where the disease is actively spreading.

Yellow fever is most commonly spread by the A aegypti mosquito, which also transmits Zika virus. Most infected people are asymptomatic, but some experience fever, headache, muscle pain, nausea, vomiting, and fatigue. In about 15% of patients, according to the CDC, the disease progresses to a severe phase that can lead to death in 20% to 50% of affected patients.
Apr 4 WHO article
Apr 4 Science story
Most recent (Mar 22) CIDRAP News scan on the outbreak


FDA finalizes FSMA rule on food safety during transport

The US Food and Drug Administration (FDA) today finalized a rule to enhance food safety during transport, making it the sixth major rule necessary for implementing the 2011 Food Safety Modernization Act (FSMA).

The Sanitary Transportation of Human and Animal Food rule requires all human and animal food shippers, loaders, carriers, and receivers to follow best practices for maintaining food safety during transport by motor or rail within or across state lines. The rule employs best practices identified by the transportation industry, including proper refrigeration, maintenance of written records, adequate and frequent vehicle cleaning, and food protection during transport.

The finalized rule was proposed in February 2014 and implements the 2005 Sanitary Food Transportation Act. More than 200 comments from industry and government leaders were incorporated into the final rule, leading to greater flexibility in temperature monitoring standards during transport and clear definitions of food adulteration as it relates to safety, the FDA said.

Businesses are required to comply with the final rule 1 year after it is published in the Federal Register, and smaller businesses receive 2 years to comply. The FDA estimates that initial costs for implementing the program will be around $163 million, with an annual cost of about $94 million.

The seventh and final FMSA rule, focused on mitigating intentional food adulteration, will be finalized later this year, the FDA said.
Apr 5 FDA press release
Apr 6 Federal Register notice on final rule


Study: Ebola detected in semen more than 2 months after disease onset

Infectious Ebola virus was detected in survivors' semen for up to 70 days following the onset of symptoms, while Ebola RNA persisted in semen for up to 290 days, according to an Apr 3 study in Clinical Infectious Diseases.

In an effort to understand the risk of sexual transmission of Ebola between male survivors and their partners, a team of researchers led by CDC scientists evaluated semen specimens from five men who had survived the disease.

Infectious Ebola virus was isolated in semen samples from three survivors and persisted for up to 70 days after symptom onset and for 34 days following the first negative blood tests. Viral RNA was identified in semen up to 290 days following symptoms and for 272 days after blood tests were negative for Ebola.

Results were similar to previous studies that indicated that infectious virus can be isolated from the semen of Ebola survivors for up to 82 days, the authors said, adding that more research into testicular viral replication and protection from immune response is needed.

Based on emerging evidence about longevity of Ebola virus in semen, the authors concur with the WHO's recommendations for male Ebola survivors to use condoms or abstain from sex for up to 6 months following infection if semen cannot be tested.
Apr 3 Clin Infect Dis study


Saudi Arabia reports fatal MERS case

After 3 days with no new MERS-CoV cases, Saudi Arabia's Ministry of Health (MOH) today reported a fatal infection in a 74-year-old man from Al-Kharj, located in the central part of the country.

The man was not a healthcare worker, and the source of his MERS-CoV (Middle East respiratory syndrome coronavirus) illness is still under investigation.

In addition, the MOH said six more people have recovered from their infections, including five from Buraydah, where a hospital outbreak is under way. The sixth patient is from Jazan. Ten earlier announced patients are still being treated.

Overall, since the virus first emerged in 2012 Saudi Arabia has reported 1,367 cases, 584 of them fatal.
Apr 5 MOH statement


PAHO reports almost 4,000 new chikungunya cases in the Americas

The Pan American Health Organization (PAHO) last week reported 3,994 new cases of chikungunya in the Americas, bringing the 2016 outbreak total to 36,529 confirmed and suspected cases. The agency, however, has now fallen a week behind in its reporting.

The agency has not reported any new 2015 cases since Mar 4, leaving that number at 731,920 cases. Therefore, the outbreak total since its 2012 onset has now reached 1,916,075 cases.

According to the latest report, which is dated Mar 25 but was not posted till late last week, a major portion of the new cases were in Brazil, which reported for the first time in 2016. Brazil noted 2,766 new cases in the first 7 weeks of the year.

Colombia, the hardest-hit nation so far in 2016, chalked up the next largest gain, with 747 new cases and 9,488 for the year. Honduras was next, with 408 new cases and 6,602 total. Many countries, however, have not reported new numbers for many weeks.

PAHO did report did not report any new chikungunya-related deaths, leaving that number at two. The outbreak was first reported in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas.
Mar 25 PAHO update
Latest PAHO 2015 cumulative case numbers

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