News Scan for Apr 12, 2016

Long-term Ebola complications
Chikungunya in blood donors
Avian flu in Taiwan, Mexico

Neurologic and optical symptoms persist in Ebola survivors

New studies of Ebola's long-term effects in survivors found evidence of neurologic, psychiatric, and optical problems more than a year after recovery, according to two presentations this week at the 26th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

Researchers from the University of Liverpool and the King's Sierra Leone Partnership evaluated 38 survivors who had been treated for Ebola infection at the 34th Regiment Military Hospital in Freetown, Sierra Leone. Survivors were between 25 and 43 years old; 17 (45%) had lost consciousness, and 7 (18%) experienced seizures during the acute phase of infection.

The most common complication more than a year after infection was headache in 28 (78%) survivors, followed by difficulty sleeping (21, or 55%), depression (12, or 32%), eye pain (11, or 29%), anxiety (11, or 29%), partial or complete visual loss (10, or 26%), and photophobia (9, or 24%).

Of the 28 survivors reporting headaches, 14 also had eye symptoms, 6 experienced intermittent fever, and 5 reported dizziness. More than half the survivors (23, or 61%) were referred to a neurologic/psychiatric clinic.

A related study of more than 150 survivors reporting eye pain or problems with vision found evidence of cataract development, chorioretinal scarring, and "dark without pressure" retinal lesions.

The authors said that, given the persistence of ocular and neurologic effects in survivors, referrals to specialized care and more rigorous case-control studies are needed in regions affected by Ebola.
Apr 12 ECCMID abstract on neurologic and psychiatric effects
abstract on ocular effects
Feb 25
CIDRAP News story on Ebola complications


Study: Evidence of chikungunya infection found in blood donations

A study of blood donated during the peak of Puerto Rico's 2014 chikungunya epidemic found that 1.9% of individual donations were positive for chikungunya RNA, according to findings yesterday in Emerging Infectious Diseases.

Researchers grouped 26,672 individual blood samples donated between Jun 20 and Dec 31, 2014, into minipools, each containing 16 samples. Of 1,667 minipools, 161 (9.7%) were positive for chikungunya RNA, and positive samples peaked at 19.5% during September 2014. Most of the positive samples (125, or 78%) had high viral loads, potentially raising the risk for transmission, the authors said.

Of 3,007 individual blood donations obtained during the peak of Puerto Rico's epidemic (September through November 2014), 56 (1.9%) were positive for chikungunya RNA, peaking at 21 (2.1%) positive samples in October. Eight positive samples had high viral loads, and 13 had previously tested seronegative. When the individual samples were diluted to mimic minipools, testing missed 35 (62.5%) positive results.

Serologic testing of 1,031 plasma samples between Mar 1 and 9, 2015, found that 242 individual donations had chikungunya antibodies. Serologic surveys estimate that nearly 25% of Puerto Rican blood donors were infected with chikungunya during the 2014 epidemic and that upwards of 800,000 infections occurred in the commonwealth at that time, the authors said.

The researchers estimate that donors whose samples tested positive were viremic for approximately 8 days after seroconversion. The likelihood of asymptomatic blood donors, the high viral RNA loads in samples, and variable testing results make chikungunya transmission via blood donation highly probable, the authors said.
Apr 11 Emerg Infect Dis study


Avian flu outbreaks reported in Taiwan and Mexico

In separate reports to the World Organization for Animal Health (OIE) on Apr 8 and 11, government officials confirmed outbreaks of several strains of highly pathogenic avian influenza : H7N3 affecting numerous farms and backyard flocks in Mexico, H5N8 and H5N2 in Taiwanese birds, and H5N2 in Taiwanese breeding geese.

In Mexico, 19 outbreaks of H7N3 occurred between Jan 28 and Mar 23. They involved nine farms holding mainly commercial layers in Jalisco; three farms containing breeding birds in Veracruz; and three backyard flocks, three farms of commercial layers, and one farm of 25 peafowl in Puebla.

Of the 2,725,151 birds at the 19 Mexican sites, at least 28,836 became ill, 14,386 died, and 145,201 were culled. Several of the outbreaks are listed as ongoing, and officials have instituted disinfection and surveillance measures.

In Taiwan, H5N8 and H5N2 were detected on Mar 15 following a postmortem examination of 13 birds in an abattoir in the southwestern city of Kaohsiung. The 664 remaining birds of the total 677 at the abattoir were destroyed, and disinfection procedures were implemented at the infected birds' currently empty farm of origin.

Also reported in Taiwan were three H5N2 outbreaks in breeding geese in Yunlin and Chiayi counties. Outbreaks began between Mar 23 and Apr 1, and flocks ranged in size from 1,705 to 2,200 birds. Of the 5,935 geese on affected farms, 1,148 died and 4,787 were culled to prevent the spread of infection.
Apr 8 OIE report on H7N3 in Mexico
Apr 11 OIE
report on H5N8 and H5N2 in Taiwan
Apr 11 OIE
report on H5N2 in Taiwan

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