News Scan for Jun 20, 2016

DRC yellow fever
US plague, tularemia cases
Anthrax vaccine
Acute flaccid myelitis

Yellow fever declared epidemic in parts of DRC; 1,000 cases suspected

Yellow fever in the Democratic Republic of Congo (DRC) has been declared an epidemic in three provinces as officials report 1,000 suspected cases, Reuters reported today.

Confirmed cases have risen to 67, up from 61 reported by the World Health Organization (WHO) on Jun 17. Health Minister Felix Kabange, MD, said 7 of the confirmed cases were locally acquired, while 58 were imported from Angola, where the outbreak began, and 2 cases came from remote forested areas not linked to the current outbreak.

Five people have died from the disease, Kabange said. "I declare today a localized epidemic of yellow fever in the provinces of Kinshasa, Kongo Central, and Kwango," he added.

Kinshasa is of special concern, because it is home to 12 million densely packed people and has poor health infrastructure, the story noted.

The global stockpile of yellow fever vaccines has already been depleted twice this year in response to the outbreak and now stands at 6 million doses after 18 million have been administered, the report said. The WHO late last week approved fractional vaccine dosing to stretch the supply.
Jun 20 Reuters story
Jun 17 CIDRAP News story on fractional dosing


Human cases of plague, tularemia reported in New Mexico, Colorado

A teenage boy from Rio Arriba County, New Mexico, is the first person in the United States to be diagnosed as having plague this year, while an urban gardener in Colorado's Front Range was diagnosed as having tularemia. 

Plague, which is carried by rodents and other animals and usually transmitted to humans through flea bites, is caused by the bacterium Yersinia pestis. Plague can also be passed to humans through contact with infected animals, including household pets. The disease causes fever, chills, and swollen lymph nodes, and requires early treatment with antibiotics.

Paul Ettestad, DVM, the public health veterinarian for the New Mexico Department of Health (NMDH) said sick or dead rodents and rabbits are being reported throughout the state, according to a Jun 17 NMDH statement. He urged citizens to avoid rodents and report any sick pets to local health departments. Last year New Mexico reported five cases of human plague and one death.

A patient in Larimer County, Colorado, presented with a lung infection and was later diagnosed as having tularemia this weekend, the county's Department of Health & Environment said in a Jun 17 news release. Tularemia, caused by the Francisella tularensis bacterium, is usually passed to humans though animal bites. Rabbits and rodents are the most common carriers, but any warm-blooded animal is susceptible to infection. The bacteria can also live in water and soil contaminated with an infected animal's urine or feces. 

Health officials suspect the patient was exposed after inhaling infected soil while gardening in his urban subdivision. Gardeners, landscapers, and agricultural workers along Colorado's Front Range are advised to wear gloves and dust masks when working outdoors, wash their hands frequently, and avoid touching dead animals with their bare hands.

This is the first case of human tularemia in Larimer County this year. Last year the county reported nine cases, according to its Web site.

Symptoms of infection include fever, chest pain, fatigue, and skin ulcers (in the case of an animal bite.) Tularemia can be fatal if it's not treated with antibiotics.
Jun 17 NMDH statement
Jun 17 Larimer County press release
Related CIDRAP overviews of plague
and tularemia


Study: Capsule-conjugate anthrax vaccine protects macaques

A capsule-conjugate anthrax vaccine provides full protection to rhesus macaques at two doses of 50 micrograms (mcg), according to a Jun 18 study in Vaccine.

Currently licensed anthrax vaccines use a single protective antigen, which may promote more limited immune response. A team led by the US Army Medical Research Institute of Infectious Diseases developed a capsule-conjugate vaccine, which couples a Bacillus anthracis polyglutamic acid capsule to a Neisseria meningitidis serotype B outer membrane protein complex (OMPC). The capsule-OMPC vaccine has previously demonstrated partial protection in macaques at two 2.5-mcg doses, the authors said.

Four of five macaques vaccinated with two doses of 10 mcg capsule conjugated to 125 mcg OMPC administered 28 days apart survived an inhalational anthrax challenge, with an average anti-capsule immunoglobulin (IgG) concentration of 481 mcg per milliliter (mcg/mL) and mean opsono-adherence titers of 4,189. Though one macaque died following anthrax exposure, the authors said that 10 mcg of the capsule-conjugate vaccine promoted the maximum antibody response.

All five macaques who received two doses of 50-mcg capsules coupled to 625-mcg OMPC on the same schedule survived the challenge, with an average IgG concentration of 412 mcg/mL and mean titers of 2,315. Vaccination with an unconjugated capsule or OMPC alone failed to provide protection, the authors said.

Rabbits who received two doses of the 50-mcg conjugate vaccine had IgG concentrations comparable to the macaques but lower titers and failed to survive the challenge. Because the capsule-OMPC vaccine appears to protect primates with a dose-ranging effect, next steps likely include selecting an appropriate adjuvant and considering the capsule conjugate for incorporation in future anthrax vaccines, the authors said.
Jun 18 Vaccine study


Study: More than 100 AFM cases detected in 2014 enterovirus outbreak

Surveillance systems detected 120 pediatric cases of acute flaccid myelitis (AFM) from 34 states during a national outbreak of enterovirus-D68 (EV-D68) in 2014, according to a Jun 17 study in Clinical Infectious Diseases.

Though surveillance for AFM is not conducted routinely, a team led by the Centers for Disease Control and Prevention documented cases from Aug 1 to Dec 31, 2014. The median age of children with AFM during the 5 months was 7.1 years. More than half (64, or 56%) had both respiratory and febrile illness prior to AFM onset and limb weakness, 28 (25%) had only respiratory symptoms, and 10 (9%) had only fever, the authors said.

The median time between illness onset and AFM was 5 days, the authors said. Imaging most commonly showed lesions in the cervical (103 cases, or 87%) and/or thoracic (80, or 80%) spinal cord, and most children (81%) had an increased white blood cell count in cerebrospinal fluid. A significant percentage of patients (81%) had decreased or absent deep-tendon reflexes, and 51% experienced pain, the authors said.

Though all but one child was hospitalized, no deaths occurred. A fifth (20%) of patients required mechanical ventilation due to neuromuscular respiratory failure, and 43% experienced weakness in both upper and lower limbs. Only three patients fully recovered limb strength; 38 children (68%) had some functional impairment 4 months after treatment, and 8 (14%) were completely dependent on caregivers, the authors said.

EV-D68 was detected in 11 respiratory specimens, and 12 other specimens were positive for other enteroviruses or rhinoviruses. All stool and/or rectal samples were negative for poliovirus, the authors said.

Because AFM surveillance is non-routine, the presence of viral pathogens was inconsistent across cases, and long intervals occurred between specimen collection and testing. The researchers said those factors make it difficult to determine potential viral causes of AFM and whether the 2014 cases represent an increase in national incidence.
Jun 17 Clin Infect Dis study

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