News Scan for Jul 08, 2016

US Zika death
More yellow fever in Angola
CDC Ebola recap
Resistance to MDR-TB drugs
Measles in Arizona

US reports first travel-linked Zika death

Utah health officials today announced the first known Zika death in the continental United States, in a Salt Lake County resident who died in late June.

The patient was elderly and had an underlying health condition and had traveled to a region where mosquitoes are known to spread the virus, according to information on the county health department's Facebook page. It said though the patient tested positive for Zika virus, the exact cause of death hasn't been determined, and it might not be possible to sort out how the virus may have contributed to the death.

Surveillance has not detected Aedes mosquitoes in the region around Salt Lake County.

Dagmar Vitek, MD, MPH, medical director for Salt Lake County Health Department (SLCHD), said, "This unfortunate situation is a tragic reminder of how important it is to receive proper pre-travel education and to protect yourself from mosquitoes when travelling abroad." She also advised travelers to be aware of other mosquito-borne diseases, such as dengue, malaria, and chikungunya.

Deaths from Zika virus infection are very rare. In early April, Colombian researchers described four of them, all involving patients with underlying health conditions and two of the older patients showing evidence of ischemic brain lesions. At the time of the report, Brazil had noted three Zika deaths.
SLCHD Facebook page
Apr 8 CIDRAP News story "Report outlines patterns in rare fatal Zika infections"


WHO: 88 more yellow fever cases in Angola bring total past 3,500

The World Health Organization (WHO) said today that, as of Jul 1, there were 88 new yellow fever cases in a worrisome outbreak in Angola, bringing the total number of suspected cases to 3,552.

Lab tests have confirmed 875 of those cases, the WHO said in the weekly update. The number of reported deaths increased by 2 this week, bringing the total to 355 since the outbreak began in Luanda in January.

The report said Marimba district, in the northern province of Malange, had its first suspected case. Most cases are still in Luanda and Huambo, the major urban centers of Angola.

The Democratic Republic of the Congo (DRC), meanwhile reported no new epidemiologic information. As of Jun 24, the total number of suspected DRC cases was 1,307, with 68 confirmed cases and 75 reported deaths. Of the 68-lab confirmed cases, 59 were imported from Angola.

Seven other countries—Brazil, Chad, Colombia, Ghana, Guinea, Peru, and Uganda—are reporting sporadic yellow fever cases not connected to the outbreak in Angola. China (11 cases), Kenya (2 cases), and the DRC remain the only countries with cases imported from Angola.

The WHO also said that, as of Jul 5, 15 million people in Angola, 3 million people in the DRC, and 1.3 million people in Uganda had been vaccinated. An additional 10 million are projected to be vaccinated by Jul 31.
Jul 8 yellow fever report
Related Jul 7 CIDRAP news story


CDC details unprecedented Ebola response

The Centers for Disease Control and Prevention (CDC) yesterday published a detailed account of its work on the longest, largest outbreak response in its history: the Ebola epidemic of 2014 to 2016, which involved more than 3,700 CDC staff.

The recap, published as a supplement of 14 articles in Morbidity and Mortality Weekly Report (MMWR), comes on the second anniversary of the official activation of the CDC's emergency response to the outbreak.

The CDC's response involved both combating the epidemic in West Africa and strengthening US preparedness. The MMWR supplement focuses mainly on the agency's work in the first year and a half of the outbreak. The agency activated its Emergency Operations Center (EOC) on Jul 9, 2014. On Aug 5 it elevated the EOC to level 1, its highest category. The CDC officially deactivated the EOC just over 3 months ago.

By that time—Mar 31, 2016—more than 3,700 CDC staff, including all 158 Epidemic Intelligence Service officers, had participated in international or domestic response steps. There were 2,292 total deployments to Guinea, Liberia, and Sierra Leone and 3,544 total deployments overall. More than 1,500 CDC personnel were deployed to West Africa, and 454 responders had repeat deployments.

"The Ebola epidemic in West Africa killed thousands and directly or indirectly harmed millions of people living in the region," said CDC Director Tom Frieden, MD, MPH, in a CDC news release.

"The resilience of those affected; the hard work by ministries of health and international partners; and the dedication, hard work, and expertise of mission-driven CDC employees helped avoid a global catastrophe. We must work to ensure that a preventable outbreak of this magnitude never happens again."

More than 11,300 people died in the outbreak, making it many times more deadly than all previous Ebola outbreaks combined.
Jul 7 MMWR supplement
Jul 7 CDC news release


Five-nation study finds range of resistance to essential MDR-TB drugs

A new WHO study is shedding some light on the extent of resistance to drugs that are considered essential for the treatment of multidrug-resistant tuberculosis (MDR-TB).

The study, published yesterday in The Lancet Infectious Diseases, used population-based surveys from Azerbaijan, Bangladesh, Belarus, Pakistan, and South Africa to investigate the levels of resistance to pyrazinamide and fluoroquinolones among TB patients.

Pyrazinamide and fluoroquinolones are "second line" drugs used mainly for the treatment of MDR-TB, and they are considered essential for treating TB that is resistant to the "first line" drug rifampicin. They are also an important component of shorter, more easily administered regimens for the treatment of MDR-TB.

In a retrospective analysis of samples from 4,972 TB patients, the researchers found that levels of pyrazinamide resistance varied substantially in the five countries—from 3.0% to 42.1%—but were significantly associated with rifampicin resistance. This is important, the authors said, because it means that treatments that include pyrazinamide may be no more effective than first-line treatments for patients with rifampicin-resistant TB, and therefore should be carefully evaluated.

Among the 5,015 patients tested for susceptibility to fluoroquinolones, the overall prevalence of resistance in the five countries was low, with the exception of Pakistan, where high levels of ofloxacin resistance were detected. The authors said that could be the result of extensive and unregulated use of fluoroquinolones in Asia. But they were encouraged by negligible resistance in all countries to two newer fluoroquinolones—moxifloxacin and gatifloxacin.

The authors said more studies of this nature are needed to avoid the risk of introducing ineffective treatments for MDR-TB that could amplify the development of drug resistance.

The WHO estimates that 480,000 people developed MDR-TB in 2014, and 190,000 people died from it.
Jul 7 Lancet Infect Dis study

Arizona measles outbreak grows to 22 cases

Arizona's detention center measles outbreak that was first reported in late May has now grown to 22 cases, making it the largest in the country, and might be fueled by vaccine-skeptical staff members, the Associated Press (AP) reported today.

All of the cases of the highly contagious disease have been traced to the 1,200-resident Eloy Detention Center, an Immigration and Customs Enforcement facility managed by the private Corrections Corporation of America (CCA) in Pinal County. The case count has doubled since May 30. The most recent 2 cases were confirmed on Jul 2 by the Arizona Department of Health Services (ADHS).

The outbreak likely began with a migrant, but detainees have since been vaccinated, the AP story said. Convincing employees to get vaccinated has proved tougher, and they have been passing the disease to each other and exposing people in the community. The ADHS on its outbreak page lists potential exposure sites and times, some as recently as Jun 26.

ADHS Director Cara Christ, MD, MS, says the facility has been more responsive in the past few days to vaccinations, adding that a large number of CCA employees were immunized late last week. "Once they understand how important it is and the outcomes it can have on the community, they tend to cooperate," Christ said.

CCA said most of its Eloy staffers have been vaccinated or shown proof of immunity. Those who have not must wear surgical masks or stay home.
Jul 8 AP story
Jul 2 ADHS news release
ADHS outbreak page
May 31 CIDRAP News Scan on the outbreak

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