News Scan for Dec 16, 2016

New Zika cases
H7N2 avian flu in NYC cats
Ricin exposure
Immune globulin for anthrax
Cholera in Yemen

Zika count declines in Mexico; virus may be circulating in Angola

Yesterday the Pan American Health Organization (PAHO) released its epidemiologic survey of Zika virus and said the mosquito-borne illness was on the decline in Mexico but increasing in Anguilla, Paraguay, and Peru. Zika cases in the United States, meanwhile, topped 4,600.

Mexico’s downward trend has continued for 6 weeks. Paraguay and Peru are the only countries in South America reporting increases; all other nations in the region are reporting declining case counts. To date, 48 countries in the Americas have reported Zika activity.

Both PAHO and the World Health Organization (WHO) said no new countries reported Zika infections in the last week or cases of microcephaly or Guillain-Barre syndrome.

The WHO's weekly report did note that France detected possible Zika virus in a traveler returning from Angola, raising questions about circulation of the virus there. But yellow fever vaccination and seropositivity for other flaviviruses in the patient make for an inconclusive diagnosis.

The Centers for Disease Control and Prevention (CDC) also updated US Zika numbers yesterday. There are still 32 infants born with Zika-related birth defects and 5 Zika-related pregnancy losses, the same numbers the CDC published last week.

The country has seen a total of 4,617 Zika cases, 185 of which are locally acquired. US territories have reported 34,268 cases, 97% of which are in Puerto Rico.
Dec 15 PAHO Zika update
Dec 15 WHO Zika update
Dec 15 CDC Zika update


Low-path H7N2 avian flu sickens cats at Manhattan animal shelter

Health officials in New York City yesterday announced a low-pathogenic H7N2 avian influenza outbreak affecting cats at a Manhattan animal shelter, which has triggered testing and monitoring in employees and volunteers who had contact with the animals.

The virus has sickened 45 cats housed at the facility, and the illnesses are generally mild to moderate, though one older cat with underlying health conditions has died, according to a statement from the New York City Department of Health and Mental Hygiene (NYC Health). H7N2 is thought to pose a low risk to humans and has been linked to two illnesses in the United States. In 2002, H7N2 was detected in a farmer who worked closely with chickens, and in 2003 another infection was found in a person with an unknown source.

Oxiris Barbot, MD, first deputy health commissioner, said in the statement, "We will continue to actively monitor all people involved and adapt our response accordingly."

Tests by the University of Wisconsin-Madison School of Veterinary Medicine identified the outbreak strain and suggest that the virus was introduced to the shelter as early as November 12. Health officials have contacted people who adopted cats from the shelter since then and have urged them to keep the the cats away from other animals and be on the lookout for symptoms in pets or people.

So far no human infections have been found, and tests on 20 dogs at the shelter were negative. Authorities are also sampling other animals at the shelter, including rabbits and Guinea pigs.

Health officials believe the outbreak is limited to just the one shelter, Animal Care Centers of NYC. The investigation hasn't determined the source of the virus.
Dec 15 NYC Health statement


Almost 10,000 exposed to ricin during training exercises in Alabama

Yet another mix-up involving a pathogen that was supposedly weakened exposed 9,600 firefighters, paramedics, and other first responders to a potentially lethal form of ricin powder during terrorism response exercises in Alabama, USA Today reported yesterday.

Ricin is a highly toxic protein derived from the pressed seeds of the castor oil plant and has been used by terrorists. In the training mishap, the Federal Emergency Management Agency's (FEMA's) Center for Domestic Preparedness blamed an outside lab for mistakenly shipping a potentially lethal form of ricin to the center.

The Alabama center said it asked for a benign type of ricin extract, but Toxin Technology, the Florida company that has sent nine shipments to the FEMA center since 2011, said its ricin products were all labeled as "RCA60," a scientific name for the intact ricin toxin, which can be fatal.

After issuing multiple statements to USA Today since Dec 12 blaming the vendor, yesterday FEMA Administrator W. Craig Fugate called for the Department of Homeland Security's Office of Inspector General to investigate the incidents. The training center has suspended all training with biological agents.

Former Homeland Security Secretary Tom Ridge said of the situation, "It's beyond careless and outrageous. It's almost malfeasance."
Dec 15 USA Today story


Study finds mixed results of immune globulin treatment for anthrax

A small study of anthrax in injection drug users in Scotland in 2009-2010 found that use of immune globulin intravenous (AIG-IV) was not associated with lower death rates, but patients who received the treatment were sicker than those who didn't.

US and UK researchers, including from the National Institutes of Health and Centers for Disease Control and Prevention, noted in Emerging Infectious Diseases that they analyzed outcomes for 15 patients prescribed AIG-IV and 28 patients who did not receive the therapy. AIG-IV patients had a death rate of 33%, compared with 21% for non-recipients, which was not a statistically significant difference.

They noted, however, that 7 of 13 patients (54%) categorized as high risk of death (sequential organ failure assessment score of 6 to 11) received AIG-IV. That compares with only 8 of 30 patients (27%) who were at low risk of death having received AIG-IV. Also, AIG-IV patients had surgery more often, had longer hospital stays, and were sicker than the other patients.

The authors conclude, "This difference and the small number of higher risk patients confound assessment of AIG-IV effectiveness in this outbreak."
Dec 14 Emerg Infect Dis study


Yemen's cholera outbreak continues to grow

The WHO today said Yemen's cholera outbreak continues to spread, with 1,173 new suspected cases since last week, bringing the total number of illnesses to 10,148. As of Dec 13, there were 3 more deaths, bringing total fatalities to 92 deaths.

Although cholera is widespread throughout the country, more than 65% of the reported cases were from Aden, Al Bayda', Al Hudaydah, and Taizz governorates. Ongoing conflict in parts of the country have made acute, watery diarrhea, which is endemic in Yemen, a strain on the national health system.

The WHO said that it and partner agencies have tried to increase surveillance and education in the country, but additional governorates are still experiencing outbreaks. According to the WHO, more than 7.6 million people, 3 million of them internally displaced, live in areas affected by the outbreak.
Dec 16 WHO update

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