News Scan for Mar 06, 2017

Zika in Canadian travelers
H7N9 infections in China
New MERS cases

Zika complications in Canadian travelers higher than thought

A study today of Zika infections in Canadian travelers who visited destinations in the Americas revealed they were just as common as other mosquito-borne diseases, with complications more severe than expected. A team from Canada reported its findings in the Canadian Medical Association Journal (CMAJ).

The researchers reviewed data on 1,118 travelers who got sick after travel in the Americas and visited one of seven CanTravNet clinics, located in large cities in five provinces, from October 2015 to September 2016.

Lab-confirmed Zika infection was found in 41 (3.7%), dengue in 3.7%, and chickungunya in 2.1%. Except for one sexually transmitted case, nearly all of the Zika infections were likely transmitted by mosquitoes. About 60% of the Zika-infected patients were women, and 19 of the 24 were of child-bearing age. The most common symptoms during the acute phase were rash and fever, and about half noted muscle or joint pain or headaches. Only one in six had conjunctivitis.

As for serious complications, three pregnant women were infected, with two cases of congenital infection, and two other travelers had Guillain-Barre syndrome, putting the total of severe complications at 10% of Zika cases. Researchers said no complications were seen in any of the patients infected with dengue or chikungunya.

In a press release on the study, Andrea Boggild, MD, a tropical disease specialist with the University of Toronto and Public Health Toronto, said, "Referral bias to our centres may have contributed to the more severe clinical presentations noted for Zika, though we would have expected the same phenomenon to occur with dengue and chikungunya were this a significant contributing bias." She also noted that the clinics primarily serve adults, so kids may be under-represented in the data.

The authors urged people to take precautions, such as delaying travel for women who are pregnant or considering getting pregnant, wearing insect repellent, and using barrier protection during sexual activity.
Mar 6 CMAJ abstract
Mar 6 CMAJ press release


H7N9 sickens two more in China

Two more H7N9 avian influenza infections have been reported from China, both in Guangxi province, Hong Kong's Centre for Health Protection (CHP) said today in a statement.

Provincial health officials didn't note the genders or ages of the patients but said they are from two different cities—Baise and Wuzhou—and are both hospitalized in critical condition. Guangxi province is in south central China.

China is experiencing its fifth and biggest H7N9 wave since the outbreak began in 2013, and though overall activity has peaked, the country is still reporting smaller but steady stream of cases. So far the country has reported at least 474 cases since October, and imported cases were also reported from Hong Kong, Macao, and Taiwan.
Mar 6 CHP statement


Three new Saudi MERS cases hint at hospital outbreak

The Saudi Arabian Ministry of Health (MOH) reported three new cases of MERS-CoV yesterday and today in Wadi ad-Dawasir in south central Saudi Arabia.

Two patients were identified as having MERS-CoV (Middle East respiratory syndrome coronavirus) yesterday, a 31-year-old Saudi man in critical condition and a 32-year-old Saudi woman in stable condition. The MOH said the sources of their infections are under review.

Today a 48-year-old Saudi woman is listed in critical condition after presenting with symptoms of MERS-CoV. The MOH said she contacted her illness through a healthcare exposure. The MOH also said today that a 63-year-old Saudi man with preexisting disease has died of MERS in Mahayel-Aseer in the southwest. His case was previously reported.

The new cases bring Saudi Arabia's total since the outbreak began in 2012 to 1,572 MERS cases, including 652 deaths. Fifteen patients are still recovering from the disease.

In related news, a new study in Emerging Infectious Diseases said a robust surveillance program has helped limit the spread of MERS-CoV in Saudi Arabia. Researchers from the Saudi MOH and the US Centers for Disease Control and Prevention said that from April 2015 to February 2016, Saudi health officials tested 57,363 people who had suspected MERS-CoV infection, and only 384 (0.7%) tested positive.

Saudi Arabia has accounted for more than 80% of the world's MERS cases.
Mar 5 MOH report
Mar 6 MOH report
Mar 3 Emerg Infect Dis study

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