News Scan for Jan 16, 2018

Suspected Rift Valley fever
Avian flu in 5 nations
Dengvaxia reimbursement
Kids pneumonia criteria
Measles scare

Rift Valley fever suspected in South Sudan VHF cluster; 2 cases reported

Preliminary indications into South Sudan's recent viral hemorrhagic fever outbreak suggest that Rift Valley fever (RVF) may be the cause, the World Health Organization (WHO) Regional Office for Africa said in its latest outbreak and health emergencies update. The initial cluster included three patients from the same area of Eastern Lakes state who had similar symptoms and died from their infections in December.

No samples from the three patients were available for testing, but health officials have been looking for clues by testing their close asymptomatic contacts, according to the report. Six samples were negative in polymerase chain reaction testing for Ebola, Marburg, Crimean-Congo hemorrhagic fever, RVF, and Sosuga viruses.

Serologic tests, however, showed that one sample had high RVF immunoglobulin M (IgM) and IgG titers, and two other others had high RVF IgG titers. Authorities had also reported evidence of hemorrhagic disease in animals, and tests are under way on samples from sheep, goats, and cattle.

Also, two more suspected human cases have been reported and involve an 18-year-old pregnant woman who is a contact of a patient in the initial cluster and a 14-year-old girl from a neighboring village who had no epidemiologic links to the original three cluster patients. State and national task forces have been activated. The WHO said surveillance in humans and animals needs to be strengthened in the area while efforts continue to confirm the cause of the outbreak.
Jan 12 WHO report
Jan 9 CIDRAP News scan "Three deaths reported in suspected VHF cluster in South Sudan"


H5N8 strikes poultry farm in India as Cambodia reports more H5N1

India reported its first highly pathogenic H5N8 outbreak of the year, with Iraq and Saudi Arabia reporting more events involving the strain. Elsewhere, Cambodia reported another highly pathogenic H5N1 outbreak, and Taiwan reported three more H5N2 outbreaks.

In India, the outbreak began on Dec 26 in village birds in Karnataka state in the south of the country, according to a report yesterday from the World Organization for Animal Health (OIE). The virus killed 9 of 951 birds, and authorities culled the remaining ones to control the spread of the virus.

Meanwhile, Iraq reported its second H5N8 outbreak of the year, which struck a poultry farm in the city of Babil in Babil province, located in the central part of the country, the OIE said in a separate report. The setting appears to be a commercial poultry farm, where 98,000 deaths were reported in 209,000 susceptible birds. The surviving ones were destroyed as part of response efforts. A week ago, the country reported an outbreak involving a poultry farm in neighboring Diyala province.

Elsewhere, Saudi Arabia over the past few days reported six more H5N8 outbreaks in ongoing activity there, according to agriculture ministry statements translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.
Jan 15 OIE report on H5N8 in India
Jan 14 OIE report on H5N8 in Iraq
Jan 15 AFD post

In developments involving other highly pathogenic strains, Cambodia's latest H5N1 outbreak occurred in backyard birds in Phnom Penh, according to an OIE report today. The event began on Jan 7, killing 33 of 325 birds. Cambodia has now reported four H5N1 outbreaks since the middle of December. The earlier outbreaks affected poultry in Kampong Cham and Kampong Thom provinces.

In Taiwan, agriculture officials reported three new H5N2 outbreaks, all involving poultry farms in Yunlin County. The outbreaks began on Jan 4, killing 3,748 of 25,970 susceptible birds. The remaining ones were destroyed to curb the spread of the virus.

And finally, the United Kingdom's Department for Environment, Food and Rural Affairs (DEFRA) issued a full risk assessment yesterday on the recent detection of an H5N6 reassortant in wild birds in Dorset. It said initial analysis suggests the virus has the same characteristics as the one found earlier in the Netherlands. Germany and Switzerland have also reported similar detections in wild birds.

DEFRA said the virus appears to be an emerging strain in Europe, but it doesn't substantially increase the risk overall to Great Britain's poultry or poultry farms, except in the immediate area.
Jan 16 OIE report on H5N1 in Cambodia
Jan 15 OIE report on H5N2 in Taiwan
Jan 15 DEFRA risk assessment


Sanofi will reimburse Philippines government for unused Dengvaxia

Yesterday Sanofi Pasteur, the French pharmaceutical giant, announced it will reimburse the Philippines government for unused doses of Dengvaxia, its controversial dengue vaccine.

The announcement comes weeks after the company recommended the vaccine not be used in people without prior dengue infections, as it may prime dengue-naive recipients for more severe infections. More than 800,000 Filipino children had already received Dengvaxia when the recommendation was made.

"Sanofi Pasteur has responded positively to the Philippine Department of Health's (DoH) request that we provide reimbursement for the doses of Dengvaxia that were not used by the government in the public vaccination program," the company said in a statement printed in The Manila Times.

The company, however, emphasized that the decision was not based on safety concerns, but made to placate public outcry that the company knowingly put Filipino children at risk with Dengvaxia. The reimbursement equals $27.8 million.
Jan 15 Manila Times story


Study finds PIDS/IDSA pneumonia severity criteria for kids lacking

The Pediatric Infectious Diseases Society (PIDS)/Infectious Diseases Society of America (IDSA) criteria for severe community-acquired pneumonia (CAP) in children have only a fair ability to predict the need for hospitalization, experts reported in a Clinical Infectious Diseases study.

To validate the PIDS/IDSA criteria, University of Cincinnati scientists conducted a retrospective cohort study involving 518 children 3 months or older admitted to their pediatric emergency department from September 2014 through August 2015 and diagnosed as having CAP.

Of the 518 children, 360 (69.5%) met PIDS/IDSA severity criteria for CAP, which would involve admission to an intensive care unit (ICU) or continuous monitoring, according to PIDS/IDSA guidelines. Of the 360 children meeting the severity criteria, however, fully 73.1% did not demonstrate a need for hospitalization upon examination. In addition, 54.3% of patients who were immediately discharged and 80.8% of those hospitalized for less than 24 hours met the severity criteria, decisions that go against the guidance.

The authors calculated a sensitivity of 89% and a specificity of only 46% for admission-versus-discharge decisions, and 95% and 16%, respectively, for predicting the need for hospitalization. They conclude, "New predictive tools specifically for children are required to improve clinical decision making."
Jan 13 Clin Infect Dis study


Travelers in Illinois, New Jersey possibly exposed to measles

Travelers at O'Hare International airport in Chicago may have been exposed to measles by an international passenger on Jan 10, officials said.

According to an announcement from the Illinois Department of Public Health (IDPH), an international traveler with confirmed measles arrived in Terminal 5 at Chicago O'Hare International Airport and departed on a domestic flight from Terminal 1. People at O'Hare between 6:30 am and 1:00 pm on Jan 10 may have been exposed.

"If infected, you could develop symptoms as late as January 31, 2018," the IDPH warned.  "Symptoms of measles include rash, high fever, cough, runny nose, and red, watery eyes."

Late last week, health officials in New Jersey issued a similar warning, stating that a woman with infectious measles arrived in Terminal C at Newark Liberty International Airport and departed for Indianapolis from a domestic terminal on Jan 2. People at that airport between 6:30 am and 5:30 pm may have been exposed and could develop symptoms as late as Jan 23.
Jan 14 IDPH statement
Jan 12 New Jersey Department of Health statement

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