News Scan for Mar 21, 2018

Kansas measles outbreak
Dallas ED visits and Ebola
Vaccine campaigns in Syria
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Kansas measles outbreak sickens 10 people in 3 counties

Following an initial report of a case of measles at a daycare in Johnson County on Mar 8, the Kansas Department of Health and Environment (KDHE) said today that 10 cases in three counties have now been identified, including one not associated with the daycare center.

Eight of the illnesses are in Johnson County residents, one involves a Linn County individual, and one patient is a resident of Miami County, whose measles infection doesn't appear to be associated with the daycare. Investigators from the three counties have identified when and where each patient was infected and are working to identify other possible contacts. Secondary cases are now appearing outside the daycare, the KDHE said.

The KDHE news release today listed 11 locations where patients visited while they were infectious.

At the national level, the Centers for Disease Control and Prevention (CDC) said in a Mar 6 update that so far this year, 13 measles cases in 7 states have been reported.
Mar 21 KDHE press release
Mar 6 CDC measles outbreak page


Study: Dallas Ebola case prompted rise in area emergency room visits

Emergency department (ED) visits in the Dallas-Fort Worth area increased significantly after the first Ebola case in the United States was detected at a Dallas hospital more than 3 years ago, as did visits for fever with gastrointestinal illness, some of the key symptoms of the disease. Researchers from the US Centers for Disease Control and Prevention (CDC) reported their findings yesterday in PLoS Currents Outbreaks.

The index patient was a 45-year-old Liberian man who arrived at a Dallas ED on Sep 30, 2014. The man died from his infection, and two nurses involved in his care contracted the virus, but survived.

For the study, the researchers looked at syndromic surveillance data from two sources, The Texas Health Services Region 2/3 and the North Texas Syndromic Surveillance System from Jul 21, 2013, through July 22, 2015. The data included all EDs from Collin, Dallas, Denton, and Tarrant counties.

Visits for all conditions increased by 12% immediately after the man's Ebola infection was detected, remaining elevated by more than 11% 2 weeks after his diagnosis before returning to baseline on Jan 22, 2015. For fever with gastrointestinal illness, the rate of visits increased by over 40% immediately after the man was diagnosed, remaining elevated by over 35% until 2 weeks after the event, before returning to baseline on Mar 20, 2015.

The authors wrote that the findings have implications for surge capacity planning and public health messaging in the wake of a public health emergency. However, they noted that most of the surge did not involve Ebola-like symptoms and none of the increase they observed involved Ebola, given that health teams contained the outbreak. "This suggests a need for targeted public health messaging to improve public understanding of disease symptoms as well as allay concerns," they said.
Mar 20 PLoS Curr abstract


Polio and measles vaccination campaigns begin in Syria

The World Health Organization (WHO) announced today the beginning of a polio vaccination campaign targeting 764,550 children under the age of 5 in Syria.

Last year, the WHO declared an outbreak of 74 cases of circulating vaccine-derived poliovirus type 2 in Syria, with the most recently diagnosed case in September of 2017. The campaign will take place in two phases and be concentrated in Idleb and parts of Aleppo, Homs and Hama.

The WHO also said Syrian displacement camps will be the site of a measles vaccination campaign. There have been 364 measles cases reported in camps since January.

"There have been a number of polio and measles vaccination campaigns throughout Syria aimed at protecting children against the diseases, but ongoing unrest has hindered access to all areas, and ongoing displacement increases the risk of the diseases spreading," said Mostapha Loutfy, MD, an immunization expert with the WHO.

Many areas of Syria, including Idleb and Aleppo, have lacked routine vaccination programs since the onset of the 7-year Syria conflict.

In other polio news, a study published in The Lancet Infectious Diseases shows that the serotype 2 monovalent oral poliovirus vaccine (mOPV2), which is used only in response to serotype 2 vaccine-derived poliovirus outbreaks, elicits a strong immune response in infants but no additional benefit when the administered alongside the inactivated polio vaccine (IPV).
Mar 21 WHO statement
Mar 20 Lancet Infect Dis study

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