News Scan for Jul 02, 2018

H3N2v in Indiana
MSF announces DRC Ebola activity transition
Meningitis in the UK

First H3N2v case of season detected in Indiana

The Indiana State Department of Health (ISDH) announced the first case of variant influenza H3N2 (H3N2v) detected this year in a county fairgoer who was in close proximity to pigs. The Centers for Disease control and Prevention (CDC) confirmed the infection on Jun 29.

This is the first human case of H3N2v recorded in Indiana since 2013.  The ISDH said the patient is recovering. No additional details about the patient or the county fair were being released at this time in an effort to protect the patient's privacy, but the county in question had been alerted to the case.

H3N2v can be transmitted from swine to humans through contact, but not through eating pork or other animal products.

More than 400 cases of H3N2v have been identified in people in the United States since 2011. More than one-third of those cases have occurred in Indiana.

The ISDH said summer fairgoers need to practice good handwashing hygiene, and exhibitors should monitor animals for signs of illness.
Jun 29 ISDH statement
CDC H3N2 fact page


MSF announces handover of Ebola activities to DRC and its partners

Doctors Without Borders (MSF) announced today that after a 2-month response in the Democratic Republic of Congo (DRC),  its teams have started handing its activities to the country's health ministry and other nongovernmental organizations in Mbandaka, Bikoro, Itipo, and Iboko.

Henry Gray, MSF's emergency coordinator in Equateur Province, said in a press release, "This Ebola outbreak is not officially over, but we are very pleased with the progress that has been made." He said with the low volume of cases and increased local expertise, the health ministry is well positioned to finish the work.

MSF said the handover process began with the closure of the Ebola Transit Center on Jun 20 at Itipo General Reference Hospital, with new suspected cases to be handled at a nearby Ebola treatment center run by the Alliance for International Medical Action (ALIMA). On Jun 25 MSF handed over the Ebola treatment center at Bikoro to the health ministry and its partners.

The DRC declared the outbreak on May 8, and its teams with support from MSF have cared for 38 patients with confirmed infections, including 24 who survived and returned home. Fourteen of those who were treated died from their illnesses. Over the course of the outbreak, which is in its final 21-day countdown, 120 patients with symptoms were isolated and tested, but were negative for the Ebola.

In a related development, MSF said one of its teams is constructing a small isolation unit at Mbandaka General Reference Hospital, which will be used to isolate and test any new suspected patients. A 40-bed Ebola treatment center constructed by MSF on the outskirts of Mbandaka will be disinfected and taken down by early July.

Symptom onset for the DRC's last confirmed case was Jun 2, and last week the monitoring period ended for all contacts, including those of the last patient.
Jul 2 MSF press release


Study: Viruses most commonly identified cause of meningitis in UK

Most cases of meningitis diagnosed in the United Kingdom are viral in origin, according to a major study looking at the causes of meningitis published today in The Lancet Infectious Diseases.

A team of researchers from the University of Liverpool Institute of Infection and Global Health looked at the diagnoses and treatment of 1,126 patients diagnosed as having meningitis in the UK from 2011 to 2014. Only 16% percent of those cases were bacterial, 26% were viral, 42% had an unknown cause, and 6% of cases had other causes for their illnesses. The authors estimate the annual incidence of confirmed viral meningitis in UK adults to be 2.73 per 100,000 people.

Enteroviruses accounted for just above 50% of all confirmed viral meningitis cases, and herpesviruses accounted for 44% of viral cases. Moreover, although viral meningitis was once thought of as benign, the authors said a majority of patients complained of mental health problems in the months following a diagnosis.

"This study shows that viruses are the major cause of meningitis in adults in the UK, and impose a considerable clinical burden, both acutely and longer term," the authors concluded. "To improve management and reduce costs, there is a pressing need for better diagnostic practices, including rapid tests and the delivery of high-quality viral diagnostics locally."

In a commentary published adjacently to the study, two scientists from the Academic Medical Centre in Amsterdam write that meningitis patients in the UK suffer from a delay in diagnosis. In the University of Liverpool study, the median time to lumbar puncture after emergency room admittance was 17 hours, and in 25% of patients it took more than 29 hours before a lumbar puncture was done.
Jun 29 Lancet Infect Dis study
Jun 29 Lancet Infect Dis comment

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