News Scan for Nov 26, 2018

E coli romaine source
Polio cases in 3 nations
H5N6 case in China
Small US flu increase

Romaine in latest E coli outbreak likely came from California

Romaine lettuce suspected in Escherichia coli O157:H7 illnesses in the United States and Canada probably came from California, based on growing and harvesting patterns, Scott Gottlieb, MD, US Food and Drug Administration (FDA) commissioner, said in a Nov 23 Twitter post.

The next step is to withdraw the product that's at risk from the market, then restock the market, he said.

New romaine lettuce from different growing regions, including Florida and Arizona, will soon be harvested, Gottlieb said, adding that officials are working with growers and distributors on labeling produce for location and harvest date as a way of informing consumers that the products are "post purge." Authorities are considering making the labels the new standard to improve product identification and traceability.

Meanwhile, California Leafy Greens Marketing Agreement (LGMA), an industry group centered around government food safety audits, said on Nov 20 that it supports government advisories and the withdrawal of all romaine, which it says is the fastest way to clear the supply chain of contaminated product and make a clean break from harvesting and shipping until the source of the outbreak is identified. It said a group of food safety experts from the produce industry is coming together to help pinpoint the specific source, and it noted that whole-genome sequencing by federal agencies has shown that the same E coli isolate was closely related to two similar outbreaks in 2016 and 2017 linked to leafy greens.

The LGMA said in a Nov 21Twitter post that the industry recently underwent a seasonal transition, wrapping up production in Central California and moving to Yuma, Ariz., a growing cycle designed to provide consumers with lettuce year round.
Nov 23 Scott Gottlieb Twitter thread
Nov 20 LGMA
Nov 21 LGMA

In a related development, the Public Health Agency of Canada (PHAC) on Nov 23 said three more cases have been linked to the outbreak, lifting its total to 22 in three provinces: Ontario, Quebec, and New Brunswick. The number of infections in the United States so far remains at 32 in 11 states.
Nov 23 PHAC update


Six more polio cases recorded in Papua New Guinea, Nigeria, DRC

According to the latest update from the Global Polio Eradication Initiative (GPEI), three countries reported vaccine-derived polio cases in the last week.

Papua New Guinea, which is battling its first polio outbreak in nearly 20 years, recorded three cases of circulating vaccine-derived poliovirus type 1 (cVDPV1), with onsets of paralysis reported from Aug 17 to Sep 30. The cases come from East Sepik and Enga provinces and raise the country's total number of polio cases this year to 25.

In Nigeria, two circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in Jigwa and Borno states. The patients reported an onset of paralysis on Oct 13 and 17. The cases raise Nigeria's yearly total to 27.

Finally, the Democratic Republic of the Congo (DRC) also recorded a cVDPV2 case in a previously uninfected province, Sankuru. The patient had onset of paralysis on Sep 25. There have now been 19 cases of polio in the DRC in 2018, compared with 10 at this point in 2017.
Nov 23 GPEI


China reports human H5N6 avian flu case, more poultry outbreaks

China has reported another H5N6 avian flu infection, this time involving a 10-year-old girl from the city of Suzhou in Jiangsu province, according to a Nov 23 statement from Hong Kong's Centre for Health Protection (CHP).

The girl's symptoms began on Oct 29, and she was hospitalized on Nov 3. The report did not say if she had contact with poultry or their environments. Jiangsu province is in the east central part of China.

H5N6 has been reported in poultry in a few Asian countries, but China is the only one to report human infections, which are often severe or fatal. Since the first human H5N6 illness was detected in 2014, China has reported 23 cases. The last was reported at the end of October and involved a man from Guangxi province who died from his infection.
Nov 23 CHP statement

In other H5N6 developments, China recently reported three more outbreaks in poultry, according to notifications from the World Organization for Animal Health (OIE) late last week. One of them occurred at a commercial farm in the village of Huinan in Jiangsu province. The event began on Nov 10, killing 320 of 31,649 birds.

The other two outbreaks struck commercial farms at different locations in Yunnan province in southwestern China, with start dates on Oct 28 and Nov 3. Taken together, the outbreaks killed 9,820 of 20,100 susceptible birds. In both provinces, the remaining poultry were culled to curb the spread of the virus.
Nov 23 OIE report on H5N6 in China
Nov 22 OIE report on
H5N6 in China


CDC: Flu activity still low but picking up a bit

Though flu activity in the United States is still low, the US Centers for Disease Control and Prevention (CDC) today reported small increases, with all three seasonal strains circulating, though 2009 H1N1 has been most commonly reported.

Two of the CDC's regions are above their specific baselines for flu-related clinic visits: region two, which mainly includes New York, New Jersey, and the US territories, and region eight, which covers six west central states. Nationally, the percentage of clinic visits for influenza-like illness (ILI) was at 1.9%, which is below the national baseline of 2.2%.

Geographic spread of flu was regional for one state, Kentucky, while Guam and 14 states reported local geographic spread. Georgia, Louisiana, and Oklahoma experienced moderate ILI activity.

One more pediatric flu death was reported, which involved the 2009 H1N1 virus and raises the season's total to three. Overall deaths from pneumonia and flu remained below the seasonal baseline.

Of samples analyzed at public health labs, 98.7% that tested positive for flu were influenza A, and, of subtyped influenza A viruses, 81.7% were 2009 H1N1 and 18.3% were H3N2.
Nov 26 CDC FluView report

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