News Scan for Nov 27, 2018

Ebola in the DRC
More acute flaccid myelitis
Freeze-dried polio vaccine
Zika in India

Two more Ebola cases, 1 death recorded in DRC; total stands at 421

Today the ministry of health of the Democratic Republic of the Congo (DRC) reported two more Ebola cases in the ongoing outbreak in North Kivu and Ituri provinces. The outbreak total now stands at 421 cases (374 confirmed and 47 probable), including 241 deaths.

The two new cases are from Kyondo and Kalunguta, and one additional death was recorded in Beni. Seventy-four cases are still under investigation.

A ring vaccination campaign is still under way throughout the region. A total of 36,612 people have been vaccinated with Merck's unlicensed Ebola vaccine, including 17,465 in Beni.

If the outbreak reaches 426 Ebola cases—which is highly likely soon—it will become the second-largest in history, behind Uganda's 2000 outbreak (425 cases) and the massive 2014-2016 outbreak in West Africa (28,652 cases).
Nov 27 DRC


CDC confirms 10 new acute flaccid myelitis cases, 116 total

In an update yesterday on the ongoing accuse flaccid myelitis (AFM) outbreak, the Centers for Disease Control and Prevention (CDC) confirmed 10 more cases, raising the outbreak total to 116 confirmed cases in 31 states.

The 116 confirmed cases are part of 286 reports CDC has received of patients under investigation in 2018. Colorado has reported the most confirmed cases, with 15, followed by Texas (14).

There is still no consensus on the cause of AFM. Though some cases have been linked to enteroviruses, the CDC said that virus is common in children and most often does not lead to AFM.

AFM is a rare, polio-like illness that affects the nervous system and causes muscles and limbs to weaken. Since 2014, the CDC has tracked AFM, which seems to operate on a cyclical seasonal schedule, with most outbreaks occurring every 2 years in the early fall.

In 2016, there were 149 confirmed cases of AFM in 39 states and Washington, D.C., the most of any year.
Nov 26 CDC


New polio vaccine candidate requires no refrigeration

Scientists from the University of Southern California (USC) have developed a freeze-dried polio vaccine that could one day prove a useful tool in the endgame of the virus.

The thermostable lyophilized Sabin inactivated poliovirus vaccine (sIPV) is an injected vaccine that can be stored without refrigeration and reconstituted at the time of use. According to a study in mBio, the vaccine performed well in mice.

"The feasibility of the use of current IPV formulations in developing countries is limited, because IPV is insufficiently stable to be purified, transported, and stored under unrefrigerated conditions," the authors wrote. "We successfully designed the sIPV for use in the dry state that maintains the full vaccine potency in animal models after incubation at ambient temperature."

In the study, the freeze-dried sIPV was kept at 37°C (98.6°F) for 4 weeks before being reconstituted and injected into mice, where it induced an antipoliovirus immune response.

A temperature-stable vaccine could be useful in countries where refrigeration is unreliable. In recent weeks, Nigeria, the Democratic Republic of the Congo, and Papua New Guinea have all reported new polio cases.
Nov 27 mBio study


Report urges vigilance for Zika spread from India's outbreak hot spot

India is currently experiencing its largest Zika virus outbreak, with most cases reported from the Rajasthan state capital of Jaipur, and Indian cities and countries with close connections to the city should prepare for possible imported cases, a Canadian-led research team recently reported in a letter to the Journal of Travel Medicine.

By the end of October, 147 cases had been reported in Jaipur, a popular tourist destination, and as of Nov 2, neighboring Gujarat state reported 1 case and Madhya Pradesh state reported 3 infections.

To look at potential spread of the virus, the group analyzed the timing and volume of airline connections to Jaipur, along with the environmental suitability of populations of mosquitoes that can carry the virus in destinations cities within and outside of India. Based on airline data from November 2016 through January 2017, the investigators found there were 326 cities near areas that can support Zika transmission. Of passengers traveling out of Rajasthan, 94% traveled to Indian cities, mostly Mumbai, New Delhi, Bengaluru, and Kolkata. International cities in the top 20 destinations included Bangkok, Muscat, and Singapore.

The authors concluded that because there are so many regions that can support Zika transmission that have large populations with limited exposure and immunity to the virus, Indian cities and international locations with close travel ties to Jaipur should prepare for possible cases in upcoming months. They added that the risk of domestic spread is greater, especially in the city of Chennai, with its close ties to the outbreak hot spot, large population, and environment that could support year-round transmission by Aedes aegypti mosquitoes.
Nov 22 J Travel Med abstract

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