News Scan for Jan 07, 2019

New Saudi MERS case
Acute flaccid myelitis in US
Lyme burden, legislation
Sick HCWs and flu spread
Avian flu in India, Iran

Third case of MERS recorded in Riyadh household cluster

Today Saudi Arabia's ministry of health (MOH) reported a new MERS-CoV case, the third case connected to a household cluster in Riyadh. The notice came in an epidemiologic week 2 notification.

The patient is a 33-year-old man from Riyadh who is in home isolation for his MERS-CoV (Middle East respiratory syndrome coronavirus) infection. The man did not have camel contact and is listed as a household contact of a previously recorded MERS case.

Last week two men, 54 and 87, were also diagnosed as having MERS. The three cases are part of a household cluster.

The new case likely lifts on the global total since 2012 to 2,283 cases, at least 806 of them fatal.
Jan 7 MOH


CDC notes 7 more acute flaccid myelitis cases, 193 total

In an update today, the US Centers for Disease Control and Prevention (CDC) recorded 7 new cases of acute flaccid myelitis (AFM), bringing the total for 2018 to 193 confirmed cases, the most of any year since the CDC began tracking the mysterious illness in 2014.

Thirty-nine states have recorded cases, a number that has not changed since the CDC's previous update on Dec 31. Texas has reported the most cases, 25, followed by Colorado (16), and Ohio (13). Three states—Minnesota, New Jersey, and Washington—have recorded 10 cases. Illinois Pennsylvania, and Wisconsin have each confirmed 9 cases.

AFM affects mostly children and follows a seasonal pattern, with activity spiking every other year in the fall. 2014 saw 120 cases, followed by 22 in 2015, 149 in 2016, and 35 in 2017.

More than 90% of patients report mild respiratory symptoms before AFM symptom onset, which typically involves limb weakness and paralysis.

The CDC has yet to establish a definitive cause for the 2018 cases, but some previous cases have been connected to enterovirus infections.
Jan 7 CDC


As data show high Lyme burden, tick-borne disease law proposed

A systematic review of studies on the economic burden of Lyme disease found that the disease poses a significant burden on the United States and other developed countries, researchers from the University of Toronto reported in PLOS One.

They focused on 21 studies, which included 10 cost-effectiveness analyses (CEA) and 11 cost analyses (CA). Most of the CEAs were done before 2003, when a human Lyme disease vaccine was available before it was withdrawn. Seven CAs focused on overall healthcare costs, three targeted diagnostic testing, and one addressed Lyme cardiac treatment.

Three CEAs concluded that Lyme disease vaccine was probably cost-effective, but only in endemic areas. Six studies looked at the economic burden from a societal standpoint and found an annual economic impact that ranged from 0.014 US dollars per capita in Scotland ($5.4 million) to 2.41 US dollars per capita in the United States ($326.6 million).

The authors concluded that the economic burden is significant enough to justify further research into disease control and management. "A greater understanding of the indirect costs of Lyme disease and cost-effectiveness of interventions in countries where the incidence rates of the disease are increasing, is warranted for guiding Lyme disease evidence-informed health policy decision making," the team wrote.
Jan 4 PLOS One abstract

In a related development, US Rep Chris Smith, R-N.J., on Jan 4 reintroduced legislation that would forge a new national policy on Lyme and other tick-borne diseases and to boost national efforts to fight, treat, and prevent the diseases, according to a press release from Smith's office.

The bill has bipartisan cosponsors and follows the November 2018 release of a report to Congress from a US Department of Health and Human Services (HHS) working group on tick-borne diseases. Smith is the founder and co-chair of the Congressional Lyme Disease Caucus.

The bill, called the National Tick-Borne Diseases Control and Accountability Act, would create an oversight and coordination office at HHS to oversee federal efforts to prevent and treat the diseases, craft a new national strategy, and require the HHS secretary to report to Congress, promote coordination of federal tick-borne disease activities, and expand research.
Jan 4 Rep Smith news release
Nov 14, 2018, CIDRAP News story "
Task force spotlights US tick-borne disease as cases set records"


Study links 'presenteeism' to flu outbreak in cancer patients

A nosocomial outbreak of influenza in an oncology ward likely occurred because sick healthcare workers (HCWs) came to work when feeling ill, according to a study detailing the outbreak in the American Journal of Infection Control.

The outbreak of influenza A H3N2 took place over 8 days in November 2017 and affected 7 of 10 inpatients on the oncology ward, 16 HCWs (14 confirmed, 2 probable), and 2 visitors.

An anonymous survey was given to all HCWs and staff who had confirmed or probable influenza to characterize symptoms, timeline of illness, and reasons for attending work during illness.

Sixty-four percent of surveyed HCWs said they reported to work even when experiencing influenza-like illness symptoms; 56% said they did so because of a sense of duty as an HCW. Others said they felt their symptoms were minor and insignificant.

"It is possible that the nosocomial spread of influenza could have been prevented if the ill HCW either did not come to work or wore a mask," the authors concluded. "It is important for health care facilities to re-educate all employees annually about the importance of avoiding work during peak respiratory symptoms and strict adherence to respiratory etiquette and hand hygiene."
Jan 7 Am J Infect Control study


H5 outbreaks strike again in India, Iran

In highly pathogenic avian flu developments, India reported new H5N1 outbreaks in poultry and wild birds, and Iran reported a pair of H5N8 outbreaks at poultry farms, according to the latest notifications from the World Organization for Animal Health (OIE).

In India, which has reported other recent H5N1 detections, the virus struck again at two poultry farms in Orissa state in outbreaks that began on Dec 17. Between the two events, the virus killed 7,228 of 8,300 susceptible birds. The surviving ones were culled as part of response steps.

The country also reported H5N1 in house crows found dead in the city of Munger in Bihar state and in two cities in Orissa state, as well as in peacocks at a zoo in Patna, also in Bihar state, an event that was reported earlier by the media. The outbreaks in house crows began between Dec 15 and Dec 18, killed 46 birds, and are now considered resolved. The outbreak at the zoo began on Dec 16, killed 6 peacocks, and is also classified as resolved.

Iran's agriculture ministry reported two more H5N8 outbreaks, both affecting farms—one housing ducks and the other broiler breeder chickens—in Mazandaran in the north central part of the country. The outbreaks began on Dec 24 and Dec 25, killing 794 of 37,060 birds between the two locations. Authorities destroyed the survivors to curb the spread of the virus.

Iran reported its last H5N8 outbreak in early December, which affected poultry in Tehran province.
Jan 4 OIE report on H5N1 in India
Jan 7 OIE report on
H5N1 in Indian wild birds
Jan 5 OIE report on
H5N8 in Iran

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