News Scan for Jan 14, 2019

More acute flaccid myelitis
Cake mix Salmonella probe over
URIs, sinusitis in children
Lone star ticks' female affinity
Severe flu outcomes
Avian flu outbreaks

CDC records 3 more acute flaccid myelitis cases, 196 total

The US Centers for Disease Control and Prevention (CDC) today recorded 3 new cases of acute flaccid myelitis (AFM), bringing the total for 2018 to 196 confirmed cases. The confirmed cases are among the 357 reports that CDC received of patients under investigation. 

2018 has seen the most AFM cases 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 in weeks. Texas has reported the most cases, 25, followed by Colorado (16), and Ohio (13). Washington state recorded 1 new case, bringing the state's total to 11. Minnesota and New Jersey each have 10 cases. California, Illinois, Pennsylvania, and Wisconsin have each confirmed 9 cases.

AFM appears to follow 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 14 CDC update


CDC wraps up cake mix Salmonella probe after 7 cases confirmed

The CDC today posted a final outbreak update for a Salmonella Agbeni outbreak linked to certain Duncan Hines cake mix varieties.

In early November, ConAgra brands recalled four types of its cake mix after Oregon officials identified Salmonella Agbeni in a box of the company's classic white cake mix. The CDC has reviewed the PulseNet national subtyping network to identify recent Salmonella Agbeni infections matching the same strain as the cake mix.

Since its last update on Nov 7, the CDC has identified two more illnesses, raising the total to seven. The newly identified patients are from Florida and Missouri, raising the number of affected states to five: Florida, Maryland, Missouri, Ohio, and Wisconsin.

The CDC said there isn't enough epidemiologic and trace-back information to determine if the sick people have links to the contaminated cake mix. Two people reported eating cake the week before their symptoms began, including one who consumed raw batter, but information about the brand wasn't available. The close genetic match of Salmonella isolated from the sick patients, however, suggests a common source of infection, the CDC said.
Jan 14 CDC final outbreak notice
Nov 7, 2018, CIDRAP News scan "Feds share more details about cake mix Salmonella outbreak


Frequent upper respiratory infections tied to sinusitis in kids

A study today in Clinical Infectious Diseases looks at the differences between uncomplicated upper respiratory infections (URIs) and those that precede sinusitis in children, and finds that children with sinusitis have more frequent URIs and are more likely to test positive for respiratory syncytial virus (RSV).

The 5-year prospective study followed children ages 4 to 8 years from two pediatric practices in Wisconsin, for a total of 519 URIs. Study subjects provided nasal samples on days 3, 4, and 10 of a URI, and when sinusitis was diagnosed. Thirty-seven illnesses in 31 patients met the study criteria for sinusitis.

According to the study, RSV was detected more frequently in URI visits that led to sinusitis compared with uncomplicated URIs (10.8% vs. 3.4%, P = .05). The median number of URIs per subject per year was 1 (range, 0-9) in patients with uncomplicated URIs, and 3 (range, 1-9) in those with sinusitis.

Most important, the authors said that 30% of nasal samples taken on the day of sinusitis diagnosis actually identified a new virus, which suggests the children were experiencing sequential viral URIs. 

"We found that using the criteria of persistent or worsening symptoms, 71% of patients had the same or no virus detected on the 10-day nasal sample supporting the diagnosis of bacterial sinusitis in these patients. However, nearly 30% had a new virus identified suggesting that sequential viral infection may be the explanation for the symptoms," the authors wrote.
Jan 14 Clinical Infect Dis study


Lone star ticks prefer females' breath over males', study says

The lone star tick exhibited a clear preference for human female breath over the breath of males, according to a new study in Experimental and Applied Acarology. The findings suggest either that chemical compounds in female breath attract the disease-carrying vectors, or that male breath repels the bugs, the authors say.

To conduct the study, researchers at Oklahoma State University had 20 mean and 20 women breathe into tubes containing 10 Amblyomma americanum ticks. An average of 42.5% of ticks chose a female host, 18% chose a male host, and 39.5% did not make a choice, the authors said.

This is the first study to demonstrate human sex preferences for lone star ticks, which can transmit diseases such as ehrlichiosis, Rocky Mountain spotted fever, and tularemia.

"Understanding what causes individual variation in attractiveness to ticks can lead to a better assessment of what aspects make one person more susceptible to tick bite and which individuals may be at higher risk for exposure to a tick-borne disease," the authors concluded.
Jan 10
Exp Appl Acarol study


Severe flu outcomes tied to immune deficiency, advanced age

In separate studies published late last week, Spanish researchers determined that the comorbidity most closely associated with severe outcomes with flu infection was immune deficiency, with older age also a factor, while scientists in Turkey reported that the death rate of H3N2 flu was significantly higher than H1N1 in the 2015-16 flu season.

In the first study, which appeared in PLOS One, researchers conducted an observational study of adult patients in 12 Catalonian hospitals from 2010 through 2016 that included 1,726 hospitalizations. Of the total, 595 patients (34.5%) were admitted to the intensive care unit (ICU), and 224 (13.0%) died.

The researchers found that the 65-to-74 and 75 and older age-groups were associated with an increased risk of death in all types and subtypes, especially for influenza type B, for which the adjusted odds ratio (aOR) reached 27.4 for the younger age-group and 16.0 for the oldest group. In contrast, older age was associated with a lower rate of ICU admission.

The comorbidity most closely associated with severe outcomes, however, was immune deficiency, which was associated with death for influenza type B (aO,R 9.0) and 2009 H1N1 (aOR, 3.16). The authors conclude, "Although possible explanations are not always available, our results suggest that predictors of poor outcomes of influenza may vary by type/subtypes."
Jan 11 PLOS One study

Results also varied  by subtype in second study, published in the International Journal of Infectious Diseases, which highlighted higher death rates in those infected by the H3N2 strain in Turkey, findings that have been noted in other countries.

Investigators included 222 cases of lab-confirmed flu in hospital patients, of whom 25 (11.2%) died. The fatality rate was significantly higher among patients older than 65 and those with chronic heart or kidney diseases.

They determined a 4.2 times higher risk of dying for those infected with H3N2 compared with other strains. And the OR of dying was 6.9 for those 65 and older and infected with any flu strain, compared with their younger counterparts.
Jan 11 Int J Infect Dis abstract


Russia, Taiwan report more high-path avian flu at poultry farms

Russia and Taiwan reported new highly pathogenic H5 avian flu detections, according to recent notifications from the World Organization for Animal Health (OIE).

In Russia, an outbreak that began on Jan 4 at a commercial turkey farm in Rostov oblast in the far west of the country killed 6,355 of 17,211 susceptible birds. The surviving birds were slated for culling, and so far the source of the virus hasn't been determined.

The country has been reporting a small but steady number of H5 outbreaks since last June, the last of which occurred in November. European health officials have said that the Russian outbreaks mainly involve H5N8.

Elsewhere, Taiwan reported another H5N2 outbreak, part of a string of similar detections involving the virus that began in early 2015. The latest outbreak began Dec 25 at a commercial duck farm in Yunlin County that had early been placed under movement restriction. Authorities culled all 2,139 birds at the location and have intensified surveillance at poultry farms within 3 kilometers of the affected farm.
Jan 11 OIE report on H5 in Russia
Jan 11 OIE report on H5N2 in Taiwan

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