News Scan for Jan 22, 2019

Washington state measles
Acute flaccid myelitis tops 200
Saudi MERS cases
HPV vaccine herd immunity
Avian flu in 3 countries

Washington state measles outbreak sickens 22; exposures in Portland area

Washington state's Clark County, which is part of the Portland, Ore., metropolitan area, has declared a public health emergency related to a measles outbreak, with 22 cases confirmed so far, along with 3 more suspected cases.

The outbreak began in the Vancouver, Wash., area in early January, with exposure risks at various locales in the Portland metro area, including a Portland Trailblazers basketball game on Jan 11.

Most of the illnesses have been in children ages 1 to 10, and one patient has been hospitalized, county officials said. Nineteen people were unvaccinated, and immunization status was unverified in the three other cases.

The county is requiring that students and staff without documented immunity be excluded from schools identified as possible exposure sites, and it has set up a call center for questions about the investigation and possible exposure. In a Jan 18 statement announcing the public health emergency, Clark County said the step is needed to ensure that it has enough resources to continue its response and access to resources outside of its region.
Jan 21 Clark County Public Health measles update
Multnomah County measles outbreak information
Jan 18 Clark County public health emergency announcement

In its latest measles update, the US Centers for Disease Control and Prevention (CDC) said 349 cases of measles were confirmed in 2018, the second most since the US eliminated measles in 2000. The cases include illnesses related to outbreaks in New York state, New York City, and New Jersey, mainly involving unvaccinated people in Orthodox Jewish communities. The CDC said 81 imported measles cases were reported in 2018, the most since the disease was eliminated.
Jan 10 CDC measles update


CDC: More than 200 cases of acute flaccid myelitis documented in 2018

In its latest update on acute flaccid myelitis (AFM), the CDC yesterday confirmed 5 new cases in the last week, raising 2018's total to 201, the most in any year since the agency began tracking the puzzling condition in 2014.

A total of 40 states have confirmed cases of the polio-like illness, with Texas reporting the most, with 25. Colorado has 16 cases, Ohio has 13, and Washington state has 11. California, Minnesota, and New Jersey each have recorded 10.

AFM affects the spinal cord, leaving patients — almost always children — with partial or total limb paralysis or muscle weakness. The cause of the disease is unknown, but 90% of patients report upper respiratory virus symptoms in the weeks prior to limb weakness.

In a study published today in mBio, researchers provided evidence of enterovirus D68 (EV-D68) in a cluster of AFM cases investigated in Arizona in September of 2016. Enteroviruses have previously been connected to AFM outbreaks. In this study, 3 of 4 confirmed AFM cases had evidence of EV-D68 in either nasal swabs or cerebrospinal fluid material.

As of yesterday's update, the CDC said it will now post AFM case counts biweekly.
Jan 21 CDC update
Jan 22 mBio


Two new cases of MERS recorded in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) recorded two new cases of MERS  in recent days, one each in epidemiologic weeks 3 and 4.

In week 3, the MOH said a 40-year-old man from Riyadh was hospitalized for his MERS-CoV (Middle East respiratory syndrome coronavirus) infection. In the week 4 update, the MOH said a 66-year-old man from Riyadh was also hospitalized with MERS.

Neither man had camel contact, and both sources of infection are listed as "primary, community acquired."

The new cases likely lifts on the global total since 2012 to 2,288 cases, at least 806 of them fatal.
Jan 19 MOH update
Jan 22 MOH update


New study shows HPV vaccine highly effective, offers herd immunity

A study today in Pediatrics shows that both the quadrivalent (four-strain) and nine-valent human papillomavirus (HPV) vaccines are highly effective and provide herd immunity for women in the United States.

The study was based on four cohorts of vaccine recipients (aged 13 to 26 years) tracked from 2006 to 2017 at two US clinic sites, with the early cohorts receiving the quadrivalent vaccine and the later cohort receiving the nine-valent vaccine. A total of 1,580 women at high risk for HPV infection were included in the study.

Vaccine effectiveness in each wave of recipients was high, from 80.1% to 90.6%. Overall, women vaccinated with the quadrivalent vaccine saw an 80.9% decline in HPV infections.

The study authors also provided evidence of herd immunity. The prevalence of HPV-6, HPV-11, HPV-16, and HPV-18, the four strains of HPV included in the quadrivalent vaccine, dropped among unvaccinated women from 32.4% to 19.4% during the study period.

"This degree of effectiveness is remarkable given the fact that vaccination was defined as having received ≥1 dose (ie, was not defined as having completed the vaccination series) and that women in this study were likely at a substantially higher risk for preexisting HPV infection than those in the HPV vaccine clinical trials because of their reported sexual behaviors," the study authors wrote.

The researchers also reported good protection against strains not included in the vaccine.

In an unexpected finding, herd immunity was not seen among unvaccinated women for the five additional strains of HPV included in the nine-valent vaccine but not in the quadrivalent version. The authors said continued community-level research is needed to monitor this trend.
Jan 22 Pediatrics


Nigeria, Iran, Denmark report more H5 avian flu detections

In new highly pathogenic avian flu developments, Nigeria reported an H5N1 outbreak in poultry, Iran confirmed another H5N8 event, and Denmark noted a pair of H5N6 detections in wild birds, according to the latest notifications from the World Organization for Animal Health (OIE).

Nigeria's H5N1 outbreak, where the virus is considered endemic, began on Jan 19 and affected backyard birds in Bauchi state in the north central part of the country. The virus killed 27 of 848 susceptible birds, and the remainder are slated for culling. Though the source of the virus hasn't been determined, the OIE report said new pullets had recently been introduced to the farm.

In Iran, the country's agriculture ministry reported another H5N8 outbreak, this time affecting backyard poultry in Qom province. The event began on Jan 2, killing 8,000 of 12,138 birds at the location. Authorities destroyed the surviving birds, and the event is now listed as resolved. Iran reported its last H5N8 outbreaks earlier this month, which struck farms in Mazandaran province.

In Denmark, officials recently reported two H5N6 detections in wild birds, one involving a white-tailed eagle found dead on Dec 22 near Naestved on Zealand island in the east and the other in a buzzard found dead on Jan 4 on a different part of the island. The H5N6 strains detected in European wild birds are not closely related to zoonotic strains in Asia.
Jan 22 OIE report on H5N1 in Nigeria
Jan 19 OIE report on H5N8 in Iran
Jan 15 OIE report on H5N6 in Denmark
Jan 21 OIE report on H5N6 in Denmark

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