News Scan for Feb 04, 2019

More US acute flaccid myelitis
2017-18 flu vaccine protection
Lassa fever in Nigeria
Jamaica dengue outbreak
H9N2 avian flu case in China

CDC confirms 9 new acute flaccid myelitis cases for 2018

The US Centers for Disease Control and Prevention (CDC) today confirmed 9 new cases of the polio-like condition known as acute flaccid myelitis (AFM), boosting the 2018 numbers to 210. The agency also noted that 7 patients so far this year are under investigation for AFM.

Forty-one states have confirmed AFM cases in 2018, which is one more than the CDC reported in its most recent update on Jan 22. Texas has reported the most, with 29. Colorado has 16 cases, Ohio has 13, and Washington state and California have 11. Minnesota and New Jersey have recorded 10.

The condition has been following an every-other-year pattern. The CDC first started tracking the disease in August of 2014, and that portion of the year saw 120 cases. In 2015 the agency confirmed 22 cases, in 2016 there were 149, and 2017 saw 35 cases. The 210 cases confirmed so far for 2018 have set a record.

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 previous years the syndrome has been tied to enterovirus infections.
Feb 4 CDC update


CDC estimates low flu vaccine protection last season still saved many lives

An end-of-season 2017-18 flu vaccine effectiveness (VE) estimate by a team led by CDC researchers found an overall VE of 38% against medically attended influenza and 22% for the H3N2 strain, but even this fairly low level of protection still saved thousands of lives, according to a Feb 2 study in Clinical Infectious Diseases.

The investigators used national age-specific estimates of 2017-18 flu vaccine coverage and disease burden and measured VE against medically attended flu confirmed by polymerase chain reaction testing. They used a test-negative design. Last year's season was severe, and the H3N2 strain was predominant.

VE against all strains was 38% (95% confidence internal [CI], 31% to 43%). For H3N2 VE was 22% (95% CI, 12% to 31%), for 2009 H1N1 it was 62% (95% CI, 50% to 71%), and against influenza B it was 50% (95% CI, 41% to 57%).

In addition, the researchers estimated that vaccination prevented 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths. Vaccination prevented 10% of expected hospitalizations overall and 41% among children 4 years old and younger.

In an accompanying commentary, Kathleen M. Neuzil, MD, MPH, and Meagan C. Fitzpatrick, PhD, of the University of Maryland School of Medicine, said, "The results are qualitatively similar to a previous model that looked at a range of effectiveness estimates and applied them to US burden. In fact, the model published here is considerably more conservative, and represents the lowest possible bound for estimates of disease averted."

They add that the data reinforce the importance of routine seasonal flu vaccination.
Feb 2 Clin Infect Dis study
Feb 2 Clin Infect Dis commentary


Deadly Lassa fever outbreak in Nigeria grows to 213 cases

The World Health Organization (WHO) said late last week it is scaling up its response efforts in Nigeria after a Lassa fever outbreak affecting people in 16 states has grown to 213 confirmed cases, including 41 deaths.

All of the cases and deaths have been recorded since Jan 1. The WHO said of the outbreak, "This represents a significant increase in the number of cases reported compared to the same period in 2018." Nigerian officials reported the outbreak to the WHO on Jan 21.

In response, the WHO intensified its technical assistance to local and national authorities. Peter Clement, MD, MPH, the WHO officer in charge for Nigeria, said, "WHO reorganized its staff to provide assistance to each of the response pillars and directed field offices to assist in outbreak investigation, coordination and response activities at the state level."

"WHO is supporting coordination, enhanced surveillance, contact tracing, and risk communication. We are also mobilizing experts to support case management and detailed epidemiological analysis to monitor situation in the affected states."
Feb 1 WHO news release


WHO reports 339 cases in Jamaican dengue outbreak

Jamaican health officials have reported a rise in dengue cases to the WHO and have declared an outbreak, with 339 suspected and confirmed cases, including 6 deaths, reported from Jan 1 through Jan 21, the WHO said today in a statement.

Lab tests have identified dengue virus 3 (DENV3) as the circulating serotype.

For 2018, Jamaica's dengue cases were 4.5 times higher than the previous year, piling up 986 suspected and confirmed cases, 13 of them fatal. For the new year, cases reported have passed the epidemic threshold. Jamaica's last major outbreak occurred in 2016, registering more than 2,200 cases, in which DENV3 and DENV4 circulated.

Toward the end of 2018, the hot spots were Kingston and Saint Andrew parishes, and in 2019, the largest number of cases have been reported from Saint Catherine parish, the WHO said.

Other countries and territories in the Caribbean region are also reporting dengue increases, including Guadeloupe, Martinique, and St. Martin. However, the circulating serotype in St. Martin and Guadeloupe is DENV1.
Feb 4 WHO statement


H9N2 avian flu infects boy from China's Hunan province

China has reported a human H9N2 avian flu case involving a 2-year-old boy from Hunan province in the south central part of the country, according to a report yesterday from the Taiwan Centers for Disease Control translated and posted by Avian Flu Diary, an infectious disease news blog.

The boy is from Changde City and the report said on Dec 27 his illness symptoms were mild and he had a history of exposure to live poultry. The boy's infection raises China's number of H9N2 cases in 2018 to seven. H9N2 cases are typically mild and often reported in children.

H9N2 is enzootic in China's poultry, and exposure to live poultry is a known risk factor for contracting the virus. According to the WHO, no case clusters have been reported and current evidence suggests H9N2 hasn't acquired the ability for sustained transmission.
Feb 3 AFD post

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