News Scan for Mar 04, 2019

US measles rise
More acute flaccid myelitis
Nipah virus in Bangladesh
Novel H5N2 avian flu in Egypt
Global polio emergency

US measles total climbs to 206 cases

The US Centers for Disease Control and Prevention (CDC) today reported 47 more measles cases, raising the total since the first to the year to 206 cases in 11 states. For comparison, the CDC reported 372 cases for all of 2018, the most since 2014.

Affected states are California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, Oregon, Texas, and Washington.

Meanwhile, the number of outbreaks remained at six, which includes a large outbreak centered in Clark County in the area around Vancouver, Washington. In that outbreak, county officials reported 5 more cases, raising its total since early January to 70. No more suspected cases or possible exposure locations have been reported, and all but 2 patients are known to have been vaccinated.

In New York, Rockland County officials reported 2 more cases, raising the total since September to 140, and an outbreak in an Orthodox Jewish community in Brooklyn has 121 cases as of Feb 26. In Illinois, a measles outbreak near Champaign-Urbana area involves 1 more case, raising the total to 5.
Mar 4 CDC update


With 9 new acute flaccid myelitis cases, CDC will switch to monthly reports

In a separate update, the CDC today confirmed 8 more 2018 acute flaccid myelitis (AFM) cases in the past 2 weeks, raising 2018's total number of cases to 223 reported in 41 states, and 1 more for 2019, raising this year's cases to 2.

The 223 cases—which are by a large margin the most US cases in 1 year—were confirmed from 374 reports of patients under investigation (PUIs). The CDC said no deaths have been attributed to AFM in 2018 or 2019.

The 2019 AFM cases have been diagnosed in patients from North Carolina and Utah, with the latter being a new case since the CDC's previous update on Feb 15.

Texas has reported the most AFM cases in 2018, with 29. Colorado has 16 cases, Ohio and California have 14 each, and Washington state and New Jersey both have 11. Minnesota and Pennsylvania have each recorded 10.

As of today, the CDC said it will update AFM counts monthly instead of biweekly because of a reduction in the number of PUIs.

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.
Mar 4 CDC


Bangladesh confirms Nipah case in suspected family cluster

Lab tests in the investigation into the early February deaths of five family members in Bangladesh revealed that one was infected with Nipah virus, according to a report from the Daily Star, Bangladesh's largest English-language newspaper, which cited a statement from the country's Institute of Epidemiology, Disease Control and Research (IEDCR).

The family members are from Baliadangi upazila in Rangpur division in the far northwest of the country. IEDCR committees have conducted investigations at hospitals and other locations, collecting samples from health workers, as well as other family members, neighbors, and villagers. None of other family member tested positive.

The IEDCR said it's not known if the patient whose sample was positive had a history of drinking raw date palm sap, a known risk factor for the disease because of virus contamination through bat droppings. The agency said the four others may have been infected by the individual whose samples were positive.

Nipah virus is harbored by bats, which can transmit the disease to people and other animals. It is one of three priority areas targeted by the Coalition for Epidemic Preparedness and Innovations (CEPI). In 2018, a Nipah virus outbreak in India's Kerala state was linked to 17 deaths. In 2018, Bangladesh recorded three Nipah virus cases, one of them fatal, according to a list from the IEDCR.
Mar 4 Daily Star story
IEDCR yearly distribution of Nipah virus cases


Novel H5N2 detected at Egyptian farm; Denmark reports low-path H5

Egypt's agriculture ministry yesterday reported a novel H5N2 avian flu virus on a duck farm, according to a brief agriculture ministry statement and Arabic media report translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The reports didn't say if it was a highly pathogenic virus or where the farm was located.

Another Egyptian media report translated and posted by FluTrackers, an infectious disease news message board, quoted a veterinary official as saying the virus is a reassortant between H5N1 and H9N2, both of which are known to circulate in Egyptian poultry.
Mar 4 AFD post
Mar 3 FluTrackers thread

In other avian flu developments, Denmark reported a low-pathogenic H5 outbreak at an organic layer farm in Terndrup in North Jutland County, according to a Mar 1 report to the World Organization for Animal Health (OIE).

The outbreak began on Feb 26, and the birds had subclinical infection. The holding has 7,000 hens, and all will be destroyed to curb the spread of the virus. So far, the source isn't known.
Mar 1 OIE report on low path H5 in Denmark


WHO agrees to extend public health emergency for polio

The 20th meeting of the Emergency Committee under the International Health Regulations of the World Health Organization (WHO) nanimously agreed late last week that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC).

During the meeting, which convened in Geneva on Feb 19, the group considered several developments, including a rising number of wild poliovirus type 1 cases, the international spread of circulating vaccine-derived polio in several African countries, and population movement, before deciding the PHEIC status needed to stay in place.

"The current situation calls for unabated efforts and use of every tool available, to achieve the goal in these most challenging countries," the WHO said. "Particularly in the three remaining endemic countries, further engagement with senior levels of government and other key stakeholders is needed to advocate for polio eradication, and ensure all levels of government maintain a strong commitment until the job is done."

Polio is endemic in Afghanistan, Pakistan, and Nigeria. Several countries, including Indonesia, Papua New Guinea, and Somalia, have also reported recent cases.
Mar 1 WHO statement

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