News Scan for Mar 29, 2019

MERS in Saudi Arabia
Measles death rate
More hedgehog-related Salmonella
Polio in Pakistan, Nigeria
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Two more MERS infections confirmed in Saudi Arabia

Saudi Arabia today announced two new MERS-CoV cases today, another in Hofuf and one in Khafji, according to an update to the Ministry of Health's (MOH's) epidemiologic week 13 report.

The patient from Hofuf is a 50-year-old man whose exposure is reported to be primary, meaning he wasn't likely exposed to another known case. Hofuf has reported a few other MERS-CoV (Middle East respiratory syndrome coronavirus) cases over the past several days. The man did not report recent camel contact.

The other case involves a 75-year-old man from Khafji (in northeastern Saudi Arabia near the border with Kuwait) who had contact with camels. The pair of new infections lifts the country's total to 113 this year, which includes 57 linked to a large outbreak in Wadi ad-Dawasir that has mostly involved healthcare spread.

In other MERS-CoV developments, the World Health Organization (WHO) today fleshed out details about 19 cases outside of Wadi ad-Dawasir that were reported by Saudi Arabia in February. Fifteen were sporadic, and 4 were part of two unrelated clusters, 1 in Buraidah and 1 on Riyadh. Of the 19 patients, 2 were exposed to other sick patients, likely reflecting the cluster patients. Of the other 17 patients, 9 had been exposed to camels or camel milk. Aside from Riyadh and Al Qassim regions where clusters were reported, other affected regions were Asir, Qurayyat, Najran, Tabuk, Mecca, Jeddah, and Medina.

The WHO said it will update the Wadi ad-Dawasir in a separate statement, but it noted that three more cases have been reported since February, bringing the total reported to the WHO to 52.

From 2012 through the end of February, the WHO has received reports of 2,374 MERS cases, at least 823 of them fatal. The vast majority are from Saudi Arabia.
Mar 29 MOH report
Mar 29 WHO statement


Study notes rising death rate in 2015-17 measles outbreak in Mongolia

As measles outbreaks grow in many nations, including the United States, a study today on a previous outbreak in Mongolia demonstrates just how deadly the disease can be, while the WHO issues a call for full vaccination coverage in the Western Pacific in the wake of a huge outbreak in the Philippines.

In the study, published in the Journal of Infectious Diseases, investigators from the US Centers for Disease Control and Prevention (CDC) and Mongolia linked national vital records with surveillance data of clinically or lab-confirmed measles cases in babies younger than 1 year who had an onset of rash from March to September 2015 (wave 1) and October 2015 to June 2016 (wave 2).

They note that infant measles deaths in the outbreak rose from 3 among 2,224 cases (case-fatality rate [CFR], 0.13%) in wave 1 to 113 among 4,884 cases (CFR, 2.31%) in wave 2—or almost 18 times higher. They also noted that hospital admission 7 to 21 days before measles rash onset for pneumonia or influenza, but not other diagnoses, was significantly associated with death.

The WHO, meanwhile, said in a news release that measles outbreaks in its Western Pacific Region are putting children at risk and threatening progress toward elimination. It said the region had historically low measles cases and no major outbreaks in 2017, but so far this year the Philippines has reported 23,000 cases and 333 deaths—already more than all of last year's totals.

Australia, Cambodia, China, Hong Kong, Japan, Laos, New Zealand, South Korea, Singapore, and Vietnam have also reported cases. The agency encouraged comprehensive vaccination campaigns to make sure all children are protected. "Measles spreads like wildfire," said Regional Director Takeshi Kasai, MD, PhD. "It is the most contagious human disease, and it's very good at seeking out and spreading among even small groups of people who are not immune."
Mar 29 J Infect Dis study
Mar 29 WHO news release


CDC reports more cases in hedgehog-linked Salmonella outbreak

Six more illnesses have been reported in a multistate Salmonella Typhimurium outbreak linked to pet hedgehogs, the CDC said today in an update.

So far, 17 infections have been reported, including 2 in patients needed hospital treatment. Cases were reported in 3 more states—Iowa, Virginia, and Washington—raising the total affected to 11. The latest illness onset was Mar 1.

Interviews with 15 sick patients revealed that 13 had contact with pet hedgehogs, though a common supplier has not been identified. The outbreak strain was found in samples collected from eight hedgehogs in Minnesota, including three from two of the sick patients' homes.
Mar 29 CDC outbreak update
Jan 28 CIDRAP News scan on initial notification


Pakistan and Nigeria report four more polio cases

In its weekly report today the Global Polio Eradication Initiative (GPEI) today noted four new polio cases, two from Pakistan involving wild poliovirus type 1 (WPV1) and two from Nigeria involving circulating vaccine-derived poliovirus type 2 (cVDPV2).

In Pakistan, the WPV1 cases are in Khyber Pakhtunkhwa tribal district in a patient with a Feb 14 paralysis onset and in Karachi in a person with a Feb 25 paralysis onset. The country has now reported six polio cases for 2019.

Nigeria's cases are in Borno and Kwara states, with polio onsets of Feb 14 and Feb 20, respectively. The pair of new cases brings the country's total for the year to four. Nigeria is experiencing two cVDPV2 outbreaks, one in Jigwa state that resulted in spread to other parts of Nigeria as well as to neighboring Niger, and one in Sokoto state.
Mar 29 GPEI report

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