News Scan for Apr 08, 2019

US measles surge
;
Saudi MERS cases
;
Lassa fever in Nigeria
;
Waning pertussis vaccine effect
;
Vaccine allergies

CDC confirms 78 new measles cases; US on track for record year

The US Centers for Disease Control and Prevention (CDC) recorded 78 more measles cases in the last week, a sign that ongoing outbreaks in several states are growing.

The 2019 total number of cases has jumped to 465 in 19 states, as Florida, Indiana, Massachusetts, and Nevada all reported their first cases of the year last week.

"This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000," the CDC said. In 2014 the agency recorded 667 measles cases, and last year saw 372 cases, now the third-most since 2000. If the current pace of cases continues, the nation could top the 2014 total as soon as the end of this month or in May.

Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington have all recorded cases.

Of note this week is a growing outbreak in Michigan, where 39 cases have been reported between Mar 13 and Apr 5 in Oakland and Wayne counties. As with outbreaks in New York and New Jersey, the Michigan outbreak is connected to an imported case of measles from Israel.

New York City recorded 45 more cases in an outbreak in Queens and Brooklyn that's been ongoing since October. There are now 259 cases in that outbreak, which began with an unvaccinated child who contracted the virus in Israel.

In addition to Michigan and New York City, the CDC is tracking five other measles outbreaks: Rockland County, New York (157 cases); Washington state (74); New Jersey (13); Butte County, California (6); and Santa Clara County, California (3).
Apr 8 CDC
update

 

MERS infects 3 more in latest Saudi cluster

Saudi Arabia today reported two more MERS-CoV cases that appear to be part of a cluster in Khafji in the northeastern part of the country, plus a case in Jeddah in the west.

In its epidemiologic week 15 report, the Saudi Ministry of Health (MOH) said the newly confirmed MERS-CoV (Middle East respiratory syndrome coronavirus) cases in Khafi involve two men, ages 28 and 34. Both had secondary exposure, meaning they probably contracted their infections from another sick patient. The history of contact with camels is unknown for both patients.

The patient in Jeddah is an 80-year-old man. His case is listed as "primary," meaning it's unlikely he contracted the disease from another patient. As with the other cases, it's not known whether he had recent contact with camels, a known MERS risk factor.

With the new cases, 9 MERS-CoV illnesses have been reported in Khafji since Mar 29. Also, the 3 new illnesses lift Saudi Arabia's total since the first of the year to 123 cases, including 57 linked to a large outbreak in Wadi ad-Dawasir.
Apr 8 MOH update

 

Nigeria reports 16 more Lassa fever cases

The Nigeria Centre for Disease Control (NCDC) reported 16 new confirmed Lassa fever in five states, officials said in a report covering epidemiologicl week 13, which ended on Mar 31. The new infections lift the country's outbreak total since the first of the year to 526 confirmed cases. Currently, 29 patients are being treated at seven centers across the country.

One more health worker infection was reported, raising the total sickened in the country's latest outbreak to 17.

Two more people died from their Lassa fever infections, raising the year's fatality count to 121.

The virus—typically contracted by coming into contact with rodent excreta—is endemic in Nigeria. Human-to-human transmission can occur, as well, and 6,489 contacts have been identified in 20 states, of which 22.2% are still being followed and 76.8% have completed their 21-day follow-up.
Apr 8 NCDC update

 

Study confirms decline in pertussis vaccine protection after first decade

In children vaccinated against pertussis, vaccine effectiveness (VE) is high during the first decade of life but falls rapidly, according to case-control study from Canadian researchers in Vaccine.

To track pertussis VE, scientists examined 1,335 cases reported to public health officials in Ontario from Jan 1, 2009, to Mar 31, 2015. Then they compared them with 5,340 randomly selected matched controls. In Ontario, children receive three priming doses of acellular pertussis vaccine at infancy, toddler, and preschool ages, followed by an adolescent booster dose between 14 and 16 years.

For 2- to 3-year-olds, VE against pertussis was 92% and declined only slightly, to 90%, in 8- to 9-year-olds. However, in 12- to 13-year-olds, VE fell quickly, to 49%. The researchers also found that the teenage booster didn't fully restore protection: VE reached 76% in 14- to 16-year-olds and 78% in 16- to 22-year-olds. The team noted that VE was generally higher and waned more slowly than they found previously in a test-negative case-control study.

There were no widespread outbreaks or deaths in infants during the study period, which the authors said seems to support substantial and sustained VE, though they noted that disease activity patterns could be influencing immunity from earlier infections in older age-groups.

They said the findings suggest the current pertussis vaccine schedule seems to be working well, though more efforts are needed to protect infants, including immunization during pregnancy. And they noted that consistent waning in immunity between the two study designs is a useful finding for policymakers.
Apr 6 Vaccine abstract

 

Vaccine allergies occur in only 1 of 760,000 vaccinations, experts say

Only 1 in 760,000 vaccinations will result in hives, swelling, or anaphylaxis, according to an article published today in the Canadian Medical Association Journal (CMAJ). This means that allergies to vaccines are extremely rare, and even if someone does have an allergy, an allergist can safely administer injections.

Most true allergic reactions to vaccines occur within minutes of receiving an immunoglobulin E (IgE)–mediated vaccine, and very rarely occur more than 4 hours after an injection. Injection-site pain and swelling are not signs of an allergy.

And people with egg, latex, yeast, and gelatin allergies can also confidently receive most vaccines, though they may require an allergist's administration. 

"Allergists can facilitate immunization of patients with vaccine allergy through techniques such as graded administration. Possible allergies to vaccines should not be a source of vaccine hesitancy for patients and health care providers," the article concludes.
Apr 8 CMAJ
study

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