News Scan for May 01, 2019

Philippines measles outbreak
Enterovirus and neurologic disease

Philippines measles outbreak linked to Dengvaxia troubles

A growing measles outbreak in the Philippines is being fueled by vaccine hesitancy that originated in the Dengvaxia vaccine controversy, which has embroiled that nation for the last 3 years.

According to a report today from UNICEF and the World Health Organization (WHO), there have now been 31,056 measles cases, including 415 deaths (case-fatality rate, 1.34%) reported in the Philippines since Jan 1, which is 368% more cases than the number recorded during the same period last year.

The outbreak is connected to low vaccine uptake, a problem that has worsened after Dengvaxia, Sanofi Pasteur's dengue vaccine, was widely administered to school-age children in the Philippines despite evidence the vaccine could lead to severe dengue cases in some recipients.  

Last year, the Philippines recorded 20,827 measles cases and 199 deaths. The outbreak in the Philippines has also been connected to US measles cases.

"Outbreak and supplementary immunization activities in 2018 were ineffective in addressing the outbreak as the immunization activity was met with increased vaccine hesitancy due to the Dengue vaccine controversy," the report said.
May 1 UNICEF-WHO report


French study notes emergence of enterovirus strain tied to neuropathy

French investigators have detailed the recent emergence of a recombinant enterovirus A71 (EV-A71) strain associated with neurologic disease in recent years in France that has the potential to be associated with a long-term risk for severe disease among children, according to a study yesterday in Emerging Infectious Diseases.

National surveillance data from 2016 revealed 77 cases of infection with EV-A71 subgenogroup C1v2015 lineage viruses, one of seven genogroups of the virus. In comparison, France saw 136 total EV-A71 infections from 2010 through 2015.

The C1v2015 cases were widespread throughout the country and associated with various conditions, including meningitis, cerebellitis, encephalitis, and myelitis, as well as hand, foot, and mouth disease (HFMD). "One fatal case resulted from HFMD and cardiorespiratory failure," the authors report.

Whole-genome sequencing revealed that the C1v2015 substrain "appears to be a mosaic comprising 4 modules defined by distinct patterns of similarity possibly arising through recombination." The researchers note that the close genetic relatedness between the French C1v2015 and those reported in 2015 through 2017 in Germany, Japan, and the United States indicated rapid widespread transmission. They surmise that person-to-person spread of this lineage began during 2009 to 2011 and was sustained in 2013 and 2014, just 1 to 2 years before C1v2015 was first reported.

The authors conclude, "Given the propensity of enteroviruses to recombine their genomes and spread rapidly across distant countries and that C1v2015 circulation continued throughout 2017 and 2018 in France, we need to determine if this virus is associated with a long-term recurrent risk for severe disease in the pediatric population through sharing of data from global surveillance."
Apr 30 Emerg Infect Dis study

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