News Scan for Dec 02, 2019

Measles deaths in Samoa
Asymptomatic MERS spread
H5N6 avian flu in Nigeria

Samoan government closes in effort to battle measles as deaths top 50

The Samoan government will temporarily close later this week to allow officials to focus on the country's growing measles outbreak, which has resulted in more than 3,700 cases and in 53 deaths since October, the Washington Post reported today.

Civil offices will be closed on Thursday and Friday, Prime Minister Tuilaepa Aiono Sailele Malielegaoi announced today, as all public officials will be assisting in vaccination campaigns across the country.

Schools have already been closed since mid-November in an attempt to stop the spread of the virus, which is hitting children the hardest; so far, 48 of the 53 deaths have been in unvaccinated children under the age of 4 years.

According to the Post, Samoa's measles vaccination rate has declined since 2013 and was 31% before the epidemic began. The outbreak was likely tied to international travel between Samoa and New Zealand, and fears over the vaccine grew in 2018 after two babies in Samoa died when their vaccinations were incorrectly mixed.

A vaccination coverage rate of 95% or higher is needed to prevent outbreaks.
Dec 2 Washington Post article


Review highlights role of asymptomatic MERS in human transmission

New research conducted by World Health Organization (WHO) investigators highlights the potential threat of asymptomatic, human-to-human MERS-CoV transmission.

In a paper published late last week in Epidemiologic Reviews, WHO researchers aimed to get a better understanding of human-to-human spread of MERS-CoV (Middle East respiratory syndrome coronavirus), particularly the role that asymptomatic or subclinical infections play in transmission. They conducted a systematic review of 43 studies published from 2012 through 2018 and of laboratory-confirmed MERS-CoV infections reported to the WHO since 2012.

Twenty-three of the studies reported evidence of MERS-CoV infection outside of healthcare settings, mainly of camel workers, showing ranges of seroprevalence of 0% to 67% depending on the study location; 20 studies involved healthcare settings, healthcare workers, and family contacts, of which 11 showed molecular evidence of infection among asymptomatic contacts. In addition, the researchers identified 298 lab-confirmed cases reported as asymptomatic to the WHO, 164 of whom involved healthcare workers.

Although the studies conducted in healthcare settings did not investigate onward transmission, they did capture evidence of RNA shedding, which suggests human-to-human transmission is possible from people who have no signs or symptoms of infection. The authors of the review say this finding reinforces the evidence that healthcare workers are more likely to be at risk of MERS-CoV infection due to close unprotected contact with MERS patients before their diagnosis, and they present a silent risk of human-to-human transmission.

While screening of healthcare worker contacts of confirmed MERS-CoV patients is currently recommended, the authors suggest systematic screening of non-healthcare worker contacts should also be encouraged.
Nov 29 Epidemiol Rev abstract

The study was published on the same day that Saudi Arabia's Ministry of Health (MOH) reported a MERS case involving a 48-year-old man in Medina, located in the western part of the country. The MOH investigation found that the man had contact with camels, and his MERS-CoV exposure is classified as primary, meaning he probably wasn't exposed to another patient. The case was the eleventh reported by Saudi Arabia in November, compared with 14 in October and 4 in September.

As of the end of October, the WHO has received reports of 2,482 cases, at least 854 of them fatal. Saudi Arabia has been by far the hardest-hit country.
Nov 29 Saudi MOH report


H5N6 avian flu reported for first time in Arica

The H5N6 strain of avian flu has been confirmed for the first time in Africa, the World Organization for Animal Health (OIE) reported last week.

Nigerian veterinary officials said the low-pathogenic form of the disease was confirmed at a livestock market in an outbreak that began in June. Among a flock of 2,449 birds at the live-bird market, 150 were infected but none died, according to a Nov 27 OIE report. The strain was detected during active surveillance.

The market is in Sokoto province in the northwest. Healthy birds will be quarantined and the premises disinfected, Nigerian officials said.

Highly pathogenic H5N6 viruses first emerged in China in 2013 and have since been reported in birds in several Asian nations. The strain has also caused 19 human infections and 6 deaths in China, according to the WHO A highly pathogenic H5N6 variant emerged in 2017 and caused outbreaks in wild birds and poultry in Asia and Europe. The OIE report does not specify the origin of the Nigerian virus.
Nov 27 OIE Nigeria report

Elsewhere, highly pathogenic H5N2 avian flu was detected in chickens at a slaughterhouse in Taipai City, Taiwan, according to a separate OIE report.

The virus was detected in 1 of 11 susceptible poultry in an outbreak that began on Nov 13. The strain was confirmed by polymerase chain reaction on Nov 14 and by gene sequencing on Nov 15 at Taiwan's national lab. Since 2015 Taiwan has confirmed dozens of H5N2 outbreaks.
Nov 29 OIE Taiwan report

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