News Scan for Jan 31, 2020

US flu rebound, kids' deaths
Recent DRC Ebola cases
Pathogen-spewing hospital toilets
MERS in the UAE
Polio in 4 countries

Flu levels rising again in US as 14 more pediatric deaths reported

After US flu activity peaked at the end of 2019 and fell for 2 straight weeks, it has now increased measurably for the second straight week, while the number of flu-related deaths in children rose by 14, to 68, the Centers for Disease Control and Prevention (CDC) said in its weekly FluView report today.

The CDC estimated that so far this season flu has sickened 19 million people, hospitalized 180,000, and killed 10,000.

Clinic visits for influenza-like illness (ILI) rose from 5.1% the week before to 5.7% last week, the CDC said. The national baseline is 2.4%. And the number of states reporting high ILI activity jumped from 35 to 41. In addition, every state but Hawaii reported widespread flu, compared with 48 states the week before.

Eight of the 14 new pediatric deaths were caused by influenza B, the season's predominant strain, and 6 were caused by influenza A. Three "A" strains were subtyped, and all were 2009 H1N1 strains. The percentage of deaths attributed to pneumonia and flu was 6.7%, the same as the week before and below the epidemic threshold of 7.2%.

For the season, influenza B viruses have accounted for 54.0% of flu-positive respiratory specimens analyzed at public health labs, compared with 46.0% for influenza A. For the most recent week, however, A strains outpaced B strains 55.7% to 44.3%. Among specimens from clinical labs, however, influenza B made up 50.2% of flu viruses last week and 62.6% for the season. Public health labs assess circulating strains, while clinical labs assess those infecting patients.

The overall hospitalization rate was 29.7 per 100,000 population last week, compared with 24.1 the week before, which the CDC said is at expected levels. As is typical, people 65 and older are the hardest-hit group, with a flu hospitalization rate of 71.3 per 100,000, up from 58.1 per 100,000 the week before.
Jan 31 CDC FluView update


WHO links recent Ebola cases to earlier transmission chain

In its weekly snapshot of the Ebola outbreak, the World Health Organization (WHO) said yesterday that five new cases were reported from Beni health zone in the Democratic Republic of the Congo (DRC) from Jan 22 to Jan 28. The cases had epidemiologic links to a transmission chain that originated in Mabalako health zone, and most likely occurred through exposure to a traditional healer.

In addition, the WHO said that one case-patient confirmed on Jan 20 stayed in the community for 4 days before going to an Ebola treatment center and infected two additional people in the community. Because those two patients, and another confirmed patient, stayed in the community for several days prior to isolation, the WHO warned that further cases can be expected in the coming 2 weeks in Bundji and Kanzulinzuli health areas and neighboring health areas in Beni Health Zone.

The WHO said 28 cases were confirmed from Jan 8 to Jan 28, and that Beni health zone remains the current hot spot of the outbreak, having confirmed 64% of confirmed cases over the past 21 days. But the agency noted that encouraging trends have been observed in the past 21 days, as well, with the most recent epidemiologic week (Jan 20 to Jan 26) seeing the fewest cases since the beginning of the response. Contact tracing has also improved, the WHO said.

Meanwhile, the WHO online Ebola dashboard reported no new cases today, keeping the total at 3,427 cases, of which 2,245 were fatal. Yesterday's daily update from the DRC's Ebola technical committee (CMRE) said a recently confirmed new case in North Kivu was in Mabalako. CMRE also updated its vaccination numbers, reporting that 8,828 people have been vaccinated with Johnson & Johnson's Ebola vaccine, and 280,426 have received Merck's rVSV-ZEBOV.
Jan 30 WHO situation report
WHO Ebola dashboard
Jan 30 CMRE update


Study: Toilet flushing could aid spread of pathogens in hospitals

A pilot study by researchers with the University of Iowa has found that bioaerosols from flushed toilets in the rooms of patients with Clostridioides difficile infection (CDI) may contribute to the spread of healthcare-associated bacteria in hospitals. The research was published today in Infection Control and Hospital Epidemiology.

In the study, which was conducted at the University of Iowa Hospitals and Clinics, researchers collected bioaerosols on plates placed 0.15 meters (m), 0.5 m, and 1.0 m from the rims of toilets in 24 rooms of patients hospitalized with CDI and collected bathroom air continuously with a bioaerosol sampler before and after toilet flushing. They then cultured and identified bacteria on the plates (focusing on C difficile), measured bacterial density, and calculated the difference in bioaerosol production before and after flushing.

Bacteria were positively cultured from 8 of 24 rooms (33%). In total, 72 preflush and 72 postflush samples were collected, with healthcare-associated bacteria found in 9 of the preflush samples (12.5%) and 19 of the postflush samples (26.4%); postflush plates had a significantly higher probability of culturing positive than preflush plates (P = .0309). The predominant species cultured were Enterococcus faecalisE faecium, and C difficile. Compared with the preflush air samples, the postflush samples showed significant increases in the concentrations of the two large particle-size categories: 5.0 micrometers (P = .0095) and 10.0 micrometers (P = .0082).

The authors conclude, "This study potentially supports the hypothesis that toilet flushing may lead to the spread of clinically significant pathogens in healthcare settings. More information is needed to determine the risk factors associated with toilet flushing and environmental contamination by pathogens."
Jan 31 Infect Control Hosp Epidemiol abstract


UAE reports 2 MERS cases involving camel contact

The WHO today said the United Arab Emirates (UAE) has reported two more MERS-CoV cases, both in men who had contact with camels.

Both of the men are from Abu Dhabi. One is a 51-year-old man whose symptoms began on Dec 26 and the other is a 53-year-old man with underlying health conditions whose symptoms began on Dec 18. Both were hospitalized on Dec 31 and survived their Middle East respiratory syndrome coronavirus (MERS-CoV) infections.

The WHO said the UAE has now reported 91 cases, 12 of them fatal. It said as of Jan 15, the global total of MERS-CoV cases reported since the virus was first detected in humans in 2012 is 2,506, at least 862 of them fatal. Saudi Arabia has been the hardest hit country.
Jan 31 WHO statement


Four countries report more polio cases, including 6 in Pakistan

The Global Polio Eradication Initiative (GPEI) in its latest weekly update said four countries have reported new cases: Pakistan, the Democratic Republic of Congo (DRC), Angola, and the Philippines.

Pakistan reported six wild poliovirus type 1 (WPV1) cases, including four from Sindh province and one each from Balochistan and Khyber Pakhtunkhwa province. Some had 2019 illness onsets, raising that annual total to 139, a steep increase from previous years. The new cases with January paralysis onsets lift the 2020 total so far to 4 cases.

Earlier this week, two polio workers were killed in an attack on a team in Swabi district in Khyber Pakhtunkhwa province, according to a Jan 29 report from Dawn, an English-language newspaper based in Pakistan.

Two African countries reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, including two from the DRC (from Sankuru and Kwilu provinces) that lift the total for 2019 to 75. The other is Angola, which reported 15 cases from eight different provinces, putting the total for 2019 at 103 cases from seven different outbreaks.

Elsewhere, the Philippines reported a second cVDPV1 case for 2019, which involves a patient from Southern Mindanao province. The country is also experiencing a cVDPV2 outbreak that totaled 13 cases for 2019.
Jan 31 GPEI report
Jan 29 Dawn story

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