News Scan for Aug 09, 2021

Guinea confirms first Marburg virus case
Fourth US melioidosis case
Respiratory activities and COVID-19 aerosols

Guinea confirms its first Marburg case

Guinea's ministry of health (MOH) has confirmed the country's first Marburg virus case, also marking the first in West Africa, the World Health Organization (WHO) African regional office said today in a statement.

A few days ago, Guinea's government said the suspected case was reported from Gueckedou in the N'zerekore region near the borders of Liberia and Sierra Leone. The area—located in southern Guinea—was the epicenter of Guinea's recent Ebola outbreak, which totaled 23 cases and 12 deaths. The event was declared over on Jun 19.

The patient with the confirmed Marburg infection sought care at local clinic in Koundou, where medical experts were sent to explore the man's worsening symptoms. Samples were obtained when the he died and were sent to a field lab in Gueckedou.

Marburg virus is similar to Ebola virus, and both filoviruses can result in fatal viral hemorrhagic fever illnesses. A large Marburg virus outbreak in Angola in 2004 and 2005 resulted in 252 cases, 27 of them fatal.

Though tests were positive at two of Guinea's labs, the ministry said since this would be Guinea's first case, further confirmation testing was planned at Pasteur Institute in Senegal.

Matshidiso Moeti, MBBS, who directs the WHO's African regional office, praised Guinea's quick actions in detecting the case. "The potential for the Marburg virus to spread far and wide means we need to stop it in its tracks."
Aug 9 WHO African regional office statement
Aug 6 Guinea MOH statement


CDC reports 4th US melioidosis case

The US Centers for Disease Control and Prevention (CDC) said Georgia health officials are investigating a fatal Burkholderia pseudomallei case that was identified at the end of July after the patient died in the hospital. Genetic analysis suggests a close match between the Georgia cases and three earlier cases reported from Kansas, Minnesota, and Texas.

None of the patients had traveled outside the country, and the findings so far suggest a common exposure source, such as an imported product or animal, the CDC said today in a health alert network (HAN) update. The CDC said it has collected more than 100 samples from products, soil, and water from patients' homes, but so far, but none were positive for the bacteria.

The CDC said the patients' initial symptoms ranged from cough and shortness of breath to fatigue, nausea, vomiting, intermittent fever, and rash on the trunk, abdomen, and face. Cases include both children and adults. Two patients have died and two had long hospitalizations before discharge to rehabilitation facilities. Two patients, including one of the patients who died, had underlying risk factors.

B pseudomallei is a tier 1 select agent and is most commonly found in tropical and subtropical areas. Most cases from the United States are linked to travel to areas where the disease is endemic. Symptoms are often nonspecific, and human infections are rare. The CDC is urging health workers to consider melioidosis in patients with similar symptoms, even if they don't have a travel history.
Aug 9 CDC HAN update
Aug 9 CDC statement
Jul 1 CIDRAP News scan


Viral COVID-19 detected in singing, talking, breathing

Between breathing, singing, and talking, researchers detected SARS-CoV-2 RNA copies mostly from talking and singing (94%), and 85% of all viral particles were detected in fine aerosols, according to a small study late last week in Clinical Infectious Diseases.

The researchers had 22 COVID-19 patients at Singapore's National Centre for Infectious Diseases breathe for 30 minutes, talk for 15 minutes, or sing for 15 minutes into a G-II exhaled breath collector. Thirteen patients (59%) had detectable SARS-CoV-2 levels, of whom three were asymptomatic and one was presymptomatic. Variables such as age, sex, virus variant, and clinical symptoms were not significantly associated with detectable viral RNA in aerosols, but median day of illness was, with a higher likelihood earlier on in a patient’s illness (median, 3 vs 5 days after illness onset).

Overall, 85.4% of the total viral RNA load in the study was from fine aerosols (up to 5 micrometers) versus the larger coarse aerosols. Six people created detectable RNA levels for all three activities, two only had some from talking, and two only had some from singing. None of the viral samples were able to be cultured.

While more RNA copies were created from singing (53%) than talking (41%) or breathing (6%), the researchers note that seven patients emitted more viruses from talking than singing and that there was large person-to-person variation in total viral loads. For instance, two patients contributed 52.4% of the study's total viral load. N gene copies ranged from 63 to 5,281 per activity per person.

"Our sampling yielded viral RNA loads below 103.8 genome copies per sample, suggesting that increased sampling duration is needed to reach culturable virus levels," the researchers write. "However, critical mutations in certain SARS-CoV-2 variants can augment virus infectivity, eg, some patients infected with the Delta variant demonstrate higher viral loads in their respiratory swabs."

They conclude, "Our study demonstrates that SARS-CoV-2 can be aerosolized in the absence of coughing, sneezing, and aerosol-generating medical procedures."
Aug 6 Clin Infect Dis study

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