Suspected yellow fever cases double in Brazil

The number of suspected yellow fever cases in Brazil is climbing quickly, with 421 suspected infections and two more states reporting cases, the health ministry said yesterday in a statement. The case total reflects an increase of 215 cases from the Pan American Health Organization (PAHO) update on Jan 18.

Most of the cases are from Minas Gerais state, and PAHO's recent report said neighboring Espirito Santo state also had suspected cases—both are in southeastern Brazil. Today, however, the health ministry said Bahia and Sao Paulo state are also investigating suspected cases. It also added that Federal district, in central Brazil, is probing a possible case.

Of the total number of suspected cases, 62 have been confirmed and 1 has been discarded. The rest are still under investigation. So far 87 deaths have been reported, up from 53 in the recent PAHO report.

Brazil has sent 4.6 million yellow vaccine doses to the four affected states, 2.4 million of them to Minas Gerais. Sao Paulo state had already received 88,300 doses, because part of it is in the area slated for routine vaccination, but the outbreak prompted health officials to send 400,000 more. Despite a global yellow vaccine shortage, the health ministry has enough vaccine to meet the demand, it said.

Several cities in Minas Gerais and Espirito Santo states have also reported recent yellow fever outbreaks in monkeys.
Jan 23 Brazil health ministry statement
Jan 18 CIDRAP News scan "Brazil's yellow fever outbreak climbs to 206 cases"


H5N8 outbreaks affect more Israeli farms, wild birds in Europe

Israel reported three more highly pathogenic H5N8 avian influenza outbreaks on farms, as three countries in Europe—Ireland, Slovakia, and Slovenia—reported more detections in wild birds, according to the latest reports from the World Organization for Animal Health (OIE).

In Israel, the virus struck three turkey farms in the northwestern part of the country in Hafazon, Hamerkaz, and Haifa districts. The outbreaks began in early to mid January, killing 1,400 of 96,000 birds. The remaining ones were culled to curb the spread of the virus.

In Europe, Ireland detected H5N8 in a sick wild duck found at the end of December on a seashore in Galway County and in a whooper swan found dead on Jan 13 in a wetlands area of Tipperary County. Slovakia reported 15 more outbreaks in wild birds found sick or dead from Jan 11 to Jan 18, affecting 65 birds from five different regions, most of them whooper and mute swans. And Slovenia reported three more H5N8 detections in mute swans found dead near bodies of water on Jan 17 and Jan 18.
Jan 23 OIE report on H5N8 in Israel
Jan 23 OIE report on H5N8 in Ireland
Jan 22 OIE report on H5N8 in Slovakia
Jan 24 OIE report on H5N8 in Slovenia

In other avian flu developments, South African veterinary officials announced another low-pathogenic H5N2 outbreak at a commercial ostrich farm. The event began on Nov 21, sickening 31 of 977 birds. The country has reported several H5N2 outbreaks in commercial ostriches since 2014.
Jan 23 OIE report on H5N2 in South Africa

Saudi Arabia reports new MERS cases

The Saudi Arabian Ministry of Health (MOH) reported one new case of MERS-CoV today, in a woman from Riyadh.

The 41-year-old Saudi woman was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) and is in stable condition. The source of her infection is listed as primary, meaning she did not contract the disease from another person.

The new case raises Saudi Arabia's MERS-CoV total to 1,544 infections, including 641 deaths. Seven people are still in treatment or monitoring.
Jan 24 MOH report


CDC's new quarantine rule allows federal government more power

The day before the inauguration of President Donald Trump, the Centers for Disease Control and Prevention (CDC) released new quarantine regulations that for the first time allow the federal government to restrict interstate travel during a suspected disease outbreak. The new rules go into effect on Feb 21.

In an op-ed published in The New York Times, the authors, including two health policy and law experts, said that the rule, inspired in part by the 2013-2016 outbreak of Ebola, also relies on lengthy CDC oversight processes during the detaining process. "The new rules give the CDC significant in-house oversight of the decision to quarantine, with up to three layers of internal agency review. This internal review has no explicit time limit and could easily stretch on for weeks while a healthy person languishes in quarantine."

But the CDC said the final rule does not "expand CDC's authority beyond what is granted by Congress."

Traditionally, states controlled quarantines through health departments. Critics say the CDC does not have the same expertise in handling quarantines as local health departments and state-run organizations.
Jan 19 CDC final rule
Jan 23 New York Times


WHO board set to vote on director-general finalists

The World Health Organization (WHO) announced today that its executive board meeting in Geneva this week has narrowed the number of candidates for the next director-general from six to five, removing the nominee from Hungary—Miklos Szocska, MD, PhD—from the list. Szocska is Hungary's former health minister and is currently a professor of health systems management at Semmelweis University.

In a statement, the WHO said the board will interview the remaining five people tomorrow, then vote on the final three in the evening, with an announcement to follow.

On Jan 26 the finalists are each slated to participate in telebriefings with the media.

Member states will select the next director-general at the World Health Assembly in May. The new director-general will take office on Jul 1 for no longer than two 5-year terms.
Jan 24 WHO press release


Pneumonia vaccine underperforms among older adults

A new study published in The Lancet Infectious Diseases showed that the 23-strain pneumococcal polysaccharide vaccine (PPV23) underperformed among adults ages 65 and older. The vaccine was only 27.4% effective in protecting against all pneumococcal pneumonia, 33.5% effective against PPV23 serotypes, and a non-significant 2% effective against non-PPV23 serotypes.

The multi-center, prospective study was based on 2,621 adult patients at four Japanese hospitals who were admitted with suspected pneumonia between September 2011 and August 2014. Of the patients eligible for the study, 419 (21%) tested positive for pneumococcal infection. Twenty-six percent of those patients had received the PPV23 vaccine prior to admittance.

Although the differences were not significant, the authors noted that adults under the age of 75 and woman, as well as those diagnosed as having lobar pneumonia or healthcare-associated pneumonia, were more likely to be protected by PPV23.
Jan 24 Lancet Infect Dis study


Analysis: Rapid screening tests can lower MRSA surveillance costs

Rapid screening tests can help hospital intensive care units (ICUs) reduce unnecessary surveillance costs for methicillin-resistant Staphylococcus aureus (MRSA), according to a new study in the American Journal of Infections Control.

For the study, investigators set out to analyze the costs associated with two surveillance approaches commonly used in ICUs to mitigate MRSA infections. One approach is universal preemptive isolation, in which all patients are screened upon admission and isolated until the absence of MRSA carriage is shown. This strategy, the authors explain, can result in some non-colonized patients being unnecessarily isolated, which leads to excess costs.

As a result, some hospitals use a targeted isolated strategy, in which all patients are screened but only MRSA-positive patients are isolated. The downside of this approach, however, is that delaying the isolation of colonized individuals while waiting for the results of screening tests could lead to MRSA transmission to other patients.

The question investigators were trying to answer was whether rapid screening tests, though more expensive than conventional screening methods, can help enhance both these surveillance approaches and reduce costs by providing quicker screening results and removing non-colonized patients from isolation sooner or reducing the number of days a MRSA-positive patient is not isolated.

Four screening tests were evaluated, including conventional culture and chromogenic agar 48-hour test, which generate results in a few days, and chromogenic agar 24-hour and polymerase chain reaction (PCR) screening tests, which produce results within 24 hours

In their cost and sensitivity analysis, the investigators found that the total cost of universal preemptive isolation was lowest when PCR screening tests were used, resulting in a cost of $82.51 per patient. For targeted isolation surveillance, they found that the total cost was lowest when using the chromogenic agar 24-hour test, which produced a cost of $8.54 per patient.

"With knowledge of the screening test that minimizes inappropriate and total costs, hospitals can maximize the efficiency of their resource use and improve the health of their patients," the authors conclude.
 Jan 23 Am J Infect Control study

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