Saturday, November 15, 2014

Outbreak News This Week Radio Show is back on the air



The talk radio program on infectious diseases is back in the Tampa Bay area. Starting this November, the Outbreak News This Week Radio Show has returned to the Tampa airwaves with “all the news about worms and germs”.

Show host, Microbiologist and Editor of the the news site, Outbreak News Today, Robert Herriman returns with all the latest news and information about infectious diseases on a new station on the AM dial–860 AM WGUL.

In addition, just like his previous show, Herriman will have on a great assortment of expert guests from all levels of government, medicine, academia and personal stories of people dealing with the outcomes of these infectious agents.

The Outbreak News This Week Radio Show airs every Sunday at 5 PM ET on 860 AM WGUL. If you are out of the Tampa Bay area, you can listen online at the WGUL website.

If you miss a show, be sure to listen to past shows on the Outbreak News This Week podcast page HERE.

Also visit and “like” the Infectious Disease News Facebook page HERE


Separate circulating vaccine-derived polioviruses confirmed in South Sudan and Madagascar

In separate and unrelated events, circulating vaccine-derived polioviruses (cVDPVs) have been confirmed in South Sudan and Madagascar.

South Sudan

In South Sudan, 2 cases due to cVDPV type 2 (cVDPV2) have been confirmed. The strains were isolated from 2 acute flaccid paralysis (AFP) cases in Unity state, with onset of paralysis on 9 September and 12 September 2014, respectively. In Unity state, as many as 33% of children remain under-immunized against poliovirus. Both cases are from an internally-displaced persons camp in Unity state. Unity state has been affected by civil unrest, leading to population displacements and declining vaccination coverage in most of the areas.
In 2014, South Sudan has been participating in regional Horn of Africa outbreak response, given the risk posed by an ongoing wild poliovirus type 1 (WPV1) outbreak affecting the region (with cases in 2014 in parts of Somalia and Ethiopia). Two National Immunization Days (NIDs) were conducted in April (with trivalent oral polio vaccine – OPV) and May (with bivalent OPV). In response to confirmation of the cVDPV2, NIDs were held on 4 November with trivalent OPV and further Subnational Immunization Days (SNID) covering the 3 states with civil unrest (Unity, Upper Nile and Jonglei) are planned for 2 December 2014 and January 2015 with trivalent OPV. The objective is to rapidly stop the cVDPV2 in the internally-displaced persons camp and prevent further spread, while further boosting immunity to type 1 polio and minimize risk of re-infection from other parts of the Horn of Africa.

Madagascar

In Madagascar, cVDPV type 1 (cVDPV1) has been confirmed after the virus was isolated from 1 case of AFP (onset of paralysis on 29 September 2014) and 3 healthy contacts. The most recent supplementary immunization activities in Madagascar were conducted in December 2011/January 2012. SNIDs are planned for December, with NIDs to be held in January 2015. An estimated more than 25% of children remain under-immunized against poliovirus in the country. Madagascar was previously affected by a cVDPV2 outbreak in 2001/2002 (resulting in 5 cases) and in 2005 (resulting in 5 cases). A VDPV was also isolated during a research study among healthy children in Toliara I in 2011. Concerted outbreak response each time rapidly stopped those events. However, repeated emergence of separate cVDPV events underscores the risk of these events occurring in populations which are not fully immunized and of the importance of maintaining high levels of vaccination coverage.

WHO risk assessment

Circulating VDPVs are rare but well-documented strains of poliovirus which can emerge in some populations which are inadequately immunized. Due to the small risk of cVDPVs, use of OPV must be stopped to secure a lasting polio-free world. OPV will be withdrawn in a phased manner, beginning with the removal of type 2-containing OPV. The type 2 component contained in trivalent OPV accounts for 90% of all cVDPV cases.
In South Sudan, given that the cases detected are in an internally-displaced persons camp which can be accessed for vaccination, the World Health Organization (WHO) assesses the risk of international spread of the cVDPV2 from South Sudan to be low. However, the risk of international spread would increase if other areas are infected by the cVDPV2. With regard to Madagascar, given the history associated with previous cVDPVs, WHO assesses the risk of international spread from Madagascar to be low.

WHO advice

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.
WHO’s International Travel and Health recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.
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Uganda declared Marburg virus free

On 11 November 2014, the Government of Uganda declared that Uganda was free of the Marburg virus. This declaration was made at the National Media Centre by the Minister of State for Primary Health Care, Hon. Sarah Achieng Opendi.
On 4 October 2014, WHO was notified by the Government of Uganda of a case of Marburg virus disease. The case was a male health professional that developed symptoms on 11 September. On 17 September, the patient was admitted to a district health facility in Mpigi. He was later transferred to a hospital in Kampala. On 28 September, the case passed away and was buried on 30 September in Kasese district.
A national task force with 5 sub committees (surveillance/epidemiology, case management, social mobilization, psychosocial, and coordination) oversaw the outbreak response. A total of 197 case contacts were listed and followed up for 21 days. Thirteen contacts developed Marburg-like symptoms but all tested negative for the virus. Suspected Marburg cases were managed in 4 isolation facilities in Kampala, Wakiso/Entebbe, Mpigi, and Kasese districts. Psychosocial support was provided to contacts and family members of the deceased. The public was sensitized about Marburg and viral haemorrhagic fevers.
Since there have been no active cases of Marburg for 42 days, the outbreak is considered to be contained.
Heightened surveillance activities will be maintained to identify potential outbreaks in the future. Public awareness campaigns will also continue in view of the ongoing Ebola virus disease outbreak in West Africa.
The response was supported by WHO, UNICEF, USAID, World Vision, Uganda Red Cross, Médecins Sans Frontières (MSF), the African Field Epidemiology Network (AFENET) and the US Centers for Disease Control and Prevention (CDC).
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Saturday, June 14, 2014

Global MERS update

The following is the latest update on the global Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak from the ECDC.

Since April 2012 and as of 13 June 2014, 828 cases of MERS-CoV have been reported by local health authorities worldwide, including 318 deaths.

Cases and deaths by region:

Middle East:

Saudi Arabia: 700 cases/287 deaths
United Arab Emirates: 71 cases/9 deaths
Qatar: 7 cases/4 deaths
Jordan: 18 cases/5 deaths
Oman: 2 cases/2 deaths
Kuwait: 3 cases/1 death
Egypt: 1 case/0 deaths
Yemen: 1 case/1 death
Lebanon: 1 case/0 deaths
Iran: 3 cases/1 death

Europe:

UK: 4 cases/3 deaths
Germany: 2 cases/1 death
France: 2 cases/1 death
Italy: 1 case/0 deaths
Greece: 1 case/0 deaths
Netherlands: 2 cases/0 deaths

Africa:

Tunisia: 3 cases/1 death
Algeria: 2 cases/1 death

Asia:

Malaysia: 1 case/1 death
Philippines: 1 case/0 deaths

Americas:

United States of America: 2 cases/0 deaths

Twenty one cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), USA (2), Italy (1), Malaysia (1), Philippines (1), Greece (1), Netherlands (2) and Algeria (2). In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities.

Image/Philippines DOH




Thursday, June 12, 2014

Bedbugs: What are they and how to check for infestations


According to the Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA), the United States is experiencing an alarming increase in the number of bedbug populations. In addition to being found in private residences, such as apartments and single-family homes, bedbugs are increasingly affecting restaurants, hotels, hospitals, and schools and day care centers.
Cimex lectularius/CDC

Bed bugs are small insects that feed on human blood. They do not transmit diseases, but their bites can leave itchy red welts on their victims. Adult bed bugs appear reddish-brown and have a flattened, oval shape. They are wingless and look about the size of an apple seed. They are big enough to be seen, but they hide in cracks in furniture, floors, walls, suitcases or clothing.

Most bed bug bites are initially painless, but they may turn into large, itchy skin welts. These wounds do not have a red spot in the center like lea bites. Some people don’t develop welts at all and can carry bugs without knowing it.

Although bed bugs are a nuisance, they are not known to spread disease.

“Although bedbugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights,” said board-certified dermatologist Seemal R. Desai, MD, FAAD, who maintains a private practice in Plano, Texas and serves as clinical assistant professor of dermatology at University of Texas Southwestern Medical Center. “The most common sign of bedbugs is having bite marks on your body, which can sometimes turn into itchy welts.”


To help find bedbugs before they find you (and your belongings), Dr. Desai recommends looking for the following signs near places where you sleep:
  1. A sweet, musty odor: If you notice a sweet, musty odor in your hotel room, cruise ship cabin, or other sleeping area, there may be a heavy bedbug infestation in the room. Bedbugs produce chemicals to help them communicate, although not everyone will notice the smell.
  2. Specks of blood on bedding, mattresses, or upholstered furniture: Look carefully at your blankets, sheets and mattress pads, and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bedbug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.
  3. Exoskeletons: Bedbugs have an outer shell that they shed and leave behind. Do you see shell-like remains on the mattress, mattress pad or beneath couch cushions?
  4. Tiny, blackish specks: If you see blackish specks on the bedding, mattress, or headboard, it could be bedbug excrement.
  5. Eggs: After mating, female bedbugs lay white, oval eggs in cracks and crevices. Keep in mind that these will be small, as a bedbug is only about the size of an apple seed.
“Most people who get bedbugs do so while traveling, making it critical to keep an eye out for infestations,” said Dr. Desai. “If you do get bedbugs and have many bites or a bite that looks infected, see a board-certified dermatologist. A dermatologist can treat an infection and help relieve the itch.”

How can I get rid of Bed Bugs? 
Non-chemical eradication methods like vacuuming, steaming, laundering and sealing mattresses in plastic can help, but these methods usually do not completely eradicate a bed bug population. Also, bed bugs have become resistant to some types of insecticides, making it difficult to get rid of them. For this reason, you will probably need to consult a licensed pest control company, which should: 

• Inspect your home to confirm the presence of bed bugs. 
• Find and eliminate their hiding places. 
• Treat your home with special cleaning and/or pesticides if necessary. 
• Make return visits to make sure bed bugs are gone.




CDC
Nymph/CDC

4,000 pounds of beef products recalled because the dorsal root ganglia may not have been completely removed

WASHINGTON, June 11, 2014 – Fruitland American Meat, a Jackson, Mo. establishment is recalling approximately 4,012 pounds of fresh beef products because the dorsal root ganglia may not have been completely removed, which is not compliant with agency regulations that require their removal in cattle 30 months of age and older, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. 
The products subject to recall include:
  • 40-lb. cases containing two, roughly 20-lb. cryovac packages of bone-in “Rain Crow Ranch Ribeye” bearing the establishment number “EST. 2316” inside the USDA mark of inspection with the following production dates: 9/5/13, 9/10/13, 9/11/13, 9/26/13, 10/2/13, 10/3/2013, 11/8/13, 11/22/13, 12/17/13, 12/26/13, 12/27/13,1/16/14, 1/17/14, 1/23/14, 1/31/14, 2/13/14, 2/14/14, 2/21/14, 2/28/14, 3/8/14, 3/20/14, 4/4/14 or 4/25/14 printed on the box. 
  • Quartered beef carcasses stamped with the USDA mark of inspection and establishment number “EST. 2316.”   
The products were produced and packaged on various dates between September 2013 and April 2014. The bone-in ribeye roasts were the source material of concern.
Fruitland American Meat advises that the bone-in ribeye roasts were distributed to a restaurant in New York, NY, and a Whole Foods distribution center in Connecticut which services its stores in New England. The quartered carcasses were distributed to an FSIS-inspected establishment in Missouri for further processing and distribution, and to a restaurant in Kansas City, Mo. All products would have been processed into smaller cuts with no identifying consumer packaging.
The problem was discovered by FSIS during a review of company slaughter logs. The problem may have occurred as a result of the way some company employees were recording information and determining the age of various cattle. Dorsal root ganglia, branches of the nervous system located in the vertebral column are considered specified risk materials (SRMs) and must be removed from cattle 30 months of age and older in accordance with FSIS regulations. SRMs are tissues that may contain the infective agent in cattle infected with Bovine Spongiform Encephalopathy (BSE), as well as materials that are closely associated with these potentially infective tissues. Therefore, FSIS prohibits SRMs from use as human food to minimize potential human exposure to the BSE agent.
Every animal received ante-mortem inspection by an FSIS Public Health Veterinarian. This involves observing each animal at rest and in motion and there is no indication that any of the cattle slaughtered displayed any signs of BSE.
FSIS and Fruitland American Meat have received no reports of adverse reactions due to consumption of these products. Anyone concerned about a reaction should contact a healthcare provider.
FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list will be posted on the FSIS website at www.fsis.usda.gov/recalls.
Consumers and media with questions about the recall should contact company sales manager James Fortner at 573-243-3107.

Saturday, June 7, 2014

Oritavancin's potential

MRSA Image/CDC
DURHAM, N.C. – In the battle against stubborn skin infections, including methicillin-resistant Staphylococcus aureus (MRSA), a new single-dose antibiotic is as effective as a twice-daily infusion given for up to 10 days, according to a large study led by Duke Medicine researchers.

Researchers said the advantage of the new drug, oritavancin, is its potential to curtail what has been a key driver of antibiotic resistance: a tendency for patients to stop taking antibiotics once they feel better. In such instances, the surviving bacteria may become impervious to the drugs designed to fight them.

“The prolonged activity is what makes oritavancin distinctive,” said G. Ralph Corey, M.D., lead author of the study published June 5, 2014, in the New England Journal of Medicine (NEJM). “This drug has a long half-life, which allows for a single-dose treatment.”

Corey, a professor of medicine and infectious diseases at Duke University School of Medicine, led a three-year study of oritavancin that encompassed two large clinical trials enrolling nearly 2,000 patients. Findings from the trials will be presented to the U.S. Food and Drug Administration as part of the drug’s approval application.

Results reported in the NEJM are for the first of the two clinical trials, which included 475 patients randomized to take the investigational drug, and 479 patients following a typical regimen of vancomycin, including two infusions a day, for seven to 10 days.

Researchers found that the single intravenous dose of oritavancin was as effective as vancomycin in shrinking the size of the lesion and reducing fever. Both were also similar in rates of requiring a rescue antibiotic.

The new antibiotic also performed similarly to vancomycin in reducing the area of the wound by 20 percent or more within the first 48-72 hours of treatment, and in curing the patients of infection, including those infected with MRSA.

“Having a single-dose drug could potentially prevent hospitalizations or reduce the amount of time patients would spend in the hospital,” Corey said.

In addition to Corey, study authors include Heidi Kabler of Sunrise Hospital and Medical Center in Las Vegas; Purvi Mehra and William O’Riordan of Sharp Chula Vista Medical Center in Chula Vista, Calif.; Sandeep Gupta of MV Hospital and Research Center in Lucknow, India; J. Scott Overcash of Sharp Grossmont Hospital in San Diego; Ashwin Porwal of Inamdar Multispecialty Hospital in Pune, India; Philip Giordano of Orlando Health in Orlando, Fla.; Christopher Lucasti of Somers Point, N.J.; and Antonio Perez, Samantha Good, Hai Jiang and Greg Moeck of The Medicines Company.

The study was funded by The Medicines Company, which owns and is seeking to market oritavancin. Corey was a paid consultant to The Medicines Company and the principle investigator of the SOLO trials, the three-year study of oritavancin.

China: 433 H7N9 avian influenza cases reported on the mainland

The Hong Kong Centre for Health Protection (CHP) of the Department of Health (DH) today (June 4) received notification of four additional human cases of avian influenza A(H7N9) in Jiangsu (two cases) and Shandong (two cases) from the National Health and Family Planning Commission.
 
The two patients in Jiangsu are a man and a woman, both aged 51, who are now hospitalised for treatment. The two cases in Shandong involve a man aged 61 who had poultry exposure and died and a man aged 33 who is hospitalised for management.
 
A total of 433 human cases of avian influenza A(H7N9) have been confirmed in the Mainland, including Zhejiang (138 cases), Guangdong (108 cases), Jiangsu (56 cases), Shanghai (41 cases), Hunan (23 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Shandong (five cases), Beijing (four cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one imported case from Zhejiang) and Hebei (one case).

Image/Cynthia S. Goldsmith and Thomas Rowe

Thursday, June 5, 2014

Florida DOH reminds public of dangers of Naegleria fowleri

The Florida Department of Health cautions those who swim frequently in Florida’s lakes, rivers and ponds during warm temperatures about the possible presence of Naegleria fowleri. Contact with this amoeba is rare, but the organism targets a person’s brain and usually results in death. Adverse health effects on humans can be prevented by avoiding nasal contact with the waters, since the amoeba enters through the nasal passages.

Naegleria fowleri seen under direct fluorescent antibody
 (DFA) stain/CDC
Though there are only 34 reported cases in Florida since 1962, Naegleria fowleri can cause Primary Amebic Meningoencephalitis (PAM) disease which usually leads to death once infected. As a precaution, health officials recommend the following:

• Avoid water-related activities in bodies of warm freshwater, hot springs and thermally polluted water such as water around power plants.
• Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
• Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
• Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.
• Please note exposure to the amoeba may also occur when using neti pots to rinse your sinuses of cold/allergy-related congestion or conducting religious rituals with tap water. Use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.

If you experience any of these symptoms after swimming in any warm body of water, contact your health care provider immediately: headache, fever, nausea, disorientation, vomiting, stiff neck, seizures, loss of balance, or hallucinations. It is essential to seek medical attention right away, as PAM usually becomes fatal within five days of exposure.

Remember, this disease is rare and effective prevention strategies can allow for a safe and relaxing summer swim season.

Monday, August 12, 2013

DHHS Identifies First Jamestown Canyon Virus And Powassan Virus Cases In New Hampshire

PRESS RELEASE

August 1, 2013

Concord, NH – The New Hampshire Department of Health and Human Services (DHHS) is announcing that a male from Hillsborough County tested positive for the Jamestown Canyon virus (JCV) and the Powassan virus, the first time either of these vector-borne diseases has been identified in the State. JCV is transmitted by infected mosquitoes and Powassan is transmitted by infected ticks.


“While this is our first announcement of Jamestown Canyon virus and Powassan virus in New Hampshire,” said Dr. José Montero, Director of Public Health at DHHS, “these have been in the U.S. for a while and Powassan was found in Maine and Vermont previously so this is not entirely unexpected. There are many mosquito- and tick-borne illnesses and unfortunately we are probably going to continue to see cases of them, which makes prevention steps all the more important. The same precautions we now take for Lyme and West Nile and EEE are effective against these viruses as well. So, as people enjoy New Hampshire we are urging them to use an effective repellent and do regular tick checks.”

Because these viruses are very rare, there is not a lot known about the illness they cause, where they are located in the environment, and how many people may have already been infected. JCV is a mosquito-borne pathogen that circulates widely in North America primarily between deer and a variety of mosquito species, but it can also infect humans. Reports in humans thus far of JCV are unusual and have been confined to the Midwestern and northeastern states. Most reported illnesses caused by Jamestown Canyon virus have been mild, but moderate-to-severe central nervous system involvement has been reported.

Powassan virus infection is caused by an arbovirus, which is similar to the mosquito-borne West Nile virus, but it is transmitted to people by infected ticks. Fewer than 60 cases of the disease have been detected in the United States and Canada since its discovery in 1958. In New Hampshire, Ixodes scapularis, or the blacklegged tick or more commonly deer tick, is capable of transmitting the virus to people. A tick needs to be attached to a person for a sufficient amount of time before it can cause disease. The time interval for Powassan virus is not known, but it is likely shorter than the time needed for Lyme disease (24–48 hours). Some people who are infected may experience mild illness or no symptoms. Powassan virus can also infect the central nervous system and cause brain inflammation.

Residents and visitors to New Hampshire should protect themselves and their family members by using an effective mosquito repellant that contains 30% DEET, wearing long sleeves and pants at dawn and dusk when mosquitoes are most active, and removing standing water from around your house so mosquitoes do not have a place to breed. Repellents with picaridin, IR3535 and some oil of lemon eucalyptus and para-menthane-diol products also provide protection.

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