Tuesday, October 30, 2012

USAID to provide $20 million to fight bird flu, other emerging threats

Avian influenza (H5N1) virions   Image/CDC

The United States Agency for International Development (USAID) announced their commitment to $20 million in new funding to support the Food and Agricultural Organization’s (FAO) battle with avian influenza and other emerging threats in global hotspots, according to a FAO news release Oct. 29.
According to the release, the US assistance will help strengthen preparedness and response to H5N1 highly pathogenic avian influenza (HPAI) with the majority of the money going to Bangladesh, China, Indonesia and Viet Nam to upgrade laboratory and surveillance capacities.
Funding will also be provided to the neighboring countries of Cambodia, Lao PDR, Nepal and Myanmar for surveillance and prevention.
"The US Government has been key in generating international support to combat avian influenza and to reduce the chances for a human pandemic by assisting FAO and others to address the threat in animals before it spills over into humans. Such support for basic prevention measures is rare, yet most sensible and cost effective," said FAO Chief Veterinary Officer Juan Lubroth.
Southeast Asia is considered a ‘hotspot' region given already high population numbers and the rates of population expansion - of people and animals living in ever closer contact.
China is one example- it is home to half the world's pigs, about a quarter of its chickens, 70 percent of all ducks and 90 percent of the globe's geese. Close contact among them all provides viruses with many hosts and the opportunity to jump species, which in turn can lead to virus adaptations and eventually an influenza virus with pandemic potential.
The FAO says two out of three emerging infectious diseases in humans are zoonotic, or have their origins in animals. Of those zoonotic diseases, 75 percent come from wildlife.
According to the World Health Organization, most avian influenza viruses do not cause disease in humans. However, some are zoonotic, meaning that they can infect humans and cause disease. The most well known example is the avian influenza subtype H5N1 viruses currently circulating in poultry in parts of Asia and northeast Africa, which have caused human disease and deaths since 1997.
Other avian influenza subtypes, including H7N7 and H9N2, have also infected people. Some of these infections have been very severe and some have resulted in deaths, but many infections have been mild or even subclinical in humans.
Humans are at risk:
  • when people's work brings them in contact with infected animals.
  • when people contact infected animals during their everyday lives, such as when visiting live animal markets or when these animals are kept as part of the household.
  • when people handle or slaughter infected animals, or work with raw meat and by-products from infected animals.
  • when people contact things around them, such as animal housing areas and equipment, ponds and other water sources, faeces, and feathers, if these things are contaminated with influenza viruses.
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Wednesday, October 24, 2012

ACIP’s new recommendations include HibMenCY in infants, Tdap in pregnant women

The federal panel that develops recommendations on the use of vaccines to prevent and control infectious diseases and protect the public health came out with new immunization recommendations for the use of Tdap in pregnant women and meningococcal vaccination in infants, according to a Centers for Disease Control and Prevention (CDC) Media Advisory Oct. 24.
The Advisory Committee for Immunization Practices (ACIP) voted today 13 to 1, with 1 abstention, to recommend that infants at increased risk for meningococcal disease should be vaccinated with 4 doses of HibMenCY at 2, 4, 6, and 12 through 15 months.
HibMenCY is a vaccine for the prevention Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y, common causes of serious bacterial meningitis infections.
The committee says infants with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia including sickle cell disease are at increased risk and should receive the vaccine regimen.
In addition, the vaccine can be used in infants ages 2 through 18 months who are in communities with serogroup C and Y meningococcal disease outbreaks.
The ACIP also voted unanimously (14-0, with one abstention) to recommend that providers of prenatal care implement a Tdap immunization program for all pregnant women.
This new recommendation expands the ACIP's June 2011 recommendation that, among pregnant women, only those who have not had the Tdap vaccine should receive it.
The panel says health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. If not administered during pregnancy, Tdap should be administered immediately postpartum.
According to an email media release from the CDC, officials say, “By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant. If not vaccinated during pregnancy, Tdap should be given immediately postpartum, before leaving the hospital or birthing center.”
The ACIP consists of 15 experts who are voting members and are responsible for making vaccine recommendations. Fourteen of the members are experts in a scientific discipline such as virology and immunology. The 15th member is a consumer representative who provides perspectives on the social and community aspects of vaccination.
Their recommendations are forwarded to CDC’s Director for approval. If the ACIP recommendations are approved by the CDC Director, they will be published in CDC’s Morbidity and Mortality Weekly Report (MMWR) and represent the official CDC recommendations for immunizations in the U.S.; until then, they are considered provisional.
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Wednesday, October 17, 2012

Sunday, October 14, 2012

Indian boy vomits out 4 live Fasciolopsis buski flukes according to case report

Fasciolopsis buski adult   Image/CDC DPDx

An 11-year-old boy from India, with no symptoms of parasitic infection, was surprised and startled his parents when he woke up one morning to vomit out four live fasciolopsiasis, or Fasciolopsis buski adults.

The case was published in the journal, the Annals of Tropical Medicine and Public Health on Oct. 8.

According to the report, his parents took the expelled worms to the pediatrician, which were referred to the department of microbiology for identification. What they found were was a adult fluke that was dorsoventrally flattened, non-segmented, and flesh- colored. It measured about 34 mm x 20 mm in size (about 1 and 1/3 inches by 3/4 of an inch).

Two suckers were seen; ventral and oral, and the ventral sucker was relatively prominent about 2 mm in size. The worm was fleshy and nearly oval in shape with the anterior end narrower and the posterior end broadly rounded. There was no cephalic cone present.

Based on these morphological characteristics, the worm was identified as Fasciolopsis buski.

The boy had no specific symptoms prior to this event, except occasionalabdominal discomfort, nausea, and mild distension.

The boy was treated with nitazoxanide 250 mg twice-daily for 5 days. After 2 weeks of treatment, stool samples were examined but did not show any evidence of any parasite or ova.

Fasciolopsis buski is the largest intestinal fluke in humans. It causes a parasitic disease called fasciolopsiasis. It is found in Asia and the Indian subcontinent, especially in areas where humans raise pigs and consume freshwater plants.

In India, F. buski infestation has been reported mainly from Bihar, Uttar Pradesh, and Maharashtra and sporadically from other states like Assam and West Bengal. It is usually seen in rural areas where water plants are eaten raw according to the case report authors.

The pathology of fasciolopsiasis can be described as: more worms , more disease, but usually asymptomatic.

Large number of worms attached to the mucosa can cause bleeding,inflammation and ulceration. In addition, large numbers may block the intestinal lumen.

Hunger pains, abdominal distention, increased appetite, diarrhea and foul-smelling greenish-yellow stools may be seen.

The most important plants involved in human infection are water caltrop  (see a picture of water caltrops) and water chestnuts where the metcercariae are found on the outer shell.

The outer cover is peeled off with the teeth and the metcercariae are released into the mouth.
Pigs are reservoir hosts.

Praziquantel is the drug of choice.

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Saturday, October 6, 2012

Measles outbreak sweeps through Kenya, 32 dead


The Kenya Ministry of Public Health and Sanitation has reported that the measles outbreak that has affected nearly every county in the country, has sickened 767 people so far in 2012, including 32 fatalities in children.

In a Capital FM news report, Public Health and Sanitation Director Shahnaaz Sharif said the deadly epidemic started in refugee camps in north eastern Kenya before spreading to the rest of the country.

The refugees from Somalia are not typically vaccinated against the respiratory virus, notes Sharif.

Cases of the “vaccine-preventable disease” has been reported  in 45 out of the 47 Counties in Kenya. Only Lamu and Marsabit Counties have been said to be free of the outbreak.
In 2011, there were 665 measles cases reported.

Sharif goes on to say, 441 measles cases have been detected in Narok County after numerous children were diagnosed following the pronouncement of the outbreak.

Dr Sharif said 281 cases have also been recorded in Kitui and 225 in Garissa Counties. He further revealed that 194 cases detected in Mandera and 128 in Nairobi following the diagnosing of the children in these Counties.

In response to the outbreak, the government is set to launch a countrywide measles immunization campaign targeting over 6 million children.

Measles or rubeola, is an acute highly communicable viral disease that is characterized by Koplik spots in the cheek or tongue very early in the disease. A couple of days later a red blotchy rash appears first on the face, and then spreads, lasting 4-7 days. Other symptoms include fever, cough and red watery eyes. The patient may be contagious from four days prior to the rash appearance to four days after rash appearance.

The disease is more severe in infants and adults. Complications from measles which is reported in up to 20% of people infected include; seizures, pneumonia, deafness and encephalitis.

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