Sunday, December 23, 2012

Norovirus confirmed as cause of outbreak that sickened 85 in Thunder Bay

Image/CDC

Thunder Bay health officials report that the gastrointestinal outbreak that sickened at least 85 people linked to three events catered by Maltese Grocery has been laboratory confirmed as norovirus, according to a Thunder Bay District Health Unit news release Dec. 21.
"We are very sorry for everyone who has been affected and we take full responsibility," say Lisa and Dave Maltese, owners of Maltese Grocery. "We are working with the Health Unit and have taken every precaution to ensure this does not happen again. We thank our customers and friends for their ongoing support through this difficult time."
The grocery store suspended it’s catering operations late last week after initial reports of illnesses in people attending social events catered by the Thunder Bay establishment.
Health officials say now that they determined the source of the outbreak, which appears to be a food handler, Maltese Grocery will be reopening catering operations. The grocer has a good inspection record and has been fully cooperative throughout the investigation.
CBC News reports that Maltese Grocery is making some additional changes to its cleaning and hand-washing procedures, including the use of new chemicals and sanitizers.
"We are confident in the steps that have been taken by Maltese Grocery," says Abby Mackie, senior public health inspector.
Earlier in May, another Thunder Bay establishment, This Old Barn, was linked to a norovirus outbreak that sickened 136 people who dined at a Mother’s Day Buffet.
Noroviruses are a group of viruses that cause the “stomach flu,” or gastroenteritis in people.
The symptoms include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. In most people, the illness is self-limiting with symptoms lasting for about 1 or 2 days. In general, children experience more vomiting than adults do.
Norovirus is spread person to person particularly in crowded, closed places. Norovirus is typically spread through contaminated food and water, touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth and close contact with someone who is vomiting or has diarrhea.
The Health Unit would like to remind the public of the importance of proper hand washing techniques as one of the most effective ways to prevent the spread of illness-causing germs. Taking 15 seconds to wash with soap and water will reduce your risk of getting a cold, the flu and other common infections.
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Europe measles cases return to pre-2010 levels: ECDC

Image/CIA

The EU has returned to similar numbers of measles cases as seen before the large outbreaks of 2010 and 2011.

The new December Measles and Rubella Monitoring report by ECDC shows that the total number of measles cases in the EU is 7,016 for 2012 compared to some 30,000 for 2011.

Individually, 12 of 29 EU/EEA countries had less than one case of measles per million population in the last 12 months, low enough to meet the WHO elimination target set for 2015. 
However, five countries: France, Italy, Romania, Spain and the United Kingdom accounted for 94% of the reported cases, according to an European Centre for Disease Prevention and Control news release Dec. 21.

Here are some other measles developments from the surveillance report:

  • The 29 contributing EU/EEA countries reported 7,016 cases of measles from January to October 2012 and 8,795 cases during the last 12-month period from November 2011 to October 2012.
  • The number of reported cases is substantially lower in 2012 compared with the same period in 2011, but the aggregated EU/EEA notification rate for the last 12-month period continues to exceed the elimination target of less than one case per million population.
  • Of the cases reported in the last 12-month period for which vaccination status was available, 82% were unvaccinated.
  • Fifteen percent (1,279) of the cases were under one year of age; of these, 97% were reported as unvaccinated.
  • Of the 2,254 cases aged 1–4 years, targeted by vaccination programs in all European countries, 77% were reported as being unvaccinated.
  • There were no measles-related deaths reported during the last 12 months but 10 cases were complicated by acute measles encephalitis.

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For more Outbreak News, visit the Global Dispatch

Monday, December 10, 2012

Second hand smoke increases children’s risk to meningitis: Study


Passive or second hand smoke (SHS) has been linked to a plethora of conditions in the non-smoker to include heart disease, lung cancer and SIDS. Research from the United Kingdom now suggests that SHS significantly increases the risk of invasive meningococcal disease in children, according to a University of Nottingham press release Dec. 10.
Researchers from the University of Nottingham’s UK Centre for Tobacco Control Studies identified 18 studies from four databases, which assessed the effects of SHS on the risk of invasive meningococcal disease in children.
What they found was children exposed to second-hand smoke risk had double the risk of invasive meningococcal disease. For children under five this risk was even higher, and for children born to mothers who smoked during pregnancy the risk tripled.
According to Dr. Rachel L. Murray, Professor of Health Policy and Promotion at the University of Nottingham, “While we cannot be sure exactly how tobacco smoke is affecting these children, the findings from this study highlight consistent evidence of the further harms of smoking around children and during pregnancy, and thus parents and family members should be encouraged to not smoke in the home or around children.”
Invasive meningococcal disease remains an important cause of serious morbidity and mortality in children and young people. In addition to being a major cause of bacterial meningitis, it can also cause severe illness when bacteria invade the blood, lungs or joints.
According to the release, meningococcal disease is particularly prevalent in children and young adults, and nearly 1 in 20 affected individuals will die despite medical attention. One in 6 will end up with a severe disability, including neurological, behavioral and hearing disorders.
The researchers conclude that SHS exposure, and particularly passive fetal exposure to maternal smoking during pregnancy, significantly increases the risk of childhood invasive meningococcal disease. It is likely that an extra 630 cases of invasive meningococcal disease annually in children under 16 are directly attributable to SHS exposure in UK homes.
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Sunday, December 9, 2012

Taiwan: Hundreds of chickens destroyed in response to avian influenza outbreak


Some 631 chickens were destroyed at one Taiwanese farm in an effort to prevent further spread of an outbreak of highly pathogenic avian influenza virus (HPAI), according to a World Organization for Animal Health (OIE) immediate notification report Dec. 7.
The outbreak occurred on a farm in Ma-Gong City in Peng-hu prefecture.
The owner of the farm called in Taiwanese veterinary experts to check on an unusually high number of bird deaths in November.
The farm had more than 800 susceptible chickens, in which 200 had already died. The remaining 631 birds were culled as a precautionary measure.
Laboratory analysis by the Animal Health Research Institute revealed positive findings for HPAI serotype H5N2 using reverse transcription - polymerase chain reaction (RT-PCR) and intravenous pathogenicity index (IVPI) test.
According to the report, a clinical and epidemiological investigation of three surrounding poultry farms was conducted. No other cases were detected.
According to the World Health Organization, Avian influenza (AI) is an infectious viral disease of birds (especially wild water fowl such as ducks and geese), often causing no apparent signs of illness. AI viruses can sometimes spread to domestic poultry and cause large-scale outbreaks of serious disease. Some of these AI viruses have also been reported to cross the species barrier and cause disease or subclinical infections in humans and other mammals.
AI viruses are divided into two groups based on their ability to cause disease in poultry: high pathogenicity or low pathogenicity. Highly pathogenic viruses result in high death rates (up to 100% mortality within 48 hours) in some poultry species. Low pathogenicity viruses also cause outbreaks in poultry but are not generally associated with severe clinical disease.
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Localized fungal infections seen in increasing numbers from tainted steroid

Exserohilum rostratum/CDC

It is being reported that localized, injection site fungal infections are being reported from some state health departments in increasing numbers. Michigan health officials have reported scores of such infections since the beginning of the multistate outbreak linked to contaminated methylprednisolone acetate (MPA) injection, according to a Michigan Department of Community Health update Dec. 7.
In Michigan, officials have reported 131 epidural abscesses, 36 meningitis plus epidural abscess and one epidural abscess plus peripheral joint fungal infection.
Moreover, Michigan is not alone. The Tennessee Department of Health (TDH) has reported a total of 23 people have been identified as having new, localized infections since Thanksgiving.
According to a statement by TDH Commissioner John Dreyzehner, MD, MPH, “As of today, we have identified 23 persons who have developed these less serious infections at or near the site of their MPA injections. The early identification of these infections, made possible by a strong collaborative effort by clinicians, our department and the CDC, has helped several individuals get effective treatment at an earlier stage, thereby fending off a more serious illness.”
Dreyzehner says he cannot tell with certainty how long they can expect to identify new cases of localized infections. “Nationally", he says, "the longest reported infection occurred 120 days after last injection.”
The latest data on the Multistate Fungal Meningitis Outbreak Investigation from the Centers for Disease Control and Prevention is 541 cases reported from 19 states. 36 of these infections have ended in death as of Dec. 3.
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Brazil reports first case of ‘Mad Cow disease’ in a cow that died two years ago


In a case, that has left U.S. cattle producers critical of the government’s reliance on foreign countries and the World Organization for Animal Health (OIE), Brazil has reported its first case of bovine spongiform encephalopathy (BSE or mad cow disease), two years after the cow died, according to an R-CALF USA, the Ranchers-Cattlemen Action Legal Fund news release Dec. 7.
What happened in Brazil to cause such a delay?
According to the OIE notification report, in Dec. 2010, Brazilian veterinary officials were called to check on a 13-year-old cow exhibiting limb stiffness in the city of Sertanopolis, Parana state. However, when they arrived, the bovine was dead.
Suspecting rabies, as it is not uncommon to see this disease in cattle and other herbivores, the animal was tested, which turned out negative.
Since it appeared to be a neurologic disease, a sample was sent to an accredited lab to rule out BSE. In April 2011, the histopathological test was reported as negative.
According to the OIE report, a sample was then sent to the National Reference Laboratory, National Agricultural Laboratory (LANAGRO-PE), Recife, Pernambuco, for BSE diagnosis and it tested positive on 15 Jun 2012 by immunohistochemical test—a full 18 months after the death of the cow. It was again confirmed for BSE at the UK OIE lab this month.
Brazil authorities say the delay in testing was due to a low-prioritization of this particular sample based on several reasons.
This chain of events has brought criticism from R-CALF USA who report, even though the OIE considers Brazil as having a “negligible BSE risk”, that approximately 67 million pounds of Brazilian beef were imported into the United States since the Brazilian BSE suspect was identified.
“That means the U.S. imported enough beef from Brazil in 2011 and 2012 to feed over 1 million Americans their annual consumption of beef,” said R-CALF USA CEO Bill Bullard.
“None of that Brazilian beef imported into the U.S. during the past two years was subject to BSE mitigations that are supposed to apply to countries where BSE is known to exist, meaning U.S. consumers have been subjected to an unnecessary and avoidable risk of mad cow disease from Brazil,” Bullard added.
"This failure by Brazil to provide timely notice of its disease problem clearly demonstrates that USDA’s ongoing reliance on foreign countries and the OIE to protect U.S. citizens from unsafe imports is absolutely foolish and without basis, and is another example of why we need country-of-origin labeling,” Max Thornsberry, D.V.M. and Chair of R-CALF USA’s Animal Health Committee concluded.
According to the Centers for Disease Control and Prevention, BSE (bovine spongiform encephalopathy) is a progressive neurological disorder of cattle that results from infection by an unusual transmissible agent called a prion. The nature of the transmissible agent is not well understood.
Currently, the most accepted theory is that the agent is a modified form of a normal protein known as prion protein. For reasons that are not yet understood, the normal prion protein changes into a pathogenic (harmful) form that then damages the central nervous system of cattle.
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Saturday, December 8, 2012

FDA warns the public of salmonella risk with certain Nature’s Deli dog treats

Image/FDA

Federal health officials are warning consumers of a popular dog treat that may be tainted with Salmonella. The warning comes after the distributor of the dog treats declined to perform a voluntary recall at this time,according to a Food and Drug Administration (FDA) news release Dec. 6.
One lot of affected product, Nature’s Deli Chicken Jerky Dog Treats, packaged and distributed by Kasel Associates Industries Inc. of Denver, Co., was recalled in early October after routine testing revealed the presence of Salmonella.
The affected lot during the October recall of the dog treats is lot number BEST BY 091913 DEN. This lot was distributed to 57 Sam's Club locations in the following states: CO,IA,ID,IL,KS,MO,MT,NE,OK,SD,UT and WY.
However, the Nature’s Deli product lot the FDA is warning about now comes after a retail sample of Nature’s Deli Chicken Jerky Dog Treats lot code BESTBY061913DEN taken by the Colorado Department of Agriculture tested positive for Salmonella in November.
Kasel did not include this additional lot in the recall and declined to recall it now.
According to the FDA, The product is sold in 3.0 lb. packages labeled as Nature’s Deli Chicken Jerky Dog Treats. The product is packaged in flexible plastic, which is yellow, blue, green and red, with black and white print writing. The packaging also has a digital photo of a dog on the front panel, and transparent sections to view the product inside. Lot code BESTBY061913DEN is located on the reverse side of the packaging in the transparent section immediately following the term “All American Dog.”
The affected products are sold at Costco stores in the Denver, Colo., area. Costco is working with FDA and has removed all of the affected products from its shelves. The company will also contact customers who may have purchased the product to provide additional instructions.
Salmonella is a pathogen to both humans and animals. There is a risk for humans handling the contaminated dog food if poor hand washing techniques are not performed or surfaces in contact with the dog food are not properly cleaned.
In humans, Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain.
In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.
Pets, including dogs, with Salmonella can become lethargic and have diarrhea or bloody diarrhea, fever and vomiting. The clinical features of canine salmonellosis vary on strain, amount ingested and dog host factors.
Many dogs however are asymptomatic carriers of the bacteria and may shed Salmonella for up to 100 days after being infected. This can become a risk for family members and anyone with confirmed salmonellosis without a known risk of exposure, the family pet should be tested regardless of symptoms.
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Friday, December 7, 2012

Injectable bath salts linked to invasive strep A cluster in Maine

Image/CDC

Health officials in Maine are investigating a cluster of invasive Group A Streptococcal (GAS) infections in patients who have reported a history of injecting bath salts,according to a Maine Center for Disease Control and Prevention (Maine CDC) health advisory Dec. 6.
In addition, physicians and other health providers are being advised to be on the lookout for the symptoms of invasive GAS among intravenous (IV) drug users.
There have been four cases of invasive GAS infection in drug users ages 23 to 37.
All cases reported injecting bath salts, two had Streptococcal Toxic Shock Syndrome (STSS), all required hospitalization, one required intensive care, and one had necrotizing fasciitis according to the alert.
All four patients were from two Maine counties, Aroostook and Penobscot.
Health providers who suspect invasive GAS in an IV drug user should perform skin, wound, and/or blood cultures and consider prompt antibiotic treatment for patients presenting with symptoms of GAS (including cellulitis) and STSS.
Streptococcus pyogenes, or beta streptococcus group A is a very common pathogenic bacterium in humans.
Probably the most common disease caused by Streptococcus pyogenes is pharyngitis, or strep throat. Strep throat is very common in school-aged children, particularly in the winter and spring months. Untreated strep throat can lead to more serious complications like rheumatic fever; however, this is relatively uncommon.
It is also a cause of several skin infections such as impetigo and cellulitis. Impetigo is a characterized by a crusty lesion frequently found on the mouth area. Cellulitis typically occurs after a wound or burn where the bacteria enters and spread through the skin and lower tissues.
More serious, potentially life-threatening infections caused by Streptococcus pyogenes include necrotizing fasciitis (commonly called flesh-eating bacteria) and toxic shock syndrome.
Approximately 25% of patients with necrotizing fasciitis and more than 35% with STSS die.
In addition, Streptococcus pyogenes can cause scarlet fever, septicemia and pneumonia. The death of Muppets creator Jim Henson was a result of an infection with Streptococcus pyogenes.
“Bath Salts” are an increasingly popular drug which goes by a number of names including "Ivory Wave," "Purple Wave," Vanilla Sky," and "Bliss."
The drug is a chemical synthetic stimulant, most commonly methylenedioxypyrovalerone (MDPV), but others like mephedrone and methylone are known to cause intoxication in users, and the effects include paranoia, delusions, suicidal tendencies and chest pains. The drug is taken by oral, smokable, snortable means and now to achieve a quicker high, injection is becoming more common.
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Thursday, December 6, 2012

Darfur yellow fever death toll at 165


In a follow-up update to the yellow fever outbreak in Sudan, numbers compiled by the World Health Organization (WHO) show that the number of cases and fatalities due to the mosquito borne virus continue to rise,according to a Global Alert and Response Dec. 6.
As of 4 December, a total of 732 suspected cases of yellow fever, including 165 deaths have been reported in 33 out of 64 localities in Darfur the UN agency reports.
The National Public Health Laboratory in Khartoum in conjunction with NAMRU-3 has confirmed the yellow fever virus in 40 samples using IgM ELISA and PCR methodologies.
The mass vaccination program for the Darfur region began in late November, immunizing some 2.2 million residents. The second phase of the vaccination program is to begin this month with more than one million people expected to be vaccinated.
According to a WHO yellow fever fact sheet, there are an estimated 200,000 cases of yellow fever, causing 30,000 deaths annually, primarily in tropical areas of Africa and Latin America where the virus is endemic.
Up to 50% of severely affected persons without treatment will die from yellow fever.
There is no cure for yellow fever. Treatment is symptomatic, aimed at reducing the symptoms for the comfort of the patient.
Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, and appears to provide protection for 30–35 years or more. The vaccine provides effective immunity within one week for 95% of persons vaccinated.
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Tuesday, December 4, 2012

Carriers of low numbers of malaria parasites are probable source of infections

Image/CDC

In a study published today, London, the Netherlands and Burkina Faso researchers show that low-level malaria carriers are the likely source of 20–50 percent of all human-to-mosquito transmissions, according to an Imperial College of London news release Dec. 4.
The study, “Factors determining the occurrence of submicroscopic malaria infections and their relevance for control” was published today in the online journal Nature Communications.
Researchers gathered data from more than 100 surveys from endemic countries, which tested for malaria using both sensitive molecular techniques and routine microscopy.
The more sensitive PCR method detects on average twice as many malaria infections, showing that low-level, submicroscopic infection is common.
In addition, although these low-level carriers are less likely to transmit the malaria parasite than someone with a heavy infection, in certain geographic areas, there are so many of these people that they are likely to be a significant source of transmission.
Lead author of the study, Dr. Lucy Okell, from the Medical Research Council (MRC) Centre for Outbreak Analysis and Modeling at the Imperial College London said, “The data show that low-density, submicroscopic malaria infections are most common in areas with low levels of malaria transmission, which is surprising since people are less likely to have immunity from previous malaria attacks.
“Control programs are increasingly considering the use of screen and treat programs, and our results suggest that in some areas it may be worth investing in more sensitive diagnostic methods.”
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Sunday, December 2, 2012

Romania: Officials recommend resuming the use of BCG vaccine

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After a temporary suspension of the use of the bacille Calmette–Guérin (BCG) vaccination by Romanian health officials ten days ago, UN and European health agencies are recommending the “immediate resumption” of the BCG vaccine program,according to a World Health Organization (WHO) Regional Office for Europe news release Nov. 30.
Out of an abundance of precaution, the Romanian Ministry of Health suspended the use of BCG vaccine after several reports of enlarged lymph nodes in some children who had received the vaccine on Nov. 22.
The BCG vaccine was produced by the State Serum Institute (SSI) of Denmark.
The new BCG vaccination program, when implemented, was announced by the Romanian Ministry of Health and will include:
  • strengthening the risk management plan including guidelines for vaccine administration, follow up and treatment of adverse events;
  • reinforcing close monitoring of adverse events to detect them early and enable rapid and appropriate action;
  • developing a communication plan for healthcare workers and for the public.
A joint WHO/European Centres for Disease Prevention and Control mission, requested by the Minister of Health, arrived in Romania 26 November and determined that restarting BCG vaccination with the SSI strain in infants was both safe and urgent.
Bacille Calmette Guerin (BCG) is the most widely used vaccination in the world. BCG is made of a live, weakened strain of Mycobacterium bovis, (a cousin of Mycobacterium tuberculosis, the TB bacteria). It was developed in the 1930's and it remains the only vaccination available against tuberculosis today.
It is used because it is effective in reducing the likelihood and severity of TB in infants and young children. That is especially important in areas of the world where TB is highly prevalent, and the chances of an infant or young child becoming exposed to an infectious case are high.
In countries with high rates of TB, BCG is often given to infants at the time of birth because it helps prevent the more serious forms of TB disease from developing in children. In some countries BCG is given to the same person several times during childhood and early adult life, in an effort to maintain an immunity to TB.
According to the WHO, during the last decade, BCG vaccination has halved the number of TB cases in children under 14 years in Romania. For every million children aged under 5 years with BCG vaccination, over 350 severe TB cases are avoided.
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