Flu Scan for Dec 16, 2013

News brief

Two more H7N9 cases reported in Guangdong province

Chinese health officials reported two new H7N9 avian flu cases in Guangdong province over the past 2 days, in a 36-year-old man and a 65-year-old woman, both of whom are hospitalized in critical condition, according to reports from Hong Kong's Centre for Health Protection (CHP).

The man is from Dongguan, a city in the central part of the province that is located in the Pearl River delta area. Monitoring of 53 of his close contacts has so far turned up no additional cases, the CHP reported yesterday.

The woman is from Yangjiang, a town on the South China Sea coast that is about 170 miles southwest of Dongguan. Her case was reported today. Both of the CHP reports are based on information from Guangdong province's Health and Family Planning Commission.

The two cases are the third and fourth reported from Guangdong province, and they push the overall number of H7N9 outbreak cases to 145, which includes 45 fatal cases. All but three of the infections were detected on mainland China. Hong Kong recently reported its first two H7N9 infections, both of which were imported cases from the Guangdong province city of Shenzhen.

Reports on the two new H7N9 cases did not reveal any details about any exposure the patients may have had to live poultry. As part of the response to the patients infected in Shenzhen, authorities temporarily closed live-poultry markets in one of the city's districts after the virus was found in three environmental samples.
Dec 15 CHP statement
Dec 16 CHP statement
Dec 13 CIDRAP News scan "H7N9 findings prompt Shenzhen market closures"

Study: Flu, rhinovirus, enterovirus common in ARI, ILI samples

Influenza, rhinoviruses, and enteroviruses are the leading causes of acute respiratory infection (ARI) and influenza-like illness (ILI) in US outpatients, according to a recent study in the Journal of Infectious Diseases.

Centers for Disease Control and Prevention and state health officials analyzed data from August 2010 through July 2011 from the federal Influenza Incidence Surveillance Project (IISP), which compiles information from 57 outpatient providers at 12 US sites.

They estimated that the age-adjusted annual incidence of ARI and ILI combined at these sites was 95/1,000 population. They were able to ascertain a viral source of the infection in 58% of cases. The most frequently detected viruses were rhinoviruses/enteroviruses (which are combined in the IISP data) and influenza, with a 21% incidence each. Flu incidence was highest among patients 2 to 17 years old.

The investigators concluded that the three viruses "represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children."
Dec 12 J Infect Dis abstract

News Scan for Dec 16, 2013

News brief

AAP says no to raw milk for kids and pregnant women, calls for ban

The American Academy of Pediatrics (AAP) today recommended that all infants, children, and pregnant women avoid raw (unpasteurized) milk, and called for a nationwide ban on the sale of all raw-milk products.

In a policy statement in Pediatrics, the AAP said that 82% of all dairy-related disease outbreaks reported to the US Centers for Disease Control and Prevention (CDC) in recent decades were caused by raw milk or raw cheese, even though unpasteurized dairy products constitute only 1% to 3% of all dairy products consumed.

"Given the progress we have made in prevention, there is no reason to risk consuming raw milk in this day and age," said Jatinder Bhatia, MD, a coauthor of the AAP statement, in an AAP news release. "Consumption of raw milk products is especially risky for pregnant women, infants, immunocompromised individuals, and the elderly, and the evidence overwhelmingly establishes the benefits of pasteurization on food safety."

"Raw milk poses a significant health risk, since the process of obtaining fresh milk from cows and goats can be fraught with risks of contamination both while milking the animals and during storage," said Mary Glode, MD, another coauthor.

The statement says that health claims from raw-milk advocates have little foundation in science, whereas "numerous scientific analyses have demonstrated that pasteurized milk and milk products contain equivalent levels" of nutrients to those in raw milk.
Dec 16 AAP statement
Dec 16 AAP press release

CDC issues chikungunya alert as St. Martin cases rise to 10

As chikungunya cases on St. Martin in the Caribbean rose to 10 late last week, the CDC alerted US public health officials and clinicians to watch for the disease in patients.

The agency said in a Dec 13 Health Alert Network (HAN) advisory that, as of Dec 12, 10 cases have been confirmed on the French side of St. Martin, and lab testing is pending in further suspected cases. Onset of illness for those with the mosquito-borne disease has ranged from Oct 15 to Dec 4, the CDC said in the advisory.

Chikungunya should be considered in patients who have sudden onset of fever and pain in multiple joints, especially in those who recently traveled to the Caribbean, the alert said.

In addition, healthcare providers should report suspected cases to state or local health departments, health departments should watch for chikungunya cases in returning travelers, and state health departments should report lab-confirmed chikungunya cases to ArboNET, the national surveillance system for arthropod-borne viruses, the CDC said in the HAN advisory.
Dec 13 CDC HAN advisory

FAO: Holistic approach to zoonoses needed in diverse landscape

Animal-origin diseases are expanding at an alarming rate and must be fought proactively rather than after the fact, says a report released today by the United Nations Food and Agriculture Organization (FAO) that calls for a more holistic approach to managing disease threats at the animal-human-environment interface.

The new report, World Livestock 2013: Changing Disease Landscapes, says that 70% of new diseases in humans over the past few decades are of animal origin. In an FAO release, FAO official Ren Wang said, "What this means is that we cannot deal with human health, animal health, and ecosystem health in isolation from each other—we have to look at them together, and address the drivers of disease emergence, persistence and spread, rather than simply fighting back against diseases after they emerge."

Among the causes of the surge in emerging diseases are the growth in human population and with it poverty and unsanitary conditions in some areas and a push for more protein-rich foods in others, agricultural expansion into formerly wild areas with the boom in livestock production, climate change that affects disease-transmission dynamics, "intensive" food-production methods, and the rise in international trade and travel that allows organisms "to travel the globe with ease," the FAO said. Livestock and wildlife are more in contact with each other than ever before, the report says, as are animals and humans.

A holistic approach to emerging diseases needs to involve professionals in human health, veterinary specialists, sociologists, economists, and ecologists, states World Livestock 2013.

Among key action items are strategies that address the causes above as well as the assembly of better evidence on the drivers of animal disease, improved risk assessment and prevention measures, and development of stronger mechanisms for international information exchange on animal disease management and best practices in livestock rearing.
Dec 16 FAO report (130 pages)
Dec 16 FAO news release