News Scan for Jul 10, 2015

News brief

Power outages, airflow system failures reported at CDC labs

In 2013 and 2014, high-containment laboratories at the Centers for Disease Control and Prevention (CDC) logged about a dozen power outages and airflow system failures that could have compromised safety, USA Today reported yesterday.

The problems were disclosed in a lab incident summary that the newspaper obtained through a Freedom of Information Act request. They occurred between January 2013 and July 2014.

The incidents resulted in staff evacuations and exposed flaws in safety communication systems that are critical in emergencies, the story said. The airflow systems are important for preventing the release of pathogens.

The CDC document provides few details about most of the incidents, but it says a lightning strike and electrical surge in July 2013 "caused airflow changes that 'made it nearly impossible to open the lab hallway doors over approximately 1 hour' in a $365 million, 16-story CDC lab tower in Atlanta known as Building 23 that also lost phone service and had no backup communication plan," according to the story.

CDC spokesman Tom Skinner told USA Today that it's critical to address airflow systems, but said the negative-pressure systems in high-containment labs are only one of several layers of defense against pathogen leaks. "Airflow is not our primary means of containment," he said.

The power outages and airflow problems are among about 170 line items in a spreadsheet in the CDC document, the story said. Other problems included needle-stick exposures for workers, malfunctions of full-body protective suits, and lab doors propped open by maintenance workers.

The CDC deleted the names of the organisms involved in several of the incidents, citing a law that provides for oversight of bioterror pathogens, the story said.

The story also says that in responses to questions this week, "the CDC gave a series of evolving answers about whether any single office at the agency collects and reviews information about lab incidents of all types to spot emerging safety trends."

The new disclosures come against the backdrop of three high-profile CDC lab mistakes disclosed last year, including the potential exposure of dozens of lab workers to Bacillus anthracis and one worker to Ebola virus and the shipment of a deadly strain of avian flu virus to another lab.
Jul 9 USA Today story
Related Jun 17 CIDRAP News item on CDC disclosure plans

Texas Cyclospora outbreak total reaches 151

Sixteen more Cyclospora infections have been reported in Texas since Jul 8, boosting the outbreak total to 151, the Texas Department of State Health Services (TDSHS) reported today.

So far 30 of the state's 254 counties have reported cases, though Travis County, which includes Austin, has reported the largest share with 70 illnesses.

Cyclosporiasis is a parasitic infection caused by consuming tainted food or water. Its main symptom is watery diarrhea that can last from days to months.

A similar outbreak in Texas last summer resulted in 200 illnesses, and health officials said some of the cases were associated with cilantro sourced from Mexico's Puebla region.
Jul 10 TDSHS update
Jul 8 CIDRAP News scan on previous update

South Korea reports another MERS death; Philippines patient recovers

South Korea has reported the death of another MERS patient, while a case-patient in the Philippines is now free of the virus, according to reports today.

A MERS-CoV (Middle East respiratory syndrome coronavirus) patient who also had lung cancer died while being treated at the Boramae Medical Center in Seoul, according to a Yonhap news story citing the Ministry of Health and Welfare. The story provided no details about the patient.

The event raises South Korea's MERS death toll to 36. The case count in the outbreak there remains at 186, with no new cases reported in the past 5 days, the story said.

Meanwhile, a MERS patient in the Philippines has recovered and was expected to be released from a Manila hospital today after two tests showed he was free of the virus, the World Health Organization (WHO) said in a statement today.

The patient, a 36-year-old foreigner, got sick on Jun 30 and tested positive for the virus Jul 4, the WHO noted. A WHO statement 2 days ago said the man was from Finland, but today's statement did not list his nationality, and an Associated Press (AP) story today said officials have not disclosed his home country.

The WHO's earlier statement said the man had spent 8 days in Saudi Arabia in mid-June before traveling to the Philippines via Dubai. His stay in Manila was interrupted by a side trip to Malaysia and Singapore.

Today's AP story said a Filipino woman who is a close contact of the man remains well. A total of 112 contacts are being monitored.
Jul 10 Yonhap story
Jul 10 WHO report on Philippines case
Jul 10 AP story

CDC advises travelers to follow the Yellow Book road

The CDC today announced the release of the 2016 edition of its health guide for international travelers, nicknamed the Yellow Book, with updated sections on emerging diseases such as Ebola, MERS, and chikungunya.

Titled "CDC Health Information for International Travel," the book is updated every 2 years. The new edition features expanded guidelines for 16 popular travel destinations, including Brazil, Cambodia, the Dominican Republic, and Haiti, the agency said. Other new features are:

Yellow fever vaccination recommendation maps for 10 countries
15 country-specific malaria risk maps
Comprehensive advice for healthcare workers traveling to provide care overseas
Discussion of complementary and alternative health approaches to travel medicine
Commentary on the cost analysis of travel health care

The book includes a complete catalog of travel-related diseases and up-to-date vaccine and booster recommendations, the CDC said. Besides infectious disease information, it includes advice about preventing and treating common travel-related ailments such as altitude illness, motion sickness, and jet lag. Also included are tips on traveling with pets, packing a travel health kit, avoiding counterfeit medications, and getting travel health and evacuation insurance for emergencies.

The print version of the book is available from Oxford University Press, and the content is available at the CDC Traveler's Health Web site (see link below). In addition, a new mobile app with the complete 2016 edition will be available for purchase on iOS and Android devices in September.
CDC Yellow Book homepage

Flu Scan for Jul 10, 2015

News brief

China reports five H7N9 cases, four deaths

Health officials in China yesterday reported five new H7N9 avian influenza infections, as well as four deaths. The events occurred in June and were included in a monthly surveillance update from the country's National Health and Family Planning Commission that was posted by FluTrackers, an infectious disease news message board.

No details such as gender, age, illness onset date, or location were included the individual cases. One of the cases was previously reported in early June, that involving a 61-year-old man from Shanghai.

The total for June is a decrease from the 15 cases and 6 deaths that China reported in May. The additional infections lift the global H7N9 case total to 685, according to a list that FluTrackers maintains.
Jul 10 FluTrackers thread
FluTrackers H7N9 case list

Study: Influenza B lineages differ little in disease severity, drug resistance

The two lineages of influenza B—Victoria and Yamagata—seem to differ little or not at all in the severity of disease they cause or in resistance to antiviral drugs, according to a study by an international team of researchers.

The authors examined data from influenza B patients from the first 5 years of the Influenza Resistance Information Study, a prospective study involving centers in seven countries, according to their report yesterday in the Journal of Infectious Diseases.

Of 914 influenza B patients identified in the study, 586 had the Victoria lineage and 289 had Yamagata, with the other 39 cases not subtyped. Antiviral treatment was used in 474 patients.

The viruses were cultured and tested for phenotypic resistance to oseltamivir (Tamiflu) and zanamivir (Relenza); no resistance was observed in either lineage. In sequencing of the virus's neuraminidase component, the researchers found just 2 of 15 predefined resistance mutations, one in each of two patients. Testing of the two isolates showed that one of them had reduced sensitivity to oseltamivir, while the other was susceptible to both drugs.

As for disease outcomes, the team found "no consistent differences between virus lineages in times to viral clearance or to symptom or fever resolution" in adults, adolescents, or children.

"Influenza B virus lineage had no notable effect on disease outcomes or antiviral susceptibility in this population," the researchers concluded.
Jul 9 J Infect Dis abstract