News Scan for Apr 21, 2015

News brief

CDC reports two more cases in ice cream-linked Listeria outbreak

Through a review of DNA data from listeriosis cases, federal health officials have identified two more patients who were affected by a Listeria monocytogenes outbreak linked to Blue Bell Creameries products, increasing the case count to 10.

The two cases occurred in Arizona and Oklahoma, states not previously known to be affected by the outbreak, the Centers for Disease Control and Prevention (CDC) announced today. The outbreak also includes five cases in Kansas and three in Texas. All 10 patients were hospitalized, and 3 of the Kansas patients died.

Illness-onset dates in the outbreak ranged from January 2010 through January 2015, the CDC said. Patients with illness onsets through 2014 were identified through a retrospective review of the PulseNet database for DNA fingerprints that were similar to isolates collected from Blue Bell ice cream samples.

One more isolate from a listeriosis patient is still being tested to determine if the illness is related to the outbreak, the CDC said.

Meanwhile, Blue Bell yesterday announced a recall of all of its products currently on the market, including ice cream, frozen yogurt, sherbet, and frozen snacks, because of potential Listeria contamination. Previously the company had recalled products made at its Broken Arrow, Okla., plant from Feb 12 to Mar 27, 2015.

In a statement, the company said that it now has had several positive tests for Listeria in various places and plants. "We're committed to doing the 100 percent right thing, and the best way to do that is to take all of our products off the market until we can be confident that they are all safe," Paul Kruse, Blue Bell CEO and president, said in the statement.
Apr 21 CDC update
Apr 20 Blue Bell statement

WHO says warfare has left Yemen's health system near collapse

The World Health Organization (WHO) warned today that warfare in Yemen has pushed the country's health system to the brink of collapse as facilities struggle with shortages of medicines and supplies along with power supply interruptions.

The agency said lack of fuel has hindered the use of back-up power generators and has also disrupted ambulance services and the delivery of supplies.

"Power cuts and fuel shortages also threaten to disrupt the vaccine cold chain, leaving millions of children below the age of five unvaccinated," the WHO said in a statement. "This increases the risk of communicable diseases such as measles, which is prevalent in Yemen, as well as polio, which has been eliminated but is now at risk of reappearing."

In addition, shortages of clean water have increased the risk of diarrheal and other diseases, the agency said. "Over the past 4 weeks, national disease surveillance reports show a doubling in the number of cases of bloody diarrhoea in children below the age of 5, as well as an increase in the number of cases of measles and suspected malaria. High rates of malnutrition among women and children below the age of 5 have also been reported," Ahmed Shadoul, MBBS, WHO representative for Yemen, said in the statement.

The agency also said many people are having trouble accessing healthcare services because of blocked roads and fighting in the streets, while ambulances and medical supply vehicles can't move without risk.
Apr 21 WHO statement on Yemen

CDC issues travel notices for Uganda, World Expo, Brazil

The CDC yesterday posted three travel-related health notices involving three different continents, addressing typhoid in Uganda, the World Expo in Italy, and dengue in Brazil. All three are green watch level 1 alerts, the lowest of the three levels. Level 1 alerts advise travelers to take usual precautions.

Since Jan 1 Uganda has reported more than 12,000 suspected cases of typhoid, 2 of them fatal. The outbreak has affected three of the country's districts: Kampala, Wakiso, and Mukono, all located in the south-central part of Uganda near the capital city of Kampala. The CDC urges Uganda travelers to get the typhoid vaccine before departing and to follow food and water precautions to help prevent the disease.

Meanwhile, the CDC said about 20 million travelers are expected to attend the World Expo, which will be held in Milan from May 1 through Oct 31 and whose theme is "Feeding the Planet, Energy for Life." The CDC said 140 countries will be participating. The agency urged travelers to take normal health precautions, such as following security guidelines and observing heat, food, and water safety tips.

The notice for Brazil says so far this year the country has reported 224,101 cases of dengue fever, a dramatic spike compared with 2014. The hardest-hit states are Acre, Sao Paulo, and Goias. Acre is in northwestern Brazil, and Goias and Sao Paulo are located in the south-central part of the country. The CDC advises Brazil travelers to take steps to protect themselves from mosquito bites.
Apr 20 CDC travel notice on typhoid in Uganda
Apr 20 CDC travel notice on World Expo in Italy
Apr 20 CDC travel notice on dengue in Brazil

Nigeria reports more than 1,300 meningitis cases

Nigeria is dealing with a meningitis outbreak of more than 1,300 cases, including 83 deaths since January, and Ghana and Niger are reporting smaller outbreaks, the WHO said in an update today.

The Nigerian outbreak began Jan 19 in Kebbi state and has now spread to two additional states: Sokoto and Zamfara. The country's Centre for Disease Control notified the WHO of 1,380 cases as of Apr 5. "Of confirmed cases, Neisseria meningitidis serogroup C is the type identified," the WHO said in the update.

Through the same period, Ghana has reported 205 meningitis cases and 23 deaths in its Upper West region. Lab results are pending on the causative organism, the WHO said.

Niger, meanwhile, has had 461 cases, including 62 fatalities, through Apr 5. Serotypes W135 and C have both been identified. Dosso and Niamey regions are most affected.

The WHO and its partners, including Medecins Sans Frontieres and the United Nations Children's Fund (UNICEF), are closely monitoring the situation and supporting Nigeria in implementing mass vaccination and other emergency control measures. The International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control has provided 204,850 doses of meningococcal vaccine, with the support of the GAVI Alliance, as well as 5,000 antibiotic vials.
Apr 21 WHO update

Study: BSE enters CNS differently in monkeys than in other animals

The prion responsible for foodborne bovine spongiform encephalopathy (BSE, or "mad cow" disease) enters the central nervous system (CNS) differently in monkeys than in rodents and ruminants and spreads to the tonsils and spleen later in the incubation period, according to a study yesterday in the Journal of Infectious Diseases.

German and Swedish scientists fed cynomolgus monkeys bovine BSE brain tissue and euthanized some before and after they displayed neurologic signs of illness. They noted that BSE prions—the misfolded proteins that cause BSE—were preferentially transported from the gut to the CNS along sensory nerve fibers, initially entering the CNS at lumbar levels.

The team found BSE infections in 50% of gut samples and 12% of tonsil samples in asymptomatic animals.

They conclude, "Unlike in rodents and ruminants, foodborne BSE prions entered the simian CNS via afferent neurons. From sites of initial CNS invasion, prions spread centrifugally to tonsils and spleen at an advanced stage of the incubation period, thus explaining why tonsil specimens were not reliable for detection of simian disease carriers before onset of clinical signs."
Apr 20 J Infect Dis abstract

Flu Scan for Apr 21, 2015

News brief

Study: School closures in Michigan didn't curb pandemic flu

School closures in Michigan during the fall wave of the 2009 H1N1 flu pandemic had little impact on disease spread, according to a retrospective study by a team based at the University of Michigan. The group published its findings yesterday in Clinical Infectious Diseases.

Temporary school closure was a nonpharmaceutical option for curbing the spread of the disease, and during the first wave of infection in the spring, federal health officials revised their recommendation, urging localities to make their own decisions and consider closures only when absenteeism interfered with a school's educational mission.

The analysis is the first of its kind to link community influenza-like illness (ILI) surveillance with reports of school closures in real time for an entire state. Using the surveillance data, the researchers determined the peak week of flu activity for each school district, comparing them by three different levels of school closure, ranging from none closed due to flu to 51% to 100% closed.

They found that 559 Michigan schools closed at least once during the fall pandemic wave, and closure was a reactive decision in 83% of them. School districts in the middle range (1% to 50% closure) had lower levels of ILI than the no-closure or higher-closure districts, likely because of population or peak wave timing differences, the team wrote.

The highest level of flu activity was seen in the schools in the highest closure tier, with a significant association between lower housing density and higher ILI activity, which the authors said correlated with findings that less populated parts of the state were heavily affected and had high rates of closures.

Researchers also said school closures may have been implemented too late to be effective, and that more studies are needed to gauge the impact of school closure as an intervention to slow the spread of flu.
Apr 20 Clin Infect Dis abstract

WHO: Flu continues to decline across the globe

Influenza activity across the globe decreased further in recent weeks but remained slightly above the seasonal threshold in the Northern Hemisphere, and influenza B mounted its typical late-season surge, according to an update today from the World Health Organization (WHO).

Almost all regions of North America, Europe, western Asia, northern Africa, the Middle East, temperate and tropical Asia, and tropical countries in the Americas reported decreased flu activity.

Exceptions were in Turkey, where flu detections increased and flu B and 2009 H1N1 viruses co-circulated; South Korea; and India and Bhutan, where levels remained high and H1N1 predominated. Flu activity remained at inter-seasonal levels in the Southern Hemisphere.

Globally, 51% of recently circulating flu viruses typed were influenza A and 49% influenza B. Influenza A viruses were divided almost equally between H3N2 and 2009 H1N1. Almost all "B" strains belonged to the Yamagata lineage, which is the strain in the trivalent (three-strain) vaccine.
Apr 21 WHO update