News Scan for Feb 10, 2014

News brief

Caribbean chikungunya cases top 1,400

The count of confirmed and probable chikungunya cases on Caribbean islands and neighboring areas reached 1,446 late last week, a spike of 411 cases in only 4 days, the European Centre for Disease Prevention and Control (ECDC) reported on Feb 7.

The ECDC said St. Martin has reached 601 cases on the French side of the island, an increase of 125 cases, and 60 on the Dutch side, which saw a dramatic 51-case increase.

Other areas in the region now have the following case totals, the agency said: Martinique, 518 (154 new cases); Guadeloupe, 175 (56 new); Saint Barthelemy, 83 (27); British Virgin Islands, 6 (3); and Dominica, 3, plus 1 imported case. The ECDC also reported 4 imported cases in French Guyana in northeastern South America and 1 imported case each on the islands of Aruba and Anguilla.

The outbreak, which began on St. Martin in early December 2013, is the first known instance of indigenous cases of the mosquito-borne disease in the Americas. The new total is 411 more than the 1,035 cases reported by the ECDC on Feb 3.
Feb 7 ECDC update
Feb 3 CIDRAP News scan on previous ECDC report

CDC estimates West Nile hospital cases cost almost $800 million

Researchers from the Centers for Disease Control and Prevention (CDC) in a study today estimate that hospitalized cases of West Nile virus (WNV) infection in the United States since the disease was introduced in 1999 have cost $778 million in healthcare expenses and lost productivity.

Writing in the American Journal of Tropical Medicine and Hygiene, published by the American Society of Tropical Medicine and Hygiene (ASTMH), the researchers said they determined the expense of initial hospitalization for 80 patients during a 2003 WNV outbreak in Colorado. For a subset of the patients, they then calculated costs of additional related medical care and missed work incurred in the 5 years after the initial infection.

To estimate the total US cost of WNV disease, then, the investigators extrapolated those costs to the total number of hospitalized cases of WNV disease reported to the CDC since 1999. Those findings suggest an annual burden of $56 million, or $778 million over the 14 years (95% confidence interval, $673 million to $1.1 billion).

This is the first published study to calculate hospital costs for the four specific "clinical syndromes" of the disease: fever, meningitis, encephalitis, and acute flaccid paralysis, the ASTMH said in a press release.

Since 1999, 37,088 WNV cases have been reported to the CDC, the ASTMH said, including more than 18,000 hospitalizations and 1,500 deaths. The CDC said that WNV patients over 50 are more likely to develop severe neurologic disease.

"We believe that previous costs associated with West Nile virus disease have been underestimated because they've predominantly focused on the costs of the initial illness," said J. Erin Staples, MD, PhD, the study's lead author.
Feb 10 Am J Trop Med Hygiene abstract
Feb 10 ASTMH news release
Feb 10 Am J Trop Med Hygiene commentary on the study

Report says local health department jobs down 12%

Local health departments (LHDs) have shed the equivalent of 20,000 full-time workers, or about 12%, in 5 years, according to a new report from the National Association of County and City Health Officials (NACCHO).

NACCHO researchers surveyed all 2,532 LHDS in its database from January through March 2013 and received a response from 2,000 of them, for a 79% response rate. Only Massachusetts (40%) and Indiana (59%) had response rates below 60%. The organization has conducted such an LHD "profile" survey every 3 years since 2005, and less often before that.

The survey data revealed that the LHD workforce, in full-time equivalents, dropped from 166,000 in 2008 to 146,000 in 2013, and from 190,000 workers overall to 162,000, the report said.

A separate NACCHO report last September found that LHDs have lost 43,900 jobs since 2008 owing to layoffs and attrition.

The survey also found that funding for LHD preparedness activities dropped from $2.07 per person in 2010 to $1.15 per person in 2013. The report noted, however, that 87% of LHDs have developed or updated a written emergency plan, while 76% have participated in tabletop exercises or drills.

On the upside, 56% of LHDs now have formal quality improvement programs, compared with just 45% in 2010.

"This 2013 Profile report is a valuable resource for all public health professionals, policymakers, federal agencies, researchers and others to use to understand our nation’s current local public health infrastructure,” said CDC Director Tom Frieden, MD, MPH, in a news release today from the American Public Health Association (APHA).
Feb 10 APHA news release
NACCHO's LHD profile report
Profile report landing page
Sep 12, 2013, CIDRAP News scan on previous NACCHO report

Polio eradication effort receives $100 million gift

A planned gift of $100 million toward the Global Polio Eradication Initiative's (GPEI's) fund-raising goal of $5.5 billion to eradicate polio worldwide by 2018 has been announced by the Lawrence Ellison Foundation, according to a recent PR Newswire press release. A total of $4 billion has been pledged so far by governments and private donors.

About $20 million of the Ellison donation was delivered in 2013, says the release. The gift brings to 10 the number of philanthropies that committed $535 million, and the Bill & Melinda Gates Foundation has pledged another $1.8 billion.

Polio remains endemic in only three countries, Afghanistan, Pakistan, and Nigeria, compared with 125 as recently as 1988. The lowest-ever number of new wild poliovirus cases worldwide occurred in 2012, but outbreaks occurred in five previously polio-free countries in 2013, including conflict-ridden Syria and the Horn of Africa.

Vaccination efforts in northwest Pakistan and northern Nigeria have proved difficult because of security issues for healthcare workers and even for the law-enforcement personnel guarding them. Despite this, however, the number of new cases in Nigeria was reduced by 65% in 2013 compared with 2012 and in Afghanistan by 65%. Also in 2013, India, once thought to be the most difficult place to eradicate polio, was declared polio-free after having no new wild polio cases for 3 years.
Feb 8 PR Newswire press release

Flu Scan for Feb 10, 2014

News brief

Study of Hajj group found flu cases, but no MERS-CoV

Most of a group of French pilgrims who traveled to Saudi Arabia for the Hajj last fall had respiratory symptoms during their journey, and some had influenza, but none tested positive for the Middle East respiratory syndrome coronavirus (MERS-CoV), according to a report in Emerging Infectious Diseases.

The 2013 Hajj drew more than a million foreign visitors to Saudi Arabia, the country hit hardest by MERS-CoV, which raised worries about possible spread of the virus.

The study involved a group of 129 pilgrims from the Marseilles area who traveled together from Oct 3 through 24, accompanied by a physician. Nasal swabs were taken the day before they left Saudi Arabia and were tested for MERS-CoV and influenza, says the report by French and Saudi researchers.

Of the 129 travelers, 117 (90.7%) had respiratory symptoms, mostly cough, sore throat, and fever, during the journey. None of them tested positive for MERS-CoV, but 10 had flu viruses, including 8 H3N2 infections, 1 H1N1, and 1 influenza B.

The authors say their findings are consistent with data from a similar study in 2012 that found no MERS-CoV in a group of Hajj pilgrims from France, but only two flu cases were detected in the earlier study.

The detection of flu in the travelers "may represent a potential for early introduction of influenza in southern France," the authors say. Therefore they suggest that flu vaccination is important for those attending the Hajj.

Last November Spain reported probable MERS-CoV cases in two women who had traveled from Spain to Saudi Arabia for the Hajj. But in January the World Health Organization said follow-up testing did not confirm those cases. No other Hajj-related cases have been reported.
Feb 7 Emerg Infect Dis report
Related Jan 21 CIDRAP News story

Giant pandas infected during H1N1 pandemic

Three pandas named Ximeng, Zhangka, and Gege that live at a conservation center in Sichuan province got sick with 2009 H1N1 infections when the virus was circulating in humans in China during the pandemic, an event that extends the host range of the virus. A Chinese research team reported the findings in Emerging Infectious Diseases.

The three animals experienced respiratory symptoms, which included pyrexia, anorexia, malaise, conjunctivitis, and sneezing. Researchers put Ximeng under anesthesia and collected a nasal sample. The pandas got better after receiving 75 mg of oseltamivir (Tamiflu) twice a day for 5 or 6 days.

The team obtained serum sample from all three animals about 3 months after they were sick. They also analyzed serum samples that had been collected before the bears were sick.

Ximeng's nasal swab tested positive for the 2009 H1N1 virus, which on gene sequencing was nearly identical to the circulating human strain. Phylogenetic analysis suggested that the virus was transmitted directly to the pandas without recombination or significant adaptation.

Serum studies showed Zhangka may have been previously exposed to 2009 H1N1 or a related virus, as well as the H3 subtype, before getting sick. Gege and Zhangka also had antibodies to an H6 avian influenza after their 2009 H1N1 infections.

Researchers said the findings raise the possibility that giant pandas may be infected with human- and avian-origin viruses, which has implications for panda conservation and shows that the 2009 H1N1 virus can infect a wider range of mammals than other flu viruses.
Feb 7 Emerg Infect Dis study