New MERS case recorded in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) today reported one new MERS-CoV case for epidemiologic week 44. The MOH did not note any cases in epidemiologic week 43, which was last week.

The new case of MERS-CoV (Middle East respiratory syndrome coronavirus) occurred in a 74-year-old man from Riyadh who had contact with camels—a known risk factor for MERS transmission. The man is currently hospitalized.

Since 2012, at least 2,264 cases of MERS have been recorded, including 803 fatalities.
Oct 29 Saudi MOH report

New Jersey reports 9th pediatric adenovirus death as cases climb to 26

The New Jersey Department of Health (NJ Health) yesterday reported a new death in an at-risk child who had an adenovirus infection, bringing to nine the number of deaths in an outbreak that has now reached 26 cases.

"Another medically fragile child with respiratory illness at the Wanaque Center for Nursing and Rehabilitation in Haskell unfortunately passed away at a hospital late last night," NJ Health said in a news release. The child had become ill on Oct 22 and had a confirmed case of adenovirus 7, the outbreak strain.

The outbreak includes 25 cases involving residents of the facility, who range in age from toddlers to young adults, but the vast majority of them are children—plus 1 staff member at the center. The staff member has since recovered, NJ Health said. All the deaths have involved children.

The residents began developing symptoms from Sep 26 to Oct 22. All had severely compromised immune systems and respiratory problems before the outbreak began, NJ Health said.

"We are working every day to ensure all infection control protocols are continuously followed and closely monitoring the situation at the facility," said NJ Health Commissioner Shereef Elnahal, MD, MBA. On Oct 27 Elnahal said in a news release, "The type of adenovirus virus involved in this outbreak (#7) is associated with communal living arrangements and is known to cause severe illness—especially in those with compromised immune systems."
Oct 28 NJ Health news release
Oct 27 NJ Health news release

Study highlights flaws in California's vaccine exemption law

Although kindergarten vaccination coverage went up substantially after California in 2015 passed a law eliminating personal belief vaccine exemptions, medical exemptions since then have more than tripled and health officers have voiced frustration over the lack of authority to review such exemptions and other problems, according to a study today in Pediatrics.

California passed Senate Bill 277 (SB277) in 2015 to abolish all nonmedical exemptions to schoolchildren receiving vaccinations. For the 2014-15 school year, kindergarten vaccination coverage in the state was 90.4%, but by 2016 it rose to 95.1%, according to a commentary that accompanied the study.

For the study, researchers in August and September 2017 conducted 34 interviews with 40 health officers and immunization staff in 35 of California's 61 local health districts. Noting that the rates of medical exemptions in the state after the passage of SB277 increased 250% (from 0.2% in 2015-16 to 0.7% in 2017-18), the investigators wanted to dig deeper into the rise of medical exemptions and the ramifications.

They found several problems highlighted during the interviews, including a lack of authority to validate or question the growing number of medical exemptions—even those that seemed highly dubious—and the fact that only five local jurisdictions actively tracked medical exemptions received by schools, and one of those jurisdictions was sued for those efforts.

One health officer expressed frustration thus: "The law didn't give the health officer any role, and I'll tell you how ridiculous this is. In comparison with the fact that I have to review dog rabies vaccine exemption requests and I get to see medical records of dogs and I have the authority to disapprove requests for exemptions for rabies vaccines…and for people, we don't have that authority." Other health officers said it was unfair for school staff to review exemptions.

Another spotlighted a healthcare provider who was apparently profiting from the law by having patients return for a renewed medical exemption every 3 months, at $300 a pop. One primary care physician granting exemptions was "like a medical marijuana dispensary," according to the interviews. The health officer detailing the lawsuit called it a scare tactic and said it did not deter their efforts.

In the commentary, Richard J. Pan, MD, MPH, and Dorit Rubinstein Reiss, LLB, PhD, said, "Pediatricians can partner with public health advocates and pro-science parents to pass laws that empower public health officers to protect our children and community. Every child needs community immunity."
Oct 29 Pediatrics study
Oct 29 Pediatrics commentary