News Scan for Dec 19, 2014

News brief

CDC reports 8 more polio-like illnesses, 3 EV-D68 cases

The national count for acute flaccid myelitis (AFM), an unexplained polio-like illness in children, has increased by 8, to 102 cases in 34 states, the Centers for Disease Control and prevention (CDC) reported yesterday.

In addition, the CDC reported three more cases of enterovirus D68 (EV-D68) respiratory infection, which may be related to AFM. The new total is 1,152 cases since August in 49 states and the nation's capital.

Earlier this month, a CDC official said that close to half of the AFM patients to that point had tested positive for EV-D68 in nasal or stool samples, suggesting a likely link between the two conditions. But the connection was not certain, because the virus had not been found in any cerebrospinal fluid samples, which would signal infection in the nervous system.

CDC spokeswoman Jeanette St. Pierre said today that the agency has no new findings to report in its investigation of the causes of the myelitis cases.

EV-D68, which was rare until recently, has been the most common enterovirus identified in the United States this year, according to the CDC. It typically triggers cold-like symptoms but can cause a severe respiratory illness, almost exclusively in children, many of whom have asthma.
CDC update on AFM cases
CDC update on EV-D68
Related Dec 12 CIDRAP News item

Report describes lack of federal food safety coordination

Greater interagency collaboration is needed at the federal level to coordinate food safety practices and performance, according to a Government Accountability Office (GAO) report issued yesterday.

The GAO evaluated how the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) have implemented the 2010 Government Performance and Results Modernization Act (GPRAMA) across food safety programs. The report revealed shortfalls in two main areas: documentation of collaborative effort and broad-based coordination of goals and activities across the 15 federal agencies responsible for food safety.

The GAO found that USDA and HHS planning documents did not describe relevant cross-agency food safety efforts and could not be reconciled across individual programs, even though several inter-agency efforts are active (eg, the National Antimicrobial Resistance Monitoring System and the Food Emergency Response Network). In a review of strategic plans, the GAO found that individual agencies did not provide specifics about their food safety goals and partners.

Although the Office of Management and Budget was tasked to develop a government-wide food safety performance plan in 2011, no action on this front has been taken, the report says. The Food Safety Working Group, which was moving toward drafting centralized performance measures, stopped meeting 3 years ago. The GAO recommends that Congress formalize the performance plan by statute and reinstate the working group.

HHS's Food and Drug Administration (FDA) and the USDA's Food Safety and Inspection Service (FSIS) have implemented collaborative efforts focused on specific topics, such as tracking outbreak sources and monitoring chemical residues on food. Despite these gains, no centralized interagency program allows federal agencies to define and reach agreements on performance goals.

Interviews GAO conducted with federal food safety experts revealed that 10 out of 12 officials believed that a centralized and collaborative food safety performance mechanism is necessary, maintaining that it will foster accountability, diversity of opinion, and public trust.
Dec 18 GAO report
Dec 18 GAO report summary

Cryptosporidiosis hit first responders after cattle-truck crash

Confirmed or probable cryptosporidiosis developed in 6 of 15 law enforcement and volunteer emergency workers who responded during an April 2013 storm in Kansas to the rollover of a cattle truck carrying young calves, says a report in today's issue of Morbidity Mortality Weekly Report. The account is billed as the first report of emergency responders contracting the disease solely through direct contact with animals and their feces.

The tractor-trailer was carrying 350 pre-weaned Holstein steer calves less than 10 days of age under crowded conditions. Many of the surviving calves had to be carried from the wrecked truck or immediate surroundings to cattle and horse trailers for further transport. According to the MMWR article, "Responders noted that most of the calves had scours" (diarrhea).

The Kansas Department of Health and Environment investigated the accident after it was notified by the local health department of two confirmed cases of cryptosporidiosis in workers who had been at the accident scene. During questioning of the 13 remaining accident responders, 4 more reported having diarrhea and either abdominal cramping, vomiting, or anorexia within 10 days after the accident, and so were considered probable cases.

Bivariate analysis showed ill responders were more likely than responders who stayed healthy to have carried calves (relative risk [RR], 3.0) and to have come in contact with fecal matter (RR, 4.5). Responders who returned from the accident to places without power (due to the storm) were more likely to have become ill than those returning to places with power, presumably because they did not have hot water and were not able to properly wash their hands and decontaminate equipment and clothing.

According to the article, scours is common in young calves, with pre-weaned calves most likely to be infected with Cryptosporidium species. Very young steer calves being transported away from dairy operations may be deprived of colostrum, and stressful conditions can increase shedding of pathogens. The stressful conditions in the truck as well as during and after the accident "might have led to an increased probability of pathogen transmission," says the article.

The outbreak points to the need for people handling calves, including emergency responders, to be educated about the potential for zoonotic transmission of Cryptosporidium and other pathogens, says the article.
Dec 19 MMWR article

Avian Flu Scan for Dec 19, 2014

News brief

Oregon reports H5N8 virus in backyard poultry

An H5N8 influenza virus has been detected in a backyard poultry flock in southwestern Oregon, the Oregon Department of Agriculture (ODA) reported today, just 3 days after H5N8 and H5N2 viruses were found in wild birds in neighboring Washington.

The virus was found in guinea fowl and chickens from a backyard flock of about 100 birds in the Douglas County town of Winston, the ODA reported. The flock has access to the outdoors, and migratory birds frequent a pond and marsh on the property, the statement said.

The agency said the virus was found quickly because of increased awareness sparked by the avian flu detections in Washington. "This H5N8 virus is the same virus that was found in a Washington captive gyrfalcon," the statement said.

"The virus has not been found in commercial poultry anywhere in the US," the ODA said. "Surveillance for avian influenza is ongoing in commercial poultry operations, live bird markets, and in migratory wild bird populations."

"Steps are being taken to contain the disease and we have not diagnosed avian influenza elsewhere in Oregon's domestic poultry population, but the presence of the virus in migratory waterfowl poses a potential risk to our backyard poultry," said ODA State Veterinarian Brad LeaMaster, DVM, PhD. He didn't specify what the control steps are.

He urged poultry owners to prevent contact between their birds and wild birds, monitor their flocks, and report any sick birds.

In Washington, an H5N8 virus was found in a captive gyrfalcon that had been fed hunter-killed birds, federal and state agencies reported on Dec 16. In addition, an H5N2 virus was found in a wild pintail duck after a waterfowl die-off at Wiser Lake. Both detections were in Whatcom County, which is just across the border from the area of an ongoing H5N2 outbreak on poultry farms in British Columbia.

The US Department of Agriculture said the Washington H5N2 virus is similar to the one circulating in British Columbia. In addition, a bulletin from the US Geological Survey's (USGS's) National Wildlife Health Center this week said the H5N8 and H5N2 isolates both may be related to a highly pathogenic H5N8 virus "previously known to have circulated during 2014 among wild birds and poultry . . . in Asia and Western Europe."

Several H5N8 outbreaks have been reported since early November on poultry farms in Germany, the Netherlands, the United Kingdom, and Italy (see item below). Earlier in the year, South Korea was hit by widespread H5N8 outbreaks in poultry.

No H5N8 or H5N2 infections have ever been reported in humans, according to federal officials.
Dec 19 ODA statement
Dec 16 USGS bulletin
Related Dec 16 CIDRAP News story

Report notes similarities between H5N8 and earlier H5N1 in Europe

The introduction of H5N8 avian flu in Europe in recent weeks is in some ways comparable to the introduction of H5N1 to the continent almost a decade ago, although there are still many unknowns regarding how H5N8 arrived, a report yesterday in Eurosurveillance noted.

From Nov 5 through Dec 16, officials have confirmed nine H5N8 poultry outbreaks in Germany, Italy, the Netherlands, and the United Kingdom, as well as in wild birds in Germany and the Netherlands.

The affected area in Germany is similar to that affected in 2005 by H5N1 as that strain spread across Europe after first being detected in 2005, the report said. Britain and Italy were also affected in 2006 by H5N1 but in different regions than with H5N8, while the Netherlands was not affected at all by H5N1.

The spread of H5N1 from East Asia to Europe about 9 years ago may have occurred via a activities related to poultry production, illegal poultry trade, spillover infections to wild birds, and migratory-bird dispersal, "but no consistent route of infection into poultry holdings within Europe has been identified," the authors wrote. Two-way transmission of H5N8 might likewise occur, they say, and note that recent genetic analyses have shown high similarity between European H5N8 and H5N8 viruses from wild birds in Japan.

The authors conclude, "These similarities may point to common routes of introduction into Europe, although these are not fully understood and the exact sources of infection of the affected indoor poultry holdings have not been identified yet."

Similarly, a report earlier this week from the European Food Safety Authority (EFSA) concluded that the path of H5N8 into Europe has not yet been fully elucidated.
Dec 18 Eurosurveillance report
Dec 15 EFSA report