News Scan for Apr 08, 2016

News brief

Travel alert for Angola upgraded as yellow fever outbreak grows

The US Centers for Disease Control and Prevention (CDC) yesterday upgraded its travel alert for individuals going to Angola to level 2 out of 3 ("practice enhanced precautions"), recommending that all travelers to the country who are 9 months of age or older be vaccinated for yellow fever, and Angola's ministry of health now requires that anyone of this age entering the country have proof of vaccination, according to the CDC.

Furthermore, the World Health Organization (WHO) in its new Weekly Epidemiologic Record today states that the continuing outbreak of yellow fever in urban Angola should serve as a warning for the need to strengthen prevention and control activities and warned about limited global supply of vaccine.

West Africa, after years of mass vaccination campaigns, saw no yellow fever outbreaks in 2015, says the report. However, similar programs have not been implemented in other parts of Africa.

The total burden of the Angola outbreak, which began last December and has been largely confined to the urban Luanda area, stands as of Apr 4 at 501 lab-confirmed and 1,562 suspected cases, with 225 deaths, the WHO says.

The WHO gave the outbreak a level 2 out of 3 emergency grading earlier this year and, because of the urban concentration of cases and the high risk of outbreak extension, worked with the ministry of health in Angola and other partners to conduct a reactive vaccination campaign targeting 6.4 million individuals in Luanda province.

The WHO states that to effectively curtail transmission of yellow fever, a reactive vaccination campaign needs to achieve 80% coverage within 2 weeks. It took 6 weeks for the campaign to reach 80% coverage of the target population in Luanda province (this has reached 89% as of Apr 4), but not all the urbanized areas in the province have yet reached the target.

The mass vaccination campaigns have faced three challenges, according to the WHO: (1) technical constraints (eg, shortages of vaccination teams, lack of security, cold-chain problems), (2) funding shortages for the purchase of vaccines and program operation, and (3) limited global supplies of yellow fever vaccine.

Extension of the outbreak is a real possibility, the WHO notes. Cases in people entering from Angola have been reported in China (9), Democratic Republic of Congo (3), Kenya (2), and Morocco (10).

The 6-million-dose GAVI-funded emergency stockpile of yellow fever vaccine for 2016 was depleted by the Angola campaigns, with about 1.4 million doses obtained elsewhere. Although the stockpile has since been replenished, the WHO and other international agencies are working to identify sources of more vaccine, including diverting doses intended for routine campaigns.
Apr 7 CDC travel alert
Apr 8 WHO report

Study: Many ICU workers' cell phones harbor resistant Enterobacteriaceae

The cell phones of half of healthcare workers (HCWs) treating very ill children were contaminated with Enterobacteriaceae, with half the isolates resistance to multiple drugs, according to a study yesterday today in the American Journal of Infection Control.

Researchers swabbed the cell phones of 114 HCWs who worked in three pediatric and two neonatology intensive care units (ICUs) in three Peruvian hospitals. They obtained swabs every other week for an average of four swabs per phone during the 5-month study.

Three quarters of the HCWs said they never decontaminated their phones, and 47% reported using their phones in the ICU more than five times while working.

The team found that half of the phones were colonized with an Enterobacteriaceae at least once during the study period. Half of the isolates were multidrug resistant, and 33% were extended-spectrum beta-lactamase producers. Findings were "apparently randomly distributed through the hospitals without clear clustering or strongly associated risk factors for having a positive sample," the authors wrote.
Apr 7 Am J Infect Control abstract

Flu Scan for Apr 08, 2016

News brief

Kids' deaths continue amid slow decline in US flu activity

Major markers of US influenza generally continued their gradual decline last week, but seven more flu-related deaths in children were reported, according to the Centers for Disease Control and Prevention's (CDC's) weekly update today.

Four of the 7 pediatric deaths were attributed to influenza B viruses, 2 were due to 2009 H1N1 viruses, and 1 was caused by a type A virus that was not subtyped, the CDC reported. The deaths, which occurred in February and March, raised the season total to 40.

In reporting on data through Apr 2, the CDC said the estimated share of clinic visits prompted by flu was 2.4%, down from 2.9% a week earlier but still a bit above the national baseline of 2.1%.

The two states reporting high influenza-like illness (ILI) activity last week were the same ones as the week before: New Jersey and New Mexico. Another seven states had moderate ILI activity; the previous week seven states and New York City were in that category.

Flu cases were listed as geographically widespread in 25 states and Puerto Rico, compared with 29 states and Puerto Rico a week earlier, the CDC reported. Another declining measure was the share of respiratory samples that tested positive for flu: 16.2%, versus 18.3% the week before.

The proportion of deaths related to pneumonia and flu in the CDC's 122 Cities Mortality Reporting System was 7.4% for the week, a drop from 7.7% a week earlier, but still above the epidemic threshold of 7.1%.

The cumulative incidence of flu-related hospitalizations for the season reached 24.4 per 100,000 people, up from 21.4 a week earlier. The rate for seniors, who are hardest hit, was 62.8 per 100,000.

Of viruses that were tested, influenza A viruses accounted for 65.5% and type B viruses for 34.5%, marking a slight increase in the share of B viruses. Over the season, 73.5% of viruses have been type A and 26.5% have been type B.
Apr 8 CDC FluView update

Flu contributed to big increase in overall UK mortality in 2015

England and Wales in 2015 had their largest increase in overall mortality in more than a decade, in part because of influenza in older people, which contributed along with dementia and Alzheimer's disease, the UK Office for National Statistics (ONS) reported yesterday.

The agency said 529,613 deaths were registered in England and Wales last year, an increase of 28,189 (5.6%) from 2014, with 86% of the extra deaths occurring in people older than 75 and 38% in those over 90.

The numbers marked the highest annual deaths since 2003 and the biggest year-on-year percentage increase since 1968, the ONS reported.

"The majority of the increase in deaths in 2015 happened during the first few months of the year, coinciding with an increase in hospital admissions for flu and reports of numerous outbreaks of the virus in care homes," Claudia Wells, head of mortality analysis at ONS, said in the agency statement. "Respiratory diseases, such as flu, were also mentioned in a third of deaths from dementia and Alzheimer's last year."

The ONS commented that the predominant flu subtype in 2015 was A/H3N2, "a strain known to predominantly affect older people." The effectiveness of the seasonal flu vaccine was unusually low in the 2014-15 season, mainly because the H3N2 strain used in the vaccine didn't match the dominant circulating strain.

The agency also said the peak in influenza admissions to intensive care units occurred in January, at the same time as the peak increase in deaths.
Apr 7 ONS press release