Archive for January, 2016
24 people attempting to cross to Europe from Turkey drowned when their boat sank off a Greek island, the Greek coast raising to at least 80 the number of migrants and refugees to have died at sea in the past week.
Friday, January 29th, 2016
The global H7N9 total—almost all cases have been in China—has reached 712 cases.
Thursday, January 28th, 2016PAHO: In the Americas—chikungunya—continues its steady increase, with 3,083 new cases reported last week.
Thursday, January 28th, 2016Saudi Arabia’s Ministry of Health confirmed a new MERS-CoV case today in Al-Kharj, the country’s 5th case in under a week.
Thursday, January 28th, 2016
The WHO will hold a special session today on the Zika virus as the U.N. agency comes under pressure for quick action.
Thursday, January 28th, 2016“The President met today with leaders of his health and national security teams to discuss the spread of Zika and other mosquito-borne viruses in the Americas as well as steps being taken to protect the American public. The President’s senior health advisors, including Health and Human Services Secretary Sylvia Mathews Burwell, Centers for Disease Control Director Dr. Thomas Frieden, and NIH/NIAID Director Dr. Anthony Fauci, briefed him on the factors that could affect the potential spread of the Zika virus in the United States, as well as recently issued travel advisories and guidance for domestic health care providers who care for pregnant women. The President was briefed on the potential economic and development impacts of the Zika virus spreading in the Western Hemisphere. The President emphasized the need to accelerate research efforts to make available better diagnostic tests, to develop vaccines and therapeutics, and to ensure that all Americans have information about the Zika virus and steps they can take to better protect themselves from infection.”
Rotavirus vaccinations work on Rwandan children
Thursday, January 28th, 2016Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis. Ngabo, Fidele et al. The Lancet Global Health , Volume 4 , Issue 2 , e129 – e136.
Background
In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings.
Methods
We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals.
Findings
Compared with the 2009–11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17–29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48–49%, and admissions specific to rotavirus captured by active surveillance fell by 61–70%.
The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group.
Interpretation
The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings.
CDC: Interim Guidelines for The Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection — United States, 2016
Wednesday, January 27th, 2016Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection — United States, 2016
CDC has developed interim guidelines for health care providers in the United States who are caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy. These guidelines include recommendations for the testing and management of these infants. Guidance is subject to change as more information becomes available; the latest information, including answers to commonly asked questions, can be found online (http://www.cdc.gov/zika). Pediatric health care providers should work closely with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission [http://wwwnc.cdc.gov/travel/notices]), and review fetal ultrasounds and maternal testing for Zika virus infection (see Interim Guidelines for Pregnant Women During a Zika Virus Outbreak*) (1). Zika virus testing is recommended for 1) infants with microcephaly or intracranial calcifications born to women who traveled to or resided in an area with Zika virus transmission while pregnant; or 2) infants born to mothers with positive or inconclusive test results for Zika virus infection. For infants with laboratory evidence of a possible congenital Zika virus infection, additional clinical evaluation and follow-up is recommended. Health care providers should contact their state or territorial health department to facilitate testing. As an arboviral disease, Zika virus disease is a nationally notifiable condition.
Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes (2,3). Aedes albopictus mosquitoes also might transmit the virus. Ae. aegypti and Ae. albopictus mosquitoes are found throughout much of the Region of the Americas, including parts of the United States, and also transmit dengue and chikungunya viruses (4). Zika virus infections have also been documented through both intrauterine transmission resulting in congenital infection and intrapartum transmission from a viremic mother to her newborn (5,6). Zika virus RNA has been detected in breast milk, but Zika virus transmission through breastfeeding has not been documented (5).
During outbreaks, humans are the primary host for Zika virus. An estimated 80% of persons infected with Zika virus are asymptomatic (2,7). Symptomatic disease generally is mild and characterized by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. Symptoms typically last from several days to 1 week. Based on information from previous outbreaks, severe disease requiring hospitalization is uncommon and fatalities are rare (6,7). During the current outbreak in Brazil, Zika virus RNA has been identified in specimens (i.e., brain tissue, placenta, and amniotic fluid) from several infants with microcephaly and from fetal losses in women infected with Zika virus during pregnancy (6,8,9). The Brazil Ministry of Health has reported a marked increase from previous years in the number of infants born with microcephaly and intracranial calcifications in 2015, although it is not known how many of these cases are associated with Zika virus infection (6,8–11).
Zika Virus Testing Considerations and Classification
The diagnosis of Zika virus infection is made through molecular and serologic testing (2). This includes reverse transcription-polymerase chain reaction (RT-PCR) for viral RNA, and immunoglobulin (Ig) M ELISA and plaque reduction neutralization test (PRNT) for Zika virus antibodies. Because it is currently not known which type of testing most reliably establishes the diagnosis of congenital infection, CDC recommends both molecular and serologic testing of infants who are being evaluated for evidence of a congenital Zika virus infection (Box 1). No commercial tests for Zika virus are available; Zika virus testing is performed at CDC and some state and territorial health departments. Health care providers should contact their state or territorial health department to facilitate testing.
Zika virus RT-PCR testing should be performed on serum specimens collected from the umbilical cord or directly from the infant within 2 days of birth (12). In addition, cerebrospinal fluid (CSF) obtained for other studies, and frozen and fixed placenta obtained at delivery, should also be tested by RT-PCR. IgM ELISA for Zika virus and dengue virus should be performed on infant serum, infant CSF, and maternal serum; however, results of these assays can be falsely positive because of cross-reacting antibodies (9,12). PRNT can be performed to measure virus-specific neutralizing antibodies and to discriminate between cross-reacting antibodies from closely related flaviviruses (e.g., dengue or yellow fever viruses). Finally, immunohistochemical staining to detect Zika virus antigen on fixed placenta and umbilical cord tissues can be considered.
An infant is considered congenitally infected if Zika virus RNA or viral antigen is identified in any of the samples submitted, including testing of amniotic fluid and testing of the placenta or umbilical cord. In addition, Zika virus IgM antibodies with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in the infant serum or CSF constitute evidence of a congenital Zika virus infection. If Zika virus neutralizing antibody titers are <4-fold higher than dengue, results are considered inconclusive.
Recommendations for Infants with Microcephaly or Intracranial Calcifications Detected Prenatally or at Birth Whose Mothers Were Potentially Infected with Zika Virus During Pregnancy
For the purpose of evaluating an infant for possible congenital Zika virus infection, microcephaly is defined as occipitofrontal circumference less than the third percentile, based on standard growth charts (e.g., Fenton, Olsen, CDC, or WHO growth curves) for sex, age, and gestational age at birth (13). For a diagnosis of microcephaly to be made, the occipitofrontal circumference should be disproportionately small in comparison with the length of the infant and not explained by other etiologies (e.g., other congenital disorders). If an infant’s occipitofrontal circumference is equal to or greater than the third percentile but is notably disproportionate to the length of the infant, or if the infant has deficits that are related to the central nervous system, additional evaluation for Zika virus infection might be considered.
When an infant is born with microcephaly or intracranial calcifications to a mother who was potentially infected with Zika virus during pregnancy, the infant should be tested for Zika virus infection (Figure 1) (Box 1). In addition, further clinical evaluation and laboratory testing is recommended for the infant (Box 2). The mother should also be tested for a Zika virus infection, if this testing has not already been performed during pregnancy. An ophthalmologic evaluation, including retinal examination, should occur during the first month of life, given reports of abnormal eye findings in infants with possible congenital Zika virus infection (11).
For infants with any positive or inconclusive test findings for Zika virus infection, health care providers should report the case to the state, territorial, or local health department and assess the infant for possible long-term sequelae (Box 3). This includes a repeat hearing screen at age 6 months, even if the initial hearing screening test was normal, because of the potential for delayed hearing loss as has been described with other infections such as cytomegalovirus (14).
For infants with microcephaly or intracranial calcifications who have negative results on all Zika virus tests performed, health care providers should evaluate for other possible etiologies and treat as indicated.
Recommendations for Infants without Microcephaly or Intracranial Calcifications Whose Mothers Were Potentially Infected with Zika Virus During Pregnancy
For an infant without microcephaly or intracranial calcifications born to a mother who was potentially infected with Zika virus during pregnancy, subsequent evaluation is dependent on results from maternal Zika virus testing (Figure 2). If the test results for the mother were negative for Zika virus infection, the infant should receive routine care (e.g., newborn metabolic and hearing screens). If the mother received positive or inconclusive results of tests for Zika virus infection, the infant should be tested for a possible congenital Zika virus infection (Box 1). If the results of all of the infant’s tests are negative for evidence of Zika virus infection, then no further Zika virus testing and evaluation is recommended. If any of the infant’s samples test positive or inconclusive, then the infant should undergo further clinical evaluation (Box 2). The infant should also be followed to assess for possible long-term sequelae (Box 3), and the infant’s case should be reported to the state, territorial, or local health department. Infant follow-up should include a cranial ultrasound to assess for subclinical findings, unless prenatal ultrasound results from the third trimester demonstrated no abnormalities of the brain. Ophthalmologic examination and a repeat hearing screen are also recommended, as previously described for infants with microcephaly or intracranial calcifications. Developmental monitoring and screening during the first year of life is recommended for all children with congenital Zika virus infection.
If the mother has not undergone any previous testing for Zika virus infection during pregnancy, CDC recommends that she receive testing only if she reported symptoms consistent with Zika virus disease during or within 2 weeks of any time spent in an area with ongoing Zika virus transmission while she was pregnant (1,15). If the mother has any positive or inconclusive findings from tests for Zika virus infection, then the infant should undergo testing for evidence of a congenital Zika virus infection (Box 1). If the mother has not received any previous testing for Zika virus, and did not report clinical illness consistent with Zika virus disease during pregnancy, no further testing of the mother or infant is recommended (Figure 2).
Management and Prevention of Congenital Zika Virus Infections
No specific antiviral treatment is available for Zika virus infections and no vaccine against Zika virus is available (2). Treatment of congenital Zika virus infection is supportive and should address specific medical and neurodevelopmental issues for the infant’s particular needs; investigations are ongoing to better understand what services will be most effective for these children as they grow (16). Mothers are encouraged to breastfeed infants even in areas where Zika virus is found, as available evidence indicates the benefits of breastfeeding outweigh any theoretical risks associated with Zika virus infection transmission through breast milk (5,17).
The only way to prevent congenital Zika virus infection is to prevent maternal infection, either by avoiding areas where Zika virus transmission is ongoing or strictly following steps to avoid mosquito bites (15,18). Mosquito-bite prevention includes using air conditioning or window and door screens when indoors, wearing long sleeves and pants, using permethrin-treated clothing and gear, and using insect repellents. When used according to the product label, U.S. Environmental Protection Agency-registered insect repellents are safe for pregnant women (18).
** United Arab Emirates notified WHO of 2 additional cases of MERS-CoV infection, including 1 death.
Wednesday, January 27th, 2016- A 73-year-old male from Abu Dhabi developed symptoms on 27 December and visited a health care clinic in Abu Dhabi. He was treated symptomatically and sent home on the same day. On 31 December, the patient travelled to Oman with family members and returned back to Abu Dhabi on 1 January. On the same day, he developed symptoms and was admitted to hospital. The patient, who had no comorbidities, tested positive for MERS-CoV on 10 January. He passed away on 25 January. The patient had a history of frequent contact with camels. He consumed raw camel milk once in the 14 days prior to the onset of symptoms. He had no history of exposure to other risk factors in Abu Dhabi and in Oman in the 14 days prior to onset of symptoms.
- An 85-year-old female from Abu Dhabi was detected through the tracing of contacts. The patient is a contact of a laboratory-confirmed MERS-CoV case. She has no history of exposure to other risk factors in the 14 days prior to detection. The patient, who has comorbidities, tested positive for MERS-CoV on 13 January. Currently, she is asymptomatic admitted to a negative pressure isolation room on a ward.
WHO advice
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific.
Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.
Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.
WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.
The Kingdom of Saudi Arabia: 4 additional cases of MERS-CoV
Wednesday, January 27th, 2016- A 50-year-old male from Madinah city developed symptoms on 3 January and, on 10 January, was admitted to hospital in Madinah. The patient, who has comorbidities, tested positive for MERS-CoV on 12 January. Currently, he is in critical condition in ICU. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- An 85-year-old male from Bisha city developed symptoms on 3 January. On the same day, the patient visited a hospital where he was treated symptomatically and sent home. On 9 January, the patient travelled by airplane to Riyadh to seek medical care. Once in Riyadh, he was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 11 January. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- A 59-year-old male from Onizah city developed symptoms on 18 December and, on 27 December, was admitted to hospital. The patient, who is a heavy smoker and has comorbidities, tested positive for MERS-CoV on 28 December. Currently, he is in critical condition in ICU. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- A 54-year-old male from Jeddah city developed symptoms on 14 December and, on 24 December, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 26 December. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of frequent contact with camels.