Rubella in Taiwan: Second Case Confirmed

Apr 17, 2015 | Yuki Ara | Outbreak News

On March 18th, a female flight attendant was confirmed to be infected with rubella in Taiwan [1].  Before she developed symptoms, she had a travel history that included Vietnam, Indonesia, and Hong Kong [1]. After her confirmation, she was determined to be the first imported case of rubella in Taiwan this year, though the second confirmed case of rubella in the country overall, this year.

Prior to this imported case, the first case of rubella was reported on January 29, 2015 [2]. A 41-year-old male who resided in northern Taiwan was confirmed of rubella infection. Since he did not have a history of traveling outside of the country, Taiwan Centers for Disease Control (Taiwan CDC) determined his case of rubella as an indigenous one.

Health officials have identified close contacts to these cases and have placed them under monitoring. None of the first case’s contacts tested positive and the second case’s contacts were monitored until April 11th to ensure the prevention of any further outbreaks. More than 1500 people are followed for the flight attendant’s case and it has set a new record for the Taiwan CDC’s monitoring list [3]. 

In Taiwan, the average number of rubella cases tend to be small for these years, though the years 2007, 2008, and 2011 seem to be exceptions. These increase in cases for those years coincided and were often linked with the increase in rubella cases of other countries in Asia for those years [4]. In 2014, there were seven cases in Taiwan and six of the seven cases were imported [4, 5]. Yet, these numbers still seem to be limited compared to other countries in Asia [6].  

 

About Rubella

Rubella is caused by a virus [7]. Symptoms of rubella infection include mild fever, rash in the face and body, swollen lymph nodes in the neck or behind the ears [7]. Further, there may be body aches, fatigue and coughing, as well as other symptoms that may resemble a common cold [7]. It is highly contagious and is transmitted through close contact with an infective case [7].

However, rubella infection is preventable through vaccination. A live attenuated rubella vaccine was introduced to Taiwan in 1986, mandated for female junior high school students [8]. In 1992, Taiwan CDC expanded to a more universal vaccination program providing Measles-Mumps-Rubella (MMR) vaccines to 15 month old children [8]. Since 2001, Taiwan CDC provides the second dose regularly for children at seven years of age before they enter school [8]. MMR vaccine coverage in Taiwan is approximately 95% among the general population [8].

 

Rubella & Pregnancy

Pregnant women are unable to receive vaccination during pregnancy, so it is strongly encouraged to take a blood test and see if they have enough rubella immunity [9]. It is also encouraged to wait at least a month after the vaccination to become pregnant [9].

If women who are not vaccinated or have low antibodies contract rubella during pregnancy, especially during the first trimester, the fetus may also have a chance of contracting the virus and congenital rubella syndrome (CRS) may occur [10]. Babies with CRS may have birth defects such as eye abnormalities, congenital heart disease, mental disabilities, and organ damage. Worldwide, more than 100,000 babies are born with CRS every year [10]. In Taiwan, due to effective vaccination programs, only five cases of congenital rubella syndrome (CRS) have been confirmed from 1994 to 2008 [8]. Four out of five patients’ mothers were foreigners. No confirmed CRS cases have been reported since 2009 [8].

 

Why Vaccination Matters

Although vaccine coverage in Taiwan is high, there is always risk of rubella resurgence due to several factors. First, there is frequent travel amongst the population, so there will always be risk of an imported case from countries with lower vaccination coverage [11].  According to the WHO, global coverage of rubella vaccine is approximately 44% in 2013 which indicates, there still are countries with lower coverage compared to other regions in the world [12]. Second, Taiwanese who were born before the country’s universal vaccine program started, are susceptible to rubella infection due to not being vaccinated. This so-called a “vaccine gap” was also one of the factors behind the rubella outbreak in Japan in 2013 [13, 14]. Third, although the vaccine coverage at the country level is high in Taiwan, there are communities with less than enough vaccine coverage (at least 80% of vaccine coverage is necessary to prevent a rubella outbreak) remain at risk of an outbreak [4, 15]. Further, MMR vaccine is effective after the first dose. The second dose assures another chance to achieve immunity for people who did not achieve immunity the first time around. If people miss receiving the second dose, some of them may also be susceptible [15].

Therefore, not only having a high percentage but maintaining high vaccination coverage is considered important. The advantage of the rubella vaccine is that although there are several genotypes of rubella virus, they share a common serotype so the current used vaccine is considered effective [16]. There may be a possibility of mild adverse events such as fever, mild rash, or swelling in the cheeks or necks, but severe adverse events are rare [15, 17]. Taiwan CDC is encouraging people who are susceptible to receive MMR vaccine and to maintain vigilance as new cases arise [4, 10]. 

 

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Sources

[1] http://outbreaknewstoday.com/taiwan-flight-attendant-is-countrys-2nd-rubella-case-contact-tracing-ongoing-76925/

[2] http://outbreaknewstoday.com/taiwan-reports-years-first-indigenous-rubella-case-31708/

[3] http://www.taipeitimes.com/News/taiwan/archives/2015/03/20/2003613987

[4] http://nidss.cdc.gov.tw/en/SingleDisease.aspx?dc=1&dt=2&disease=056

[5] http://www.cdc.gov.tw/english/info.aspx?treeid=BC2D4E89B154059B&nowtreeid=EE0A2987CFBA3222&tid=46B4CC320AE574DC

[6] http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencerubella.html

[7] http://www.cdc.gov/rubella/about/index.html

[8] http://www.cdc.gov.tw/english/info.aspx?treeid=e79c7a9e1e9b1cdf&nowtreeid=e02c24f0dacdd729&tid=F53EF5695666723D

[9] http://www.cdc.gov/vaccines/adults/rec-vac/pregnant.html

[10] http://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html

[11] http://focustaiwan.tw/news/asoc/201501300021.aspx

[12] http://www.who.int/immunization/monitoring_surveillance/global_immunization_data.pdf?ua=1  

[13] http://theconversation.com/vaccination-gaps-led-to-rubella-outbreaks-in-japan-and-poland-15970

[14] http://www.nih.go.jp/niid/en/iasr-vol34-e/865-iasr/3469-tpc398.html

[15] http://www.who.int/wer/2011/wer8629.pdf?ua=1

[16] http://idsc.nih.go.jp/iasr/32/379/tpc379.html

[17] http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html

Canine Influenza in Chicago

Apr 15, 2015 | Marie Killerby Colleen Nguyen | Outbreak News

Chicago has recently seen an increase in cases of canine influenza. Cook County Department of Animal and Rabies Control issued a warning earlier this month for dogs to avoid areas where other dogs may congregate [1]. So far, the outbreak has resulted in the death of five dogs, sickened many more, and has caused closures of a local dog park and pet hotels [1,2,3].

You may or may not be surprised that dogs catch influenza, as we sometimes associate flu with other animals such as birds and pigs. However, whilst the media are announcing that ‘canine influenza virus is nothing new’, within the history of the flu virus, dogs becoming infected with flu is a relatively recent phenomenon [4]. The first canine influenza virus, a H3N8 strain, was detected in racing greyhounds in 2004 and was thought to have passed from horses to dogs [5]. Prior to this incident, the same virus is thought to have existed in horses for over 40 years [5]. Even more recently, another flu virus, the H3N2 strain, was detected in dogs in South Korea and China in 2006 [6]. This strain is thought to have passed from birds to dogs [6]. Whilst the current outbreak in Chicago was originally thought to be the H3N8 strain already found in North America, further testing by scientists have revealed the outbreak strain to be the H3N2 strain, which originally emerged in Asia in 2006 [6]. After this revelation, further investigations will likely take place to locate how this particular strain infected dogs in Chicago.

 

Zoonosis

So, which other species can get flu viruses and how do they pass between species? Many different non-human animal species can get influenza viruses, including ducks, chickens, pigs, whales, horses, and seals [7]. Wild waterfowl, however, are the natural carriers of the virus, and the virus can naturally live in their intestines without the birds getting sick [8]. Therefore, the influenza virus is thought to have originally existed in these birds and ‘jumped’ to other species from there. Influenza viruses can pass from one species to another on close contact between a sick animal and a new species. However, even with close contact, it is very unlikely that the influenza virus will cause an infection in a new species. The reason? Flu viruses are usually well adapted to infecting and spreading between members of the same species, but are not as well-adapted to infect a different species. This is why people commonly catch flu from each other but only very rarely catch influenza from other animal species.

 

What Does This Mean?

Dogs with canine influenza are therefore very unlikely to pass it to humans. In reference to H3N8 canine influenza, the Center for Disease Control (CDC) states that ‘there is no evidence that this virus infects humans’ [5]. Also, in the 40 years that the H3N8 virus has been present in horses, no humans have ever been observed to become ill from the equine influenza virus [9]. However, other strains of the H3N2 virus have been passed from pigs to humans and then shown limited human-to-human transmission, so this canine influenza virus may pose a higher risk of dog to human transmission than previously thought [10]. Whilst it is very unlikely, it isn’t impossible that canine influenza could infect people, so scientists, doctors and veterinarians should remain vigilant to this possibility.

As for dogs, if you are concerned about your dog becoming infected with canine influenza, there is a vaccination available. However, this vaccination was developed to protect dogs from the H3N8 strain, so there is some concern over how effective this vaccination will be in preventing dogs catching the H3N2 strain circulating in the current outbreak [6]. As a result, dog owners in the outbreak area should be wary of their dogs mixing with other dogs and should call their veterinarian if they notice any of the symptoms of canine influenza: cough, runny nose or fever [5].

 

 

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Sources

[1] http://www.chicagotribune.com/news/local/breaking/ct-dog-flu-deaths-met-0404-20150403-story.html

[2] http://www.chicagotribune.com/suburbs/daily-southtown/news/ct-sta-evergreen-dog-park-st-0409-20150408-story.html

[3] http://www.chicagotribune.com/business/breaking/chi-petsmart--dog-flu-20150403-story.html

[4] http://wgntv.com/2015/04/03/outbreak-of-dog-flu-hits-chicago-area/

[5] http://www.cdc.gov/flu/canine/

[6] http://mediarelations.cornell.edu/2015/04/12/midwest-canine-influenza-outbreak-caused-by-new-strain-of-virus/

[7] http://www.cdc.gov/flu/avianflu/virus-transmission.htm

[8] http://www.cdc.gov/flu/avianflu/avian-in-birds.htm

[9] http://www.oie.int/doc/ged/D14001.PDF

[10] http://www.cdc.gov/flu/swineflu/h3n2v-cases.htm

Nipah in Bangladesh

Apr 12, 2015 | Colleen Nguyen | Outbreak News

According to the Bangladesh Institute of Epidemiology, Disease Control and Research (IEDCR), as of February 2015, nine cases of Nipah virus have been recorded across the country [1]. The reported cases stem from six districts – Nilphamari, Faridpur, Magura, Ponchoghor, Naugaon, and Rajbari [1]. Case analysis reveals that 56% of recent cases have been male, with the median age across those infected, as 15 years of age [1].

A History of Nipah Virus

Nipah virus (NiV) was isolated and identified for the first time in 1998, when pig farmers and individuals who had close contact with pigs, became ill with encephalitis and respiratory illness in Malaysia and Singapore [2,3]. The first outbreak took place in Kampung Sungai Nipah, Malaysia – a location for which the virus would be named after [3]. The first outbreak produced only mild disease in pigs, but resulted in approximately 300 human cases, with 100 fatalities [2]. Case fatality for Nipah in general is estimated to be between 40% to 75%. However, the World Health Organization (WHO) highlights that this rate may vary depending on surveillance capacities involved in the outbreaks [1].  Since the first outbreak, there have been no intermediate hosts associated with subsequent outbreaks – that is, no pigs were linked to human infections. A CDC study discovered that human infections have been due to the consumption of virus-contaminated date palm sap [3,4]. 

NiV is part of the family Paramyxoviridae, within the genus Henipavirus [2]. Scientists have since traced NiV back to Indian flying foxes, a type of fruit bat found across southern Asia [4]. Date palm sap happens to be a delicacy sought after by both bats and humans [4]. The sap is collected from date palm tree trunks. The trees are tapped using machetes and the flowing sap collected into clay pots overnight [4]. At night, when the bats forage for food, they sometimes drink the sweet sap collected in the pots, and subsequently contaminate the sap with NiV through their bodily fluids, such as saliva, feces, or urine [4]. The unknowingly-contaminated sap is then sold at markets, where direct consumption of NiV results in the spread of the virus through local populations [4].  

Preventive Measures

There is no treatment or vaccine for NiV, so preventive measures are of critical importance for protection against infection [1].  Cooking or fermenting palm sap can destroy the virus, but most sap sold at markets is often sold and consumed raw [4]. Therefore, avoiding palm sap completely can prevent NiV infection. Additionally, people can avoid exposure with ill pigs and bats in areas considered to be endemic with NiV [5]. Efforts that include enhanced surveillance systems, increased public awareness, and interventions including the use of bamboo screens on top of the palm sap pots, can also prevent future outbreaks [5,6].

 

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Sources

[1] http://outbreaknewstoday.com/bangladesh-reports-nine-nipah-virus-cases-to-date-in-2015/

[2] http://www.cdc.gov/vhf/nipah/

[3] http://www.who.int/csr/disease/nipah/en/

[4] http://science.kqed.org/quest/2014/05/27/sweet-and-deadly-bat-borne-virus-brews-in-bangladeshs-date-palm-pots/

[5] http://www.cdc.gov/vhf/nipah/prevention/index.html

[6] http://www.ncbi.nlm.nih.gov/pubmed/22669914

Ross River Virus Strikes Brisbane

Apr 8, 2015 | Noushin Berdjis | Outbreak News

Brisbane, Australia is currently the epicenter of the largest outbreak of Ross River Virus the country has experienced since 1996 [2]. As of March 14th, there have been 2,835 cases since January 1, 2015 [2]. This is approximately 500 more cases than were seen in the previous year [2].

 

About Ross River Virus

This vector-borne disease is primarily found in Australia, Papua New Guinea, parts of Indonesia, and the western Pacific Islands [1].  Ross River Virus (RRV) is spread indirectly, through the bite of an infected mosquito. This means that the virus cannot be spread through person-to-person contact. Animals such as wallabies and possums are the natural reservoir for the virus [2]. When a mosquito bites an infected animal, it becomes a vector and is capable of passing the virus to humans through an infectious bite [1,2]. The incubation period for RRV is 7 to 14 days, and common symptoms include swollen joints (primarily the ankles, fingers, knees, and wrists) and muscles. Other symptoms include fever, fatigue, headache, swollen glands, as well as rash [1].

Currently, there is no medical cure for Ross River Virus [1]. Patients are treated with drugs to minimize inflammation and alleviate joint pain [1].

 

Rainfall & Mosquitoes

Heavy rainfall and high tides over the recent Australian summer have created the perfect environment for mosquito proliferation throughout Queensland [2]. The situation was exacerbated when Tropical Cyclone Marcia hit Queensland on February 20, 2015, resulting in widespread flooding [2,3]. These environmental factors contributed to an increased prevalence of mosquitoes, which led to an increased number of individuals being bitten by infected mosquitoes, ultimately resulting in this large outbreak of RRV. A major mosquito control program has been implemented by the Brisbane City Council to decrease the vector population in hopes of controlling the outbreak [2].

Australia is host to an assortment of mosquito breeds capable of spreading RRV [1]. To further complicate matters, each of these mosquito species has a preferred breeding habitat, making targeted vector control difficult. For example, the Aedes vigilax mosquito prefers to breed in salt marshes, while the Aedes normanensis mosquito proliferates in floodwater, and the Aedes notoscriptus is commonly found in backyards [1].

 

Prevention

Because there is no vaccine for RRV, prevention typically focuses on limiting contact with the disease’s vector – mosquitoes. This includes adding screens to your house and staying indoors during peak mosquito biting hours. If you are outdoors around sunrise or sunset, be sure to wear long-sleeved shirts, long pants, and use repellants containing DEET [1,2]. Reducing mosquito habitats and breeding sites is another important preventive measure. Any pool of water, including household items such as empty containers and flowerpots, can serve as a mosquito breeding ground.

There are also seasonal fluctuations related to the spread of RRV.  Water availability and temperature greatly impact mosquito prevalence. For instance, humid weather allows the mosquito to live longer allowing it to become infectious, breed, and infect a human. In the Northern Territory of Australia, for example, the main risk season is from December to March [1]. The highest risk is in January, when high tides and increased rainfall result in an increase of mosquitoes [1].

To address the outbreak in Australia, health authorities in Queensland recommend that residents clean out their gutters to limit stagnant water, as well as other mosquito breeding ground on their property [2]. Additionally, they have recommended that individuals add protective screens to their windows and doors, use repellents and sleep under insecticide treated nets [2].

 

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Sources:

  1. http://health.nt.gov.au/library/scripts/objectifyMedia.aspx?file=pdf/45/27.pdf&siteID=1&str_title=Ross%20River%20virus.pdf
  2. http://www.couriermail.com.au/news/queensland/queenslands-worst-ross-river-virus-outbreak-in-almost-20-years-hits-brisbane/story-fnn8dlfs-1227261900933
  3. http://news.yahoo.com/1-500-homes-damaged-cyclone-marcia-australia-060956262.html
HIV in Indiana: 81 Cases and Counting

Apr 5, 2015 | Colleen Nguyen | Outbreak News

Last week, Governor Mike Pence of Indiana declared the state’s current HIV outbreak a public health emergency [1]. As of March 27th, 2015, there was a total of 81 new positive HIV tests – most of which stem from Scott County. Out of those 81, 74 were confirmed and seven considered to be preliminary – and experts expect those numbers to rise [2,3]. Considered to be the worst in state history, this outbreak comes as a bit of a surprise, given Indiana’s declining HIV rates in recent years [1]. In 2002, Indiana reported 463 cases of HIV, but only 205 in 2012 [1].

At the epicenter of the outbreak is Austin, a rural city of 4,200 residents, located seventy miles south of Indianapolis [1].

What happened in Scott County that led to HIV rates exploding so quickly? According to media outlets, it is the product of a deadly combination of factors – the nature of HIV transmission, drug addiction, poverty, and a weak local healthcare system.  

 

HIV and IDUs

In the late 1990s, rates of opiate abuse rose in Austin including heroin, Oxycontin, and now, Opana [3]. Opana, also known as Oxymorphone, is a prescription painkiller that can be ground up with water and injected intravenously [3,4]. Those who inject themselves are often categorized as Injection Drug Users (IDUs) and for Austin, users gather in “shooting galleries” – usually abandoned buildings – to use drugs like Opana [3, 5]. More often than not, they will also share or re-use needles amongst themselves, which is an effective means of transmitting HIV [6]. While HIV may not be able to survive for long outside of the human body, it has been shown to survive inside a hermetically sealed syringe for up to 28 days [6].

However, not every injection will lead to infection – according to the National AIDS Manual, there are two risk factors that can determine whether transmission is successful. One factor is the viral load of HIV in the blood that is injected – higher levels indicate a higher probability, and lower levels having a lower probability [6]. The second factor is the quantity of infected blood injected [6]. Research has shown that HIV is ‘dose-related’ – that is, the higher the quantity of blood injected, the more likely seroconversion of HIV will happen [6].

 

The National and Global Scale

According to the World Health Organization (WHO), there are approximately 16 million IDUs worldwide, with about 3 million of them currently living with HIV [5]. Additionally, ten percent of new HIV infections globally are caused by injection drug use. In some parts of the world such as Central Asia and Eastern Europe, injection drug use can be attributed to over 80% of all HIV cases [5]. In the United States, IDUs also account for ten percent of new HIV infections and nearly half of those who tested positive did not previously know they were infected [1]. An IDU’s lack of awareness as to their HIV status may contribute to needle sharing behavior.

 

The Poverty Factor

Exacerbating the situation is the city’s poverty. The median household income in Austin is estimated to be $33,000, which lies below Indiana’s overall median household income of $48,000 [3]. There is also a striking 26% of the city living at the poverty level, with 19% of families living at the poverty line across Scott County [3]. These figures are higher than the statewide estimate of 15.9% [3].

According to Austin’s chief of police, Donald Spicer, local poverty has contributed to increased drug use.  In an article published by the Los Angeles Times about the outbreak, Spicer notes the city’s ‘lack of opportunity, too few jobs, few resources, and few things to do’ as some of Austin’s deep-rooted issues that need to be addressed [3].

 

The Doctor Is In

Scott County closed its remaining HIV testing clinic in early 2013 and Dr. William Cooke is Austin’s only doctor [3,7]. For him, this outbreak has not come as a surprise. In an interview with the Chicago Tribune, Dr. Cooke states, “We saw this coming a long time ago. There’s a lot of poverty and very few resources for the community. We’ve been asking for help for some time.”

While Dr. Cooke may be Austin’s only doctor – he says that the nearest hospital with the HIV testing capability and additional social services stands only five miles away [1]. The problem? Most of Austin’s drug users also lack transportation to get to the services they need – including the necessary testing to prevent outbreaks like this one [1]. Additionally, the average HIV patient that enters these clinics tends to be between the ages of 20-30 and often does not have insurance [1].

In response to the outbreak, collaborating agencies, including local officials, have opened pop-up HIV clinics across the county, including one in Dr. Cooke’s office [1]. The Executive Order issued by the governor included a targeted, short-term, emergency needle exchange program – this is notable because needle exchange programs have been illegal in Indiana [1]. On Tuesday, the Scott County Board of Health approved the emergency needle exchange program to combat the epidemic. It is outbreaks like this one in Austin that shine light on larger issues and finally get communities the help they need.

 

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Sources

[1] http://www.chicagotribune.com/news/chi-indiana-hiv-outbreak-drug-use-20150330-story.html   

[2] http://outbreaknewstoday.com/indiana-hiv-outbreak-up-to-81-cases-actions-taken-to-stem-the-outbreak-52928/

[3] http://www.latimes.com/nation/la-na-indiana-hiv-20150401-story.html#page=1

[4] http://www.opana.com/prescriber/

[5] http://www.who.int/hiv/topics/idu/en/

[6] http://www.aidsmap.com/Why-is-injecting-drug-use-a-risk-for-HIV-transmission/page/1324128/

[7] http://www.huffingtonpost.com/2015/03/31/indiana-planned-parenthood_n_6977232.html

Sexual Transmission of Ebola

Apr 1, 2015 | Marie Killerby Colleen Nguyen | Outbreak News

Over the weekend, various news sources announced that the Liberian government recommended indefinite sexual abstinence or condom use for Ebola survivors in light of the 2014-2015 West Africa outbreak ravaging the region [1]. Recent media reports speculate that a recent Ebola case in Liberia, acquired the virus through sexual transmission – though this has not been confirmed [2]. Currently, the World Health Organization (WHO) recommends that whilst sexual transmission of Ebola virus has not yet been verified or documented, it may be possible and sexual transmission from convalescent patients cannot be ruled out [3].

Due to the potential risk of Ebola infection through sexual contact, the WHO currently recommends that condoms be worn for a minimum of three months by Ebola survivors [3]. This recommendation is based on a study in which semen samples from five men were tested for presence of Ebola virus [4]. In one semen sample, taken 82 days after recovery from illness, they discovered live Ebola virus. The virus from that sample was then grown in cells in the laboratory, suggesting the virus could still be transmissible. However, no live virus was found in the semen samples tested from the four other individuals, each sampled across one to three time points between 51 and 707 days after infection [4,5]. Other studies have shown evidence of live virus surviving for shorter times -- for example, only up to 40 days after recovery when testing one patient [6]. Studies have also found genetic fragments of virus in semen even longer after infection, e.g. up to 101 days after infection [4]. However, genetic fragments alone are not necessarily infectious, therefore given 82 days is the longest time after recovery when live virus has been found, this aided in the formation of the recommendation that condoms should be worn for a minimum of three months.

Overall, these studies have shown that it is possible to find live, infectious Ebola virus in the semen of men recovering from Ebola virus. However, given that only a small number of semen samples have ever been tested, the maximum amount of time over which live Ebola virus could be present in semen is currently unknown. Although there has been no confirmed case of sexual transmission of Ebola in past outbreaks, there has been a single described instance of sexual transmission of Marburg virus, a closely related virus from the same family, filoviridae [7]. Even less evidence is available for the possibility of sexual transmission from female Ebola survivors -- one study found detectable genetic fragments of Ebola up to 33 days after recovery, but no live virus [4].

Therefore, given the limited evidence on the amount of time for which live, transmissible Ebola virus could be present in semen, recommendations have had to be made on the small amount of evidence available. However with the current outbreak, as new evidence comes to light, recommendations may change with time as more is learnt about the virus. Therefore, the biological possibility of sexual transmission of Ebola should not generate further fear and stigma for survivors. Instead, it is important for the implications of sexual transmission to be carefully discussed, both in considering appropriate recommendations for sexual protection and ensuring that people remain vigilant to the possibility of further Ebola transmission happening later in time than expected. Further scientific research is also needed to quantify the risk of infection from Ebola survivor’s semen, as well as to determine how long this risk is present for.

 

 

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Sources

1. http://www.nbcnews.com/storyline/ebola-virus-outbreak/can-you-get-ebola-...

2. http://www.nytimes.com/2015/03/29/world/africa/indefinite-safe-sex-urged-for-liberia-ebola-survivors.html?_r=0

3. http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/

4. Rodriguez, L. L., A. De Roo, Y. Guimard, S. G. Trappier, A. Sanchez, D. Bressler, A. J. Williams, et al. “Persistence and Genetic Stability of Ebola Virus during the Outbreak in Kikwit, Democratic Republic of the Congo, 1995.” The Journal of Infectious Diseases 179, no. s1 (February 1999): S170–76

5. Rowe, Alexander K., Jeanne Bertolli, Ali S. Khan, Rose Mukunu, J. J. Muyembe‐Tamfum, David Bressler, A. J. Williams, et al. “Clinical, Virologic, and Immunologic Follow‐Up of Convalescent Ebola Hemorrhagic Fever Patients and Their Household Contacts, Kikwit, Democratic Republic of the Congo.” The Journal of Infectious Diseases 179, no. s1 (February 1999): S28–35.

6. Bausch, Daniel G., Jonathan S. Towner, Scott F. Dowell, Felix Kaducu, Matthew Lukwiya, Anthony Sanchez, Stuart T. Nichol, Thomas G. Ksiazek, and Pierre E. Rollin. “Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites.” The Journal of Infectious Diseases 196, no. s2 (November 15, 2007): S142–47

7. Slenczka, Werner, and Hans Dieter Klenk. “Forty Years of Marburg Virus.” The Journal of Infectious Diseases 196, no. s2 (November 15, 2007): S131–35


Ebola: One Year Later

Mar 29, 2015 | Colleen Nguyen | Outbreak News

On March 19, 2014, an article describing an outbreak of an unknown disease in Macenta prefecture, approximately 800 kilometers from Conakry, the capital of Guinea, came into the HealthMap System [1]. There were reports of eight deaths and several more suspected cases, with symptoms primarily consisting of excessive bleeding [1]. Lassa fever, an acute viral illness endemic in the region, was rumored to be the cause of the mysterious outbreak, but little did the world know – it was merely a warning signal of the storm to come.

As of March 22, 2015, the Ebola outbreak that has ravaged West Africa -- primarily in the countries of Liberia, Sierra Leone, and Guinea -- has killed an estimated 10,350 people, with a total of 24,957 cases [3]. The outbreak has also devastatingly extended beyond its epidemiology – the virus has decimated health systems infrastructure, crucial development and economic gains, and has even forcibly changed daily human interactions [4, 5]. The battle to beat Ebola continues to be far from over.

This weekend, Sierra Leone declared a three-day nationwide lockdown, an attempt to isolate and detect hidden cases of Ebola, as health workers move door-to-door to track them down [6]. On Saturday, Liberia reported that its most recent Ebola patient had died from the virus, after being diagnosed on March 20th [7]. This leaves two suspected cases of the disease in the country, with 80 close contacts of the initial case currently under monitoring [7]. Of the 79 recently confirmed cases of Ebola over the past week, Guinea accounted for 45 of them [8].

 

Origins of the Outbreak

Speculation on the origins of the largest Ebola outbreak in history point to the death of a two-year old boy named Emilie Ouamouno [9]. He died in the remote village of Meliandou in the Guéckédou Prefecture, Nzérékoré Region of southern Guinea [9]. Perhaps somewhat revealing, Meliandou presses up against the borders of both Sierra Leone and Liberia [9]. It is unclear and uncertain as to how the toddler contracted Ebola, but the virus also took the lives of his mother and older sister, Philomène, as well as eleven others in his village [9].

Researchers seek the zoonotic origins of this outbreak. In their effort to delve deeper into potential sources, researchers found a hollowed-out tree located in Meliandou in which a colony of insectivorous free-tailed bats lived [10]. This particular family of bats has been speculated to be a potential source of Ebola, as they have been “shown to survive experimental infection” [10]. While initial zoonotic transmission cannot be entirely certain, researchers believe that the discovery re-emphasizes the importance of broader sampling efforts that need to be conducted to further understand Ebola virus and its ecology [10].

 

HealthMap & Ebola

During the Ebola outbreak, HealthMap has worked to provide a centralized source of critical data, allowing for progression and spread to be tracked in real-time. The outbreak timeline, which was developed in July 2014, can be found here: http://healthmap.org/ebola 

 

 

Sources

[1] http://www.africaguinee.com/articles/2014/03/14/sante-une-etrange-fievre-se-declare-macenta-plusieurs-cas-de-morts-signales

[2] http://www.cdc.gov/vhf/lassa/

[3] http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20150327?lang=en

[4] http://www.bbc.com/news/health-31982078

[5] http://time.com/3755178/ebola-lessons/?xid=emailshare

[6] http://www.bbc.co.uk/news/world-africa-32083363

[7] http://www.dw.de/first-ebola-patient-in-a-month-dies-in-liberia/a-18347407

[8] http://www.reuters.com/article/2015/03/25/us-health-ebola-who-idUSKBN0ML2C820150325

[9] http://www.theguardian.com/world/2014/oct/28/ebola-virus-guinea-first-victim-patient-zero

[10] http://embomolmed.embopress.org/content/early/2014/12/29/emmm.201404792  

Three New Ebola Cases in Liberia

Mar 27, 2015 | Noushin Berdjis | Outbreak News

The First Case

On March 20, 2015 a 44-year old woman in Monrovia became the first confirmed Ebola case in Liberia in a month [1-3]. Prior to this incident, Liberia had had their last confirmed case on February 19th, 2015, resulting in hopes that the country could be declared Ebola-free by mid-April [2,3].  

The head of Liberia’s Ebola Incident Management Team, Francis Karteh, has declared that her condition as stable and she appears to be responding to treatment [2]. Because various media sources have cited that she is the partner of a cured Ebola patient, the suspected route of transmission is sexual intercourse [1]. Ebola is primarily spread through direct contact with bodily fluids, including semen, therefore sexual transmission of the virus is theoretically possible. However, no formal evidence of sexual transmission currently exists [5]. Yet, the virus has been documented in Ebola survivors’ semen and although more research is needed to determine the exact duration, the World Health Organization (WHO) has stated that males who have survived Ebola can transmit the virus in their semen for up to 7 weeks following recovery [4,6]. As a result, the WHO recommends that male Ebola survivors abstain from sexual intercourse (including oral sex) for three months following recovery [4]. If abstinence is not an option, a condom should be used to decrease the likelihood of transmission [4]. Additionally, proper hygiene should be maintained following masturbation to prevent potential transmission of the virus [4,5]. Because there are no documented Ebola cases from sexual transmission, and the duration of semen infectiousness is unclear, there has been debate around this issue. For example, an article recently accepted in Clinical Infectious Diseases states that the three-month abstinence and condom-use recommendation should be extended to err on the side of caution [7].  

 

The Second and Thirds Cases

The recent Ebola patient mentioned above was a street vendor who also sold food at a local community school [3]. She lived in a one-bathroom house located in a Monrovia suburb [3]. The single bathroom was shared between 52 people, allowing for significant potential Ebola exposure [3]. Health officials have since contacted these individuals and are currently monitoring them for signs of infection [3]. Family members and other individuals considered to be high-risk contacts have been placed in quarantine as of Monday, March 23rd [3].  

Liberia received yet another setback on Wednesday, March 25, 2015 when two additional Ebola cases were diagnosed [1]. Although it was initially believed that the Monrovian woman was an isolated case, an 18-year old woman who had taken care of her was taken to an Ebola treatment unit on Tuesday, March 24th, after developing a headache and weakness [1-3]. On March 25th she tested positive for Ebola [1]. This secondary case most likely became infected while bathing and caring for the initial case [1].

The third Ebola case is a young man from the New Kru Town area, which is located south of Monrovia [1]. He was taken to an Ebola treatment unit after individuals witnessed him vomiting blood in Clara Town [1]. The exact source of infection is unknown for this third case. However, his girlfriend is believed to be involved in cross-border trade, which may have resulted in exposure [1]. Health officials are in the process of obtaining information on individuals he came into contact with while infectious, so that they can be located and monitored for infection.

 

The occurrence of these three cases has been a setback for the country. Liberia reported their first Ebola case a year ago on March 24, 2014 [1]. About 4,264 individuals have died of Ebola in Liberia since then [1]. These cases stand as a reminder that proper protective measures must still be employed and that continued vigilance remain critical to stamping out Ebola.

 

Sources:

  1. http://www.aa.com.tr/en/rss/483684--liberia-reports-2-new-ebola-cases
  2. http://medicalxpress.com/news/2015-03-liberia-ebola-patient-month-isolated.html
  3. http://www.nytimes.com/2015/03/25/world/africa/exposure-concerns-grow-in-liberia-after-diagnosis-of-first-ebola-case-in-weeks.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&_r=0
  4. http://www.nbcnews.com/storyline/ebola-virus-outbreak/who-advises-ebola-survivors-abstain-sex-three-months-n257856
  5. http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/
  6. http://www.who.int/mediacentre/factsheets/fs103/en/
  7. Groß JV; Slanger TE; Cullen P; Erren M; Erren TC. Stopping possible sexual transmission of filoviruses. Clinical Infectious Diseases. March 12, 2015.

 

H1N1 Mutates in India

Mar 22, 2015 | Colleen Nguyen | Outbreak News

According to researchers at Massachusetts Institute of Technology (MIT), samples of the H1N1 swine flu strain currently ravaging India indicate that the strain may have mutated to become more infectious and dangerous [1]. As of March 15th, the country’s Ministry of Health estimates there to be 29,938 cases of swine flu across India, resulting in 1,731 deaths [2]. These figures surpass the country’s H1N1 numbers from the 2009 pandemic, in which 27,236 cases and 981 deaths were reported [2].

Published earlier this month in an issue of Cell Host and Microbe, researchers Kannan Tharakaraman and Ram Sasisekharanan suggest that an evolution of the hemagglutinin (HA) protein -- which encompasses “receptor binding, fusion, and transmission properties” -- has taken place, resulting in a more virulent strain of the pandemic H1N1 virus, as well as increased disease severity among current flu cases in India [1]. This is because one of the specific mutations can be linked to “increased severity of the disease, while another enhances its infectiousness” [4]. The mutations, alongside ideal environmental conditions such as high population density -- allowing for easier transmission -- has permitted the virus to become entrenched within the population [3]. According to Dr. Nicole Iovine, an infectious disease physician from the University of Florida, a majority of Indians do not get their flu vaccinations either [5].

What’s often concerning about this strain of swine flu in particular is its tendency to target young adults [5]. While flu typically strikes children and elderly populations the hardest, this year’s H1N1 strain has shown to impact young adults the most. This is the same infection pattern as the 2009 and 1918 H1N1 pandemics [5]. In their commentary, Tharakaraman and Sasisekharana call for increased influenza surveillance and monitoring, to allow for further examination of the mutation of the influenza virus and its implications [3].

Contrary to the recently published research on the topic, India’s National Institute of Virology claims that the swine flu virus strain currently causing the outbreak in the country is the same strain from the 2009 H1N1 pandemic and that the strain has not mutated [1].

 

Sources

[1] http://www.washingtonpost.com/world/asia_pacific/study-indias-swine-flu-virus-may-have-mutated-into-more-dangerous-strain/2015/03/12/bdf8a11f-934f-4991-ba42-c2be7dd23748_story.html

[2] http://timesofindia.indiatimes.com/india/Indias-swine-flu-toll-climbs-to-1731-number-of-cases-touches-30000/articleshow/46583897.cms

[3] http://www.cell.com/cell-host-microbe/abstract/S1931-3128%2815%2900076-1

[4] http://time.com/3741736/swine-flu-h1n1-india-virus-mutation-study/

[5] http://www.forbes.com/sites/fayeflam/2015/03/12/as-deadly-h1n1-spreads-in-india-scientists-find-worrisome-new-mutations/

 

Blinding Syphilis: West Coast Cases Rise

Mar 20, 2015 | Noushin Berdjis | Outbreak News

Recently, the west coast has seen an unusual increase in ocular syphilis cases. Since December 2014, there have been 14 confirmed cases and two suspected cases of this rare disease [1-3,5-6].  Eight of the confirmed cases were in individuals also infected with HIV, five of the cases were among men who have sex with men, and two of the cases have already resulted in blindness [1-3]. The confirmed cases occurred in Washington state and San Francisco, California. Los Angeles County is currently investigating the two suspected cases that were reported to the Department of Public Health on Tuesday, March 10th [3].

 

What is Ocular Syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacteria, Treponema palidium [5].  A syphilis infection occurs as the result of direct contact with a syphilis sore called a ‘chancre’, which can be present on the external genitals, anus, rectum, as well as the inner mouth and lips of an infected individual [4].  Once infected, syphilis can be spread by person-to-person transmission during vaginal, anal or oral sex [4]. The disease has been classified in the following stages: primary, secondary, and latent syphilis. Primary syphilis consists of the appearance of a single or multiple, painless syphilis sores, while secondary syphilis consists of the appearance of a skin rash and mucous membrane lesions. Latent syphilis can occur if the disease has been left untreated [4]. These individuals are generally asymptomatic for years, but the disease can ultimately damage the internal organs and brain, and cause death [4].

Ocular syphilis can develop as a complication of primary or secondary syphilis that has been left untreated, and can cause blindness [1-3,5]. Symptoms of ocular syphilis include red eyes, inflammation, eye pain, blurred vision, light sensitivity, sudden loss of vision, and seeing floating spots [5,6].

 

The Importance of Screening

As a result of this outbreak, public health officials have been encouraging health care providers - particularly primary care doctors and optometrists - to be cognizant of patients showing symptoms associated with ocular syphilis [1-3,5]. Syphilis is easy to cure with penicillin if detected in the early stages of the disease. However, despite the availability of antibiotics and continuous public health interventions, syphilis remains a common infection within the United States [4]. A steady increase in the rate of infections has been noted since 2000, with the majority of infections occurring among men who have sex with men, and concurrent in individuals infected with HIV [4].  In 2013, California had the second highest rate of syphilis infections in the nation, following Georgia [1]. This increase in ocular syphilis cases has highlighted the importance of regular STD screening exams for all sexually active individuals, but especially those who are at an increased risk [1-3]. Additionally, public health campaigns should focus on the importance of condom use to help stop the spread of this sexually transmitted disease.

 

Sources

  1. http://www.latimes.com/local/lanow/la-me-ln-blinding-syphilis-los-angeles-aids-healthcare-foundation-20150310-story.html
  2. http://www.sfcityclinic.org/Ocular%20Syphilis%20Advisory_2.20.15.pdf
  3. http://www.ibtimes.com/blinding-cases-syphilis-west-coast-prompt-health-alert-la-county-1843078
  4. http://www.cdc.gov/std/syphilis/
  5. http://www.philly.com/philly/health/Cases_of_ocular_syphilis_on_the_rise.html
  6. http://sanfrancisco.cbslocal.com/2015/03/11/cases-of-ocular-syphilis-in-san-francisco-and-other-west-coast-cities-increasing/

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