Elizabethkingia Spreads to Illinois

May 2, 2016 | Cheryl Lang Colleen Nguyen | Outbreak News

Outbreaks of the mysterious bacteria, Elizabethkingia, has been reported in Wisconsin and most recently, in Illinois. Yet, it has recently been discovered that the Elizabethkingia strain in Wisconsin is different than the strain documented in all, but one of the cases, in Illinois (1). As of April 20th, Illinois has reported ten confirmed cases, including six deaths attributed to Elizabethkingia (1). These reported deaths were over the age of 65 and all had unrelated, but severe health complications alongside the infection (1). Therefore, it is unknown whether the cause of these deaths were due to the infection of the bacteria, the underlying health conditions, or a combination of both (1).

Why is this outbreak unusual?

Perhaps the most unusual part of this outbreak is that Elizabethkingia rarely causes infections in humans (1). The bacteria, Elizabethkingia anophelis, is generally found in water sources including rivers, reservoirs, and soils (1). Many of the previously documented infections of Elizabethkingia have occurred within the context of health care facilities but this new cluster of cases in Illinois seems to be occuring within the community (2). However, the means in which individuals have become infected also remains unknown (1).

What is Elizabethkingia?

Elizabethkingia often tends to be a bloodstream infection, but in some cases it has been found to infect other sites such as the respiratory system or joints (3). Diagnoses of cases are conducted through blood tests (4). Symptoms of the infection include fever, shortness of breath, chills, and swelling and redness of the skin (1). The bacterial infection often manifests itself as meningitis in newborns or meningitis, and blood or respiratory infections in immunocompromised adults (1). Elizabethkingia is treatable, however it is resistant to many antibiotics (5). Doctors in this recent outbreak have identified a few antibiotics that have been successful in treating the infection, which include fluoroquinolones, rifampin, and trimethoprim/sulfamethoxazole (5). Hopefully these antibiotics can be used to treat more cases and prevent any additional deaths attributed to this outbreak.

Illinois Response to the Outbreak

The Illinois Department of Public Health is quite busy with determining the source of the outbreak, while also treating the people who have already contracted the infection. The agency is urging health care workers to test anyone who presents with similar symptoms of Elizabethkingia for infection (6). The agency is also trying to establish a link between the confirmed cases while investigating the source of the bacteria, why and how people are getting infected, and the exact effect that the bacteria has on a person’s health (6). Hopefully, Illinois will discover the cause of this outbreak in order to effectively treat and prevent further cases of this bacterial infection.

 

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Sources

  1. Rhodes, D. (2016, April 20). 10 Illinois residents infected with Elizabethkingia. Chicago Tribune. Retrieved April 26, 2016, from http://www.chicagotribune.com/news/local/breaking/ct-elizabethkingia-inf...
  2. Meyers, S. L. (2016, March 9). A Crash Course In Elizabethkingia, The Rare Bacterial Infection Spreading Across Wisconsin. Wisconsin Public Radio. Retrieved April 26, 2016, from http://www.wpr.org/crash-course-elizabethkingia-rare-bacterial-infection....
  3. Goldschmidt, D. (2016, April 13). Elizabethkingia outbreak spreads; source still a mystery. CNN. Retrieved April 26, 2016, from http://www.cnn.com/2016/04/12/health/elizabethkingia-illinois-bacterial-...
  4. Elizabethkingia. (2016). Retrieved April 26, 2016, from http://www.cdc.gov/elizabethkingia/about/index.html
  5. Rettner, R. (2016, April 20). 5 Things to Know About Elizabethkingia. Discovery News. Retrieved April 26, 2016, from http://news.discovery.com/human/health/5-things-to-know-about-elizabethk...
  6. Bair, D., & Czink, K. (2016, April 20). Concerns grow over Elizabethkingia. WGN Tv. Retrieved April 26, 2016, from http://wgntv.com/2016/04/20/concerns-grow-over-elizabethkingia/
Yellow Fever Deaths Reach 250 in Angola

Apr 26, 2016 | Cheryl Lang Colleen Nguyen | Outbreak News

Currently, there is a particularly worrisome yellow fever outbreak in Angola due to the increasing number of cases, a vaccine shortage, and another simultaneous mosquito-disease epidemic. Angola is experiencing its worst yellow fever outbreak in the last 30 years (1). So far, the yellow fever death toll in Angola has reached 250, with the number of reported cases has reached 1,908 as of April 20th (6, 7). The virus has hit 16 of the 18 provinces in Angola and is continuing to spread to other provinces and countries (1). Imported cases of the virus from Angola have been reported in China, the Democratic Republic of Congo, and Kenya (2).

 

What is Yellow Fever?

Yellow Fever is mosquito-borne virus that is endemic in tropical areas of Latin America and Africa (5). The virus is transmitted by two types of mosquitoes, the Aedes aegypti and Haemagogus mosquitoes (5). The Aedes aegypti is the same mosquito that transmits Zika virus and dengue fever (2). The mosquitoes contract the virus primarily from monkeys and then are able to transmit the virus to humans (5). “Yellow” in ‘Yellow Fever’ refers to the jaundice that occurs in some patients as a result of the virus (5).

Upon initial infection, the virus incubates in the body for 3-6 days. The virus occurs in two phases -- the first phase is the “acute” phase and causes symptoms of fever, muscle pain, back pain, headache, shivers, lack of appetite, and nausea or vomiting (5). The majority of people affected by the acute phase improve and recover after 3-4 days from the onset of symptoms (5).

However, 15% of infected patients do not improve from the acute phase and enter into the second and more dangerous phase of the virus -- the toxic phase (5). This phase occurs within 24 hours of the initial remission of the virus (5). Common symptoms of the toxic phase include high fever, jaundice, abdominal pain and vomiting, kidney function deterioration, and bleeding from the mouth, nose, eyes, or stomach (5). When this bleeding happens, bloody vomit and feces can also occur (5). Only 50% of patients who reach the toxic phase of the virus survive and those who do not survive, die within 10-14 days (5). Those who are lucky enough to survive can recover without severe organ damage (5).

There is no specialized treatment for Yellow Fever (5). A patient can receive supportive care that treats dehydration, respiratory failure, and fever but this is often not readily available in poorer areas (5). The most important measure to prevent the outbreak of this virus is vaccination (5). The Yellow Fever vaccine has found to be 90% effective in people within 10 days of receiving the vaccination and 99% effective in people within 30 days of receiving the vaccination (5). Mosquito control and epidemic preparedness and response are also necessary methods of control and prevention. However, lack of effective mosquito control and appropriate epidemic preparedness and response have been major contributing factors to the alarming outbreak in Angola.

 

The Vaccine Shortage

The current outbreak began in the province of Luanda, the capital of Angola and the majority of the cases are still being reported within that area (2). To control this epidemic, Angola’s Ministry of Health and the World Health Organization launched an emergency vaccination campaign in Luanda province in February with plans to vaccinate 6.5 million people (3,4). Vaccination is the best known method of prevention of Yellow Fever and is necessary to stop this continuous outbreak.

However, an extreme shortage of the vaccine has been a major concern for this epidemic. The World Health Organization exhausted its emergency stockpile of the Yellow Fever vaccine and still needed to vaccinate 1.5 million people in Luanda alone (2). Additionally, there are only four facilities globally that produce the yellow fever vaccine (4). These four facilities will be challenged to effectively meet the continuing supply and demand of the vaccines needed to address this outbreak. With the emergency stockpile completely empty, more emphasis on producing the yellow fever vaccine has been prioritized (4). Some studies have shown that using one-fifth or one-tenth of the current vaccination dose may protect people against the disease, which could provide an alternative solution to the vaccine shortage issue (4). The effectiveness of that possible solution remains to be determined, but may be a better alternative for prevention and protection.

Given the recent vaccination shortage and the continuous spread of the virus to other countries, many health experts fear this outbreak will become uncontrollable (4). The virus’ spread to Asia is the most alarming concern because there may not be enough vaccines to treat Angola’s population and other possible outbreaks in Africa and Asia. Vaccine manufacturers are attempting to increase productivity in the making of the vaccine and will continue to ship vaccines where they are needed (2). Additionally, Angola has put a ban on visitors aged 9 months and older allowed into the country without proper vaccination (3). People who wish to travel to Angola during this time must show proof of proper vaccination.

 

Replenishment of the Emergency Supply

Thankfully, at the end of March 2016, the emergency vaccine supply was replenished to include 10 million vaccines available to prevent yellow fever (6). This new supply will greatly contribute to effectively controlling the further spread of yellow fever in Angola. However, there is still a concern with regards to potential spread in other parts of Africa and Asia and whether further vaccination production, in addition to the replenished supply, should be prioritized.

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Sources

  1. Gaffey, C. (2016, April 16). Angola: Yellow Fever Death Toll Rise to 225 Amid Vaccine Shortage. Newsweek. Retrieved April 25, 2016, from http://www.newsweek.com/angola-yellow-fever-death-toll-rise-225-amid-vac...
  2. Goldschmidt, D. (2016, March 25). Yellow fever vaccine shortage as outbreak in Angola spreads. CNN. Retrieved April 25, 2016, from http://www.cnn.com/2016/03/25/health/yellow-fever-vaccine-shortage-angola/
  3. Yellow Fever in Angola. (n.d.). Retrieved April 25, 2016, from http://wwwnc.cdc.gov/travel/notices/alert/yellow-fever-angola
  4. Kupferschmidt, K. (2016). Angolan yellow fever outbreak highlights dangerous vaccine shortage. Science. doi:10.1126/science.aaf4082
  5. Yellow fever. (n.d.). Retrieved April 25, 2016, from http://www.who.int/mediacentre/factsheets/fs100/en/
  6. Angola' health officials extend vaccination campaign for yellow fever to Huambo and Benguela provinces. (2016, April 21). News Medical. Retrieved April 25, 2016, from http://www.news-medical.net/news/20160421/Angola-health-officials-extend-vaccination-campaign-for-yellow-fever-to-Huambo-and-Benguela-provinces.aspx
  7. Yellow fever outbreak in Angola: Vaccination campaigns to extend to Huambo and Benguela provinces. (2016, April 20). Outbreak News Today. Retrieved April 25, 2016, from http://outbreaknewstoday.com/yellow-fever-outbreak-in-angola-vaccination...
Months After 2014 Outbreak Ends, Ebola Flares Up in Guinea

Mar 30, 2016 | Shannon Smith Colleen Nguyen | Outbreak News

At least five people have died since 29 February 2016 due to a new flare up of Ebola virus disease (EVD) in Guinea [1]. The first two confirmed cases of the virus were detected in the village of Korokpara and involved a mother and her five-year-old son. These are the first cases of Ebola in Guinea since the World Health Organization (WHO) declared the country free of the disease in December 2015. This declaration came two years after an outbreak that began in 2013 killed approximately 2,500 people in Guinea and over 11,000 in West Africa [2]. The WHO had warned that Guinea, as well as the neighboring countries of Liberia and Sierra Leone, are at risk for ongoing smaller outbreaks due to persistence of the virus in some previously infected individuals [3]. Guinea’s 90-day heightened surveillance period was set to end in late March [4].

Ebola virus disease is an often-fatal illness caused by a virus in the Filoviridae family. The first symptoms of the disease can appear 2-21 days after exposure and typically include fatigue, fever, and muscle pain. This is followed by more severe symptoms including vomiting, diarrhea, and, in some cases, internal bleeding and multi-organ failure. The virus is transmitted to human populations through close contact with the bodily secretions of infected animal hosts, such as fruit bats, chimpanzees, gorillas, and forest antelopes [5]. This typically happens during the hunting and butchering processes involved with food preparation of “bushmeat” [6]. The virus is also capable of spreading from person-to-person through contact with infected bodily fluids. Many healthcare workers have been infected with Ebola while treating EVD patients, and transmission can occur during burial ceremonies as bodies remain highly infectious even after death [5].

The first outbreak of Ebola occurred in 1976 in Zaire--now the Democratic Republic of the Congo-- where 318 people were infected and 280 (88%) died. Several smaller outbreaks have occurred since then, mostly in Central Africa [7]. High case fatality rates are common during these outbreaks, ranging from 25% to 90% with an average of about 50% [5]. In March 2014, an outbreak of febrile illness in Guinea that had already killed 59 people was confirmed to be caused by EVD. Further investigation reveled that the first case was a two-year-old child in Guéckédou, Guinea in December 2013. The outbreak spread to Liberia and Sierra Leone and caused mass illness and death in these countries, with additional cases reported in Senegal and Nigeria as well as the United States and Europe [8]. Countries most impacted by EVD have fairly weak health infrastructure, making it difficult for governments to keep the spread of the disease under control. This also contributed to the inability to deliver proper care and isolation for infected individuals. As of 20 March 2016, an estimated 28,644 people have been infected worldwide during this outbreak and 11,320 people have died, making it significantly larger than all previous outbreaks combined [9].

Even though it was declared to be over in December 2015, it is clear that the 2014 outbreak of Ebola continues to impact the most heavily affected countries of Guinea, Sierra Leone, and Liberia. Initial tests performed on the new cases in Guinea suggest that they are part of a previously known transmission chain of the virus. This reveals that the flare up resulted from contact with survivors from the 2014 outbreak in whom the virus had persisted, and it is not believed that the current flare-up was caused by a new introduction of the virus from an animal [10]. A similar flare-up occurred in January 2016 in Sierra Leone, which had been previously declared free of Ebola in November 2015. After 42 disease-free days (two incubation periods) this outbreak was declared over by the WHO on 17 March, the same day that the first case was confirmed in Guinea [11].

Several measures have been taken so far in an attempt to contain the outbreak. The WHO deployed surveillance experts and contact tracers to Guinea on 18 March 2016 after the confirmation of two additional cases and reported that additional personnel would be sent in the coming weeks [4]. So far, the Guinean government has quarantined 816 people because of potential contact with the infected individuals. They will be kept in their homes during the 21-day incubation period of the virus and will be released if they are not exhibiting symptoms after this time [12]. Over 100 of these individuals are considered high-risk for developing the virus [10]. Additionally, Liberia has closed its border with Guinea in response to the outbreak [13]. If the reaction to this current flare-up in Guinea is as swift and effective as it was to the outbreak in Sierra Leone in January, it is likely that this outbreak will be successfully contained. This will require maintaining vigilant surveillance as well as practicing hygiene both at home and in healthcare facilities to prevent transmission of the virus [11].

 

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Sources

1. http://www.timeslive.co.za/sundaytimes/stnews/international/2016/03/22/At-least-5-dead-in-Guinea-Ebola-flare-up-health-officials

2. http://news.sky.com/story/1662070/two-cases-of-ebola-confirmed-in-guinea

3. http://www.the-scientist.com/?articles.view/articleNo/45630/title/WHO--Ebola-Confirmed-in-Guinea/

4. http://mynews4.com/news/health/who-sends-specialists-in-response-to-guinea-ebola-flare-up

5. http://www.who.int/mediacentre/factsheets/fs103/en/

6. http://www.cdc.gov/vhf/ebola/pdf/bushmeat-and-ebola.pdf

7. http://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html

8. http://www.theguardian.com/world/2014/oct/15/ebola-epidemic-2014-timeline

9. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html

10. http://www.cidrap.umn.edu/news-perspective/2016/03/guinea-ebola-cluster-likely-part-known-transmission-chain

11. http://www.who.int/mediacentre/news/statements/2016/end-flare-ebola-sierra-leone/en/

12. http://www.newsweek.com/ebola-guinea-quarantine-816-people-latest-flare-439376

13. http://www.theguardian.com/world/2016/mar/23/ebola-deaths-in-guinea-prompt-liberia-to-close-border

Food Insecurity in Eastern and Southern Africa due to El Niño

Mar 23, 2016 | Kara Sewalk | Commentary

The United Nations Children’s Fund has stated that approximately 11 million children in eastern and southern Africa face hunger, disease and water shortage due to this year’s unusually extreme El Niño season [1]. In November, the United Nations warned that the nations in the Horn of Africa, which includes Djitbouti, Eritrea, Ethiopia and Somalia, are at a heightened risk for food insecurity, due to the extreme droughts that have occurred over recent months [2].

Despite concerns from the United Nations, the Eritrean President Isaias Afwerki stated that “the country will not face any crisis in spite of reduced agricultural output” and further, “Isaias praised the government's judicious policy and approaches of bolstering its strategic food reserves” [2].

Interestingly, Eritrea has long been known to reject UN food aid and prefers a policy of self-reliance, with Isaias stating that he was not worried. Consequently, the UN has limited access to the country and many foreign aid agencies are not allowed to operate there [2]. While Eritrea may claim that it will not face food insecurity this year, the surrounding region faces crop reduction by 50-90%. In neighboring Ethiopia, there is upwards of 10 million people in need of food aid, a number that is expected to rise to 18 million by the end of 2016 [2].

In this region, food insecurity and malnutrition have become an even more heightened problem within the last year. The World Food Programme published a report in December 2015 that highlights the expected outcomes and impacts of El Niño across the globe. Most of East Africa has already seen the end of the rainy season and is now dealing with the repercussions of a stunted growing season. Ethiopia faces a major drought emergency and Sudan faces a shortage of rainfall and poor pastor production [3]. The Horn of Africa is expected to experience wetter than average conditions, with flood warnings throughout Kenya and Somalia. However, a benefit of the wet conditions is that the increase in water could help recover pastoral areas [3]. With a warming climate and fluctuations of extreme rains and droughts, El Niño also brings a greater susceptibility to infectious diseases [7]. Wet and warming temperatures are an ideal breeding ground for mosquitos that transmit vector borne diseases such as malaria, dengue, yellow fever and Zika virus as well as waterborne diseases such as cholera. In the last year, Tanzania and Somalia have both experienced major cholera outbreaks, which government officials say have been caused by the pooling of groundwater due to El Niño rains [8,9].

Leila Gharagozloo-Pakkala, UNICEF Regional Director for Eastern and Southern Africa, reports that "the El Niño weather phenomenon will wane, but the cost to children - many who were already living hand-to-mouth - will be felt for years to come. Governments are responding with available resources, but this is an unprecedented situation. Children’s survival is dependent on action taken today" [1].

Malawi is experiencing its worst food crisis in nine years, with approximately 2.8 million people facing hunger (15% of the population). UNICEF cites that from December 2015 to January 2016, cases of "severe acute malnutrition" have more than doubled in Malawi[4].

Due to extreme droughts brought on by El Niño, South Africa has also experienced its driest year in over a century, and will be importing at least half of its required maize crop. Food prices have drastically increased because of reduced production and availability [4].

In response to the emergency situation, many nations have contributed funds to implement food insecurity interventions. Italy, for example, has allocated one million euros between the World Food Programme and the United Nations Food and Agriculture Organization to aid in curbing food insecurity in Ethiopia [5].

Below is a list of the UNICEF humanitarian appeals in El Niño-affected countries [1]:

§  $US 26 million in Angola

§  $US 87 million in Ethiopia

§  $US 3 million in Lesotho

§  $US 11 million in Malawi

§  $US 15 million in Somalia

§  $US 1 million in Swaziland

§  $US 12 million in Zimbabwe

In order to prevent years of production failure, food insecurity and malnutrition, countries across the globe need to raise funds now to protect against the devastating impacts of El Niño. The European Union has allocated 12 million euros to provide food assistance to countries of southern Africa, including Angola, Zimbabwe, Malawi, Swaziland, Lesotho and Madagascar, and allocated an additional five million euros to southern Africa in 2016 to support disaster risk reduction activities and protect against the impact of natural disasters such as drought, floods and cyclones that frequently affect Mozambique, Malawi and Madagascar [6].

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Sources

[1] http://www.unicef.org/media/media_90252.html

[2] http://reliefweb.int/report/eritrea/eritrea-president-dismisses-food-cri...

[3] http://documents.wfp.org/stellent/groups/public/documents/ena/wfp280227.pdf

[4] https://www.rt.com/news/332733-children-malnourished-el-nino/

[5] http://reliefweb.int/report/ethiopia/ethiopia-italy-contribute-1-million...

[6] https://ec.europa.eu/jrc/en/news/el-nino-devastating-impact-southern-afr...

[7] http://www.who.int/globalchange/publications/climatechangechap6.pdf

[8] http://allafrica.com/stories/201512311089.html

[9] http://reliefweb.int/report/united-republic-tanzania/tanzania-cholera-em...

Elizabethkingia spreads throughout Wisconsin Healthcare Facilities

Mar 22, 2016 | Shannon Smith Colleen Nguyen | Outbreak News

A mysterious outbreak of an extremely rare bloodstream infection has been ongoing in Wisconsin for at least four months, and public health officials are unsure of the cause. The Wisconsin Department of Health has reported that 54 cases of Elizabethkingia anophelis infection have occurred since 1 November 2015. Elizabethkingia, an opportunistic pathogen that is abundant in the environment, has caused infections in at least 12 counties throughout the state and has been identified to be linked primarily to healthcare facilities. Symptoms of Elizabethkingia infection include fever, shortness of breath, and cellulitis [1]. The majority of cases during this outbreak have been in patients over the age of 65, and all cases have had previously diagnosed underlying illnesses [2]. To date, 17 deaths have been associated with the outbreak [1], and a case has also been confirmed in western Michigan [3].

The outbreak has created unique challenges for the Centers for Disease Control and Prevention (CDC) and for local health departments. In the past, infections from the bacteria had been so rare that they were not closely monitored, making it difficult to determine how many people are usually affected [2]. Wisconsin typically only sees one or two cases per year according to University of Wisconsin infection control director Dr. Nasia Safdar. The CDC laboratory in Atlanta is currently the only laboratory in the United States that can distinguish E. anophelis from a different, more common species in the same genus, E. meningoseptica. Thus, samples often need to be sent to the CDC lab before cases can be officially confirmed [4].

At this point, the source of the unprecedented spread of the bacteria is unknown, making it difficult for health departments to prevent future infections. Five CDC “disease detectives” have been sent to Wisconsin for an investigation of the outbreak, which will involve reviewing medical records and interviewing patients to determine if a connection exists between the cases [5]. Exposure from contaminated food and water had been identified as a potential risk factor, since the bacteria is so widely present in the environment. However, the water supply has been ruled out as a potential source of the infection after it tested negative for the presence of Elizabethkingia. No pattern of medical treatment or device usage has emerged among the cases, so it is not clear if a relationship exists between infection and specific type of treatment [4].

Another problem presented by Elizabethkingia anophelis is that it is difficult to treat with antibiotics [6]. However, despite its multi-drug resistance, Elizabethkingia is not considered a true “superbug” as Wisconsin health officials have identified antibiotics to which the bacteria are susceptible. Dr. Safdar has said that the general public should not be concerned about the bacteria as it causes disease only in the small proportion of the population with compromised immune systems. Elizabethkingia is not known to be spread from person to person, and infection is believed to occur as a result of contact with contaminated medical equipment, though this has not been confirmed. Control of the outbreak will rely on diligent reporting from healthcare workers as well as the investigative efforts by public health officials [4]. A rapid identification of cases occurred after the Wisconsin Department of Health Services initially provided guidance to health workers about identifying and reporting cases. This has led to an improvement in outcomes for patients as healthcare workers begin to administer proper treatment [1].

 

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Sources

1. https://www.dhs.wisconsin.gov/disease/elizabethkingia.htm

2. http://www.wpr.org/crash-course-elizabethkingia-rare-bacterial-infection-spreading-across-wisconsin

3. http://www.mlive.com/news/grand-rapids/index.ssf/2016/03/bacteria_outbreak_in_wisconsin.html

4. http://outbreaknewstoday.com/elizabethkingia-outbreak-what-we-know-so-far-86330/

5. http://outbreaknewstoday.com/elizabethkingia-outbreak-is-very-worrisome-to-cdc-besser-32199/

6. http://time.com/4257603/wisconsin-disease-elderly-elizabethkingia/

Mumps: Making a Comeback

Mar 17, 2016 | Tessa Runels, Cheryl Lang, Colleen Nguyen | Outbreak News

Mumps are making a comeback on college campuses nationwide. On Friday, February 25, there were two lab-confirmed cases and three probable cases of mumps reported in New Hampshire [1]. All cases were members of the St. Anselm College hockey team [1]. On the 29th of February, two cases of mumps were diagnosed at Harvard University in Massachusetts. The following week on March 2, Harvard administration reported four additional cases among their student body [2]. On March 14th, the University of San Diego in California reported five mumps cases among their students [9]. Most recently, three cases were confirmed among undergraduate students at Boston University in Massachusetts on March 16th [10].

 

Symptoms and Spread of Mumps

After initial exposure to the mumps virus, paramyxovirus, it takes around 16-18 days for symptoms to present [1, 3]. However, symptom onset can range from around 12 to 25 days after infection [1, 3]. Not everyone infected with the virus exhibits symptoms and, if symptoms do present, they are often nonspecific. Symptomatic cases generally report: fever, headache, muscle aches, loss of appetite and tender and/or swollen salivary glands [4]. These symptoms often resolve on their own, but in rare instances can cause complications in adults [4]. Serious complications include inflammation of the brain, the tissue covering the brain and spinal cord, ovaries and breasts (in females) and testicles (in males) [4]. Another rare adult complication is deafness [4]. The hallmark of mumps is noticeable swelling of the single or both parotid salivary glands in the cheek and jaw area [3]. This swelling can be differentiated from that of swollen lymph nodes of the neck because instead of swelling in the neck, mumps causes swelling that completely covers the jaw-line and causes the ears to protrude[4]. Mumps is spread through the saliva or mucus of an infected individual, with people often becoming infected through inhalation of the saliva droplets after sneezing or coughing [4,5].

 

I Thought There Was a Vaccine for That?

Mumps is a vaccine-preventable disease that most of us are vaccinated against. The Centers for Disease Control and Prevention (CDC) advises that all infants be vaccinated with a combination vaccine (MMR) 12 to 15 months after birth, and with a booster at 4 to 6 years of age [6]. Nevertheless, these are just guidelines, as immunizations that are required for enrollment and attendance at a child care facility or school are established and enforced at the state level. After completion of the two-dose series, the vaccine is estimated to be approximately 88 percent effective [1]. Now, some of you may be asking, “Doesn’t vaccination mean that I’m protected?” Unfortunately, vaccination doesn’t guarantee that a sufficient immune response, and therefore protection, is triggered. In other words, just because you are vaccinated doesn’t mean that you will be fully immune from infection.

In New Hampshire, there is no law requiring vaccines prior to entering college. Each college or university is permitted to establish their own rules surrounding required immunizations prior to enrollment at a given institution [7]. On the other hand, in the state of Massachusetts there are established laws regarding immunization for college and university students. In Massachusetts, all health science and full-time students are required to have two documented doses of the MMR vaccine [8]. As shown by the differences between regulations in these two states, vaccination laws for college-age students vary on a state-by-state basis.

For additional information on the MMR vaccine and what this means for mumps in the future, please read:

http://www.healthmap.org/site/diseasedaily/article/just-vax-please-mumps...

 

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 Sources

1.   Tranchemon, C. (2016, February 27). Health and human services warns of college campus mumps outbreak. WCVB NewsCenter 5. Retrieved March 14, 2016, from http://www.wcvb.com/news/health-and-human-services-warns-of-college-camp...

2.  Freyer, F. J. (2016, March 3). Four more Harvard students get mumps. Boston Globe. Retrieved March 14, 2016, from https://www.bostonglobe.com/metro/2016/03/02/four-more-harvard-students-...

3.  Center for Disease Control. Mumps: For Healthcare Providers. (2016). Retrieved March 14, 2016, from http://www.cdc.gov/mumps/hcp.html#virus

4.  Center for Disease Control. Transmission of Mumps. (2015). Retrieved March 14, 2016, from http://www.cdc.gov/mumps/about/transmission.html

5.  Mayo Clinic. Diseases and Conditions: Mumps. (2015, August 12). Retrieved March 14, 2016, from http://www.mayoclinic.org/diseases-conditions/mumps/basics/causes/con-20...

6.  Center for Disease Control. For Parents: Vaccines for Your Children. (2012). Retrieved March 14, 2016, from http://www.cdc.gov/vaccines/parents/record-reqs/immuniz-records-child.html

7.  National Vaccine Information Center. New Hampshire State Vaccine Requirements. (2016, January 22). Retrieved March 14, 2016, from http://www.nvic.org/vaccine-laws/state-vaccine-requirements/new-hampshir...

8.  Massachusetts Department of Public Health. Massachusetts School Immunization Requirements for School Year 2015-2016. (n.d.). Retrieved March 14, 2016, from http://www.mass.gov/eohhs/docs/dph/cdc/immunization/guidelines-ma-school...

9. University of San Diego reports five mumps cases. (2016, March 14). Outbreak News Today. Retrieved March 16, 2016, from http://outbreaknewstoday.com/university-of-san-diego-reports-five-mumps-...

10. Brown, J. (2016, March 16). Three Mumps Cases Found at BU. BU Today. Retrieved March 16, 2016, from http://www.bu.edu/today/2016/cases-of-mumps/

 

 

 

First Appearance of Dengue in Uruguay

Mar 15, 2016 | Noushin Berdjis | Outbreak News

A 31-year old Montevideo resident went to the hospital on February 9, 2016 after experiencing fever and joint pain – two classic symptoms of Dengue fever [1-5, 8]. The patient had no recent travel history outside of Uruguay and tested positive for Dengue Serotype 1 (DEN-1), thereby becoming the country’s first autochthonous - locally transmitted - case [7-9].

Located in South America, Uruguay was one of the few countries in the region where Dengue had not become prevalent [6]. Yet, as of March 10, 2016, one month after the first confirmed case, there have been 570 suspected and 17 confirmed cases of Dengue fever in Uruguay [7, 9]. The majority of these cases have occurred in Montevideo, which is home to 1.5 million people, roughly half of the country’s population [9]. The remaining cases have occurred in Canelones and Salto [9].

 

What is Dengue?

Dengue fever is a viral disease transmitted to humans through the bite of an infected female Anopheles mosquito [1-5]. Dengue can be found in tropical and sub-tropical climates across the globe, primarily in urban and semi-urban areas [5]. This places about half of the world’s population at risk [5]. The incubation period – the time between exposure to a pathogen and the appearance of symptoms - for Dengue fever is 4 to 10 days [5]. Symptoms last about 2 to 7 days and include: high fever, severe headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, and swollen glands [1-5].

Since there is currently no specific treatment or vaccine against Dengue, vector control is the most effective prevention method [5]. The primary Dengue vector in South America is the Aedes aegypti mosquito [2,5]. The Aedes aegypti mosquito is also capable of transmitting Yellow Fever, Chikungunya, and Zika virus [2]. Although these diseases are also common in the region, there have been no cases in Uruguay thus far [6]. These mosquitoes are daytime feeders that prefer urban habitats, bite multiple humans during each feeding period, and breed primarily in man-made containers such as water tanks, plastic bottles, discarded tires, and flower pots [1-2,5]. An infected mosquito is capable of transmitting the virus for the remainder of its life [5].

 

Uruguay’s Response

The emergence of Dengue in Uruguay implies that an environment favorable for Aedes aegypti mosquito proliferation has emerged [9]. In fact, Aedes aegypti larvae were discovered within the homes of Uruguay’s confirmed cases [6]. Health officials found larvae in household items such as flower pots, dressers, and water bowls for pets [6].

Prevention and control of Dengue relies heavily on eliminating Aedes aegypti breeding sites and reducing contact between mosquitoes and humans. Therefore, Uruguay health officials are focusing on strengthening vector control, clinical management, and emergency risk communications [9]. Additionally, an aid team consisting of an epidemiologist, entomologist, and risk communication specialist, has been dispatched to Uruguay [9]. Neighborhoods within Montevideo have been fumigated and public service announcements have instructed individuals to eradicate standing water sites within their households [6]. Furthermore, the public has been advised to avoid mosquito bites by regularly using repellents and wearing light colored, long sleeved shirts, as well as pants [9]. Since the Aedes aegypti mosquito is active during the day, young children, or any other individuals who sleep during the day, are encouraged to use mosquito bed nets [9].

 

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Sources

  1. http://www.bbc.com/news/world-latin-america 32589268#sthash.csLVq56t.dpuf
  2. http://www.wsj.com/articles/drought-stricken-sao-paulo-battles-dengue-fever-outbreak-1425420508#sthash.csLVq56t.dpuf
  3. http://outbreaknewstoday.com/dengue-cases-rise-in-brazil-as-does-dengue-spending-90861/#sthash.csLVq56t.dpuf
  4. http://www.wsj.com/articles/brazil-city-calls-in-army-to-fight-dengue-1429292950#sthash.csLVq56t.dpuf
  5. http://www.who.int/mediacentre/factsheets/fs117/en/#sthash.csLVq56t.dpuf
  6. http://latino.foxnews.com/latino/news/2016/02/28/mosquito-larvae-found-in-uruguayan-houses-infected-with-dengue/
  7. http://outbreaknewstoday.com/uruguay-reports-increase-in-dengue-fever-particularly-in-montevideo-64116/
  8. http://outbreaknewstoday.com/dengue-fever-uruguays-1st-local-transmission-brazil-tops-100000-cases-in-january-79425/
  9. http://www.who.int/csr/don/10-march-2016-dengue-uruguay/en/
MERS Updates: Saudi Arabia and Potential Vaccines

Mar 7, 2016 | Tuyen Tran, Emily Cohn | Outbreak News

 

The World Health Organization (WHO) has recorded 1,644 laboratory-confirmed cases and at least 590 deaths of Middle East respiratory syndrome coronavirus (MERS-CoV) in 26 countries since its identification in September 2012 [6]. The virus appears to primarily circulate in Saudi Arabia, as the country’s ministry of health has been notified of 1,326 confirmed cases (20 cases under care and 747 recovered) and 559 deaths since 2012 [1]. Around April of 2013 and 2014, the country has encountered sudden increases in the number of MERS patients and it was not clear why the spikes in cases occurred [7]. Even though the pattern did not apply during the same period in 2015, there was a hospital-based outbreak in Riyadh, Saudi Arabia in June through August of 2015 that resulted in 130 patients becoming infected and 51 of which resulted in death [8]. As of 2016, new MERS-CoV clusters are confirmed on a daily basis in Saudi Arabia, confirming approximately 34 cases and 8 deaths [1]. Close contact with confirmed/suspected cases and exposure to camels are often defined as the probable sources of infection for those clusters.

 

Although MERS-CoV case counts continue to rise slowly but steadily, no specific treatment is currently available.

 

A group of researchers at Naval Medical Research Center in Maryland, lead by LtCdr. Gabriel Defang, has used bioengineered cows to produce a large quantity of human polyclonal antibodies that have effectively protected lab mice from MERS-CoV virus infection. The researchers introduced two experimental vaccines against the virus, one of which was SAB-301 [4]. They administered SAB-301 to cows whose immunoglobulin genes – that produce antibodies – have been replaced with an artificial chromosome carrying the human immunoglobulin genes. The genetically modified cows developed a robust immune response, and produced large quantities of human polyclonal antibodies against MERS [2]. A single dose of SAB-301 also effectively protected lab mice from the virus either 12 hours before or 24 and 48 hours after MERS-CoV infection. The finding could be a crucial step toward the search for prevention and treatment of the disease. Currently, Defang’s team are taking steps to initiate phase I studies in humans [2,3].

 

Meanwhile, the Walter Reed Army Institute of Research (WRAIR), GeneOne Life Science Inc., and Inovio Pharmaceuticals, has begun to test their version of MERS vaccine on seventy-five participants in Maryland [5]. This is the first vaccine candidate to be tested in humans. In early 2015, GeneOne and Inovio Pharmaceuticals' DNA-based vaccine for MERS, GLS-5300, proved to be capable of protecting mice, camels, and monkeys from the virus. The vaccine completely freed all vaccinated lab monkeys in the study from MERS symptoms when the animals were challenged with a live MERS virus. Observing the impact of the large scale MERS outbreak in South Korean and its increasing threat to military operations, the WRAIR pledged to advance promising MERS vaccine candidates into human trials and took the opportunity to test GLS-5300 at its Clinical Trials Center [9].

 

References:

  1. Saudi Arabia's Ministry of Health. March 7, 2016 http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2016-03-07-0...
  2. Costandi, Moheb. Neutralizing MERS-CoV through human genes in cows. Nature Middle East. Feb 28, 2016. http://www.natureasia.com/en/nmiddleeast/article/10.1038/nmiddleeast.2016.20
  3. Luke, T., et al. Human polyclonal immunoglobulin G from transchromosomic bovines inhibits MERS-CoV in vivo. Sci. Trans. Med. 2016 http://stm.sciencemag.org/content/8/326/326ra21
  4. Frey, K. G., et al. Full-Genome Sequence of Human Betacoronavirus 2c Jordan-N3/2012 after Serial Passage in Mammalian Cells. Genome Announc. 2014 http://genomea.asm.org/content/2/3/e00324-14
  5. First-in-man trial of MERS vaccine begins. Medical Express. Feb 17, 2016 http://medicalxpress.com/news/2016-02-first-in-man-trial-mers-vaccine.html
  6. Middle East respiratory syndrome coronavirus (MERS-CoV) - Saudi Arabia. World Health Organization. Feb 29, 2016 http://www.who.int/csr/don/29-february-2016-mers-saudi-arabia/en/
  7. Lakhani, Leone. Saudi officials see spike in MERS coronavirus cases. CNN. April 22, 2014 http://www.cnn.com/2014/04/21/health/mers-coronavirus-saudi-arabia/index.html
  8. Wappes, Jim. Saudi Arabia confirms MERS case as report details 2015 outbreak. Center for Infectious Disease Research and Policy. Feb 19, 2016 http://www.cidrap.umn.edu/news-perspective/2016/02/saudi-arabia-confirms-mers-case-report-details-2015-outbreak
  9. GeneOne Life Science and the Walter Reed Army Institute of Research Partner to Develop MERS Vaccine. GlobeNewswire. November 10, 2015 http://www.globenewswire.com/news-release/2015/11/19/788811/0/en/GeneOne...

 

 

Lassa Fever Rages On in Nigeria

Mar 7, 2016 | Cheryl Lang, Tessa Runels, Colleen Nguyen | Outbreak News

Lassa fever is endemic to Nigeria, with annual spikes in disease incidence occurring between December and February (6). Since August 2015, there have been 175 reported cases and 101 deaths across Nigeria (9). In Nigeria, the four states being significantly affected by this disease are Bauchi, Edo, Oyo and Taraba (6). The ongoing outbreak is comparable in size to an outbreak in 2012, which resulted in 397 suspected cases, 87 confirmed cases and 40 deaths (12). In the wake of the current outbreak, and as a means of disease prevention, it is reported that Nigerians are stocking up on rat poison, although the Minister of Health promotes the use of traps instead (10,11). The WHO notes that extensive contact tracing is underway, with no contacts having contracted the disease as of January 25 (6).

 

All About Lassa Fever

Lassa fever is a zoonotic (or animal-borne) acute viral illness that is endemic to areas of West Africa (1). This illness was first discovered in 1969 and was named after the town in Nigeria where it was first identified and isolated (1). The disease is primary spread through contact with items contaminated with rodent feces. It is endemic among the rodent population in countries such as Nigeria, Sierra Leone, Guinea, and Liberia, where it is known to cause outbreaks on an almost annual basis (1, 6). Currently, Nigeria is experiencing an outbreak of Lassa fever and many states are struggling to halt the spread of the virus (6, 10).

 

Epidemiology of Lassa Fever

The natural host of Lassa fever is a rodent called the multimammate rat (2, 7, 8). This rodent is populous in the savannahs and forests of West Africa, but may also live in human homes and locations where food is stored (2). These rodents breed frequently and produce large numbers of offspring, making them perfect for spreading the virus efficiently (2). Once a rodent is infected with Lassa virus, it excretes the virus through urine and feces for an extended period of time—and sometimes even for the rest of its life (2). The virus can then be transmitted to humans through the inhalation or ingestion of dust particles containing the virus (2, 7). Due to proximity of the rodents to humans, the zoonotic transmission of the virus happens relatively frequently (2). The annual incidence of Lassa fever across this region is estimated to be as high as 300,000 cases, and 5,000 deaths (7).

Infection via contact often occurs after touching objects soiled with infected rodent excretions, eating contaminated food, and the virus entering the body through open cuts and wounds (2). Airborne transmission of the virus can occur during cleaning activities that disperse the viral particles into the air, such as sweeping the fecal matter of an infected rodent (2). 

Lassa virus can also be transmitted between humans when a person comes into contact with the blood, tissue, secretions, or excretions of another individual infected with the virus (2). It is important to note that Lassa virus is not transmitted through skin-to-skin contact and is only transmitted through the exchange of bodily fluids with an already-infected individual (2). Person-to-person transmission in endemic regions is common in healthcare settings, such as hospitals and clinics. This nosocomial spread of the virus can occur through contaminated medical equipment in resource-limited settings where proper infection-control techniques are not always practiced (2).

 

Signs, Symptoms, and Treatment

For approximately 80% of Lassa virus infections, symptoms are mild and frequently go undiagnosed (3). These mild febrile symptoms usually include a slight fever, general malaise, weakness, and headache (3). More serious symptoms, including hemorrhage, respiratory distress, vomiting, facial swelling, chest pain, back pain, abdomen pain, and shock, are experienced in the remaining 20% of infected individuals. Neurological issues, such as deafness, tremors, and encephalitis, have also been reported (3). Of these neurological complications, deafness is the most common and occurs in one-third of symptomatic infections (3). In many cases, the deafness is permanent (3).

Most symptoms do not appear until one to three weeks after initial exposure (3). For serious infections, death due to multi-organ failure can occur within two weeks after the onset of severe symptoms (3). Only 1% of all Lassa fever virus infections result in death, but the proportion of deaths is much higher among those hospitalized for Lassa fever (3,8). Historically, there have been outbreaks of Lassa fever where the case-fatality rates reached 50% in hospitalized patients (3).

The only available treatment for Lassa fever is ribavirin, an antiviral (4). It has been shown to be most effective when given to infected individuals early in the course of the illness and in conjunction with supportive care(8,4). There are currently no vaccines available to prevent Lassa fever (4).

 

Prevention

In order to quell the spread of Lassa fever, it is advised that people engage in practices such as using rodent-proof containers to store food and keeping their homes clean to deter rodents (5). These practices, along with other easily implemented changes, can help prevent the zoonotic transmission of the virus. If individuals do become infected with the virus, efforts can be taken to prevent human-to-human transmission in hospital settings as well. These precautions include wearing protective equipment around infected individuals such as masks, gloves, gowns, and goggles and other sanitation techniques (5).

Lassa Fever can be easily prevented. Further precautions need to be taken in order to control the recent outbreak in Nigeria and prevent future outbreaks from occurring. By taking these precautions, Nigeria could help it from spreading to others and prevent more deaths caused by the virus.

 

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Sources:

1.    Center for Disease Control.  Lassa Fever. (2015). Retrieved March 01, 2016, from http://www.cdc.gov/vhf/lassa/

2.      Center for Disease Control. Lassa Fever: Transmission. (2014). Retrieved March 01, 2016, from http://www.cdc.gov/vhf/lassa/transmission/index.html

3.      Center for Disease Control. Lassa Fever: Signs and Symptoms. (2014). Retrieved March 01, 2016, from http://www.cdc.gov/vhf/lassa/symptoms/index.html

4.     Center for Disease Control. Lassa Fever: Treatment. (2014). Retrieved March 01, 2016, from http://www.cdc.gov/vhf/lassa/treatment/index.html

5.     Center for Disease Control. Lassa Fever: Prevention. (2014). Retrieved March 01, 2016, from http://www.cdc.gov/vhf/lassa/prevention/index.html

6. World Health Organization. Lassa Fever – Nigeria. (n.d.). Retrieved March 01, 2016, from http://www.who.int/csr/don/27-january-2016-lassa-fever-nigeria/en/

7. Lassa Fever. (n.d.). Retrieved March 01, 2016, from http://vhfc.org/lassa_fever

8. Center for Disease Control. Lassa Fever Fact Sheet. (n.d.). Retrieved March 1, 2016, from http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Lassa_Fe...

9.  Bhadelia, Nahid et al. “Zika isn’t the only outbreak. Nigeria struggles to rein in Lassa Fever”. NPR. Retrieved March 7, 2016, from http://www.npr.org/sections/goatsandsoda/2016/03/04/468955167/zika-isnt-...

10.  NAN (n.d.). Preventing Lassa fever infection in Nigeria. The Guardian. Retrieved March 1, 2016, from http://www.ngrguardiannews.com/2016/01/preventing-lassa-fever-infection-...

11.  Rat poison sales soar as Nigeria fears spread of Lassa fever. (2016, January 25). The Guardian. Retrieved March 1, 2016, from http://www.theguardian.com/global-development/2016/jan/25/rat-poison-sal...

12. Tomasulo, A. (n.d.). Lassa Fever Spreads Through Nigeria. HealthMap. Retrieved March 1, 2016, from http://www.healthmap.org/site/diseasedaily/article/lassa-fever-spreads-t...

Two Measles Outbreaks Kill Over 40 Children in Nigeria

Mar 5, 2016 | Shannon Smith, Emily Cohn | Outbreak News

The Lagos State Government confirmed on 22 February that measles was responsible for an outbreak of Febrile Rash Illness (FRI) in southwestern Nigeria. The outbreak began in January 2016 and resulted in the deaths of over 20 children in the Ikate, Lekke area of Lagos [1]. A second outbreak, responsible for 23 deaths and over 300 cases [2], was reported on February 25 in the state of Sokoto, in the north of the country.

 

According to Lagos state Commissioner for Health, Dr. Jide Idris, children from the affected communities had not been immunized against measles during the state’s recent vaccination campaign. Mass emigration into Lagos state has made it difficult for the government to keep track of all communities in need of health services, leading to some of these communities being overlooked and under vaccinated. He also stated that malnutrition in the area likely played a role in the severity of symptoms in the infected children [3]. Dr. Sani Labaran, Executive Secretary of Sokoto’s Primary Healthcare Development Agency, attributed the outbreak in his state to the parents of affected children rejecting immunization over the past three years, and likewise expressed the importance of proper nutrition [4].

 

Measles is a highly contagious disease caused by infection with the measles virus, which belongs to the paramyxovirus family, and is spread through the air or through direct contact with infected individuals. Its symptoms are typically mild, and most commonly include a fever and a widespread skin rash that occurs about 14 days after exposure to the virus. Symptoms generally last for five to six days. However, the virus can result in serious complications in certain vulnerable populations, such as blindness, encephalitis, and pneumonia. Malnourished children, as well as those with compromised immune systems, are the groups at greatest risk of experiencing severe measles. While measles has a relatively low fatality rate overall, up to 10% of cases can result in death in areas lacking adequate health care, which results in higher death rates occurring in developing countries [5].

 

An effective vaccine against measles virus infection was first introduced in 1963, and widespread vaccination campaigns have lead to a 78% decrease in worldwide cases of the disease since 2000. Despite the success of these campaigns, there are still 20 million cases of measles worldwide each year, with 95% of deaths occurring in countries with weak health infrastructures [6]. There is a need to ensure that all communities are accounted for during immunization exercises to prevent future outbreaks and child deaths. Currently, the Sokoto government is working toward improving vaccine efficacy by providing access to cold storages for rural areas so that the vaccines can be properly refrigerated. They have also been leading enlightenment campaigns and working closely with religious and traditional leaders in the area in order to decrease skepticism about the safety and efficacy of vaccines among parents [7].

 

  1. http://www.news24.com.ng/National/News/lagos-confirms-death-of-20-children-from-measles-20160223
  2. http://saharareporters.com/2016/02/25/measles-outbreak-leaves-23-children-dead-sokoto-state
  3. http://allafrica.com/stories/201602260760.html
  4. http://allafrica.com/stories/201602230354.html
  5. http://www.who.int/mediacentre/factsheets/fs286/en/
  6. http://www.who.int/immunization/topics/measles/en/
  7. http://www.premiumtimesng.com/regional/nwest/199221-sokoto-announces-imm...

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