19 Dec 2014

#Ebola in #children: #Epidemiology, clinical #features, #diagnosis and outcomes (Pediatr Infect Dis J., abstract, edited)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pediatr Infect Dis J. 2014 Dec 17. [Epub ahead of print]

Ebola in children: Epidemiology, clinical features, diagnosis and outcomes. [      ]

Olupot-Olupot P.

 

Abstract

Ebola virus disease (EVD) is caused by a highly contagious and pathogenic threadlike RNA virus of the Filoviridae family. The index human case is usually a zoonosis that launches human-to-human transmission interface with varying levels of sustainability of the epidemic depending on the level of public health preparedness of the affected country and the Ebola virus strain. The disease affects all age groups in the population.Clinical diagnosis is challenging in index cases especially in the early stages of the disease when the presenting features are usually non-specific and only similar to a flu-like illness. However, in the agonal stages, haemorrhage frequently occurs in a high proportion of cases. The diagnostic gold standard is by detecting the antigen using Reverse Transcription - PCR (RT - PCR).Mortality rates in the last 28 outbreaks since 1976 have ranged from 30% to 100% in different settings among adults, but lower mortality rates have been documented in children. This review aims to describe Ebola virus infection, clinical presentation, diagnosis and outcomes in children.

PMID: 25522340 [PubMed - as supplied by publisher]

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West #Africa: Mystery Over #Ebola #Survivors' #Ailments (AllAfrica News, December 19 2014)

[Source: All Africa News, full page: (LINK).]

West Africa: Mystery Over Ebola Survivors' Ailments [      ]

[IRIN] Dakar -For some Ebola survivors, overcoming the lethal viral assault has not heralded a full return to good health. An array of ailments including headache, joint pains, vision and hearing problems have afflicted convalescents; experts are still uncertain of the exact cause.

(…)

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Public #Health #England #scientists receive #Ebola #treatment research funding (@PHE_uk, December 19 2014)

[Source: Public Health England, full page: (LINK).]

Press release: PHE scientists receive Ebola treatment research funding [      ]

As England’s national public health agency and a World Health Organization (WHO) Collaborating Centre for Haemorrhagic Fever Virus Reference and Research, PHE has been approached by a number of academic and commercial entities requesting rapid evaluation of repurposed drugs, experimental therapies and vaccines for Ebola.

PHE scientists will now use a £200K award from the Wellcome Trust for the first round of evaluating potential treatment options, and to determine the most viable candidates for further development. These candidates are from companies and universities in a range of countries including England, India, Norway, Scotland, USA and Wales.

PHE scientists will be able to consider up to 20 therapeutic candidates and provide developers, sponsors, funders and policy makers with guidance on appropriate course of action for the candidates which show promise.

Work is already underway, with assessment of candidates started on 9 December 2014.

Professor Miles Carroll, Head of Research Microbiology Services for PHE said:

‘’Public Health England scientists have been working tirelessly both on the ground in West Africa and here in the UK to support international efforts to combat the Ebola outbreak, and I’m delighted my team can utilise our expertise to help develop a treatment.

‘’We have robust mechanisms in place for detecting and responding to any infections within the UK, but ultimately the best possible defence is to address the Ebola outbreak at its source. Development of treatment options will not only assist with the current outbreak, but help us to prevent future outbreaks.

Dr Seshadri Vasan, PHE Senior Business Development Manager said:

‘’PHE has a track record of scientific innovation and development, and this funding from Wellcome Trust will allow us to utilise our experience and expertise to assist in the fight against Ebola.

‘’WHO has declared developing treatment a key global priority, and the Public Health England scientists at Porton will have a crucial role to play.

‘’As we are in a Public Health Emergency of International Concern, PHE has reached consensus with developers that the global scientific community should have rapid access to our results even if a candidate is inactive or poorly active against Ebola.

Ends

 

Notes to Editors

This award for rapid down selection of experimental Ebola therapies has been awarded to PHE Porton scientists Professor Miles Carroll, Professor Roger Hewson, Dr Seshadri Vasan, Dr Julia Vipond, Dr Simon Funnell and Dr Stuart Dowall.

In addition, PHE Porton is also collaborating on 2 other projects funded by the Wellcome Trust:

  • Dr Kevin Richards and colleagues are collaborating with the University of Westminster to develop EbolaCheck - a portable device that tests bodily fluids for Ebola in a single process, providing results within 40 minutes. This project is 1 of 5 to be awarded funding by the Wellcome Trust and the Department for International Development
  • Professor Roger Hewson and colleagues are collaborating with Kymab Limited in a Wellcome Trust-funded project to develop monoclonal antibodies against Ebola.

PHE’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector.

PHE is an operationally autonomous executive agency of the Department of Health. PHE has published its Global Health Strategy: 2014 to 2019 which provides a framework for its international engagement. www.gov.uk/phe Follow us on Twitter @PHE_uk

The Wellcome Trust is a global charitable foundation dedicated to improving health. It provides more than £700 million a year to support bright minds in science, the humanities and the social sciences, as well as education, public engagement and the application of research to medicine.

PHE press office, infections, 61 Colindale Avenue, London, NW9 5EQ, Email infections-pressoffice@phe.gov.uk , Telephone: 020 8327 7901 - Out of hours: 0208 200 4400

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#Traffic #Control Bundling Is Essential for Protecting #Healthcare Workers and Controlling the 2014 #Ebola #Epidemic (Clin Infect Dis., extract)

[Source: Clinical Infectious Diseases Journal, full page: (LINK). Extract.]

Traffic Control Bundling Is Essential for Protecting Healthcare Workers and Controlling the 2014 Ebola Epidemic [      ]

Muh-Yong Yen 1, Jonathan Schwartz 2, Po-Ren Hsueh 3, Allen Wen-Hsian Chiu 4, and Donald Armstrong 5,a

Author Affiliations: 1Section of Infectious Diseases, Taipei City Hospital, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan 2Department of Political Science, State University of New York, New Paltz 3Department of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine 4Department of Surgery, Taipei City Hospital, Department of Health, Taipei City Government and National Yang-Ming University School of Medicine, Taiwan 5Memorial Sloan Kettering Cancer Center, New York, New York

Correspondence: Po-Ren Hsueh, MD, Department of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (hsporen@ntu.edu.tw).

a Emeritus member.

 

To the Editor—A global health crisis, the 2014 Ebola outbreak has now struck healthcare workers (HCWs) at unprecedented levels. Whereas historically, Ebola epidemics spread via person-to-person transmission, the current outbreak in West Africa has seen unexpectedly extensive spread of nosocomial disease, despite HCWs’ reliance on previously effective infection control procedures such as patient isolation, barrier nursing procedures, and required personal protective equipment (PPE) [1]. Indeed, infection struck even among HCWs caring for patients with Ebola virus disease (EVD) in Western hospitals equipped with modern facilities and procedures. This has sparked growing concerns regarding how to protect HCWs [2], even those working outside the ill-prepared and overwhelmed regions of West Africa now grappling with Ebola [1].

(…)

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#Ebola: the #battle #plan must include specific treatments (The Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary.]

Comment

Ebola: the battle plan must include specific treatments [      ]

Jake Dunning, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK; William Fischer, Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

Published Online: 18 December 2014 / DOI: http://dx.doi.org/10.1016/S0140-6736(14)62353-9

© 2014 Elsevier Ltd. All rights reserved.

 

Summary

The outbreak of Ebola virus disease (EVD) currently devastating west Africa has reached an unprecedented scale. EVD can no longer be viewed as a disease that affects fairly small numbers of people living in remote African villages with few resources. In the 12 months since the first case in Guinea was recognised, WHO reports that 17 942 cases and 6388 deaths had been identified up to Dec 10, 2014, mainly in Sierra Leone, Liberia, and Guinea.1 The true number of infections and deaths is undoubtedly greater.

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Severe #Ebola virus disease with vascular leakage and multiorgan failure: #treatment of a patient in intensive care (The Lancet, abstract, edited)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care [      ]

Timo Wolf, Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany; Gerrit Kann, Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany; Stephan Becker, Institute of Virology and Germany Centre for Infection Research (DZIF), Partner Site Gießen-Marburg-Langen, Philipps University, Marburg, Germany; Christoph Stephan, Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany; Hans-Reinhardt Brodt, Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany; Philipp de Leuw, Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany; Thomas Grünewald, Department of Infectious Diseases, Tropical Medicine and Nephrology, Hospital St Georg, Leipzig, Germany; Thomas Vogl, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt/Main, Germany; Volkhard A J Kempf, Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany; Oliver T Keppler, Institute of Medical Virology, University Hospital Frankfurt, Frankfurt/Main, Germany; Kai Zacharowski, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany

Published Online: 18 December 2014 /  DOI: http://dx.doi.org/10.1016/S0140-6736(14)62384-9

Published Online: 18 December 2014 / © 2014 Elsevier Ltd. All rights reserved.

 

Summary

Background

In the current epidemic of Ebola virus disease in western Africa, many aid workers have become infected. Some of these aid workers have been transferred to specialised hospitals in Europe and the USA for intensified treatment, providing the potential for unique insight into the clinical course of Ebola virus disease under optimised supportive measures in isolation units.

Methods

A 38-year-old male doctor who had contracted an Ebola virus infection in Sierra Leone was airlifted to University Hospital Frankfurt, Germany, on day 5 after disease onset. Within 72 h of admission to the hospital's high-level isolation unit, the patient developed signs of severe multiorgan failure, including lungs, kidneys, and gastrointestinal tract. In addition to clinical parameters, the diagnostic work-up included radiography, ultrasound, pulse contour cardiac output technology, and microbiological and clinical chemistry analyses. Respiratory failure with pulmonary oedema and biophysical evidence of vascular leak syndrome needed mechanical ventilation. The patient received a 3 day treatment course with FX06 (MChE-F4Pharma, Vienna, Austria), a fibrin-derived peptide under clinical development for vascular leak syndrome. After FX06 administration and concurrent detection of Ebola-virus-specific antibodies and a fall in viral load, vascular leak syndrome and respiratory parameters substantially improved. We gave broad-spectrum empiric antimicrobial therapy and the patient needed intermittent renal replacement therapy. The patient fully recovered.

Findings

This case report shows the feasibility of delivery of successful intensive care therapy to patients with Ebola virus disease under biosafety level 4 conditions.

Interpretation

The effective treatment of vascular leakage and multiorgan failure by combination of ventilatory support, antibiotic treatment, and renal replacement therapy can sustain a patient with severe Ebola virus disease until virological remission. FX06 could potentially be a valuable agent in contribution to supportive therapy.

Funding

University Hospital of Frankfurt.

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#Ebola: limitations of correcting #misinformation (The Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary.]

Comment

Ebola: limitations of correcting misinformation [      ]

Clare Chandler, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; James Fairhead, Department of Anthropology, University of Sussex, Falmer, Brighton, UK; Ann Kelly, Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK; Melissa Leach, Institute of Development Studies, Brighton, UK; Frederick Martineau, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; Esther Mokuwa, School of Environmental Sciences, Njala University, Sierra Leone; Melissa Parker, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; Paul Richards, School of Environmental Sciences, Njala University, Sierra Leone; Annie Wilkinson, Institute of Development Studies, Brighton, UK; for the Ebola Response Anthropology Platform

Published Online: 18 December 2014 / DOI: http://dx.doi.org/10.1016/S0140-6736(14)62382-5

Published Online: 18 December 2014 / © 2014 Elsevier Ltd. All rights reserved.

 

Summary

Communication and social mobilisation strategies to raise awareness about Ebola virus disease and the risk factors for its transmission are central elements in the response to the current Ebola outbreak in west Africa.1 A principle underpinning these efforts is to change risky “behaviour” related to “traditional” practices and “misinformation”. Populations at risk of contracting Ebola virus disease have been exhorted to “put aside, tradition, culture and whatever family rites they have and do the right thing”.

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18 Dec 2014

#Estimation of #MERS-Coronavirus #Reproductive #Number and Case Fatality Rate for the Spring 2014 #Saudi Arabia #Outbreak: Insights from Publicly Available Data (PLOS Currents Outbreaks, abstract, edited)

[Source: PLoS Currents Outbreaks, full page: (LINK). Abstract, edited.]

Estimation of MERS-Coronavirus Reproductive Number and Case Fatality Rate for the Spring 2014 Saudi Arabia Outbreak: Insights from Publicly Available Data [      ]

December 18, 2014 · Research

Citation: Fisman D, Rivers C, Lofgren E, Majumder MS. Estimation of MERS-Coronavirus Reproductive Number and Case Fatality Rate for the Spring 2014 Saudi Arabia Outbreak: Insights from Publicly Available Data. PLOS Currents Outbreaks. 2014 Dec 18. Edition 1. doi: 10.1371/currents.outbreaks.98d2f8f3382d84f390736cd5f5fe133c. [PDF, XML]

Authors: David Fisman Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.  Caitlin Rivers Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, VA, USA. Eric Lofgren Virginia Tech. Maimuna S. Majumder Massachusetts Institute of Technology.

 

Abstract

Background:

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was initially recognized as a source of severe respiratory illness and renal failure in 2012. Prior to 2014, MERS-CoV was mostly associated with sporadic cases of human illness, of presumed zoonotic origin, though chains of person-to-person transmission in the healthcare setting were reported. In spring 2014, large healthcare-associated outbreaks of MERS-CoV infection occurred in Jeddah and Riyadh, Kingdom of Saudi Arabia. To date the epidemiological information published by public health investigators in affected jurisdictions has been relatively limited. However, it is important that the global public health community have access to information on the basic epidemiological features of the outbreak to date, including the basic reproduction number (R0) and best estimates of case-fatality rates (CFR). We sought to address these gaps using a publicly available line listing of MERS-CoV cases.

Methods:

R0 was estimated using the incidence decay with exponential adjustment (“IDEA”) method, while period-specific case fatality rates that incorporated non-attributed death data were estimated using Monte Carlo simulation.

Results:

707 cases were available for evaluation. 52% of cases were identified as primary, with the rest being secondary. IDEA model fits suggested a higher R0 in Jeddah (3.5-6.7) than in Riyadh (2.0-2.8); control parameters suggested more rapid reduction in transmission in the former city than the latter. The model accurately projected final size and end date of the Riyadh outbreak based on information available prior to the outbreak peak; for Jeddah, these projections were possible once the outbreak peaked. Overall case-fatality was 40%; depending on the timing of 171 deaths unlinked to case data, outbreak CFR could be higher, lower, or equivalent to pre-outbreak CFR.

Conclusions:

Notwithstanding imperfect data, inferences about MERS-CoV epidemiology important for public health preparedness are possible using publicly available data sources. The R0 estimated in Riyadh appears similar to that seen for SARS-CoV, but CFR appears higher, and indirect evidence suggests control activities ended these outbreaks. These data suggest this disease should be regarded with equal or greater concern than the related SARS-CoV.

Funding Statement

ETL and CMR were funded by NIH MIDAS Grant 5U01GM070694-11 and DTRA Grant HDTRA1-11-1-0016 and DTRA CNIMS Contract HDTRA1-11-D-0016-0001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.

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#Update: #Influenza #Activity — #US, September 28–December 6, 2014 (@CDCgov, MMWR Morb Mortal Wkly Rep., edited)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Edited.]

Update: Influenza Activity — United States, September 28–December 6, 2014 [      ]

Weekly / December 19, 2014 / 63(50);1189-1194

Melissa Rolfes, PhD1, Lenee Blanton, MPH1, Lynnette Brammer, MPH1, Sophie Smith, MPH1, Desiree Mustaquim, MPH1, Craig Steffens, MPH1, Jessica Cohen, MPH1, Michelle Leon, MPH1, Sandra S. Chaves, MD1, Anwar Isa Abd Elal1, Larisa Gubareva, PhD1, Henrietta Hall1, Teresa Wallis, MS1, Julie Villanueva, PhD1, Xiyan Xu, MD1, Joseph Bresee, MD1, Nancy Cox, PhD1, Lyn Finelli, DrPH1 (Author affiliations at end of text)

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CDC collects, compiles, and analyzes data on influenza activity year-round in the United States (http://www.cdc.gov/flu/weekly/fluactivitysurv.htm). The influenza season generally begins in the fall and continues through the winter and spring months; however, the timing and severity of circulating influenza viruses can vary by geographic location and season. Influenza activity in the United States increased starting mid-October through December. This report summarizes U.S. influenza activity* during September 28–December 6, 2014.†

 

Viral Surveillance

During September 28–December 6, approximately 250 World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System collaborating laboratories in the United States tested 124,618 respiratory specimens for influenza viruses; 13,641 (10.9%) were positive (Figure 1).

Of these, 12,175 (89.3%) were influenza A viruses, and 1,466 (10.7%) were influenza B viruses.

Of the 12,175 influenza A viruses, 5,122 (42.1%) were subtyped; 5,077 (99.1%) of these were influenza A (H3) viruses, and 45 (0.9%) were influenza A (H1N1)pdm09 (pH1N1) viruses.

Since September 28, influenza-positive tests have been reported from 50 states, the District of Columbia, Guam, and Puerto Rico, representing all 10 U.S. Department of Health and Human Services (HHS) regions.§ Thus far, influenza A viruses have predominated nationally and in all 10 HHS regions.

 

Influenza Virus Characterization

WHO collaborating laboratories in the United States are requested to submit a subset of their influenza-positive respiratory specimens to CDC for further virus characterization (1).

Since October 1, CDC has antigenically or genetically characterized¶ 236 influenza viruses or specimens collected by U.S. laboratories during the 2014–15 season, including 10 pH1N1 viruses, 197 influenza A (H3N2) viruses, and 29 influenza B viruses.

All pH1N1 viruses were antigenically like the 2014–15 Northern Hemisphere influenza A vaccine component (A/California/7/2009-like [H1N1]).

Of the 197 influenza A (H3N2) viruses, 64 (32.5%) were characterized as A/Texas/50/2012-like (the influenza A [H3N2] component of the 2014–15 Northern Hemisphere influenza vaccine), and 133 (67.5%) showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012.

Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine.

A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable, from the A/Texas/50/2012 vaccine virus.

A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to circulate in greater numbers over the spring and summer.

Twenty (69%) of the influenza B viruses tested belong to the B/Yamagata lineage and were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component in the 2014–15 Northern Hemisphere trivalent and quadrivalent influenza vaccines.

The remaining nine (31%) influenza B viruses tested belong to the B/Victoria lineage, and of these, seven (78%) were characterized as B/Brisbane/60/2008-like, which is included as an influenza B component in the 2014–15 Northern Hemisphere quadrivalent influenza vaccine. Two (22%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

 

Novel Influenza A Viruses

One human infection with an influenza A (H3N2) variant virus (H3N2v) was reported to CDC from Wisconsin during the week ending October 18 (week 42). Contact between the patient and swine in the week preceding illness was reported. The patient was not hospitalized and fully recovered. This is the first H3N2v infection reported for the 2014–15 influenza season.

 

Antiviral Resistance of Influenza Viruses

Testing of pH1N1, influenza A (H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) is performed at CDC using a functional assay. Additionally, pH1N1 and influenza A (H3N2) clinical samples are tested for mutations of the virus known to confer oseltamivir resistance.

Since October 1, a total of 139 influenza viruses have been assessed for antiviral resistance, including five pH1N1 viruses, 106 influenza A (H3N2) viruses, and 28 influenza B viruses.

Of the 139 influenza A and B viruses tested, all were sensitive both to oseltamivir and zanamivir.

 

Outpatient Illness Surveillance

Since September 28, the weekly percentage of outpatient visits for influenza-like illness (ILI)** reported by approximately 1,800 U.S. Outpatient ILI Surveillance Network (ILINet) providers in 50 states, New York City, Chicago, the U.S. Virgin Islands, Puerto Rico, and the District of Columbia, which comprise ILINet, has ranged from 1.2% to 2.6% and was first reported to be at or above the national baseline†† of 2.0% during week 47 (week ending November 22) (Figure 2).

Peak weekly percentages of outpatient visits for ILI ranged from 2.4% to 7.6% from the 1997–98 through 2013–14 seasons, excluding the 2009 pandemic.

Data collected in ILINet are used to produce a measure of ILI activity§§ by jurisdiction.

During week 49, Alabama, Georgia, Illinois, Louisiana, Mississippi, Texas, and Puerto Rico experienced high ILI activity, two states (Florida and Indiana) experienced moderate ILI activity, and seven states (Idaho, Kansas, Maryland, Missouri, South Carolina, Utah, and Virginia) experienced low ILI activity.

New York City and 35 states experienced minimal ILI activity, and data were insufficient to calculate an ILI activity level for the District of Columbia.

 

Geographic Spread of Influenza Activity

For the week ending December 6 (week 49), 14 states (Colorado, Delaware, Florida, Georgia, Illinois, Kentucky, Louisiana, Maryland, Minnesota, New York, North Carolina, Ohio, Pennsylvania, and Texas) reported widespread geographic spread of influenza¶¶, Puerto Rico, Guam, and 25 states (Alabama, Alaska, Arkansas, Connecticut, Indiana, Iowa, Kansas, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nevada, North Dakota, Oklahoma, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin) reported regional spread, and the U.S. Virgin Islands and seven states reported local spread (Arizona, Idaho, Nebraska, New Hampshire, New Jersey, New Mexico, and Oregon). Sporadic influenza activity was reported by the District of Columbia and four states.

 

Influenza-Associated Hospitalizations

CDC monitors hospitalizations associated with laboratory-confirmed influenza in adults and children through the Influenza Hospitalization Surveillance Network (FluSurv-NET),*** which covers approximately 27 million persons, 9% of the U.S. population.

From October 1 through December 6 (week 49), 1,028 laboratory-confirmed influenza-associated hospitalizations were reported, yielding a rate of 3.8 per 100,000 population.

The highest rate of hospitalization was among adults aged ≥65 years (13.4 per 100,000 population) and young children 0–4 years (6.2 per 100,000 population).

Among all hospitalizations, 952 (92.6%) were influenza A, 68 (6.6%) were influenza B, four (0.4%) were influenza A and influenza B coinfections, and four (0.4%) had no virus type information. Among those with influenza A subtype information, 274 (100%) were influenza A (H3N2) viruses.

 

Pneumonia- and Influenza-Associated Mortality

During the week ending December 6 (week 49), pneumonia and influenza (P&I) was reported as an underlying or contributing cause of 6.0% (794 of 13,261) of all deaths reported to the 122 Cities Mortality Reporting System. This percentage is below the epidemic threshold of 6.6% for the week.†††

Since September 28, the weekly percentage of deaths attributed to P&I ranged from 5.0% to 6.0% and has not exceeded the epidemic threshold so far this season.

Peak weekly percentages of deaths attributable to P&I in the previous five seasons ranged from 7.9% during the 2008–09 and 2011–12 seasons to 9.9% during the 2012–13 season.

 

Influenza-Associated Pediatric Mortality

As of December 6 (week 49), seven influenza-associated pediatric deaths that occurred in the 2014–15 season were reported to CDC.

Four deaths were associated with an influenza A (H3) virus, two deaths were associated with an influenza A virus for which no subtyping was performed, and one death was associated with an influenza B virus.

The number of influenza-associated pediatric deaths reported to CDC in the previous three seasons has ranged from 37 during the 2011–12 season to 171 during the 2012–13 season.

During the 2009 pandemic, 358 pediatric deaths were reported from April 15, 2009, through October 2, 2010 (traditional influenza seasons include data from October [week 40] through September [week 39] of the following year).

 

Discussion

As monitored by all CDC influenza surveillance systems, influenza activity in the United States for the 2014–15 season is low but increasing.

Although the timing of influenza activity varies from year to year, peak activity in the United States most commonly occurs during January–March, but there can be substantial influenza activity as early as November and December.

From September 28 to December 6, 2014, influenza A (H3N2) viruses were identified most frequently in the United States, but pH1N1 and influenza B viruses also were reported.

Antigenic or genetic characterization of influenza-positive respiratory specimens submitted to CDC indicate that over half of the recently examined influenza A (H3N2) viruses show evidence of antigenic drift from the A/Texas/50/2012 (H3N2) virus (the H3N2 component on the 2014–15 Northern Hemisphere influenza vaccine).

Even during seasons when the match between the vaccine viruses and circulating viruses is less than optimal and protection against illness might be reduced, vaccination remains the most effective method to prevent influenza and its complications.

Health care providers should recommend vaccination to all unvaccinated persons aged ≥6 months now and throughout the influenza season.

In 2014, the Advisory Committee on Immunization Practices recommended the preferential use of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 years (2).

However, if LAIV is not available, inactivated influenza vaccine should be used, and vaccination should not be delayed to procure LAIV (2).

Children aged 6 months through 8 years who are being vaccinated for the first time require 2 doses of influenza vaccine, administered ≥4 weeks apart (3).

For children aged 6 months through 8 years who have received influenza vaccination during a previous season, health care providers should consult Advisory Committee on Immunization Practices guidelines to assess whether 1 or 2 doses are required (2).

Antiviral medications continue to be an important adjunct to vaccination for reducing the health impact of influenza.

On January 21, 2011, Advisory Committee on Immunization Practices recommendations on the use of antiviral agents for treatment and chemoprophylaxis of influenza were released (4).

This guidance remains in effect for the 2014–15 season, and recommended antiviral medications include oseltamivir (Tamiflu) and zanamivir (Relenza).

All influenza viruses tested for the 2014–15 season since October 1 have been susceptible to oseltamivir and zanamivir. Amantadine and rimantadine are not recommended because of high levels of resistance to these drugs among circulating influenza A viruses (4).

In addition, influenza B viruses are not susceptible to amantadine or rimantadine.

Treatment with antivirals is recommended as soon as possible without waiting for confirmatory testing for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at higher risk for influenza complications§§§ (4).

Clinical benefit is greatest when antiviral treatment is administered early.

When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still have some benefits in patients with severe, complicated, or progressive illness and in hospitalized patients when started after 48 hours of illness onset.

Antiviral treatment also may be considered for previously healthy, symptomatic outpatients who are not considered to be at high risk and have confirmed or suspected influenza, if treatment can be initiated within 48 hours of illness onset.

Residents of long-term care facilities can experience severe and fatal illness during influenza outbreaks; residents with confirmed or suspected influenza should be treated with antivirals immediately, without waiting for laboratory confirmation of influenza (4).

During periods where two or more residents of long-term care facilities are ill within 72 hours with confirmed or suspected influenza, antivirals should be given prophylactically to residents and should be considered for any unvaccinated staff (4).

Additionally, antiviral chemoprophylaxis can be considered for all staff, regardless of vaccination status, if the outbreak is caused by a strain of influenza virus that is not well matched to the vaccine (4).

Influenza surveillance reports for the United States are posted online weekly and are available at http://www.cdc.gov/flu/weekly. Additional information regarding influenza viruses, influenza surveillance, influenza vaccine, influenza antiviral medications, and novel influenza A virus infections in humans is available at http://www.cdc.gov/flu.

 

Acknowledgments

State, county, city, and territorial health departments and public health laboratories. US WHO collaborating laboratories. National Respiratory and Enteric Virus Surveillance System laboratories. US Outpatient Influenza-Like Illness Surveillance Network. Influenza Hospitalization Surveillance Network. Influenza-Associated Pediatric Mortality Surveillance System. 122 Cities Mortality Reporting System.

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1) Influenza Division, National Center for Immunization and Respiratory Diseases, CDC (Corresponding author: Melissa Rolfes, mrolfes1@cdc.gov, 404-639-3747)

 

References

  1. Blanton L, Brammer L, Smith S, et al. Update: influenza activity—United States and worldwide, May 18–September 20, 2014. MMWR Morb Mortal Wkly Rep 2014;63:861–4.
  2. Grohskopf LA, Olsen SJ, Sokolow LZ, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 influenza season. MMWR Morb Mortal Wkly Rep 2014;63:691–7.
  3. Neuzil KM, Jackson LA, Nelson J, et al. Immunogenicity and reactogenicity of 1 versus 2 doses of trivalent inactivated influenza vaccine in vaccine-naive 5–8-year-old children. J Infect Dis. 2006;194:1032–9.
  4. Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM. Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60(No. RR-1).

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* The CDC influenza surveillance system collects five categories of information from eight data sources: 1) viral surveillance (World Health Organization collaborating laboratories, the National Respiratory and Enteric Virus Surveillance System, and novel influenza A virus case reporting); 2) outpatient illness surveillance (U.S. Outpatient Influenza-Like Illness Surveillance Network); 3) mortality (122 Cities Mortality Reporting System and influenza-associated pediatric mortality reports); 4) hospitalizations (Influenza Hospitalization Surveillance Network [FluSurv-NET], which includes the Emerging Infections Program and surveillance in three additional states); and 5) summary of the geographic spread of influenza (state and territorial epidemiologist reports).

† Data reported as of December 12, 2014.

§ Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Region 2: New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands. Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia. Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Region 7: Iowa, Kansas, Missouri, and Nebraska. Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. Region 9: Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau. Region 10: Alaska, Idaho, Oregon, and Washington.

¶ CDC routinely uses hemagglutination inhibition (HI) assays to antigenically characterize influenza viruses year-round to compare how similar currently circulating influenza viruses are to those included in the influenza vaccine, and to monitor for changes in circulating influenza viruses
(http://www.cdc.gov/flu/professionals/laboratory/antigenic.htm). However, a portion of recent influenza A (H3N2) viruses do not grow to sufficient hemagglutination titers for antigenic characterization by HI assays. For many of these viruses, CDC is also performing genetic characterization to infer antigenic properties.

** Defined as a temperature ≥100°F (≥37.8°C), oral or equivalent, and cough and/or sore throat, without a known cause other than influenza.

†† The national and regional baselines are the mean percentage of visits for ILI during noninfluenza weeks for the previous three seasons plus two standard deviations. A noninfluenza week is defined as periods of ≥2 consecutive weeks in which each week accounted for <2% of the season's total number of specimens that tested positive for influenza. National and regional percentages of patient visits for ILI are weighted on the basis of state population. Use of the national baseline for regional data is not appropriate.

§§ Activity levels are based on the percentage of outpatient visits in a jurisdiction attributed to ILI and are compared with the average percentage of ILI visits that occur during weeks with little or no influenza virus circulation. Activity levels range from minimal, which would correspond to ILI activity from outpatient clinics being at or below the average, to high, which would correspond to ILI activity from outpatient clinics being much higher than the average. Because the clinical definition of ILI is very nonspecific, not all ILI is caused by influenza; however, when combined with laboratory data, the information on ILI activity provides a clearer picture of influenza activity in the United States.

¶¶ Levels of activity are 1) no activity; 2) sporadic: isolated laboratory-confirmed influenza case(s) or a laboratory-confirmed outbreak in one institution, with no increase in activity; 3) local: increased ILI, or at least two institutional outbreaks (ILI or laboratory-confirmed influenza) in one region of the state, with recent laboratory evidence of influenza in that region and virus activity no greater than sporadic in other regions; 4) regional: increased ILI activity or institutional outbreaks (ILI or laboratory-confirmed influenza) in at least two but less than half of the regions in the state with recent laboratory evidence of influenza in those regions; and 5) widespread: increased ILI activity or institutional outbreaks (ILI or laboratory-confirmed influenza) in at least half the regions in the state, with recent laboratory evidence of influenza in the state.

*** FluSurv-NET conducts population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among children aged <18 years (since the 2003–04 influenza season) and adults aged ≥18 years (since the 2005–06 influenza season). FluSurv-NET covers approximately 70 counties in the 10 Emerging Infections Program states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) and additional Influenza Hospitalization Surveillance Project (IHSP) states. IHSP began during the 2009–10 season to enhance surveillance during the 2009 H1N1 pandemic. IHSP sites included Iowa, Idaho, Michigan, Oklahoma, and South Dakota during the 2009–10 season; Idaho, Michigan, Ohio, Oklahoma, Rhode Island, and Utah during the 2010–11 season; Michigan, Ohio, Rhode Island, and Utah during the 2011–12 season; Iowa, Michigan, Ohio, Rhode Island, and Utah during the 2012–13 season; and Michigan, Ohio, and Utah during the 2013–14 and 2014–15 seasons. Incidence rates are calculated using CDC's National Center for Health Statistics population estimates for the counties included in the surveillance catchment area. Laboratory confirmation is dependent on clinician-ordered influenza testing, and testing for influenza often is underutilized because of the poor reliability of rapid test results and greater reliance on clinical diagnosis for influenza. As a consequence, the number of cases identified as part of influenza hospitalization surveillance likely is an underestimate of the actual number of persons hospitalized with influenza.

††† The seasonal baseline proportion of P&I deaths is projected using a robust regression procedure, in which a periodic regression model is applied to the observed percentage of deaths from P&I that were reported by the 122 Cities Mortality Reporting System during the preceding 5 years. The epidemic threshold is set at 1.645 standard deviations above the seasonal baseline.

§§§ Persons at higher risk include 1) children aged <2 years; 2) adults aged ≥65 years; 3) persons with chronic pulmonary conditions (including asthma); cardiovascular disease (except hypertension alone); renal, hepatic, hematologic (including sickle cell) disease; metabolic disorders (including diabetes mellitus); or neurologic and neurodevelopmental conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); 4) persons with immunosuppression, including that caused by medications or by human immunodeficiency virus infection; 5) women who are pregnant or postpartum (within 2 weeks after delivery); 6) persons aged ≤18 years who are receiving long-term aspirin therapy; 7) American Indians/Alaska Natives; 8) persons who are morbidly obese (i.e., body mass index ≥40); and 9) residents of nursing homes and other chronic care facilities.

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#Influenza #Update N° 226, 15 December 2014 (@WHO, edited)

[Source: World Health Organization, full PDF document: (LINK). Edited.]

Influenza Update N° 226, 15 December 2014 [      ]

 

Summary

  • Globally, influenza activity increased in the northern hemisphere and in several countries has passed the seasonal threshold. Influenza A(H3N2) viruses predominated so far.
    • In North America, the levels of influenza activity, mainly associated with A(H3N2) virus, passed the seasonal threshold.
    • In Europe overall influenza activity continued to increase, though with no clear indication that the influenza season had begun.
    • In eastern Asia, influenza activity increased with, influenza A(H3N2) predominated.
    • In northern and western Africa influenza activity increased with influenza B virus predominant.
    • In tropical countries of the Americas, influenza activity increased in some countries of the Caribbean, decreased in Central America and was low in the tropical countries of South America.
    • In tropical Asia, influenza activity was low.
    • In the southern hemisphere, influenza activity remained at a low level, but ILI activity remained high in several Pacific Islands.
  • Based on FluNet reporting (as of 11 December 2014, 14:25 UTC , during weeks 47 to 48 (16 November 2014 to 29 November 2014), National Influenza Centres (NICs) and other national influenza laboratories from 49 countries, areas or territories reported data.
    • The WHO GISRS laboratories tested more than 59 940 specimens.
    • 7227 were positive for influenza viruses, of which 6603 (91.4%) were typed as influenza A and 624 (8.6%) as influenza B.
    • Of the sub-typed influenza A viruses, 84 (2.4%) were influenza A(H1N1)pdm09 and 3472 (97.6%) were influenza A(H3N2).
    • Of the characterized B viruses, 140 (97.2%) belonged to the B-Yamagata lineage and 4 (2.8%) to the B-Victoria lineage.
  • Due to changes in data collection platforms, data from the WHO Regional Office for Europe are temporarily not available at global level.
    • Those data will be uploaded to FluNet and FluID as soon as possible.
    • Information on European influenza activity can be found at http://www.flunewseurope.org/

 

Countries in the temperate zone of the northern hemisphere

North America

In the countries in North America, the influenza season has begun with influenza A(H3N2) virus predominating.

In Canada, influenza detections increased to 15.2% positivity (compared to 4.6% in the previous update) and hospitalizations due to influenza also increased.

Of the laboratory confirmed influenza virus detections, 34% were influenza A; 99% of these were influenza A(H3N2).

Among cases with reported ages, 61% were aged ≥ 65 years.

Hospitalizations due to influenza increased, again with influenza A(H3N2) dominating.

Influenza-like illness (ILI) activity continued to be above the average for the last 13 weeks, with 29.1 consultations per 1000, mainly reported from the <20 years old age group.

Detections of RSV and adenovirus also continued to increased, following seasonal patterns while detections of para-influenza and rhinovirus continued to decrease.

In the United States of America (USA), influenza detection continued to increase (17% positivity).

ILI activity was 2.6% which is above the national baseline of 2.0%.

The highest activity levels were seen in the southern states of the USA.

The pneumonia and influenza mortality from the 122 Cities Reporting Systems was 5.4%, which is below the epidemic threshold of 6.5%.

Of 2274 influenza positive specimens, 93.6% were influenza A and 6.4% were influenza B.

Of the influenza A viruses subtyped, 99% were influenza A(H3N2).

Influenza viral characterization data indicated that 48% of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014 were antigenically "like" the 2014-2015 influenza A (H3N2) vaccine component, but that 52% were antigenically different (drifted) from the A(H3N2) vaccine virus.

The RSV detection rate also increased.

In Mexico, acute respiratory infections (ARI) activity increased slightly but remained consistent with seasonal patterns, while influenza activity remained low.

 

Europe

In Europe, influenza activity remained low, and there was no indication that the influenza season had begun.

Of the 848 specimens tested from sentinel ILI and ARI patients from 35 countries, 34 (4%) from 14 countries tested positive for influenza virus.

The predominant influenza virus subtype circulating has been A(H3N2).

Similar to the findings in the USA, viral characterization data in Europe showed that a proportion of the A(H3N2) viruses has drifted from the H3N2 vaccine virus

 

Northern Africa

In northern Africa, influenza detections increased in Algeria, Morocco and Tunisia with influenza B virus dominating.

 

Western and Central Asia region

In the western and central Asia region, influenza activity remained low, with some increase in influenza activity in Qatar with mainly influenza A(H3N2) detections.

 

Eastern Asia

In the eastern Asian region, influenza activity increased.

In north China Influenza activity continued to increase with Influenza A(H3N2) viruses predominantly.

ILI increased to 3.1%, following the seasonal trend.

It was slightly higher but similar to the same week in the years 2011-2013, where it ranged between 2.8 and 3.0%.

In Japan influenza activity increased with influenza A(H3N2) predominating.

In Mongolia, ILI activity continued to rise with no indication of increased laboratory confirmed influenza detection.

 

Countries in the tropical zone

Tropical countries of the Americas/Central America and the Caribbean

Overall in this region, influenza activity increased in some tropical countries of the Caribbean, decreased in Central America and was low in the tropical countries of South America.

In Cuba influenza A(H3N2) detections increased further.

In Central America, increased SARI activity in Costa Rica and pneumonia rates in Nicaragua were seen over the last few weeks associated with detections of mainly RSV and influenza A(H3N2). Circulation of influenza A(H3N2) virus was also reported from Honduras and Panama.

Tropical countries in South America reported low ILI, SARI and laboratory confirmed influenza activity.

 

Central African tropical region

In Africa, influenza detections were reported from a few countries.

Ivory Coast reported mainly influenza B detections while the United Republic of Tanzania reported mainly influenza A(H3N2) detections. In Madagascar and Zambia, influenza activity was caused by both influenza A and influenza B viruses.

 

Tropical Asia

In most southern Asian and South-Eastern Asian countries, activity declined or remained low.

 

Countries in the temperate zone of the southern hemisphere

Temperate Zone of South America

In the temperate zone of South America, influenza activity remained at inter-seasonal levels.

 

South Africa

In South Africa, ILI and SARI activity remained at inter-seasonal levels

 

Oceania, Melanesia and Polynesia

In Australia and New Zealand, influenza activity remained low.

In the Pacific Islands, ILI activity was variable; high activity was reported in American Samoa, the Federated States of Micronesia, French Polynesia, Guam, the Marshall Islands, the Northern Mariana Islands, Palau, the Solomon Islands and Vanuatu.

 

Source of data

The Global Influenza Programme monitors influenza activity worldwide and publishes an update every two weeks.

The updates are based on available epidemiological and virological data sources, including FluNet (reported by the WHO Global Influenza Surveillance and Response System) and influenza reports from WHO Regional Offices and Member States. Completeness can vary among updates due to availability and quality of data available at the time when the update is developed.

 

Link to web pages

Contact fluupdate@who.int

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