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#Avian #Influenza #H7N9 in #China: Preventing the Next #SARS (@WHO, Apr. 2 ‘17)

  Title : #Avian #Influenza #H7N9 in #China: Preventing the Next #SARS. Subject : Avian Influenza, H7N9 subtype (Asian Lineage), poultry e...

30 Apr 2017

#Influenza and other #Respiratory #Viruses #Research #References #Library–April 30 2017 Issue

 

Title: #Influenza and other #Respiratory #Viruses #Research #References #Library–April 30 2017 Issue.

Subject: Human and Animal Influenza Viruses, other Respiratory Pathogens Research, weekly references library update.

Source: AMEDEO, homepage: (LINK).

Code: [  R  ]

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This Week’s References:

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  1. SANTOS AJ, Kislaya I, Machado A, Nunes B, et al.
  2. IVINSON K, Deliyannis G, McNabb L, Grollo L, et al.
    • Salivary blockade protects the lower respiratory tract of mice from lethal influenza.
  3. GILBERTSON B, Ng WC, Crawford S, McKimm-Breschkin JL, et al.
    • Mouse saliva inhibits transit of influenza virus to the lower respiratory tract by efficiently blocking influenza neuraminidase activity.
  4. SHARMA A, Wu W, Sung B, Huang J, et al.
    • Respiratory Syncytial Virus (RSV) Pulmonary Infection in Humanized Mice Induces Human Anti-RSV Immune Responses and Pathology.
  5. OTIENO JR, Agoti CN, Gitahi CW, Bett A, et al.
  6. ALJABR W, Touzelet O, Pollakis G, Wu W, et al.
    • Investigating the Influence of Ribavirin on Human Respiratory Syncytial Virus RNA Synthesis by Using a High-Resolution Transcriptome Sequencing Approach.
  7. BAZAN M, Villacorta E, Barbagelatta G, Jimenez MM, et al.
    • Health workers' attitudes, perceptions and knowledge of influenza immunization in Lima, Peru: A mixed methods study.
  8. WILKINSON K, Wei Y, Szwajcer A, Rabbani R, et al.
    • Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis.
  9. NAKATSUKASA A, Kuruma K, Okamatsu M, Hiono T, et al.
    • Potency of whole virus particle and split virion vaccines using dissolving microneedle against challenges of H1N1 and H5N1 influenza viruses in mice.

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Keywords: Research; Abstracts; Influenza References Library.

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29 Apr 2017

#MERS #Epidemic in #Saudi Arabia: One New Case reported on April 29 2017 (@SaudiMOH, edited)

 

Title: MERS Epidemic in Saudi Arabia: One New Case reported on April 29 2017.

Subject: Middle East Respiratory Syndrome Epidemic in the Kingdom of Saudi Arabia, daily update.

Source: Saudi Arabia Ministry of Health, full page: (LINK).

Code: [     ]

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MOH: '1 New Confirmed Coronavirus Case Recorded'

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4/29/2017

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New Case reported:

[Sex, Age, Citizenship, Resident in, Health Status, Note]

  1. Male, 69, Saudi, Buraidah, stable; *

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{*} Primary case (contact with camels).

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Cumulative number of confirmed cases and deaths since 2012:

  • Total No. of Cases: 1599
  • Total No. of Deaths: 661
  • Patients under treatment: 7
  • Apparent Case-Fatality Rate: 41.3%

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Keywords: MERS-CoV; Updates; Saudi Arabia.

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#Epidemiological #update: #Measles–monitoring #European #outbreaks - 28 Apr 2017 (@ECDC_EU, edited)

 

Title: #Epidemiological #update: #Measles–monitoring #European #outbreaks - 28 Apr 2017.

Subject: Measles virus activity across European Region, multi-state, current situation.

Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK).

Code: [     ]

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Epidemiological update: Measles - monitoring European outbreaks - 28 Apr 2017

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​A measles outbreak in Romania has been ongoing since February 2016 and cases continue to be reported despite ongoing response measures that have been implemented at national level through reinforced vaccination activities. Between 1 January 2016 and 21 April 2017, Romania reported 4 881 cases. In 2016, a number of additional EU/EEA countries reported measles outbreaks, and an increase in the number of cases continues to be observed in 2017. Some previous and ongoing measles outbreaks in other EU countries have been epidemiologically linked to the current outbreak in Romania.

 

Weekly Update

  • In EU countries, measles cases have been reported in 2017 in Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Slovakia, Spain and Sweden as well as in Romania, where 4 881 cases had been reported as of 21 April 2017.
  • In non-EU countries, measles cases have been reported in 2017 in Afghanistan, Australia, Canada, Central African Republic, Ethiopia, Guinea, Liberia, Nigeria, Pakistan, Somalia, South Sudan, Switzerland, Syria, Ukraine and USA.

 

Epidemiological summary EU Countries with updates since last week

    • Since 20 December 2016 and as of 16 April 2017, Wallonia reported 288 cases of which 163 confirmed, 81 probable, and 44 are clinical (ECDC 2012 definition).
    • The outbreak affects all provinces of Wallonia, with the exception of the province of Luxembourg.
    • Thirty-seven cases are among healthcare workers (31 confirmed, four probable, two possible).
    • Of the 288 cases, 111 (38%) were hospitalised.
    • Two cases of had acute encephalitis.
    • No deaths are reported.
    • The index case of the epidemic in Wallonia travelled to Romania during the incubation period.
    • In Flanders, one isolated imported case was reported in January and another in March, with possible links to a cluster in Wallonia.
    • In the Brussels Capital Region, one isolated imported case was reported in February and two cases were notified in March without known links to the epidemic in Wallonia.
    • Both imported cases had a travel history to Romania during the incubation period, and the national reference centre for measles, mumps and rubella (WIV-ISP) identified genotype B3, which is the same strain found in Romania, Italy and Austria, at the end of 2016.
  1. Bulgaria
    • Since mid-March 2017 and as of 24 April, media in Bulgaria has reported 65 cases, of which 37 are confirmed, in the city of Plovdiv.
    • This represents an increase by four cases since the last report.
    • On 9 April 2017, Bulgaria reported one death of a 10month-old unimmunised child.
    • Since the beginning of 2017 and as of 9 April 2017, Germany has reported 462 cases.
    • This is an increase by 52 cases since the previous update.
    • In the same period in 2016, Germany reported 30 cases.
    • Since the beginning of 2017 and as of 23 April, Italy has reported 1 739 cases, with 159 cases among healthcare workers.
    • The cases are reported from 18 of the 21 regions in Italy.
    • Most of the cases are above the age of 15 years and 88% of the cases were not vaccinated, 33% reported one or more complications, 39% were hospitalised.
    • Since the beginning of 2017 and as of 26 April 2017, Portugal has reported 25 confirmed cases, of which 16 (64%) are older than 18 years of age, 15 (60%) were unvaccinated, 12 (48%) are health professionals and 12 (48%) were hospitalised.
    • One death has been reported.
    • Between 1 January 2016 and 21 April 2017, Romania has reported 4 881 cases of measles, including 22 deaths.
    • Cases are either laboratory-confirmed or have an epidemiological link to a laboratory-confirmed case.
    • Infants and young children are the most affected population.
    • Thirty-eight of the 42 districts have reported cases, Caras Severin (West part of the country, at the border with Serbia) being the most affected district with 943 cases.
    • Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage.
    • On 25 April, media reported an additional death, bringing the number of deaths to 23.
  2. Slovakia
    • On 24 April 2017, Slovakia reported an imported case of measles. The case is a 25-year-old, unvaccinated Italian who studies in Kosice.
    • The last endemic cases in the Slovak Republic were reported in 1998 and the last imported cases of measles were reported in 2011 and 2012.

 

EU countries with no updates since the last week

    • Since the beginning of 2017 and as of 12 April, Austria has reported 71 cases, which exceeds the cumulative number of cases reported in 2016.
    • On 15 March 2017, Denmark reported an imported case of measles in an unvaccinated adult who was infected during a holiday in Asia.
    • On 15 March 2017, Denmark reported an imported case of measles in an unvaccinated adult who was infected during a holiday in Asia.
    • As of 10 April 2017, 38 cases of measles have been reported in the Moravian-Silesian region of the Czech Republic.
    • Twenty of the cases are children below the vaccination age and 18 are adults.
    • Of the 18 adults, six are healthcare workers.
    • According to media, a hospital has been closed due to hospital staff being infected.
  1. France
    • Since 1 January and as of 31 March 2017, France reported 134 cases, three times more than the number of reported cases in 2016 over the same period.
    • The cases are mainly linked to an epidemic outbreak in Lorraine (60 cases).
    • Two cases of encephalitis and 15 severe pneumopathies have been recorded since the beginning of the year.
    • Between 21 February and 22 March 2017, Hungary reported 54 cases of measles.
    • The health authorities have lifted the quarantine from the hospital in Mako, southeast Hungary, as no new cases were detected in two weeks.
    • On 31 March, Iceland reported two cases in two 10-month-old twin siblings. The infants were unvaccinated. The first case was diagnosed 10 days before the second case.
    • This is the first time in a quarter of a century that measles infection has occurred in Iceland.
    • An outbreak started in the first week of January in Barcelona metropolitan area, due to an imported measles case from China.
    • As of 27 March, 44 cases have been confirmed.
    • Most of the cases are unvaccinated or incompletely vaccinated adults.
    • Four of the cases are children, and ten cases were hospitalised.
    • Since the beginning of 2017 and as of 21 March 2017, Sweden reported 15 cases of measles, including three imported cases.

 

Outside the EU

    • As of 31 March 2017, Afghanistan has reported 73 measles outbreaks for the first quarter of the year.
    • As of 7 April, Australia has reported 49 cases of measles in 2017, from New South Wales (23), Western Australia (12), Queensland (8), Victoria (4) and the Northern Territory (2).
    • The median age of the cases is 18 years with a range of 0 to 47 years.
    • As of 9 April 2017, Canada has reported 31 cases of measles, resulting from nine separate import events.
    • Nova Scotia reported that due to two imported cases, 23 secondary cases have occurred in February and March.
  1. Central African Republic
    • Since the beginning of 2017 and as of 4 April 2017, Central African Republic has reported over 50 cases of measles in the prefectures of Lobaye in the south, Ouaham and Ouaham Pendé in the north.
    • Twenty cases are in serious condition.
    • Since the beginning of 2017 and as of 2 April, Ethiopia has reported 1 100 cases of measles, of which 496 are confirmed.
    • Measles campaign targeting around 22.5 million children have been conducted since February.
    • Since the beginning of 2017 and as of 19 April, Guinea has reported 5 262 cases of measles, of which 3 906 are confirmed.
    • Nineteen cases died.
    • The weekly incidence of cases declined by 68% in the last three weeks.
    • Approximately 242 cases were reported in the week ending April 14, compared to a peak with 746 cases in mid-March.
    • Vaccination campaign in Conakry ended on 17 April 2017.
    • Preparation for a vaccination campaign in the remaining 21 health districts is on-going.
  2. Liberia
    • Since the beginning of the year and as of 16 April 2017, Liberia has reported 576 suspected cases of which 487 were tested: 45 positive, 416 negative and 26 equivocal, while 89 were compatible and epi-linked.
    • From the negative cases, 188 samples have been tested for rubella, out of which 97 were positive.
    • There are more suspected cases reported in Liberia in 2017 compared to 2016.
    • Since the beginning of the year and as of March 2017, Nigeria has reported 51 cases of measles.
    • Media, quoting The Nasarawa State Government, reported that between January and the beginning of April 2017, 15 deaths due to measles, mainly children, are notified.
    • Between January and March 2017, in Pakistan four provinces have reported cases: Punjab(174), Sindh(1008)n Sindh, KPK (Khyber Pakhtunkhwa) (279) and Balochistan (94).
    • Since the beginning of the year and as of 25 April, Somalia has reported almost 5 700 cases of measles.
    • This number is higher than the number of cases reported during the same period last year.
  3. South Sudan
    • Since January 2017, 560 suspect measles cases including four deaths have been reported from 18 counties.
    • Five counties confirmed measles outbreaks since the beginning of 2017.
    • The overall downtrend continues. A measles vaccination campaign is scheduled for 17 – 28 April 2017.
  4. Switzerland
    • Since the beginning of 2017 and as of 16 April, Switzerland reported 61 cases of measles.
    • In March 2017, Idleb in northwest Syria reported 91 cases since the beginning of 2017.
    • On 24 April 2017, Ukraine reported 13 cases of measles hospitalised in Ivano-Frankivsk in the west of Ukraine. Twelve of the cases are children under the age of 15 years.
    • As of 26 April 2017, Minnesota Department of Health has reported 24 confirmed cases of measles among Somali Minnesotan children in Hennepin County.

 

ECDC assessment

  • Measles outbreaks continue to occur in EU/EEA countries, and there is the risk of spread and sustained transmission in areas with susceptible populations.
  • The national vaccination coverage remains less than 95% for the second dose of MMR in the majority of EU/EEA countries.
  • The progress towards elimination of measles in the WHO European Region is assessed by the European Regional Verification Commission for Measles and Rubella Elimination (RVC).
  • Member States of the WHO European Region are making steady progress towards the elimination of measles.
  • At the fifth meeting of the RVC for Measles and Rubella in October 2016, of 53 countries in the WHO European Region, 24 (15 of which are in EU/EEA) were declared to have reached the elimination goal for measles, and an additional 13 countries (nine in the EU/EEA) were concluded to have interrupted endemic transmission for between 12 and 36 months, meaning they are on their way to achieving the elimination goal.
  • However, six EU/EEA countries were judged to still have endemic transmission of measles: Belgium, France, Germany, Italy, Poland and Romania.
  • More information on strain sequences would allow further insight into the epidemiological investigation.
  • All EU/EEA countries report measles cases on a monthly basis to ECDC and these data are published every month.
  • Since 10 March 2017, ECDC has been reporting on measles outbreaks in Europe on a weekly basis through epidemic intelligence activities.

 

Actions

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- See more at: http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1609&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2FPages%2Fhome%2Easpx#sthash.bkqmCL0a.dpuf

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Keywords: ECDC; Updates; European Region; Measles.

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#Epidemiological #update: #Yellowfever #outbreak in #Brazil - 28 Apr 2017 (@ECDC_EU, edited)

 

Title: #Epidemiological #update: #Yellowfever #outbreak in #Brazil - 28 Apr 2017.

Subject: Sylvatic Yellow Fever Outbreak in Brazil, multi-state, current situation.

Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK).

Code: [     ]

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Epidemiological update: Yellow fever outbreak in Brazil - 28 Apr 2017

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Yellow fever is a mosquito-borne viral infection present in some tropical areas of Africa and South America. On 6 January 2017, Brazil reported an outbreak of yellow fever that started in December 2016 and that has been ongoing since then. Bolivia, Colombia, Ecuador, Peru and Suriname have also reported cases of yellow fever in 2017.

 

Weekly summary

  • Between 12 and 20 April 2017, Brazil reported 155 additional cases of yellow fever (97 suspected and 58 confirmed).
  • The additional confirmed cases have been reported in Espírito Santo (30), Minas Gerais (22), São Paulo (5) and Tocantins (1).
  • This is the first confirmed autochthonous case reported in Tocantins since the beginning of the outbreak, although it is not a recent case.
  • The additional confirmed cases reported in Espírito Santo and Minas Gerais are not recent cases either.
  • Between weeks 14 and 15 of 2017, Peru reported two additional suspected cases of yellow fever.

 

Epidemiological summary

    • Between 6 January and 20 April 2017, Brazil reported 1 449 cases of yellow fever (768 suspected and 681 confirmed), including 270 deaths (35 suspected and 235 confirmed).
    • The case-fatality rate is 18.6% overall and 34.5% among confirmed cases.
    • States reporting suspected and confirmed autochthonous cases:
      1. Minas Gerais has reported 723 cases (252 suspected and 471 confirmed), including 178 deaths (13 suspected and 165 confirmed).
      2. Espírito Santo has reported 474 cases (289 suspected and 185 confirmed), including 75 deaths (17 suspected and 58 confirmed).
      3. São Paulo has reported 122 cases (112 suspected and 10 confirmed), including seven deaths (two suspected and five confirmed).
      4. Rio de Janeiro has reported 33 cases (23 suspected and 10 confirmed), including three deaths (one suspected and two confirmed).
      5. Pará has reported 21 cases (17 suspected and four confirmed), including four confirmed deaths.
      6. Tocantins has reported eight cases (seven suspected and one confirmed), including one confirmed death.
    • States reporting suspected autochthonous cases:
      • Fourteen states have reported 68 suspected cases:
        1. Paraná (15, including 1 fatal),
        2. Bahia (12),
        3. Goiás (12),
        4. Rio Grande do Sul (6),
        5. Rondônia (5),
        6. Santa Catarina (5),
        7. Amapá (3),
        8. Maranhão (2),
        9. Mato Grosso (2),
        10. Mato Grosso do Sul (2),
        11. Amazonas (1),
        12. Ceará (1),
        13. Distrito Federal (1, fatal) and
        14. Paraíba (1).

 

ECDC assessment

  • The ongoing outbreak should be carefully monitored, as the establishment of an urban cycle of yellow fever would have the potential to quickly affect a large number of people.
  • EU/EEA citizens who travel to, or live in, areas where there is evidence of yellow fever virus transmission should check their vaccination status and obtain medical advice about being vaccinated against yellow fever.
  • In Europe, Aedes aegypti, the primary vector of yellow fever in urban settings, is present in Madeira.
  • Recent studies have shown that Aedes albopictus can potentially transmit the yellow fever virus.
  • However, the risk of the virus being introduced into local competent vector populations in the EU through viraemic travellers from Brazil is considered to be very low, as the current weather conditions in Europe are not favourable for vector activity.

 

Actions

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- See more at: http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1608&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2FPages%2Fhome%2Easpx#sthash.izJD5UmG.dpuf

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Keywords: ECDC; Updates; European Region; Yellow Fever; Brazil.

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#Liberia, Undiagnosed #Fatal #Illness: #WHO #update (ReliefWeb, Apr. 29 ‘17)

 

Title: Liberia, Undiagnosed Fatal Illness: WHO update.

Subject: Undiagnosed fatal illness, cluster of cases in Liberia.

Source: ReliefWeb, full page: (LINK). Excerpt.

Code: [  !  ]

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Liberia, Undiagnosed Fatal Illness: WHO update

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{April 28 2017}

(…)

Asked about a new disease discovered in Liberia, Fadela Chaib, for the World Health Organization (WHO), said that on 25 April, WHO had received a report from Liberia health authorities about a cluster of unexplained illness and deaths from Francis Grant Hospital in Greenville, Sinoe County.

Sinoe Country is about 4.5 hours’ drive south-east of Monrovia.

Since April 24, 17 people had fallen sick.

Among them, nine people had died, and eight were still ill and hospitalized.

Observed symptoms included fever, vomiting, headache, diarrhoea.

The response team from the country and the support team from WHO were investigating reports linking the cluster to attendance at the funeral of a religious leader.

Specimens had been collected from seven dead bodies and had been sent to the national laboratory for testing.

All had come back negative for Ebola.

Other investigations were underway, including environment testing, and samples had been taken from water sources, trying to understand what was happening.

As a precaution, doctors in the hospital were isolating those who were sick from others.

The doctors were required to wear protection uniforms, or PPEs (Personal Protective Equipment) at the hospital.

An epidemiological investigation was ongoing well as active case searching (search of sick people in the communities) and contact tracing.

There was much social mobilization, encouraging people to go to the hospital when sick, and not to touch the sick or the dead but to leave that to professionals.

Samples from water sources were being collected to test for chemicals and other bacteria.

In response to further questions, Ms. Chaib said she would check with the relevant department at WHO regarding the age group of those who had fallen sick or died. In notes sent out subsequently, it was specified that most of them were aged below the age of 21.

Ms. Chaib would also check exactly on when the nine persons had died and would get back to the press.

For the time being, the precautions described above were being taken as the causes of the sickness and death of the people were not known.

Rapid response teams had been reactivated at District and County level with technical and logistical support from WHO, the Centre for Disease Control (CDC) and other partners.

Ms. Chaib also said Ebola had been a real wake-up call for the international community to put in place mechanisms to be able to detect rapidly and respond rapidly to any events that were not explained.

Liberia had been affected by Ebola, hence the particular vigilance.

The WHO had learned the lessons of the Ebola crisis and the country, with the support of WHO and CDC, had been able to put in place the rapid response teams.

She also clarified that Liberia had activated the networks already on the ground, and for the time being no additional emergency team had been deployed.

So far there was no question of quarantine in Sinoe; doctors were just taking precautions when handling bodily fluids and sick people.

Asked about why the topic had not been raised proactively by WHO during the briefing, Ms. Chaib said that the issue had been in the media over the whole week and several journalists had already contacted WHO on the topic.

WHO had been transparent in replying to those inquiries and had provided the available information.

As soon as there would be more information regarding the results of this broad investigation, WHO would be sending a comprehensive “Outbreak News” update.

Ms. Chaib also reiterated that the samples had been sent to the national laboratory in Monrovia for testing. She did not know if there was a plan to double check the results in another testing centre.

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Keywords: Liberia; Undiagnosed Illness.

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#Zika Virus Persists in the #CNS and #lymphnodes of Rhesus #Monkeys (#NIH, Apr. 29 ‘17)

 

Title: #Zika Virus Persists in the #CNS and #lymphnodes of Rhesus #Monkeys.

Subject: Zika Virus Infection, Rhesus Monkey animal’s model viral pathology research.

Source: US National Institute of Health, full page: (LINK).

Code: [  R  ]

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U.S. Department of Health and Human Services  / NATIONAL INSTITUTES OF HEALTH NIH News / National Institute of Allergy and Infectious Diseases (NIAID)

For Immediate Release: Friday, April 28, 2017 / CONTACT: NIAID Office of Communications, 301-402-1663, <e-mail:niaidnews@niaid.nih.gov>

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ZIKA VIRUS PERSISTS IN THE CENTRAL NERVOUS SYSTEM AND LYMPH NODES OF RHESUS MONKEYS

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Virus found in tissues weeks after clearance from blood

 

Zika virus can persist in cerebrospinal fluid (CSF), lymph nodes and colorectal tissue of infected rhesus monkeys for weeks after the virus has been cleared from blood, urine and mucosal secretions, according to a study published online today in Cell. The research was led by Dan H. Barouch, M.D., Ph.D., and colleagues at Beth Israel Deaconess Medical Center and Harvard Medical School and was funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

Investigators infected 20 rhesus monkeys with Zika virus and noted that although virus was cleared from peripheral blood within 7-10 days, they detected Zika virus in CSF for up to 42 days and in lymph nodes and colorectal biopsies for up to 72 days.

Immunologic data showed that the emergence of Zika virus-specific neutralizing antibodies correlated with the rapid control of the virus in plasma.

However, Zika-specific antibodies were not detected in CSF, which could be why the virus remained in CSF longer.

The authors also found that viral persistence in CSF correlated with the activation of the mechanistic target of rapamycin (mTOR) pathway, which has been shown to be related to the development of brain tissue and brain malformations.

The findings suggest that persistent virus in the central nervous system may contribute to the neurological issues associated with Zika virus infection in people, the authors note.

Although Zika virus usually causes mild or no symptoms in people, it has been associated with neurological disorders in children and adults and can cause severe fetal defects, such as microcephaly, if an infected pregnant woman passes the virus to her fetus.

The authors note it is possible that if the virus can persist in the central nervous system and other tissues in humans with Zika infection, more extensive neurologic and lymphoid disease than currently appreciated may be occurring.

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NIAID conducts and supports research -- at NIH, throughout the United States, and worldwide  -- to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs.

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Keywords: Research; Zika Virus; Neurology.

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28 Apr 2017

Highly pathogenic #avian #influenza #H5N8, #Finland [infected #wildbirds] (#OIE, Apr. 28 ‘17)


Title: Highly pathogenic #avian #influenza #H5N8, #Finland [infected #wildbirds].

Subject: Avian Influenza, H5N8 subtype, wild birds epizootics in Finland.

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic influenza A viruses (infection with) (non-poultry including wild birds) H5N8, Finland

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Information received on 28/04/2017 from Dr Taina Aaltonen, Chief Veterinary Officer and Deputy Director General, Ministry of Agriculture and Forestry, Ministry of Agriculture and Forestry, Helsinki, Finland

  • Summary
    • Report type    Follow-up report No. 1
    • Date of start of the event    08/04/2017
    • Date of confirmation of the event    13/04/2017
    • Report date    28/04/2017
    • Date submitted to OIE    28/04/2017
    • Reason for notification    Recurrence of a listed disease
    • Date of previous occurrence    01/03/2017
    • Manifestation of disease    Clinical disease
    • Causal agent    Highly pathogenic influenza A virus
    • Serotype    H5N8
    • Nature of diagnosis    Laboratory (advanced)
    • This event pertains to    a defined zone within the country
  • Summary of outbreaks   
    • Total outbreaks: 1
      • Total animals affected: Species    - Susceptible    - Cases    - Deaths    - Destroyed    - Slaughtered
        • White-tailed Eagle:Haliaeetus albicilla(Accipitridae)  - … – 1    - 1    - 0    - 0
      • Outbreak statistics: Species    - Apparent morbidity rate    - Apparent mortality rate    - Apparent case fatality rate    - Proportion susceptible animals lost*
        • White-tailed Eagle:Haliaeetus albicilla(Accipitridae)    - **    - **    - 100.00%    - **
          • *Removed from the susceptible population through death, destruction and/or slaughter
          • **Not calculated because of missing information
  • Epidemiology
    • Source of the outbreak(s) or origin of infection   
      • Unknown or inconclusive

(...)

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Keywords: OIE; Updates; Avian Influenza; H5N8 ; Wild Birds; Finland.

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#Death toll rises to 11 as #Liberia's mysterious #disease spreads (Xinhua, Apr. 28 ‘17)

 

Title: #Death toll rises to 11 as #Liberia's mysterious #disease spreads.

Subject: Undiagnosed fatal illness, cluster of cases in Liberia.

Source: Xinhua, full page: (LINK).

Code: [     ]

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Death toll rises to 11 as Liberia's mysterious disease spreads

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Source: Xinhua / 2017-04-28 22:12:18 / Editor: xuxin

MONROVIA, April 28 (Xinhua) -- The death toll from a mysterious disease in Liberia's southeastern county of Sinoe has risen to 11, a senior health official of the west African country said on Friday.

Twenty cases of the strange illness have occurred since it began to ravage the county's capital of Greenville last Tuesday, Liberia's chief medical officer Francis Kateh told reporters.

Nine people were hospitalized following the spread of the disease in the country, he said, but as of Friday, only three were in critical conditions, three in stable condition and three others had been discharged.

Local sources said all the dead victims suffered severe stomach pain before succumbing to death.

Health authorities, in a move to stop the spread of the disease, isolated all those who had contact with the dead.

There have been speculations across Liberia that the symptoms of the illness were similar to that of Ebola, which ravaged the west African country in 2014.

Kateh countered the claims, saying the initial tests performed on the blood specimens of the deceased at the Liberian Institute of Biomedical Research had disproved that the victims died from the Ebola virus, even though they showed similar symptoms like vomiting and stomach pain, among others.

The official said more samples of blood specimens of the victims had been sent to the Center for Disease Control in the United States of America for testing.

(…)

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Keywords: Liberia; Undiagnosed Illness.

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Weekly #US #Influenza #Surveillance #Report - 2016-17 Season, Wk 16 ending Apr. 22 ‘17 (@CDCgov, summary)

 

Title: Weekly #US #Influenza #Surveillance #Report - 2016-17 Season, Wk 16 ending Apr. 22 ‘17.

Subject: Human Influenza Viruses, seasonal winter epidemic in the US, current situation.

Source: US Centers for Disease Control and Prevention (CDC), FluView, full page: (LINK). Summary.

Code: [     ]

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Weekly U.S. Influenza Surveillance Report - 2016-2017 Influenza Season Week 16 ending April 22, 2017

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Language: [ English | Español ]

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|-- Full report also available as PDF –|

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All data are preliminary and may change as more reports are received.

 

Synopsis:

    • During week 16 (April 16-22, 2017), influenza activity decreased in the United States.
  • Viral Surveillance:
    • The most frequently identified influenza virus type reported by public health laboratories during week 16 was influenza B.
    • The percentage of respiratory specimens testing positive for influenza in clinical laboratories decreased.
  • Pneumonia and Influenza Mortality:
    • The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths:
    • Six influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations:
    • A cumulative rate for the season of 62.7 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance:
    • The proportion of outpatient visits for influenza-like illness (ILI) was 1.8%, which is below the national baseline of 2.2%.
    • Two of ten regions reported ILI at or above their region-specific baseline levels.
    • Four states experienced low ILI activity; New York City, Puerto Rico, and 46 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza:
    • The geographic spread of influenza in seven states was reported as widespread; Guam, Puerto Rico and 11 states reported regional activity; the District of Columbia and 19 states reported local activity; 13 states reported sporadic activity; and the U.S. Virgin Islands reported no activity.

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Keywords: US CDC; USA; Updates; Seasonal Influenza.

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Addressing a #YellowFever #Vaccine #Shortage — #USA, 2016–2017 (@CDCgov, MMWR)

 

Title: Addressing a #YellowFever #Vaccine #Shortage — #USA, 2016–2017.

Subject: Yellow Fever, vaccine shortage in the United States.

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

Code: [     ]

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Addressing a Yellow Fever Vaccine Shortage — United States, 2016–2017

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Early Release / April 28, 2017 / 66

Format: [ PDF [127 KB] ]

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Mark D. Gershman, MD1; Kristina M. Angelo, DO1; Julian Ritchey, MBA2; David P. Greenberg, MD2; Riyadh D. Muhammad, MD2; Gary Brunette, MD1; Martin S. Cetron, MD1; Mark J. Sotir, PhD1

1Division of Global Migration and Quarantine, CDC; 2Sanofi Pasteur Inc., Swiftwater, Pennsylvania.

Corresponding author: Kristina M. Angelo, kangelo@cdc.gov, 404-639-7023.

 

Summary

  • What is already known about this topic?
    • Effective and safe yellow fever vaccines are available to prevent yellow fever disease among persons traveling to countries with yellow fever virus transmission and to comply with individual country yellow fever vaccination entry requirements; only one yellow fever vaccine (YF-VAX) is currently licensed for use in the United States.
    • Periodic, temporary yellow fever vaccine shortages have occurred in the United States as a result of manufacturing problems, including a manufacturing complication in 2016 that resulted in the loss of a large number of U.S.-licensed yellow fever vaccine doses.
  • What is added by this report?
    • To avoid a lapse in yellow fever vaccine availability to persons in the U.S. population for whom yellow fever vaccination is indicated, public health officials and private partners collaborated in pursuing an expanded access investigational new drug (eIND) application for the importation of Stamaril yellow fever vaccine into the United States.
    • Stamaril is produced by Sanofi Pasteur, the manufacturer of the U.S.-licensed YF-VAX, and it uses the same vaccine substrain.
    • A systematic, tiered process was developed to select clinics to participate in the eIND protocol, with the goal of reasonable accessibility to yellow fever vaccination for all U.S. residents, while assuring that clinic personnel could be adequately trained to participate in the protocol.
  • What are the implications for public health practice?
    • Providers need to be aware that there is a yellow fever vaccine shortage and there is a plan for providing safe vaccine at a limited number of clinics until the supply is replenished.
    • Domestic production of yellow fever vaccine in the United States should resume in 2018, and as the eIND protocol is implemented, CDC and Sanofi Pasteur will need to continue to collaborate throughout site recruitment and training, partner to resolve issues that arise, and maintain communication with health care providers and the general public.

 

Abstract

Recent manufacturing problems resulted in a shortage of the only U.S.-licensed yellow fever vaccine. This shortage is expected to lead to a complete depletion of yellow fever vaccine available for the immunization of U.S. travelers by mid-2017. CDC, the Food and Drug Administration (FDA), and Sanofi Pasteur are collaborating to ensure a continuous yellow fever vaccine supply in the United States. As part of this collaboration, Sanofi Pasteur submitted an expanded access investigational new drug (eIND) application to FDA in September 2016 to allow for the importation and use of an alternative yellow fever vaccine manufactured by Sanofi Pasteur France, with safety and efficacy comparable to the U.S.-licensed vaccine; the eIND was accepted by FDA in October 2016. The implementation of this eIND protocol included developing a systematic process for selecting a limited number of clinic sites to provide the vaccine. CDC and Sanofi Pasteur will continue to communicate with the public and other stakeholders, and CDC will provide a list of locations that will be administering the replacement vaccine at a later date.

Yellow fever is an acute viral disease caused by infection with the yellow fever virus, a flavivirus primarily transmitted to humans through the bite of an infected mosquito and endemic to sub-Saharan Africa and tropical South America (1). Most infected persons are asymptomatic (1). However, the case-fatality ratio is 20%–50% among the approximately 15% of infected persons who develop severe disease (2). In recent years, multiple yellow fever outbreaks in Angola, the Democratic Republic of the Congo, and, most recently, Brazil, have underscored the ongoing and substantial global burden of this disease (35).

Yellow fever disease can be prevented by a live-attenuated virus vaccine that produces neutralizing antibodies in 80%–100% of vaccinees by 10 days after vaccination (2). For most travelers, only one lifetime dose is necessary (1). Vaccination is recommended for international travelers visiting areas with endemic or epidemic yellow fever virus transmission. In addition, proof-of-vaccination is required for entry into certain countries as permitted by the International Health Regulations 2015 (1,6). To provide proof of vaccination, practitioners at yellow fever vaccination clinics must validate a traveler’s vaccine record using a proof-of-vaccination stamp. CDC has regulatory authority over the designation of U.S. yellow fever vaccination clinics. For nonfederal yellow fever vaccination clinics, this authority to designate is generally delegated and overseen through a collaboration between CDC and state and territorial health departments. CDC maintains the online U.S. Yellow Fever Vaccination Center Registry of these designated clinics.

In 2015, approximately eight million U.S. residents traveled to 42 countries with endemic yellow fever virus transmission (1) (Data In, Intelligence Out [https://www.diio.net], unpublished data, 2016). Yellow fever virus can be exported by unimmunized travelers returning to countries where the virus is not endemic. Reports of yellow fever in at least 10 unimmunized returning U.S. and European travelers were recorded during 1970–2013 (1). Most recently, yellow fever virus was exported from Angola during the 2016 outbreak to three countries, with resulting local transmission in the Democratic Republic of the Congo (4). The Angola outbreak caused 965 confirmed cases from 2015 to 2017 (4). The ongoing outbreak in Brazil has resulted in 681 confirmed yellow fever cases from December 2016 through April 25, 2017 (7).

In the United States, only one yellow fever vaccine is licensed for use (YF-VAX; Sanofi Pasteur, Swiftwater, PA, 2017); approximately 500,000 doses are distributed annually to vaccinate military and civilian travelers. Approximately two thirds of these doses are distributed among approximately 4,000 civilian clinical sites (Sanofi Pasteur, unpublished data, 2017).

The current YF-VAX supply depletion began in November 2015 (8). Sanofi Pasteur was transitioning YF-VAX production from an older to a newer facility set to open in 2018, but a manufacturing complication resulted in the loss of a large number of doses. In response, Sanofi Pasteur instituted YF-VAX ordering restrictions to extend the existing supply while assessing options. In spring 2016, Sanofi Pasteur notified CDC of a probable complete depletion of YF-VAX later in the year. Sanofi Pasteur succeeded in producing additional doses of YF-VAX in late 2016; this additional supply has delayed the anticipated complete depletion until mid-2017 but remains insufficient to cover anticipated demand during the interval between permanent closure of the old facility and the 2018 opening of the new YF-VAX vaccine manufacturing facility.

Concerns about maintaining a continuous U.S. yellow fever vaccine supply, in conjunction with the large yellow fever outbreak that began in Angola, led to discussions among CDC, Sanofi Pasteur, FDA, and the U.S. Department of Defense in spring 2016. Although fractional yellow fever vaccine dosing was discussed, it was deemed a nonviable option based on limited efficacy data. Sanofi Pasteur submitted an eIND application for U.S. importation and civilian use of Stamaril, a yellow fever vaccine manufactured by Sanofi Pasteur France that is not licensed in the United States; the Department of Defense submitted its own eIND application. Stamaril uses the same vaccine substrain 17D-204 as YF-VAX, and has comparable safety and efficacy (9). Stamaril has been licensed and distributed in approximately 70 countries worldwide since 1986. Sanofi Pasteur France manufactures both multidose vials for use in global yellow fever outbreak responses and single-dose vials reserved for vaccination of international travelers living outside the United States. Sanofi Pasteur projects that importing Stamaril single-dose vials into the United States under the eIND application will not substantially affect the Stamaril supply intended for global use.

FDA accepted Sanofi Pasteur’s eIND application in October 2016. Implementation of the eIND protocol included a systematic process to select sites where Stamaril will be distributed; this process was important to manage the logistics involved in outreach and training of providers regarding adherence to the eIND protocol and FDA guidance. Sanofi Pasteur, in consultation with CDC, developed a two-tiered scheme for the selection of U.S. clinic sites to be invited to participate in the eIND protocol (Table). The primary goal was to recruit large-volume sites with adequate geographic range. Tier 1 sites were those that ordered at least 250 doses of yellow fever vaccine in 2016. Additional, smaller-volume sites were added to this tier to ensure access to Stamaril in all 50 states, the District of Columbia, and the three U.S. territories (Guam, Puerto Rico, and the U.S. Virgin Islands) with yellow fever vaccination centers. Sites were also added to guarantee vaccine access for civilian U.S. government employees needing yellow fever vaccination for official work-related travel, including critical public health response work. Tier 2 sites included multisite clinical organizations in which the aggregate number of doses ordered from their affiliated sites met the threshold of at least 250 doses in 2016. In these cases, the organization was invited to select one of its clinic sites to participate as a tier 2 site in implementing the Stamaril protocol. As of April 2017, approximately 250 clinics were targeted for inclusion. This is a sizable reduction from the estimated 4,000 civilian clinics currently providing YF-VAX.

The eIND protocol rollout began in April 2017. Sanofi Pasteur and CDC are collaborating to develop an effective communication plan. Sanofi Pasteur is recruiting and communicating with selected sites and will train personnel at participating sites by webinar in April and May 2017.

 

Discussion

CDC and Sanofi Pasteur have worked to assure a continuous yellow fever vaccine supply in the United States after the anticipated complete depletion of YF-VAX in mid-2017. As the eIND protocol rollout begins in April, Sanofi Pasteur will coordinate site recruitment and training, and CDC will help to resolve any problems that arise. Although the systematic site selection process for the distribution of Stamaril took into account site volume (giving preference to larger sites) and adequate geographic reach, accessibility difficulties for some international travelers might occur, because of the decrease in the number of clinics nationwide that provide yellow fever vaccination from 4,000 to 250. CDC and Sanofi Pasteur will monitor for critical gaps in vaccine access and collaborate to address any issues, including considering the possibility of recruiting additional clinics to participate as necessary.

CDC will notify state and territorial health department immunization programs about the Stamaril protocol. Information about which clinics will be eligible to receive Stamaril will be available to the public and other stakeholders, and discussed with the Advisory Committee on Immunization Practices. CDC and Sanofi Pasteur continue to monitor the domestic yellow fever vaccine supply and will provide updates to health care providers and the public as new information becomes available.

Updates regarding yellow fever vaccine and the anticipated complete depletion of vaccine stock will be available on CDC’s Travelers’ Health website at https://wwwnc.cdc.gov/travel/ and Sanofi Pasteur’s website at http://www.sanofipasteur.us/vaccines/yellowfevervaccine. Once available, CDC will provide a complete list of clinics where travelers can receive Stamaril at https://wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics/search.

 

Acknowledgments

J. Erin Staples, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado; Pamela Diaz, Division of Global Migration and Quarantine, CDC.

Conflict of Interest

J.R., D.P.G., and R.M. are full-time employees and stockholders of Sanofi Pasteur. No other conflicts of interest were reported.

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Keywords: US CDC; USA; Updates; Yellow Fever; Vaccines.

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