[In this post: (1) Congo DR, Ebola Haemorrhagic Fever; (2) WHO Update, European Office, Chikungunya Fever in Italy; (3) Research (EID). See original texts at the source sites. EDITED.]
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(1) [CONGO DR, EBOLA] Slight fall in suspected Ebola cases in DR Congo
KINSHASA (AFP) - The number of suspected cases of Ebola in a remote area of central Democratic Republic of Congo has fallen slightly in recent days, health authorities said on Monday.
"In the past week we have seen a slight dip in suspect cases. On average we have one new case every day and a death every two or three days," said Dr. Fortunat Mtumba, health minister for the affected Western Kasai region.
Those being admitted either have Ebola, an incurable disease characterised by massive internal bleeding, or the Shigella strand of infectious dysentery which is treatable by antibiotics, he said.
In the past four months there have been 170 fatalities from 378 cases of either Ebola or shigellosis, Mtumba said. A previous tally from September 14 put the number of fatalities at 169 from 376 patients.
Ebola kills 50 to 90 percent of those it infects. For shigellosis the mortality rate is around 40 percent. The World Health Organisation (WHO) confirmed the two outbreaks on September 11.
Ebola victims suffer high fever, severe dehydration and bleed under the skin and in severe cases from the mouth, ears and eyes. The virus is highly infectious for those who come into contact with a victim's body fluids.
Ebola has killed some 450 people in the DRC since 1976, and 1,200 people across Africa in the same period. It last swept DR Congo in 1995, then known as Zaire, claiming 245 lives out of the 315 registered cases.
The survival rate can be increased by quarantine and swift treatment of symptoms.
The first cases of the latest outbreak were detected in April around the village of Kanungu, 300 kilometres (185 miles) from the provincial capital Kananga. Five cases of Ebola and one of Shigella had since been confirmed by international laboratories.
The medical charity Doctors Without Borders (MSF) has sent extra staff and equipment and has set up an isolation centre at Kampungu, where eight people have died out of 25 hospitalised since the start of September.
"At the moment we have seven people in isolation, including three in a serious condition. Three people died at the end of last week," MSF spokeswoman Pascale Zintzen told AFP.
The WHO is also sending a team to the area, as is US-based Centers for Disease Control and Prevention.
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(2) [WHO, UPDATES, ITALY, CHIKUNGUNYA FEVER] Chikungunya in Emilia Romagna Region, Italy
Update: 16 September 2007
As of 13 September 2007, 254 cases of potential Chikungunya virus infection were identified in Emilia Romagna Region as a result of ongoing active surveillance activities.
Chikungunya virus infection was confirmed by laboratory tests in samples obtained from 78 of the notified potential cases.
Among confirmed cases, the most recent date of onset was on 4 September 2007.
Epidemiological data collected so far indicate that indigenous transmission might have occurred in four different localities.
Chikungunya virus has been isolated from Aedes albopictus mosquitoes collected in the affected areas.
Intense vector control activities, led by regional and local health authorities, are continuing.
Upon invitation of the Ministry of Health of Italy, a team comprising experts form French Instituitions involved in the investigation of the Chikungunya virus outbreak in La Réunion in 2006, representatives from the European Centre for Disease Prevention and Control (ECDC), and representatives of the WHO Regional Office for Europe, will be visiting regional and national health authorities starting from 17 September 2007.
The mission will be a precious opportunity to better understand the current outbreak in Italy as well as for WHO to improve its preparedness strategy for emerging and re-emerging vector- borne diseases in the European Region.
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Update: 7 September 2007
As of 4 September 2007, 197 cases of potential chikungunya virus infection were notified in the Region.
Chikungunya virus infection was confirmed by laboratory tests in samples obtained from 36 patients.
The majority of the cases (147) are related to the outbreaks in Castiglione di Cervia and Castiglione di Ravenna, Ravenna Province, whereas two additional clusters were detected in localities close to the towns of Cervia (six cases), Ravenna Province, and Cesena (13 cases), Forlà and Cesena Province.
Thirty-one (31) additional sporadic cases are being investigated in other localities of the following Provinces in Emilia Romagna Region: Ravenna, Forlà and Cesena, Rimini, Bologna, and Reggio Emilia.
Active surveillance activities are continuing in Emilia Romagna Region.
Activities are continuing to eliminate mosquitoes, with pyrethroids and larvicide products, continue targeting public sites as well as the households of suspected and confirmed cases within a radius of 100 metres.
As no vaccine or drugs are available against chikungunya virus, the general public is being mobilised to control the spread of the virus, to participate in eliminating mosquito breeding sites and to adopt measures to protect themselves against mosquito bites. Hot lines for the public were established in Emilia Romagna Region and at national level.
As a precautionary measure, national health authorities have advised to suspend blood and organs donations from individuals who, during the 21 days prior to the potential donation, have lived in or visited the areas where suspected or confirmed cases of chikungunya virus infection were detected.
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4 September 2007
The Italian National Focal Point for the International Health Regulations has informed the WHO that, on 23 August 2007, local health authorities of Ravenna Province, Emilia Romagna Region, reported an outbreak of suspected arbovirus infection to the Ministry of Health, Italy.
On 29 August, laboratory investigations performed on serum and blood samples obtained from potential cases at the Istituto Superiore di Sanità , Rome, confirmed chikungunya virus infection by immunoassay in 21 cases and by reverse transcription-polymerase chain reaction (RT-PCR) in six additional cases.
135 cases of acute febrile illness, predominantly characterized by headache, myalgia, arthralgia and rash with dates of onset from 4 July to 28 August 2007, were observed among residents of Castiglione di Cervia and Castiglione di Ravenna, two adjacent villages divided by the River Savio.
Five of the cases were resident in four nearby villages and had visited the two most affected localities.
The acute phase of the illness which lasted 3-4 days was followed by prolonged severe asthenia (weakness and lack of energy).
Eleven (11) cases required admission to hospital, including an 83-year-old man with multiple co-morbid chronic diseases who subsequently died.
The age range was 1 to 95 years, and 52% of the cases were females.
The highest number of cases (11) was observed on 17 August 2007 with a marked decreasing trend in new cases noted since 21 August 2007.
Preliminary epidemiological investigations conducted by local and national health authorities have identified an individual who returned from southern India at the end of June 2007 as the possible source of infection.
Surveillance was enhanced locally and nationally through the implementation of a protocol for health care providers based on prospective and retrospective active case finding.
Entomological investigations conducted by the Istituto Zooprofilattico, Reggio Emilia, the Centre for Agriculture and Environment, Crevalcore, and the Department of Public Health, Cesena, have confirmed the presence of Aedes albopictus mosquitoes in the area, the most likely vector sustaining this outbreak. Further virological investigations on mosquitoes and other insects collected are being conducted at the Istituto Zooprofilattico, Brescia.
From 18 August 2007, disinsection of public sites (streets, parks and other public gardens) with permethrin was conducted in the two most affected villages. In addition, permethrin and a larvicide (Diflubenzoran) were used for door-to-door disinsection, and another larvicide, containing Bacillus thuringiensis israelensis, was distributed. Information leaflets about mosquito control were also distributed as part of community mobilisation activities.
A Coordination Board, chaired by the Ministry of Health, and including the Istituto Superiore di Sanità , Rome, and the Istituto Nazionale Malattie Infettive, Rome, was established. Health professionals and the general public are being regularly updated about the evolution of the situation.
Although during the past two years imported cases of chikungunya virus infection, related to the Indian Ocean outbreak, were recorded in Europe, this is the first event resulting in subsequent indigenous transmission of chikungunya in Europe, at least in recent historical times.
Given the presence of the competent vector documented in at least 12 European countries (Albania, Italy, France, Belgium, Montenegro, Switzerland, Greece, Spain, Croatia, the Netherlands, Slovenia and Bosnia-Herzegovina) as well as favourable climatic conditions for the vector to persist in the coming few months in the Mediterranean basin, countries should remain vigilant for the emergence of this infectious disease.
This outbreak is the first occasion that Aedes albopictus, a species introduced from Asia and now well-established in several parts of Europe, Africa and the Americas, has been involved in an outbreak of human illness in Europe. Breeding sites for Aedes albopictus are confined to natural and man-made habitats, e.g. tree and rock holes, water troughs and rain-filled containers, so the species is suitable for environmental controls.
There is currently no vaccine nor specific drug against chikungunya virus; therefore vector control and social communication for behavioural change such as preventing stagnant water in and around the household, are the most effective interventions to reduce the transmission of the virus, and therefore to control the outbreak.
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(3) [RESEARCH, POULTRY, AVIAN INFLUENZA] Super-Sentinel Chickens and Detection of Low-Pathogenicity Influenza Virus
Philip I. Marcus,* Theodore Girshick,† Louis van der Heide,* and Margaret J. Sekellick*
*University of Connecticut, Storrs, Connecticut, USA; and †Charles River Specific Pathogen Free Avian Supplies, Storrs, Connecticut, USA
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Chicken interferon-α administered perorally in drinking water acts on the oropharyngeal mucosal system as an adjuvant that causes chickens to rapidly seroconvert after natural infection by low-pathogenicity Influenza virus.
These chickens, termed super sentinels, can serve as sensitive early detectors of clinically inapparent infections.
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