Saturday, June 14, 2014

Global MERS update

The following is the latest update on the global Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak from the ECDC.

Since April 2012 and as of 13 June 2014, 828 cases of MERS-CoV have been reported by local health authorities worldwide, including 318 deaths.

Cases and deaths by region:

Middle East:

Saudi Arabia: 700 cases/287 deaths
United Arab Emirates: 71 cases/9 deaths
Qatar: 7 cases/4 deaths
Jordan: 18 cases/5 deaths
Oman: 2 cases/2 deaths
Kuwait: 3 cases/1 death
Egypt: 1 case/0 deaths
Yemen: 1 case/1 death
Lebanon: 1 case/0 deaths
Iran: 3 cases/1 death

Europe:

UK: 4 cases/3 deaths
Germany: 2 cases/1 death
France: 2 cases/1 death
Italy: 1 case/0 deaths
Greece: 1 case/0 deaths
Netherlands: 2 cases/0 deaths

Africa:

Tunisia: 3 cases/1 death
Algeria: 2 cases/1 death

Asia:

Malaysia: 1 case/1 death
Philippines: 1 case/0 deaths

Americas:

United States of America: 2 cases/0 deaths

Twenty one cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), USA (2), Italy (1), Malaysia (1), Philippines (1), Greece (1), Netherlands (2) and Algeria (2). In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities.

Image/Philippines DOH




Thursday, June 12, 2014

Bedbugs: What are they and how to check for infestations


According to the Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA), the United States is experiencing an alarming increase in the number of bedbug populations. In addition to being found in private residences, such as apartments and single-family homes, bedbugs are increasingly affecting restaurants, hotels, hospitals, and schools and day care centers.
Cimex lectularius/CDC

Bed bugs are small insects that feed on human blood. They do not transmit diseases, but their bites can leave itchy red welts on their victims. Adult bed bugs appear reddish-brown and have a flattened, oval shape. They are wingless and look about the size of an apple seed. They are big enough to be seen, but they hide in cracks in furniture, floors, walls, suitcases or clothing.

Most bed bug bites are initially painless, but they may turn into large, itchy skin welts. These wounds do not have a red spot in the center like lea bites. Some people don’t develop welts at all and can carry bugs without knowing it.

Although bed bugs are a nuisance, they are not known to spread disease.

“Although bedbugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights,” said board-certified dermatologist Seemal R. Desai, MD, FAAD, who maintains a private practice in Plano, Texas and serves as clinical assistant professor of dermatology at University of Texas Southwestern Medical Center. “The most common sign of bedbugs is having bite marks on your body, which can sometimes turn into itchy welts.”


To help find bedbugs before they find you (and your belongings), Dr. Desai recommends looking for the following signs near places where you sleep:
  1. A sweet, musty odor: If you notice a sweet, musty odor in your hotel room, cruise ship cabin, or other sleeping area, there may be a heavy bedbug infestation in the room. Bedbugs produce chemicals to help them communicate, although not everyone will notice the smell.
  2. Specks of blood on bedding, mattresses, or upholstered furniture: Look carefully at your blankets, sheets and mattress pads, and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bedbug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.
  3. Exoskeletons: Bedbugs have an outer shell that they shed and leave behind. Do you see shell-like remains on the mattress, mattress pad or beneath couch cushions?
  4. Tiny, blackish specks: If you see blackish specks on the bedding, mattress, or headboard, it could be bedbug excrement.
  5. Eggs: After mating, female bedbugs lay white, oval eggs in cracks and crevices. Keep in mind that these will be small, as a bedbug is only about the size of an apple seed.
“Most people who get bedbugs do so while traveling, making it critical to keep an eye out for infestations,” said Dr. Desai. “If you do get bedbugs and have many bites or a bite that looks infected, see a board-certified dermatologist. A dermatologist can treat an infection and help relieve the itch.”

How can I get rid of Bed Bugs? 
Non-chemical eradication methods like vacuuming, steaming, laundering and sealing mattresses in plastic can help, but these methods usually do not completely eradicate a bed bug population. Also, bed bugs have become resistant to some types of insecticides, making it difficult to get rid of them. For this reason, you will probably need to consult a licensed pest control company, which should: 

• Inspect your home to confirm the presence of bed bugs. 
• Find and eliminate their hiding places. 
• Treat your home with special cleaning and/or pesticides if necessary. 
• Make return visits to make sure bed bugs are gone.




CDC
Nymph/CDC

4,000 pounds of beef products recalled because the dorsal root ganglia may not have been completely removed

WASHINGTON, June 11, 2014 – Fruitland American Meat, a Jackson, Mo. establishment is recalling approximately 4,012 pounds of fresh beef products because the dorsal root ganglia may not have been completely removed, which is not compliant with agency regulations that require their removal in cattle 30 months of age and older, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. 
The products subject to recall include:
  • 40-lb. cases containing two, roughly 20-lb. cryovac packages of bone-in “Rain Crow Ranch Ribeye” bearing the establishment number “EST. 2316” inside the USDA mark of inspection with the following production dates: 9/5/13, 9/10/13, 9/11/13, 9/26/13, 10/2/13, 10/3/2013, 11/8/13, 11/22/13, 12/17/13, 12/26/13, 12/27/13,1/16/14, 1/17/14, 1/23/14, 1/31/14, 2/13/14, 2/14/14, 2/21/14, 2/28/14, 3/8/14, 3/20/14, 4/4/14 or 4/25/14 printed on the box. 
  • Quartered beef carcasses stamped with the USDA mark of inspection and establishment number “EST. 2316.”   
The products were produced and packaged on various dates between September 2013 and April 2014. The bone-in ribeye roasts were the source material of concern.
Fruitland American Meat advises that the bone-in ribeye roasts were distributed to a restaurant in New York, NY, and a Whole Foods distribution center in Connecticut which services its stores in New England. The quartered carcasses were distributed to an FSIS-inspected establishment in Missouri for further processing and distribution, and to a restaurant in Kansas City, Mo. All products would have been processed into smaller cuts with no identifying consumer packaging.
The problem was discovered by FSIS during a review of company slaughter logs. The problem may have occurred as a result of the way some company employees were recording information and determining the age of various cattle. Dorsal root ganglia, branches of the nervous system located in the vertebral column are considered specified risk materials (SRMs) and must be removed from cattle 30 months of age and older in accordance with FSIS regulations. SRMs are tissues that may contain the infective agent in cattle infected with Bovine Spongiform Encephalopathy (BSE), as well as materials that are closely associated with these potentially infective tissues. Therefore, FSIS prohibits SRMs from use as human food to minimize potential human exposure to the BSE agent.
Every animal received ante-mortem inspection by an FSIS Public Health Veterinarian. This involves observing each animal at rest and in motion and there is no indication that any of the cattle slaughtered displayed any signs of BSE.
FSIS and Fruitland American Meat have received no reports of adverse reactions due to consumption of these products. Anyone concerned about a reaction should contact a healthcare provider.
FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list will be posted on the FSIS website at www.fsis.usda.gov/recalls.
Consumers and media with questions about the recall should contact company sales manager James Fortner at 573-243-3107.

Saturday, June 7, 2014

Oritavancin's potential

MRSA Image/CDC
DURHAM, N.C. – In the battle against stubborn skin infections, including methicillin-resistant Staphylococcus aureus (MRSA), a new single-dose antibiotic is as effective as a twice-daily infusion given for up to 10 days, according to a large study led by Duke Medicine researchers.

Researchers said the advantage of the new drug, oritavancin, is its potential to curtail what has been a key driver of antibiotic resistance: a tendency for patients to stop taking antibiotics once they feel better. In such instances, the surviving bacteria may become impervious to the drugs designed to fight them.

“The prolonged activity is what makes oritavancin distinctive,” said G. Ralph Corey, M.D., lead author of the study published June 5, 2014, in the New England Journal of Medicine (NEJM). “This drug has a long half-life, which allows for a single-dose treatment.”

Corey, a professor of medicine and infectious diseases at Duke University School of Medicine, led a three-year study of oritavancin that encompassed two large clinical trials enrolling nearly 2,000 patients. Findings from the trials will be presented to the U.S. Food and Drug Administration as part of the drug’s approval application.

Results reported in the NEJM are for the first of the two clinical trials, which included 475 patients randomized to take the investigational drug, and 479 patients following a typical regimen of vancomycin, including two infusions a day, for seven to 10 days.

Researchers found that the single intravenous dose of oritavancin was as effective as vancomycin in shrinking the size of the lesion and reducing fever. Both were also similar in rates of requiring a rescue antibiotic.

The new antibiotic also performed similarly to vancomycin in reducing the area of the wound by 20 percent or more within the first 48-72 hours of treatment, and in curing the patients of infection, including those infected with MRSA.

“Having a single-dose drug could potentially prevent hospitalizations or reduce the amount of time patients would spend in the hospital,” Corey said.

In addition to Corey, study authors include Heidi Kabler of Sunrise Hospital and Medical Center in Las Vegas; Purvi Mehra and William O’Riordan of Sharp Chula Vista Medical Center in Chula Vista, Calif.; Sandeep Gupta of MV Hospital and Research Center in Lucknow, India; J. Scott Overcash of Sharp Grossmont Hospital in San Diego; Ashwin Porwal of Inamdar Multispecialty Hospital in Pune, India; Philip Giordano of Orlando Health in Orlando, Fla.; Christopher Lucasti of Somers Point, N.J.; and Antonio Perez, Samantha Good, Hai Jiang and Greg Moeck of The Medicines Company.

The study was funded by The Medicines Company, which owns and is seeking to market oritavancin. Corey was a paid consultant to The Medicines Company and the principle investigator of the SOLO trials, the three-year study of oritavancin.

China: 433 H7N9 avian influenza cases reported on the mainland

The Hong Kong Centre for Health Protection (CHP) of the Department of Health (DH) today (June 4) received notification of four additional human cases of avian influenza A(H7N9) in Jiangsu (two cases) and Shandong (two cases) from the National Health and Family Planning Commission.
 
The two patients in Jiangsu are a man and a woman, both aged 51, who are now hospitalised for treatment. The two cases in Shandong involve a man aged 61 who had poultry exposure and died and a man aged 33 who is hospitalised for management.
 
A total of 433 human cases of avian influenza A(H7N9) have been confirmed in the Mainland, including Zhejiang (138 cases), Guangdong (108 cases), Jiangsu (56 cases), Shanghai (41 cases), Hunan (23 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Shandong (five cases), Beijing (four cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one imported case from Zhejiang) and Hebei (one case).

Image/Cynthia S. Goldsmith and Thomas Rowe

Thursday, June 5, 2014

Florida DOH reminds public of dangers of Naegleria fowleri

The Florida Department of Health cautions those who swim frequently in Florida’s lakes, rivers and ponds during warm temperatures about the possible presence of Naegleria fowleri. Contact with this amoeba is rare, but the organism targets a person’s brain and usually results in death. Adverse health effects on humans can be prevented by avoiding nasal contact with the waters, since the amoeba enters through the nasal passages.

Naegleria fowleri seen under direct fluorescent antibody
 (DFA) stain/CDC
Though there are only 34 reported cases in Florida since 1962, Naegleria fowleri can cause Primary Amebic Meningoencephalitis (PAM) disease which usually leads to death once infected. As a precaution, health officials recommend the following:

• Avoid water-related activities in bodies of warm freshwater, hot springs and thermally polluted water such as water around power plants.
• Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
• Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
• Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.
• Please note exposure to the amoeba may also occur when using neti pots to rinse your sinuses of cold/allergy-related congestion or conducting religious rituals with tap water. Use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.

If you experience any of these symptoms after swimming in any warm body of water, contact your health care provider immediately: headache, fever, nausea, disorientation, vomiting, stiff neck, seizures, loss of balance, or hallucinations. It is essential to seek medical attention right away, as PAM usually becomes fatal within five days of exposure.

Remember, this disease is rare and effective prevention strategies can allow for a safe and relaxing summer swim season.

Monday, August 12, 2013

DHHS Identifies First Jamestown Canyon Virus And Powassan Virus Cases In New Hampshire

PRESS RELEASE

August 1, 2013

Concord, NH – The New Hampshire Department of Health and Human Services (DHHS) is announcing that a male from Hillsborough County tested positive for the Jamestown Canyon virus (JCV) and the Powassan virus, the first time either of these vector-borne diseases has been identified in the State. JCV is transmitted by infected mosquitoes and Powassan is transmitted by infected ticks.


“While this is our first announcement of Jamestown Canyon virus and Powassan virus in New Hampshire,” said Dr. José Montero, Director of Public Health at DHHS, “these have been in the U.S. for a while and Powassan was found in Maine and Vermont previously so this is not entirely unexpected. There are many mosquito- and tick-borne illnesses and unfortunately we are probably going to continue to see cases of them, which makes prevention steps all the more important. The same precautions we now take for Lyme and West Nile and EEE are effective against these viruses as well. So, as people enjoy New Hampshire we are urging them to use an effective repellent and do regular tick checks.”

Because these viruses are very rare, there is not a lot known about the illness they cause, where they are located in the environment, and how many people may have already been infected. JCV is a mosquito-borne pathogen that circulates widely in North America primarily between deer and a variety of mosquito species, but it can also infect humans. Reports in humans thus far of JCV are unusual and have been confined to the Midwestern and northeastern states. Most reported illnesses caused by Jamestown Canyon virus have been mild, but moderate-to-severe central nervous system involvement has been reported.

Powassan virus infection is caused by an arbovirus, which is similar to the mosquito-borne West Nile virus, but it is transmitted to people by infected ticks. Fewer than 60 cases of the disease have been detected in the United States and Canada since its discovery in 1958. In New Hampshire, Ixodes scapularis, or the blacklegged tick or more commonly deer tick, is capable of transmitting the virus to people. A tick needs to be attached to a person for a sufficient amount of time before it can cause disease. The time interval for Powassan virus is not known, but it is likely shorter than the time needed for Lyme disease (24–48 hours). Some people who are infected may experience mild illness or no symptoms. Powassan virus can also infect the central nervous system and cause brain inflammation.

Residents and visitors to New Hampshire should protect themselves and their family members by using an effective mosquito repellant that contains 30% DEET, wearing long sleeves and pants at dawn and dusk when mosquitoes are most active, and removing standing water from around your house so mosquitoes do not have a place to breed. Repellents with picaridin, IR3535 and some oil of lemon eucalyptus and para-menthane-diol products also provide protection.

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Dr Patricia Quinlisk discusses cyclospora outbreak in Iowa--July 20, 2013

Interview with Dr Patricia Quinlisk on Cyclospora. Dr. Quinlisk is from the Iowa Dept. of Public Health Medical Director and State Epidemiologist

























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Sunday, July 14, 2013

Potential Hot Spot for Avian Flu Transmission Identified in Western Alaska

From USGS News Release:

ANCHORAGE, Alaska — Low-pathogenic avian influenza viruses with Eurasian genes have been found among birds in the Yukon-Kuskokwim Delta of western Alaska, supporting the theory that the area is a potential point of entry for foreign animal diseases such as the more highly pathogenic H5N1 strain, according to a new study by U.S. Geological Survey scientists.

The Yukon-Kuskokwim Delta is an important breeding ground for many bird species and is located where multiple migratory flyways converge, providing opportunities for avian pathogens to spread. Among these pathogens are H5N1 avian influenza, which occurs in both low-pathogenic and the more dangerous highly pathogenic forms.  

After the outbreak of the highly pathogenic H5N1 strain of avian influenza in wild birds of China in 2005, the USGS and the U.S. Fish and Wildlife Service, in cooperation with the Yukon-Kuskokwim Health Corporation,  the Kawerak Tribal Corporation and other partners, conducted four years of testing wild migratory birds in western Alaska for the highly pathogenic H5N1 strain. 

In a paper published by the USGS and the USFWS scientists no highly pathogenic forms of avian influenza were found in more than 24,000 samples tested from 82 species on the Yukon-Kuskokwim Delta from 2006 to 2009, however, 90 low-pathogenic strains of the virus were obtained from these Alaskan samples.  Low-pathogenic avian influenza viruses are common among wild birds and do not cause mortalities to the degree often seen with highly pathogenic forms of the virus, said USGS research geneticist Andrew Reeves, lead author of the paper. The significance of this study is that it demonstrates that viruses with genes of Eurasian origin can enter North America via migratory birds. 

In addition, researchers discussed how low pathogenic virus samples from birds further from Asia contained fewer genes attributable to Eurasian strains.  

"This finding supports a 'dilution-by-distance' idea we've hypothesized in other studies," Reeves said. "Birds sampled further from Asia, such as in the lower-48 United States, very rarely contain avian influenza viruses with Eurasian genes, but in Alaska they are more common."  

"Many of the bird samples used in the study were provided by subsistence hunters in 11 villages throughout the Yukon-Kuskokwim Delta who collected samples from many species, including ducks, geese, swans and shorebirds," said Kim Trust of the USFWS.  

"Without our partners in western Alaska, we would not have the robust data set that supports the findings in this paper," Trust said.  

Reeves added that the current study provides support for retaining the Yukon-Kuskokwim Delta as a high-priority region for the surveillance of potentially harmful avian pathogens. 

The paper in the Journal of Wildlife Diseases, "Genomic analysis of avian influenza viruses from waterfowl in western Alaska, USA," by Andrew Reeves, John Pearce, Andrew Ramey, Craig Ely, Joel Schmutz, Paul Flint, Dirk Derksen and Hon Ip of the USGS and Kimberly Trust of the USFWS, is available online.

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Saturday, July 13, 2013

A Conversation About MERS Coronavirus: Dispatch Radio

With the latest case count of Middle East respiratory syndrome coronavirus (MERS-CoV) now standing at 80, there has been a great deal of attention given to this relatively new viral outbreak.

On the Saturday, July 6 Dispatch Radio program, I had the opportunity to talk to Professor of Microbiology and Immunology at Columbia University, Dr. Vincent Racaniello, about MERS.
Listen to the podcast here. The interview starts at the 23:10
There has been a lot of comparisons between the MERS coronavirus and the related Severe acute respiratory syndrome (SARS) that sickened over 8000 and killed 775 a decade ago. I asked Dr. Racaniello to explain the difference between the two viruses concerning  ability to cause disease, how lethal they are and human-to human transmission.
Racaniello says SARS appeared in China in 2003, infected thousands, killed nearly 800 and “then for reasons we still don’t understand, it disappeared.”
That virus [SARS] was not bad at spreading among people, 10% lethality, which is high. About a year ago, a new coronavirus emerged in the Middle East, the MERS coronavirus.
“So far it’s not particularly good at spreading person-to-person, with about 80 infected, Racaniello adds.
However, he does point out that the data is not really available to clearly answer that.
With the numbers of MERS cases at 79 (at the time of the show), I asked Racaniello if he thought the numbers may be higher due to undetected cases.
“Absolutely, he said. I think that the 79 cases are the ones where the people have got very sick, they’ve gone into hospitals and they’ve been diagnosed with this virus infection.
“With most viruses, many, many people get infected and have either mild symptoms, so they never go to a health care provider, or they have no symptoms at all and we have no way of detecting that for the MERS coronavirus yet because we don’t have the right diagnostic test.
“But as soon as those are developed, then we can go out into populations and say, how many people are in fact infected, and it could be that thousands of people have been infected with very little disease, which of course would bring the mortality rate pretty far down.”
Concerning the source of MERS, some have attributed it to bats, at least one report suggested a link with camels. “The bat story comes from the fact that when you sequence the genetic information of viruses and tell which are related to other viruses.
“The closest relative of this virus, aside from other coronaviruses that infect humans, is a virus isolated from a bat in 2008. It suggest, but it doesn’t prove, the virus may have originated in bats. SARS coronavirus originated in bats as well.
“Bats harbor a lot of diverse coronaviruses so it wouldn’t be unusual the virus jumped from bats, he said. People in general don’t really contact bats very frequently, so the idea that there is an intermediate animal went through. In the case of the SARS coronavirus, we think the virus went from a bat, to a Palm civet then to people, and it could be that in this case with the MERS coronavirus, it originated in bats, and it may being going through camels, as there has been reports of individuals getting sick after being close to camels.”
However, Racaniello points out that there are many cases where patients don’t have a contact history with animals of any kind. “So you have to wonder if the virus isn’t spreading in people already”, he adds.
I asked Racaniello about the diverse conclusions and statements from scientists from the Pasteur Institute in France who suggest that MERS-CoV does not yet have pandemic potential, and the statement in May by  WHO Director-General Dr Margaret Chan at the 66th World Health Assembly (WHA) who stated, “The novel coronavirus is a threat to the entire world.”
Who is closer?
“I think the Pasteur scientists are probably closer, Racaniello answers. Listen, it’s infected 80 some people, in the scheme of the world, this is not very much.
“As far as we know, this virus can’t spread efficiently among people so that’s why we say it doesn’t have pandemic potential.”
Racaniello does note that Dr. Chan is speaking as head of WHO and has to be very cautious. “If this virus somehow changed, it could acquire pandemic potential, so she’s sending out a message to health organizations globally that we need to keep an eye on this virus and get ready in case it should get more serious.”
The question, What is the threat of MERS entering the United States and are we prepared? was posed to the professor.
“That’s a very interesting question, I think it might of already come into the US, with global travel being as easy as it is. It’s very easy to imagine that someone has been infected in the Middle East, has no fever, no symptoms, has flown to the US shedding virus on the plane and within the US.
“So far, we don’t have any evidence that’s happening, but it certainly could be going on and we wouldn’t be able to detect it, especially if people haven’t been sick yet.
“It’s quite likely that the virus is here already, or will soon be brought into the US. Then the question would be, what would happen?
“Like we’ve seen in the Middle East, mainly really sick people have been infected with this virus, so you could imagine the same happening to a very sick person here in the US. You might get a few cases here of infection and that would trigger a lot of panic I think.”
Racaniello says, “Unfortunately, we don’t have any therapeutics for it–we don’t have a vaccine, we don’t have any antiviral drugs, the best we could do is try to limit people traveling and interacting with one another. But as you probably could guess would be virtually impossible.”
Without vaccines or antiviral drugs, it’s really hard to stop viral spread.
“I would guess if this virus came in to the US in a form that could transmit effectively among people, it would spread pretty efficiently. The good news is that hasn’t happened yet, even with global travel”, Racienello said.
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