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News Scan for Feb 13, 2020 | The Center for Infectious Disease Research and Policy at the University of Minnesota.

Recent DRC Ebola cases; MCR-1 resistance gene in Wyoming; Pneumococcal disease in kids; More H5N6 in Vietnam.

Recent DRC Ebola cases all involved known transmission chains.

All three confirmed Ebola cases reported in the past week in the Democratic Republic of the Congo (DRC) involved known transmission chains, which is a good sign, but volatile situations still plague the outbreak region, the World Health Organization (WHO) said yesterday in its weekly situation report.

The WHO said that, from Feb 3 to Feb 9, all three confirmed Ebola virus disease (EVD) cases were in Beni in North Kivu province. Over the past 21 days, officials confirmed 13 new cases, 12 in Beni and 1 in Mabalako, which is also in North Kivu province. Three of those patients died, all in the community, which raised the risk of disease spread.

"Although recent trends of this outbreak, including the small number of weekly cases and limited geographic area affected by EVD are encouraging," the WHO said, "continued vigilance is crucial, particularly for contact identification and follow up, in order to interrupt possible nosocomial transmission linked to traditional practitioner facilities."

"The security situation in several EVD-affected health areas remain unstable and unpredictable," the WHO added. "On 8 February, a health centre was attacked in Butembo, destroying equipment and infrastructure. On 8 February 2020, an attack on civilians in Mabalako Health Zone led to a suspension of response activities for 48 hours."

Since Feb 9, the WHO has logged 2 new cases, 1 on Feb 10 and 1 yesterday. The DRC's Ebola technical committee (CMRE) said the case reported yesterday was in Beni. No new cases were reported today, according to the WHO's online dashboard, keeping the outbreak total at 3,432 cases, including 2,249 deaths. Authorities are tracking 461 suspected cases.
Feb 12 WHO situation report
Feb 12 CMRE update
WHO Ebola dashboard

MCR-1 colistin resistance gene identified in Wyoming hospital patient.

A urinary tract infection (UTI) caused by multidrug-resistant bacteria carrying the MCR-1 colistin resistance gene was identified in a Wyoming hospital patient in early 2019, researchers from the Centers for Disease Control and Prevention (CDC) and the Wyoming Department of Health (WDH) reported today in Morbidity and Mortality Weekly Report (MMWR). It's the first MCR-1-carrying isolate identified in Wyoming or surrounding states.

The patient, who had a history of recurrent UTIs, was admitted to the hospital in mid-December 2018, and admission urine culture and antimicrobial susceptibility testing identified the infecting pathogen as carbapenem-resistant Klebsiella pneumoniae with extended-spectrum beta-lactamase production. Further testing identified resistance to 16 antibiotics. In early January 2019, the Texas Antimicrobial Resistance Laboratory Network found additional resistance to colistin and identified a plasmid-mediated MCR-1 gene.

WDH subsequently began in investigation to determine where the patient might have acquired the organism, but was not able to identify the route of acquisition. The patient had not traveled internationally or been exposed to livestock, but had experience repeated UTIs caused by K pneumoniae and Escherichia coli in the previous 2 years and had been treated with antibiotics. The authors of the case report suggest this could have increased the risk for acquiring antibiotic-resistant bacteria.

A point-prevalence survey conducted to identify possible transmission of the MCR-1 gene to other patients found six patients who were in the same hospital unit at the same time as the index patient; rectal screening of four of those patients was negative. The patient recovered after receiving appropriate antibiotics and was discharged from the hospital in January 2019.

The first US patient carrying MCR-1 was identified in Pennsylvania in July 2016, and since then MCR-1-carrying isolates have been identified in 20 more states. Colistin is considered a last-resort antibiotic.
Feb 14 MMWR case report

Study: 3-dose pneumococcal vaccine tops 2-dose regimen in infants.

A study today in Pediatrics suggests that children under 1 year old are less likely to suffer pneumococcal disease if they receive three doses of pneumococcal conjugate vaccine (PCV) than if they get only two doses, but the difference in infection rates has dropped in recent years as pneumococcal strains targeted by vaccines have become less common.

Researchers from the CDC, state health departments, and other institutions looked at the rates of invasive pneumococcal disease in children under 5 years from 2001 through 2016, using the CDC's Active Bacterial Core Surveillance data.

They note that most countries use a 3-dose PCV schedule, but a 4-dose schedule—3 primary doses and 1 booster—is licensed for infants in the United States. The team compared breakthrough disease rates in children receiving 2 or 3 doses, both with and without booster doses (2+1 versus 3+1; 2+0 versus 3+0). Children who received 7-valent and 13-valent PCV (PCV7 and PCV13) doses were included.

The researchers found 71 PCV7 and 49 PCV13 breakthrough infections among children who received the schedules studied. PCV13 breakthrough infections were higher in children under 1 year old who received 2 doses (2+0) than in the 3-dose (3+0) group: incidence rates (IRs) per 100,000 were 7.8 versus 0.6. The IR ratio was 12.9, with a 95% confidence interval of 4.1 to 40.4. The results for PCV7 cases were similar.

In addition, the study revealed that differences in case numbers between the 2-dose and 3-dose regimens in children under age 1 were greater in 2010 and 2011 (IR for 2+0 group, 18.6; IR for 3+0 group, 1.4) than in 2012 through 2016 (IR for 2+0 group, 3.6; IR for 3+0 group, 0.2).

"Fewer PCV breakthrough infections occurred in the first year of life with 3 primary doses," the team concluded. "Differences in breakthrough infection rates by schedule decreased as vaccine serotypes decreased in circulation."
Feb 13 Pediatrics abstract

Vietnam reports two more H5N6 avian flu outbreaks in poultry.

Vietnam reported two more outbreaks of H5N6 highly pathogenic avian flu yesterday, a day after four other outbreaks were reported in the northern part of the country, according to the World Organization for Animal Health (OIE).

A total of 1,000 birds were infected and died out of 8,731 susceptible birds on the two affected farms, the OIE said. The rest of the birds were killed and disposed of. The farms are in Bac Ninh province in the country's northeast. Bac Ninh adjoins Ha Noi province, site of one of the earlier outbreaks.
Feb 12 OIE report

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Somalia Weekly Polio Update: Week 5, 2020 | World Health Organization, UN Children's Fund via ReliefWeb.

[13 Feb 2020] [Published on 13 Feb 2020]

Situation Update.

  • One new circulating vaccine-derived poliovirus type 2 (cVDPV2) - positive sewage sample has been identified this week from an environmental surveillance (ES) site in Mogadishu, collected on 5 January. This brings the total number of cVDPV2 isolated from ES in 2019 and 2020 to six.

  • No new cases of children with cVDPV2 were reported this week. The date of onset of the most recent case of cVDPV2 in a child with acute flaccid paralysis (AFP) was 8 May 2019. A total of three cVDPV2 cases were reported in Somalia in 2019.

  • No new circulating vaccine-derived poliovirus type 3 (cVDPV3) - positive cases or environmental samples were identified in 2019 or 2020 to date. The date of onset of the most recent case of cVDPV3 in a child with AFP was 7 September 2018.

  • In total, 15 children with polio have been identified across Somalia since the initial detection of the ongoing cVDPV2 and cVDPV3 outbreaks in late 2017.


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Pakistan: 40 schools warned for turning away polio workers in Sindh | The Express Tribune.

[February 13, 2020]

KARACHI: The Sindh Education Department issued warning letters on Wednesday to 40 private schools and suspended the registration of two other private schools for denying polio teams entry on their premises during the on-going polio drive.

According to the education and health departments, the schools, which include daycares, pre-schools and elementary schools located in the South and West districts, had refused entry to the polio teams, claiming that their students had already received the polio vaccine.

The education department issued explanation letters to 20 such schools in each district, warning them to comply with the government’s orders or face strict action.

“We are cooperating with the health department,” said Directorate of Private Institutions registrar Rafia Mallah, adding that the education department had agreed to fully support the on-going polio drive. “This is a national cause and every citizen has to cooperate. It’s a crippling disease that not only disables our children physically but affects them mentally too,” she maintained, adding that the schools who had barred the entry of polio teams would be dealt with strictly.

Speaking to The Express Tribune about the matter, Mallah explained that there were schools in the posh areas of the city that held the belief that polio drops were only for ‘poor’ children. “These schools have a superiority complex,” she asserted, adding that the vaccination drops could safely be administered multiple times.

“The government is usually criticised for not working properly, but why do such people [the elite] not cooperate with government officials?” she asked.

“It’s not a new issue that these elite schools try to stop polio workers,” commented a health department official, adding that they often faced such complaints. “The private school managements should understand the severity of the issue. We have to eradicate the disease once and for all,” he said, appealing to parents and school administrations to allow polio workers to achieve this goal.

Sources told The Express Tribune that not just the school authorities but also the parents of students were refusing to let the health department’s polio teams immunise their children.

“Their [the parents’] response is usually that the children were given the vaccine by the most reputed hospital in the country or were vaccinated outside of Pakistan,” an official explained. “But we need to ensure that all children under the age of five have been administered the vaccine, and for that, everyone must cooperate.”

The seven-day polio drive began on February 10 and will continue till Sunday. A total of 2.3 million children under the age of five will be targeted for immunisation in the city during this time, while another campaign will be launched for the remaining districts of Sindh on Monday, targeting 6.7 million children.

Five new polio cases have been confirmed in Sindh so far this year, while the provincial tally for last year has soared to 30 cases.

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Africa: CDC issues travel notice for 15 countries due to polio outbreaks | Outbreak News.

[February 12, 2020] [NewsDesk @infectiousdiseasenews]

The Centers for Disease Control and Prevention (CDC) renewed their polio travel notice for Africa Tuesday. There are polio outbreaks in several countries in Africa. The following 15 countries have been reporting outbreaks: Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Ethiopia, Ghana, Mozambique, Niger, Nigeria, Somalia, Togo and Zambia.

Countries in Africa where a booster dose of polio vaccine is recommended before travel

The World Health Organization recommends that these countries require residents and long-term (4 weeks or more) visitors show proof of polio vaccination before leaving the country.

CDC recommends that all travelers to the countries listed above be vaccinated fully against polio. Adults who were fully vaccinated during childhood should receive an additional (single) lifetime booster dose of polio vaccine. Even if you were vaccinated as a child or have been sick with polio before, you may need a booster dose to make sure you are protected.

Polio is a crippling and potentially deadly disease that affects the nervous system. Good hand washing practices can help prevent the spread of this disease. Because the virus lives in the feces (poop) of an infected person, people infected with the disease can spread it to others when they do not wash their hands well after defecating (pooping). People can also be infected if they drink water or eat food contaminated with infected feces.

Most people with polio do not feel sick. Some people have only minor symptoms, such as fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. In rare cases, polio infection causes permanent loss of muscle function (paralysis). Polio can be fatal if the muscles used for breathing are paralyzed or if there is an infection of the brain.

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Pakistan: Unique way to attract children in polio campaign | Business Recorder.

[February 13, 2020]

A A Joyland (Pvt) Ltd has introduced an innovative idea to attract children in the recent polio eradication campaign. The company has joined hands with Pakistan Polio Eradication Programme under which they would hand over free vouchers of Aladin Amusement Park, Super Space Karachi, Bounce, XD and Battle Station to children during the polio campaigns in district East and South.

“Polio has affected Pakistan for decades and our country is among the only three countries which are yet to become polio free and we intend to help the country terminate polio entirely," said the HOD (Marketing) A.A Joyland (Pvt) Ltd, Anil Hasanali.

“We hope this initiative of ours increases awareness about polio among the people and assist PPEC in this noble cause," he added. As part of its social responsibility, A.A Joyland looks forward to collaborating with more initiatives like Pakistan Polio Eradication Programme to bring health, prosperity and joy to the citizens of Pakistan.

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