WHO Update: Marburg Virus In Uganda

 

Credit CDC PHIL

 

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The World Health Organization has updated the situation in Uganda, where authorities are dealing with a rare outbreak of Marburg virus.

 

The Marburg virus was first isolated after an outbreak at a lab in Germany (hence the name) imported via African Green Monkeys, but is normally found in parts of equatorial Africa.  It is closely related to the Ebola viruses, and is of the same family; Filoviridae.

Two weeks ago, in Marburg Virus Reported In Western Uganda, I recounted a bit of the history of the virus since it’s discovery in 1967.

 

As of now, there are 18 confirmed cases (9 deaths), and perhaps of most concern, cases have now been detected in 5 districts;  Kabale district, Kampala (the capital city), Ibanda, Mbarara and Kabarole.

 

 

 

Marburg haemorrhagic fever in Uganda - update

31 October 2012 - As of 28 October 2012, a total of 18 cases and 9 deaths, including a health worker, have been reported from 5 districts namely Kabale district, in south-western Uganda, Kampala (the capital city), Ibanda, Mbarara and Kabarole. The case fatality rate is 50%. The outbreak was declared by the Ministry of Health in Uganda on 19 October 2012. Blood samples from 9 cases have been confirmed for Marburg virus at the Uganda Virus Research Institute (UVRI).

 

Currently, 13 patients have been admitted to hospital (2 in Kampala, 8 in Kabale, 3 in Ibanda) and their contacts are listed for daily follow up. The latest confirmed case was admitted to Ibanda district isolation ward on 26 October 2012.

 

The World Health Organization (WHO) and international partners including, the Centers for Disease Control and Prevention (CDC), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Médecins-Sans-Frontières (MSF) are supporting the national authorities in outbreak investigation and response. The national task force has identified additional health care workers and epidemiologists to strengthen the teams in the field. Training of health workers on infection prevention and control, surveillance and clinical case management is ongoing. Social mobilization activities are being conducted which include the dissemination of IEC (Information Education Communication) material, sensitization on Marburg prevention and control and broadcast of information through radio channels. The first shipment of personal protective equipment (PPE) provided by WHO arrived over the weekend.

 

The WHO Regional office has deployed an epidemiologist and a logistician to Uganda to support the response teams on the ground. In addition, a social mobilization expert from WHO Zambia Country Office and a logistician from the Regional Rapid Response Team network have been mobilized for immediate deployment. More experts are being identified by the Global Outbreak Alert and Response Network (GOARN).

 

As the investigation into the outbreak continues, WHO and partners continue to support the national authorities as needed in the areas of coordination, infection prevention and control, surveillance, epidemiology, public information and social mobilization, anthropological analysis and logistics for outbreak response.

 

Neighbouring countries have been contacted to strengthen cross border surveillance and preparedness to prevent cross border spread of the outbreak.

 

WHO advises that there is no need for any restrictions on travel or trade with Uganda.

Canada & Switzerland Clear Novartis Flu Vaccine For Use

 

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Last week (see Novartis Fluad And Agriflu Vaccines Suspended In Canada), Canada joined Italy, Switzerland, and France in temporarily suspending the use of two Flu vaccines produced by a Novartis plant in Italy pending a review after `protein clumping’ was observed in some vials.

 

Today  Reuters is reporting that Health Canada, and the Swiss government have lifted their suspensions, after being reassured of the vaccine’s safety.  

 

 

Italy, reportedly, is `cautiously positive’ that they will be able to lift their ban in the next few days as well.

 

As I mentioned on Saturday, the clumping of proteins is not uncommon in flu vaccines, and has never been associated with a health risk in the past.  But given ongoing fungal meningitis outbreak due to contaminated steroids in the United States, public health officials are understandably being cautious.

 

Here is the Health Canada announcement, released earlier today.

 

Voluntary Suspension of Flu Vaccines (Agriflu and Fluad) Lifted

Information Update
2012-164
October 31, 2012
For immediate release

OTTAWA - Health Canada has completed its review of safety information for Agriflu and Fluad and is releasing the two seasonal flu vaccines for immediate use. As a precautionary step, the products were temporarily pulled from distribution last week by the manufacturer and held from use in flu vaccination clinics at the request of Health Canada while it investigated any possible concerns.

 

Health Canada looked at the results of its own testing, conducted a health risk assessment, and reviewed information from its European partners and data submitted by Novartis in making its decision. None of the information reviewed indicated a safety issue.

 

The Public Health Agency of Canada is now advising health care professionals in possession of these vaccines that they can start using them once again. As such, those administering the vaccines are reminded to follow existing labelling directions as well as allowing the vaccine to come to room temperature before use. The products should also be shaken and checked for any white floating material before they are injected. Such material is not uncommon in vaccines and does not pose a risk to health.

 

The Public Health Agency of Canada closely monitors for vaccination-related adverse events to detect potential safety issues in a timely manner. To date it has received no reports of serious or unexpected adverse events related to these vaccines.

 

The Public Health Agency of Canada and Health Canada will continue to work with the company to monitor the safety and effectiveness of the vaccines used here in Canada. Should a safety concern be identified, immediate and appropriate action will be taken.

 

Agrippal is marketed in Canada as Agriflu and is authorized for use in people older than 6 months. Fluad is authorized for use in Canadians 65 years of age or older.

 

Flu season is upon us, and a seasonal influenza vaccine is a safe and effective way to protect children, families and communities from influenza viruses. Canadians can learn more about fighting flu by getting a copy of Fight Flu: Your Seasonal Flu Guide by contacting 1 800 O-Canada or visiting  Fight Flu.

 

WHO: Yellow Fever Outbreak In Sudan

 

Source Lancet Infect Dis. 2011;11:622-32 via CDC

 

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For three weeks the newshounds on FluTrackers (among others) have been keeping track of a disease outbreak  in Sudan that has claimed several dozen lives.

 

Today, the World Health Organization’s regional office for the Eastern Mediterranean has posted the following notice (h/t Ronan Kelley on FluTrackers), indicating they’ve been notified of a yellow fever outbreak in that country.

 

Yellow fever hits Central and South Darfur

29 October 2012 – Sudan’s Federal Ministry of Health has notified the World Health Organization (WHO) of a yellow fever outbreak in seven localities in Central and South Darfur. Since the first week of October, a total of 84 suspected cases, including 32 deaths, have been reported from the districts of Azoom, Kass, Mershing, Nertiti, Nyala, Wadi Salih and Zalingei.

 

The Federal Ministry of Health has said that the immediate priority is to control the vector, reinforce the disease surveillance system and raise public awareness of prevention and control of this disease. Preparations for a mass vaccination campaign are underway to vaccinate the at-risk population in Darfur.

 

Yellow fever is spread by mosquitoes. There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever, and blood transfusion, if and when needed. It is a preventable disease with symptoms and severity varying from case to case. Protective measures such as the use of bednets, insect repellent and long clothing are considered the best methods to contain an outbreak.

 

Vaccination is the single most important measure for preventing yellow fever.

 

The Federal Ministry of Health, WHO and other health partners are working on the ground to ensure timely containment of the outbreak.

 

Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). There is a relatively safe, and effective, vaccine available and travelers to parts of equatorial Africa and South America are often advised to get it.

 

The CDC’s 2012 Yellow Book describes the clinical presentation this way:

 

Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.

 

The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.

 

After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.

 

In the 18th and 19th century Yellow fever caused major epidemics in Europe and in the United States, up the Atlantic seaboard and as far north as New England (Boston was hard hit in 1780, and Philadelphia saw several thousand deaths in 1793).

 

Yellow Fever has been cited as one of the primary reasons why the French abandoned their attempt to build a Panama canal in the late 1800’s, as the combined burden of Yellow Fever and Malaria reportedly claimed the lives of more than 20,000 construction workers.

 

 

For more on the fascinating history of `Yellow Jack’, I would point you to Ian York’s excellent Mystery Rays blog, where he gives us some terrific background in:

 

Yellow fever, stasis, and diversification

The deadliest, most awe-inspiring of the plagues

The good old days

 

While currently not a threat in Europe and the United States, yellow fever is on the radar screens of some epidemiologists as climate change, and the spread of suitable vectors, continue.

 

This from Eurosurveillance in 2010, and it is an excellent overview of the issue.

 

Eurosurveillance, Volume 15, Issue 10, 11 March 2010

 

Yellow fever and dengue: a threat to Europe?

P Reiter

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalisation of vectors and vector-borne diseases.

The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced.  The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

 

 

You can find more information on yellow fever at these websites:

 

http://www.cdc.gov/yellowfever/

http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm

http://www.who.int/topics/yellow_fever/en/

Central Florida Man Diagnosed With Dengue

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A Seminole county man, aged 19, has been diagnosed with what is believed to be locally acquired Dengue, according to a press release today from the Orange County Health Department.

 

HEALTH HEALTH ADVISORY – DEPARTMENTS  INVESTIGATING LOCALLY ACQUIRED DENGUE FEVER CASE

Tuesday, October 30, 2012 -

ORLANDO – The Seminole and Orange County Health Departments are investigating a locally acquired case of dengue fever near the Seminole and Orange County line by the University of Central Florida. The 19 year old Seminole County man was diagnosed with dengue fever based on symptoms and confirmed by laboratory tests. The individual is recovering from this illness.

 

Dengue fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics. It is not spread from person to person. Mosquitoes usually bite at dusk and dawn, but the mosquitoes that carry dengue bite during the day as well – especially indoors, in shady areas, or when the weather is cloudy.

 

Though some people may experience little to no symptoms; the most commons symptoms of dengue include high fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for dengue fever. If you are experiencing symptoms consistent with dengue fever, please call your healthcare provider to see if you need to be seen.

 

The health departments encourage all residents and visitors to help lower mosquito populations by taking appropriate measures to guard against these diseases by practicing Drain and Cover. 

This includes:

DRAIN standing water:
• Drain water from garbage cans, buckets, pool covers, coolers, toys, flowerpots or any other containers where sprinkler or rainwater has collected.
• Discard old tires, drums, bottles, cans, pots and pans, broken appliances and
other items that aren't being used.
• Empty and clean birdbaths and pets' water bowls at least once or twice a week.
• Protect boats and vehicles from rain with tarps that don't accumulate water.
• Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use.

 

The most recent Florida Arbovirus Surveillance Report (Oct 27th) only lists one other locally acquired case of Dengue in Florida in 2012 (see Miami Reports Locally Acquired Dengue Case).

 

This compared to 28 cases reported in 2009, and then 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County for 2010.

 

The following year, 2011, saw a significant reduction in cases with just three locally acquired in Miami-Dade County, two in Palm Beach County, and one each in Martin and Hillsborough counties.

 

Although cooler weather has finally arrived in the Sunshine state, we’ve yet to see a freeze, and so mosquitoes are still active.  For this reason, the Florida DOH recommends.

Flood Dangers Run Deep

 

Photo Source VOANews

 

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Although the storm has passed, flood waters are often slow to recede, and they can leave behind a multitude of dangers. 

 

Not only do flood waters easily hide dangerous objects - like broken bottles, razor sharp metal sheeting, live electrical wires, and rusty nails – they can also harbor nasty viruses and bacteria, along with dangerous wildlife. 

 

The CDC’s Webpage on Infectious Disease After a Disaster provides a long list of possible risks (many associated with flood waters) that include:

• Cryptosporidiosis
• Enteroviruses
• Escherichia coli (E. coli)
• Giardiasis
• Hepatitis B, Hepatitis C, HIV/AIDS
• Leptospirosis
  • Information for the General Public
  • Clinical Guidance
• Legionnaires' disease
• Methicillin-Resistant Staphylococcus aureus (MRSA) Infection
• Norovirus
• Rotavirus
• Shigellosis
• Skin Infections
• Tetanus
• Varicella Disease (Chickenpox)
• Vibrio cholerae (Non-O1 & Non-O139)
• Vibrio parahaemolyticus
• Vibrio vulnificus
• West Nile Virus

 

Down here in Florida, and along the Gulf Coast, alligators and poisonous snakes are a genuine threat after a hurricane. Urban legends about crocs inhabiting the sewers of New York City aside, wayward reptiles are probably not going to pose much of a threat to life and limb in the Mid-Atlantic states.

 

But there are probably a fair number of rats that have likely evacuated to higher ground or have been driven out of basements and tunnels due to the flooding.

 

And with rats, you don’t actually have to see or come in direct contact with them, to be endangered.

 

 

In June of 2010, the New York Times carried a story called Subway Study Finds Rats Remain Wily, that quoted rodentologist Robert M. Corrigan, by saying:

 

while rats were a problem in the subways, the rodents inhabited many other public spaces, particularly parks. “Virtually all of New York,” he said, “is vulnerable to this uncanny mammal.”

 

The good news, at least according to the New York City Bureau of Communicable diseases, is:

 

Could a bubonic plague outbreak occur in New York City?

In New York City and other eastern cities, the rat flea that usually transmits bubonic flea (the oriental rat flea) is rare. Outbreaks of bubonic plague in these areas would be unlikely.

 

But there are other diseases, notably Hantavirus and Leptospirosis, that are rat-borne and potentially hazards in the post-Sandy environment.

 

We’ve covered Hantavirus a number of times in the past (see here, here, & here) but Leptospirosis is less well known in the United States, although it is not exactly unheard of.

 

The CDC’s Leptospirosis Webpage describes the bacteria this way:

 

The bacteria that cause leptospirosis are spread through the urine of infected animals, which can get into water or soil and can survive there for weeks to months. Many different kinds of wild and domestic animals carry the bacterium.

These can include, but are not limited to:

• Cattle
• Pigs
• Horses
• Dogs
• Rodents
• Wild animals

When these animals are infected, they may have no symptoms of the disease.

Infected animals may continue to excrete the bacteria into the environment continuously or every once in a while for a few months up to several years.

Humans can become infected through:

• contact with urine (or other body fluids, except saliva) from infected animals
• contact with water, soil, or food contaminated with the urine of infected animals.

The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially if the skin is broken from a cut or scratch. Drinking contaminated water can also cause infection. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. Person to person transmission is rare.

 

Risk of Exposure

Leptospirosis occurs worldwide, but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as:

• farmers
• mine workers
• sewer workers
• slaughterhouse workers
• veterinarians and animal caretakers
• fish workers
• dairy farmers
• military personnel

 

While most often associated with tropical climes, according to the New York Health Department they see an average of 1 or 2 cases a year in the city.

 

 

Again, like hantavirus, not terribly likely . . . but not impossible either.  Illness after exposure to flood waters should not be dismissed as `nothing’, but checked by a doctor.

 

 

In truth, the risks associate with flood waters are more likely to come from raw sewage, chemicals, or hidden sharp objects. But for bacteria and viruses, post-disaster situations are a `target rich environment’.

 

Those dealing with flood waters or disaster cleanup, who have not had a tetanus booster in recent years, may want to consider the wisdom of getting one.

 

The CDC maintains a page on dealing with flood dangers:

 

Flood Waters or Standing Waters

Health Risks

Flood waters and standing waters pose various risks, including infectious diseases, chemical hazards, and injuries.

Infectious Diseases

• For more detailed information, see CDC’s Infectious Disease After a Disaster page

Diarrheal Diseases

Eating or drinking anything contaminated by flood water can cause diarrheal disease. To protect yourself and your family,

• Practice good hygiene (handwashing) after contact with flood waters.
• Do not allow children to play in flood water areas.
• Wash children's hands frequently (always before meals).
• Do not allow children to play with toys that have been contaminated by flood water and have not been disinfected.

For information on disinfecting certain nonporous toys, visit CDC Healthy Water's Cleaning and Sanitizing with Bleach section.

Wound Infections

Open wounds and rashes exposed to flood waters can become infected. To protect yourself and your family,

• Avoid exposure to flood waters if you have an open wound.
• Cover open wounds with a waterproof bandage.
• Keep open wounds as clean as possible by washing well with soap and clean water.
• If a wound develops redness, swelling, or drainage, seek immediate medical attention.

For more information, visit

• Emergency Wound Care After a Natural Disaster
• Emergency Wound Management for Healthcare Professionals
• Management of Vibrio vulnificus Wound Infections After a Disaster
• Vibrio vulnificus After a Disaster

Chemical Hazards

Be aware of potential chemical hazards during floods. Flood waters may have moved hazardous chemical containers of solvents or other industrial chemicals from their normal storage places.

• Protect Yourself from Chemicals Released During a Natural Disaster (CDC)
• Chemical Emergencies (CDC)

Injuries

Drowning

Flood water poses drowning risks for everyone, regardless of their ability to swim. Swiftly moving shallow water can be deadly, and even shallow standing water can be dangerous for small children.

Vehicles do not provide adequate protection from flood waters. They can be swept away or may stall in moving water.

Animal and Insect Bites

Flood waters can displace animals, insects, and reptiles. To protect yourself and your family, be alert and avoid contact.

• Protect Yourself from Animal- and Insect-Related Hazards After A Disaster (CDC)
• Wildlife in Disasters (Federal Emergency Management Agency - FEMA)

Electrical Hazards

Avoid downed power lines.

• Protect Yourself and Others From Electrical Hazards After a Disaster (CDC)

Wounds

Flood waters may contain sharp objects, such as glass or metal fragments, that can cause injury and lead to infection.

• Emergency Wound Care After a Natural Disaster (CDC).

 

Cleanup of Flood Water

When returning to your home after a flooding emergency, be aware that flood water may contain sewage. For more information on how to protect yourself and your family, visit CDC’s Cleanup of Flood Water.

 

Resources and Guidance

• After a Flood (CDC, FEMA)
• Prevent Illness and Injuries After Flooding (CDC)

And one last flood-related item to bear in mind, is:

 

Mold After a Disaster

Overview

• Fact Sheet: Protect Yourself from Mold

Educational Materials

• Flyers:
  • "Get Rid of Mold" (117 KB/1 page)
    Spanish (138 KB/1 page) | Vietnamese
  • "Check your HVAC system for Mold" (170 KB/1 page)

Public Service Announcements

• Audio Scripts
  • Preventing Mold
• Videos
  • Mold After a Disaster
  • Dealing With Mold Allergies
  • Mold Removal

Bangalore: More Poultry Culled Due To H5N1

 

Photo Credit – FAO

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Last Friday in Bangalore, India: H5N1 in Turkeys, I reported on the discovery of H5N1 at a government-run poultry operation on the outskirts of Bangalore, that had resulted in the deaths and culling of more than 3,300 birds.

 

Today, we are learning that the culling operation has been increased nearly 10-fold, with roughly 33,000 birds now culled.  This from the IBT.

 

Bird Flu Outbreak in Karnataka: Over 33,000 Poultry Birds Culled at CPDO

 

By Ankita Mehta | October 30, 2012 10:39 AM GMT

Fear of avian influenza continued to create panic in Karnataka after more than 33,000 poultry birds -19,235 chicken, 13,673 ducks and 369 emus - were culled at Central Poultry Development Organization (CPDO) in Hesaraghatta, 40 km from Bangalore.

(Continue . . )

 

 

The freewheeling Indian media is rarely shy about criticizing the government’s response to bird flu (or any other crisis). Today we get an example from DNA.

 

Bird flu is on, so is passing-the-buck

Published: Tuesday, Oct 30, 2012, 16:43 IST
By Nirad Mudur & Deepthi MR | Place: Bangalore | Agency: DNA

The Centre on October 25 notified its confirmation that avian influenza has indeed struck the Central Poultry Development Organisation & Training Institute (CPDOTI) located in Byatha village in Hesaraghatta on the outskirts of Bangalore.

 

But despite the confirmation that 4,265 turkeys had died due to avian influenza and 206 chicken and 17 ducks died due to suspected infection from the same disease, the state health department and the Bruhat Bengaluru Mahanagara Palike (BBMP)’s health department are engaged in a bureaucratic passing-the-buck. Each is stating that the responsibility of checking the disease spread lies solely with the state department of animal husbandry.

(Continue . . .)

 

 

Of particular concern, the story above goes on to state that several poultry farms close to the affected farm had already moved their flocks in order to avoid culling them.

 

Since that can spread the virus to other regions, neighboring states are now taking steps to prevent entry of birds from Karnataka.

This from the Deccan Herald.

 

Bird flu in Karnataka: Kerala bans poultry from outside

Thiruvananthapuram, Oct 30, 2012 (PTI)

Kerala has banned entry of poultry from other states following detection of avian influenza (bird flu) in a central government farm at Hesserghatt in southern Karnataka.

Following an intimation in this regard from the Karnataka Government, the state Animal Husbandry Department has banned movement of poultry from both Karnataka and Tamil Nadu since last evening, official sources said today.

(Continue . . .)

 

For now, H5N1 remains primarily a threat to poultry and wild birds.  India has yet to report a human infection from the virus. 

But elsewhere around the world more than 600 widely scattered human infections have been reported, and the mortality rate has been a horrendously high 60% among known cases.

 

And so we watch outbreaks such as this with keen interest.