Florida Declares New Area of Zika Transmission in Miami

13 October 2016 (Reuters [Julie Steenhuysen])

Florida officials announced a new area of Zika transmission in the Miami region and have called on the federal government for funding to help fight the outbreak.

Florida Governor Rick Scott said state health officials have confirmed that local transmission of the mosquito-borne Zika virus is occurring in a new small area in Miami-Dade County, where the state believes two women and three men have been infected by the virus.

The governor said the state’s health department believes Zika transmission is only occurring in Miami Beach and in the new area, which covers about 1 square mile (2.6 square km).

Last month, U.S. health officials urged pregnant women to consider putting off all nonessential travel to Miami due to the Zika virus even as the state lifted a travel warning for the Wynwood, the Miami neighborhood which was the first site of local Zika transmission in the continental United States.

Florida has reported a total of 164 cases of Zika caused by local mosquito transmission, including 19 people who were infected in the state but live elsewhere. There are also five cases in which it was not clear whether transmission occurred in Florida or elsewhere.

Scott said he has asked the U.S. Centers for Disease Control and Prevention to work directly with the Miami-Dade Mosquito Control District to identify best practices for defeating Zika in the new area.

Copyright © 2016 Reuters Limited. All rights reserved.

Editorial comment: With warm weather continuing and lack of mosquito die-off, large areas of the southern United States will continue to be at risk for localized outbreaks of Zika.

Venezuelan Doctors Sound Alarm on Reported Return of Diphtheria

7 October 2016 (Reuters [Alexandra Ulmer])

Venezuelan doctors warned of a diphtheria outbreak in the crisis- stricken country, calling on the government to boost availability of scarce vaccines and antibiotics to stem the disease which local media and the opposition report has killed some two dozen people.

Last seen in Venezuela in 1992, diphtheria has been spreading in the southern jungle state of Bolivar, according to a statement by two local public health associations.

The statement said 17 people had died from diphtheria in Venezuela, citing local media.

The government, which has stopped publishing weekly health statistics, has not spoken about the alleged outbreak.

Venezuela’s economy is in a tailspin, with shortages of items from disinfectant to chemotherapy drugs crippling the health sector and leaving 30 million Venezuelans struggling to access basic medical care.

The ruling party governor of Bolivar said this week that there was no proven case of diphtheria but that the state was already vaccinating people.

“400,000 doses of vaccines have arrived for Bolivar to guarantee all citizens can be vaccinated,” Governor Francisco Rangel said.

Diphtheria was once a major cause of illness and death of children but is now very rare in developed countries due to vaccinations.

Copyright © 2016 Reuters Limited. All rights reserved.

Editorial comment: This outbreak is the result of a lack of high immunization rates and should serve as a warning to the anti-vaccination community. Also see (<www.promedmail.org> Archive 20161005.4538127>).

Sanofi’s Dengue Vaccine Approved In 11 Countries

4 October 2016 (Reuters [Dominique Vidalon])

Sanofi Pasteur, Sanofi’s vaccines unit, said that its dengue vaccine, Dengvaxia, had received market approval in 11 countries.

To date the vaccine has been approved in Mexico, the Philippines, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Indonesia, Thailand and Singapore, the statement said.

Dengue fever is a mosquito-borne disease caused by four virus serotypes (1 to 4) as categorized by the World Health Organization.

Overall, the disease is seen as a threat to about half of the world’s population. Some 400 million people are believed to be infected annually.

Copyright © 2016 Reuters Limited. All rights reserved.

Editorial comment: Concern has been registered by Scott Halstead, MD, a leading expert on dengue fever and dengue vaccine. Dr. Halstead and others believe that based on the results of the Dengvaxia trials that the dengue vaccine sets up dengue-naive recipients for severe disease at a later time.According to his analysis, vaccine recipients less than 5 years old, on follow-up, had 5 to 7 times higher rates of hospitalizations for severe dengue fever than placebo controls.The effect seems to be antibody-dependent enhancement (ADE). Dengue ADE occurs when infection with a dengue virus results in strain-specific antibodies and cross-reactive antibodies to the other dengue serotypes. Antibody to the infecting strain persists but the cross-reactive antibodies fade over years, and when exposed to dengue infection caused by one of these serotypes, severe dengue fever is more likely. In the vaccine example, over time all serotypes would result in low levels of non-neutralizing antibody priming the recipient to severe dengue fever in subsequent years.

[<http://www.sciencedirect.com/science/article/pii/S0264410X16001304>]; [<http://www.cidrap.umn.edu/news-perspective/2016/07/contrary-dengue-vaccine-response-hints-possible-problems-zika>]

Efforts to Beat Tuberculosis Fall Far Short, WHO Warns

13 October 2016 (Reuters [Kate Kelland])

Health authorities worldwide need to move much faster to prevent, detect, and treat a “deadly epidemic” of tuberculosis (TB) if they are to reduce TB infections and deaths by 2030, the World Health Organization (WHO) warned.

In its annual report on tackling TB, which kills more people each year than human immunodeficiency virus (HIV) and malaria combined, the WHO said progress had been dismal and called for “bold political commitment and increased funding.”

Without it, the world would continue to chase the epidemic rather than get on top of it, it said.

“To save more lives now, we must get newly recommended rapid tests, drugs and regimens to those who need them. Current actions and investments fall far short of what is needed,” the director of the WHO’s TB program, Mario Raviglione, said in a statement.

There were an estimated 10.4 million new TB cases worldwide in 2015, the report found, with six countries accounting for 60 percent of those—first India, then Indonesia, China, Nigeria, Pakistan, and South Africa.

Some 1.8 million people died from TB last year, of whom 0.4 million were co-infected with the HIV.

The report noted that while global TB deaths have fallen by 22 percent between 2000 and 2015, the disease was still one of the top 10 causes of death globally in 2015.

About 84 percent of the TB funding available in low- and middle-income countries in 2016 was domestic, but this was mostly accounted for by the large and relatively wealthy BRICS countries—Brazil, Russia, India, China, and South Africa.

Other less wealthy countries rely heavily on international donor financing, with more than 75 percent coming from The Global Fund to Fight AIDS, TB, and Malaria.

Copyright © 2016 Reuters Limited. All rights reserved.

Mycobacterium Chimaera Conta mination of Heater-Cooler Devices Used in Cardiac Surgery—United States

(MMWR 65:1117, 2016)

In the spring of 2015, investigators in Switzerland reported a cluster of six patients with invasive infection with Mycobacterium chimaera, a species of nontuberculous mycobacterium ubiquitous in soil and water. The infected patients had undergone open-heart surgery that used contaminated heater-cooler devices during extracorporeal circulation. In July 2015, a Pennsylvania hospital also identified a cluster of invasive nontuberculous mycobacterial infections among open-heart surgery patients. Similar to the Swiss report, a field investigation by the Pennsylvania Department of Health, with assistance from Centers for Disease Control and Prevention (CDC), used both epidemiologic and laboratory evidence to identify an association between invasive Mycobacterium avium complex, including M. chimaera, infections and exposure to contaminated Stöckert 3T heater-cooler devices, all manufactured by LivaNova PLC (formerly Sorin Group Deutschland GmbH). M. chimaera was described as a distinct species of M. avium complex in 2004. The results of the field investigation prompted notification of approximately 1,300 potentially exposed patients. Although heater-cooler devices are used to regulate patients’ blood temperature during cardiopulmonary bypass through water circuits that are closed, these reports suggest that aerosolized M. chimaera from the devices resulted in the invasive infections. The Food and Drug Administration (FDA) and CDC have issued alerts regarding the need to follow updated manufacturer’s instructions for use of the devices, evaluate the devices for contamination, remain vigilant for new infections, and continue to monitor reports from the United States and overseas.

Whole genome sequencing was completed on isolates from 11 patients and from five Stöckert 3T heater-cooler devices from hospitals in Pennsylvania and Iowa, two of the states where clusters of infections were identified. Samples from heater-cooler devices included swabs from the interior of the device, water drained from the devices, and air samples collected while a device was operating. The results strongly suggest a point-source contamination of Stöckert 3T heater-cooler devices with M. chimaera. A recent report from Germany noted that preliminary typing results of M. chimaera from heater-cooler devices from three different European countries were almost identical to samples obtained from the manufacturing site, further supporting the likelihood of point-source contamination. Over 250,000 procedures using cardiopulmonary bypass are performed in the United States each year. Stöckert 3T heater-cooler devices represent approximately 60% of the U.S. market.

Editorial Comment: Swiss investigators have demonstrated that M. chimaera was aerosolized from heater-cooler units to an open surgical field (Sommerstein et al. http://dx.doi.org/10.3201/eid2206.160045).