Tuesday, May 23, 2017

PRO/AH/EDR> Avian influenza, human (53): CHINA, H7N9

AVIAN INFLUENZA, HUMAN (53): CHINA, H7N9
****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this Update:
[1] Poultry Market Closures
[2] Jiangsu
[3] Hebei
[4] Shandong
[5] Sichuan


******
[1] Poultry Market Closures
Date: Sun 21 May 2017, 0:53 AM
Source: VOA News [edited]
<http://www.voanews.com/a/bird-flu-china-close-poultry-markets/3863836.html>


China will shutter poultry markets in a district of southwestern
Sichuan province after a man fell ill with the H7N9 bird flu,
state-owned China News Service reported [Sun 21 May 2017]. The
44-year-old man sold live poultry at a farmers market, China News
reported, citing officials in Zigong city.

Poultry markets in Zigong's Ziliujing district will be closed starting
from midnight [Mon 22 May 2017], the report said.

Cases of bird flu have been unusually high for China since last year
[2016], with 3 times more fatalities from H7N9 in the 1st 4 months of
the year than in all of 2016, although deaths fell in April [2017] for
the 3rd consecutive month.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2] Jiangsu
Date: Sat 20 May 2017
Source: FIC (Flu Information Centre/Flu in China) [edited]
<http://www.flu.org.cn/en/news_detail?action=ql&uid=MjI0OA&pd=YXRsbXBw&newsId=19418>


Jiangsu province reported two new human H7N9 AIV cases from 8th to
14th May, according to the HFPC of Jiangsu province. The patients were
reported in Nantong city(77-year-old male, fatal) and Yancheng
city(57-year-old male)

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] Hebei
Date: Sat 20 May 2017, 12:55 PM
Source: FIC (Flu Information Centre/Flu in China) [edited]
<http://www.flu.org.cn/en/news_detail?action=ql&uid=MjI0OA&pd=YXRsbXBw&newsId=19421>

During the period from [12 May 2016] to [18 April 2017], Hebei
province reported 6 human H7N9 AIV cases. Two cases in Chengde city, 2
cases in Langfang city, 2 cases in Shijiazhuang city.

Chengde:
1) 53-year-old male
2) 71-year-old female

Langfang
1) 30-year-old male
2) 46-year-old male

Shijiazhuang
1) 62-year-old female, surname Lu, resident in Dongjiazhuang village
of Qianxiguan town of Gaocheng district of Shijiazhuang city
2) 73-year-old female

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[4] Shandong
Date: Sun 21 May 2017, 11:22 AM
Source: FIC (Flu Information Centre/Flu in China) [edited]
<http://www.flu.org.cn/en/news-19427.html>


According to the authority, Binzhou city reported 1 human H7N9 AIV
case on [19 May 2017]. The 74-year-old male patient [surname omitted]
had history of multiple visits to live poultry market prior to the
onset of symptoms, and now remains in hospital for treatment. All
close contacts are under medical monitoring and no one has showed ILI
symptoms so far.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[5] Sichuan
Date: Sun 21 May 2017, 11:28 AM
Source: FIC (Flu Information Centre/Flu in China) [edited]
<http://www.flu.org.cn/en/news-19428.html>


According to the authority, Ziliujing district of Zigong city reported
1 human H7N9 AIV case on [20 May 2017], this is the 1st human H7N9 AIV
case reported in Zigong city. The 44-year-old male, [surname omitted],
had worked in wet market for live poultry trading for years, was in
stable condition and remained in designated hospital in Chengdu for
treatment and quarantine.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The continuous reporting of human cases merits active surveillance
and more awareness efforts for the high risk groups and the general
public. Wet market closures in areas where human cases are continually
being reported can be helpful, as a temporary measure, to break the
poultry to human transmission cycle. - Mod.UBA

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/155>.]

[See Also:
Avian influenza, human (52): CHINA, H7N9
http://promedmail.org/post/20170517.5041644
Avian influenza, human (51): China, H7N9
http://promedmail.org/post/20170514.5030458
Avian influenza, human (50): CHINA, H7N9
http://promedmail.org/post/20170509.5019418
Avian influenza, human (49): China, H7N9
http://promedmail.org/post/20170504.5012923
Avian influenza, human (48): China, H7N9
http://promedmail.org/post/20170429.5000143
Avian influenza, human (47): CHINA, H7N9, WHO
http://promedmail.org/post/20170424.4989441
Avian influenza, human (46): WHO, human-animal interface
http://promedmail.org/post/20170423.4986981
Avian influenza, human (45): China, H7N9
http://promedmail.org/post/20170422.4982785
Avian influenza, human (44): China, H7N9, updates, pandemic potential
http://promedmail.org/post/20170417.4968872
Avian influenza, human (43): China, H7N9
http://promedmail.org/post/20170412.4962707
Avian influenza, human (42): China, H7N9
http://promedmail.org/post/20170409.4959020
Avian influenza, human (41): China, H7N9, WHO
http://promedmail.org/post/20170406.4945768
Avian influenza, human (39): China, H7N9
http://promedmail.org/post/20170331.4935953
Avian influenza, human (38): China, H7N9
http://promedmail.org/post/20170327.4926547
Avian influenza, human (37): China, H7N9, WHO update, control,
genetics http://promedmail.org/post/20170324.4923674
Avian influenza, human (36): China, H7N9
http://promedmail.org/post/20170320.4910882
Avian influenza, human (35): China, H7N9, WHO updates
http://promedmail.org/post/20170317.4905430
Avian influenza, human (34): China (JX,CQ) H7N9
http://promedmail.org/post/20170316.4898107
Avian influenza, human (32): China, H7N9
http://promedmail.org/post/20170310.4890695
Avian influenza, human (30): China, H7N9
http://promedmail.org/post/20170307.4885433
Avian influenza, human (29): China (SH, Mainland), H7N9, WHO
assessment http://promedmail.org/post/20170304.4878682
Avian influenza, human (28): China (GX) Taiwan, H7N9, mutations
http://promedmail.org/post/20170302.4874114
Avian influenza, human (27): Egypt (Fayoum) H5N1, RFI
http://promedmail.org/post/20170227.4866795
Avian influenza, human (26): China (HE) H7N9
http://promedmail.org/post/20170227.4866739
Avian influenza, human (25): China (SD, GX), H7N9
http://promedmail.org/post/20170225.4863940
Avian influenza, human (24): China (JX), H7N9, control measures
http://promedmail.org/post/20170224.4861044
Avian influenza, human (23): China, Taiwan, H7N9, WHO, genetic
mutations http://promedmail.org/post/20170223.4858369
Avian influenza, human (22): China (GX, SD), H7N9, WHO updates,
vaccine http://promedmail.org/post/20170222.4852285
Avian influenza, human (21): China (GZ) H7N9
http://promedmail.org/post/20170219.4849594
Avian influenza, human (20): China (SC, YN, BJ), H7N9, death toll
http://promedmail.org/post/20170215.4841682
Avian influenza, human (10): Indonesia (LA) RFI
http://promedmail.org/post/20170123.4785841
Avian influenza, human (01): China (JX), H7N9
http://promedmail.org/post/20170102.4736553
2016
----
Avian influenza, human (72): China (HK) H7N9, fatal
http://promedmail.org/post/20161229.4727495
Avian influenza, human (68): China, H7N9
http://promedmail.org/post/20161218.4705001
Avian influenza, human (67): WHO, H5N6, H7N9, risk assessment
http://promedmail.org/post/20161212.4689184
Avian influenza, human (66): China (GD) H7N9
http://promedmail.org/post/20161210.4689085
Avian influenza, human (65): China (HN) H5N6
http://promedmail.org/post/20161123.4646005
Avian influenza, human (64): China (ZJ,JS) H7N9
http://promedmail.org/post/20161114.4624064
Avian influenza, human (60): China (JX) H9N2
http://promedmail.org/post/20160912.4481431
Avian influenza, human (58): China, H7N9, update, WHO
http://promedmail.org/post/20160820.4422893
Avian influenza, human (57): China, H7N9, WHO update
http://promedmail.org/post/20160727.4370565
Avian influenza, human (55): China (mainland) H7N9, fatal
http://promedmail.org/post/20160722.4362599
Avian influenza, human (54): China, H7N9, WHO
http://promedmail.org/post/20160714.4343947
Avian influenza, human (53): China (LN) H7N9, fatal
http://promedmail.org/post/20160710.4332434
Avian influenza, human (52): WHO, human-animal interface
http://promedmail.org/post/20160625.4308644
Avian influenza, human (48): China (HN) H5N6
http://promedmail.org/post/20160610.4275291
Avian influenza, human (45): WHO, human-animal interface
http://promedmail.org/post/20160523.4239090
Avian influenza, human (44): China, H7N9, WHO
http://promedmail.org/post/20160518.4228384
Avian influenza, human (43): China, H5N6, mutations, WHO
http://promedmail.org/post/20160507.4205906
Avian influenza, human (34): China, H5N6, H7N9, WHO
http://promedmail.org/post/20160325.4118113
2015
----
Avian influenza, human (133): WHO assessment human-animal interface
http://promedmail.org/post/20151220.3881202
Avian influenza, human (115): human-animal interface, SA status
comments http://promedmail.org/post/20150718.3520025
Avian influenza, human (107): WHO assessment
http://promedmail.org/post/20150521.3376485]
.................................................sb/uba/ao/lxl/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php
Posted on 5/23/2017 01:08:00 PM | Categories:

PRO/EDR> Hepatitis C - USA (08): (TN) pregnant women, 2009-2014

HEPATITIS C - USA (08): (TENNESSEE) PREGNANT WOMEN, 2009-2014
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 12 May 2017
Source: CDC. MMWR Morb Mortal Wkly Rep 2017; 66(18): 470-73 [summ.,
edited]
<https://www.cdc.gov/mmwr/volumes/66/wr/mm6618a3.htm?s_cid=mm6618a3_w>


Hepatitis C Virus Infection Among Women Giving Birth -- Tennessee and
United States, 2009-2014
--------------------------------------------------------------------------------
Hepatitis C virus (HCV) affects an estimated 3.5 million people in the
USA (1), making it the most common bloodborne infection in the
country. Recent surveillance data showed increased rates of HCV
infection among adolescents and adults who are predominantly white,
live in nonurban areas, and have a history of injection drug use.
American birth certificate data were used to analyze trends and
geographic variations in rates of HCV infection among women giving
birth during 2009-2014. Birth certificates from Tennessee were used to
examine individual characteristics and outcomes associated with HCV
infection, using a multivariable model to calculate adjusted odds of
HCV-related diagnosis in pregnancy among women with live births.
During 2009-2014, HCV infection present at the time of delivery among
pregnant women from states reporting HCV on the birth certificate
increased 89 percent, from 1.8 to 3.4 per 1000 live births. The
highest infection rate in 2014 (22.6 per 1000 live births) was in West
Virginia; the rate in Tennessee was 10.1. In adjusted analyses of
Tennessee births, the odds of HCV infection were approximately 3-fold
higher among women residing in rural counties than among those in
large urban counties, 4.5-fold higher among women who smoked
cigarettes during pregnancy, and nearly 17-fold higher among women
with concurrent hepatitis B virus (HBV) infection.

HCV infection among pregnant women is an increasing and potentially
modifiable threat to maternal and child health. Clinicians and public
health officials should consider individual and population-level
opportunities for prevention and risk mitigation.

Data from 2009-2014 were obtained from the National Vital Statistics
System and Tennessee Department of Health vital records. The outcome
of interest was HCV infection in pregnant women at the time of
delivery (maternal HCV infection) as indicated on the infant's birth
certificate. The maternal HCV infection rate per 1000 deliveries in
Tennessee was compared with that from hospital billing data in the
Tennessee Hospital Discharge Data System, an all-payer administrative
database that includes data for all inpatient admissions in the state.
National data were compared with nationally weighted estimates
obtained from the National Inpatient Sample, the largest all payer
database in the USA.

The 1st phase of the analysis examined rates of maternal HCV infection
reported on infant birth certificates to approximate HCV infection
among pregnant women in the USA. Because HCV infection is a revised
2003 birth certificate item, states gradually reported this item over
time as they adopted the revised certificate; therefore, rates were
calculated based on records from all states with available data at any
time during 2009 and 2014. The 2nd phase of the analysis used data
from Tennessee vital records to assess sociodemographic
characteristics, gravidity, health behaviors, and other infections
during pregnancy associated with HCV infection in pregnancy. Overall,
<1 percent of data for variables included in the study were missing,
with the exception of timing of prenatal care, which was missing for
6.2 percent of records. To account for missing data, multiple
imputation using chained equations with 20 imputations was used. A
multivariable logistic regression model was fit to the data to
determine increased odds of HCV infection in pregnancy, simultaneously
adjusting for maternal age, education, marital status, race/ethnicity,
county of residence, number of previous pregnancies, late or no
prenatal care, smoking during pregnancy, and other infections present
at delivery, including chlamydia, gonorrhea, syphilis, herpes simplex
virus, and HBV. The statistical significance level was set to p<0.05
for all tests. The study was approved by the Tennessee Department of
Health's institutional review board.

During 2009-2014, the prevalence of maternal HCV infection among
reporting states increased 89 percent, from 1.8 to 3.4 per 1000 live
births (p<0.001). There was substantial state-to-state variation in
maternal HCV rates: in 2014, the highest rate (22.6 per 1000 live
births) was in West Virginia, and the lowest (0.7) was in Hawaii
(Figure 1 [for figures and table, see original URL - Mod.LL]). In
Tennessee, the prevalence of maternal HCV infection increased 163
percent, from 3.8 per 1000 live births in 2009 to 10.0 in 2014
(p<0.001). Within Tennessee, there was substantial variation among 95
counties, with the highest rates in the 52 Appalachian counties in the
eastern part of the state. For example, in 2014, Campbell County had
the highest rate in Tennessee (78 per 1000 births); 19 other counties
had rates of less or equal 1 per 1000 births, including 18 counties
that reported no cases (Figure 2). Analysis of maternal HCV infection
rates based on hospital discharge data resulted in similar findings.

In adjusted analyses of Tennessee births from 2009 to 2014, compared
with women without HCV infection, women with diagnosed HCV at the time
of live birth had higher odds of having a high school education or
less, being unmarried, having late or no prenatal care, and smoking
cigarettes. Compared with pregnant non-Hispanic white women,
non-Hispanic black women had nearly 80 percent lower odds, and
Hispanic women nearly 70 percent lower odds of having a diagnosis of
HCV. Residing in a rural county was also associated with higher odds
of maternal HCV infection. When compared with large central metro
areas (counties with more than 1 000 000 population), the odds of HCV
infection among pregnant women from rural areas (counties with less
than 50 000 population) were 3-fold higher. Concurrent infections also
were associated with higher odds of having an HCV diagnosis, with HBV
infection resulting in nearly 17-fold increased odds of HCV (Table).

Discussion
----------
From 2009 to 2014, the prevalence of HCV infection among US women
giving birth in reporting states nearly doubled. This increase in
maternal HCV infection mirrors increases in HCV infection incidence
among adults, particularly nonpregnant young adults in the USA. A
recent study identified a similar increase in HCV prevalence among
women with recent live births (2); this study builds upon those
findings, identifying several patient-level characteristics associated
with maternal HCV infection, including white race, rural county
residence, cigarette smoking during pregnancy, having a high school
education or less, and having a concurrent HBV infection. In the USA,
CDC and the American College of Obstetricians and Gynecologists
recommend selective screening of pregnant women at high risk for HCV
infection (i.e., history of injection drug use or long-term
hemodialysis) (3). These data might inform expansion of the definition
of women at risk, thereby improving clinical detection, particularly
in areas of a state reporting increasing or high rates of incident HCV
infection.

The recent increase in maternal HCV infection appears to have
disproportionately affected rural and white populations; states and
Tennessee counties with the highest prevalence of HCV infection among
pregnant women in 2014 were in predominately Appalachian regions. A
recent analysis of state surveillance data examining acute HCV
infections in the general population found a near doubling of cases in
the USA during 2006-2012, and also found that states in or near
Appalachian regions had the highest numbers of cases (4), suggesting
that primary prevention and testing and treatment strategies for HCV
infection could be targeted to these populations and areas at high
risk.

This increase in HCV infection is particularly concerning in light of
recent research highlighting poor follow-up of HCV-exposed infants
(5). The rate of vertical transmission from infected mothers to
infants is estimated at 6 percent (11 percent if the mother is
coinfected with human immunodeficiency virus [HIV]) (6); therefore, it
is important that exposed infants be followed for evidence of
seroconversion. Because passively acquired maternal antibodies can
persist for up to 18 months, anti-HCV antibody tests cannot be
completed until that time; however, testing for HCV RNA can be
performed earlier (7). A recent study in Philadelphia found that only
16 percent of HCV-exposed infants were appropriately followed (5),
suggesting that infected infants might go undetected.

The increase in maternal HCV infection coincides with the rising
heroin and prescription opioid epidemics occurring in the USA that
have also disproportionately affected rural and white populations (8,
9). There has also been a recent surge in opioid use among pregnant
women (8). Whereas HCV infections have historically been associated
with heroin use, a recent outbreak of HIV and HCV in rural Indiana
demonstrates that these infections can also be transmitted through use
of injectable forms of prescription opioids (10).

The findings in this report are subject to at least 3 limitations.
First, vital records data rely on accurate coding of birth
certificates; some variables such as HCV might be undercoded, and
misclassification bias might occur. However, evaluation of hospital
administrative data reporting of HCV infections suggests that this
effect is small. Second, the proportion of live births from which data
were collected on HCV status increased during the study period, as
more states adopted the revised certificate each year. Because the
original reporting states in 2009 were not held constant over time for
this analysis, it is possible the trend could be subject to
ascertainment bias; however, 2 additional confirmatory analyses were
performed: 1) comparison with the National Inpatient Sample
demonstrated similar rates of HCV infection during 2009-2013 (1.8 per
1000 to 3.1 per 1000), and 2) the same trend analysis was performed
holding the original 28 reporting states in 2009 constant. Results
were the same as when using all 47 states that incorporated reporting
over time. Because women are not universally screened for HCV in
pregnancy, these estimates and analyses do not represent the actual
prevalence of HCV in pregnant women. However, the findings of
increased disease prevalence among white and rural populations are
similar to those of recent studies in nonpregnant populations (4).
Instances of multiple births might have resulted in a slight
overestimation of rates of maternal HCV infection. Finally, it is
important to consider that HCV infections in a given state might
represent not only the prevalence of a condition but also the public
health efforts implemented to detect and treat the infection.

The prevalence of maternal HCV infection appears to have increased
sharply in the USA, presenting concerns for maternal and child health.
Ensuring that women of childbearing age have access to HCV testing and
treatment and consideration of universal screening among women of
reproductive age residing in areas with high HCV prevalence might
mitigate risk and prevent transmission.

References
----------
1. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD and Swan T: Toward a
more accurate estimate of the prevalence of hepatitis C in the United
States. Hepatology 2015;62(5): 1353-1363.
Available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751870/>.
2. Koneru A, Nelson N, Hariri S, et al: Increased hepatitis C virus
(HCV) detection in women of childbearing age and potential risk for
vertical transmission--United States and Kentucky, 2011-2014. MMWR
Morb Mortal Wkly Rep 2016;65(28): 705-710.
Available at: <https://www.cdc.gov/mmwr/volumes/65/wr/mm6528a2.htm>.
3. American College of Obstetricians and Gynecologists: ACOG practice
bulletin no. 86: viral hepatitis in pregnancy. Obstet Gynecol
2007;110(4): 941-956.
4. Suryaprasad AG, White JZ, Xu F, et al: Emerging epidemic of
hepatitis C virus infections among young nonurban persons who inject
drugs in the United States, 2006-2012. Clin Infect Dis 2014;59(10):
1411-1419.
Available at:
<https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu643>.
5. Kuncio DE, Newbern EC, Johnson CC and Viner KM: Failure to test and
identify perinatally infected children born to hepatitis C-positive
women. Clin Infect Dis 2016;62(8): 980-985.
Available at:
<https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw026>.
6. Benova L, Mohamoud YA, Calvert C and Abu-Raddad LJ: Vertical
transmission of hepatitis C virus: systematic review and
meta-analysis. Clin Infect Dis 2014;59(6): 765-773.
Available at:
<https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu447>.
7. American Academy of Pediatrics. Red book: 2012 report of the
Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2012
8. Patrick SW, Dudley J, Martin PR, et al: Prescription opioid
epidemic and infant outcomes. Pediatrics 2015;135(5): 842-850.
Available at:
<http://pediatrics.aappublications.org/content/135/5/842.long>.
9. Zibbell JE, Iqbal K, Patel RC, et al: Increases in hepatitis C
virus infection related to injection drug use among persons aged ≤30
years--Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012.
MMWR Morb Mortal Wkly Rep 2015;64(17): 453-458.
Available at:
<https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6417a2.htm>.
10. Conrad C, Bradley HM, Broz D, et al: Community outbreak of HIV
infection linked to injection drug use of oxymorphone--Indiana, 2015.
MMWR Morb Mortal Wkly Rep 2015;64(16): 443-444.
Available at:
<https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6416a4.htm>.

[Authors: Patrick SW, Bauer AM, Warren MD, Jones TF and Wester C]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Hepatitis C infection during pregnancy can also be associated with
intrauterine fetal growth restriction as reported in this paper:
Huang QT, Hang LL, Zhong M, Gao YF, Luo ML and Yu YH: Maternal HCV
infection is associated with intrauterine fetal growth disturbance: A
meta-analysis of observational studies. Medicine (Baltimore).
2016;95(35):e4777. doi: 10.1097/MD.0000000000004777.
Available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008616/>.

Abstract
--------
Since the evidence regarding the association between maternal
hepatitis C virus (HCV) infection and impaired intrauterine fetal
growth had not been conclusive, the aim of the present study was to
evaluate the risk of maternal HCV infection in association with
intrauterine fetal growth restriction (IUGR) and/or low birth weight
infants (LBW). We performed an extensive literature search of PubMed,
MEDLINE, and EMBASE through [1 Dec 2015]. The odds ratios (ORs) of HCV
infection and IUGR/LBW were calculated and reported with 95 percent
confidence intervals (95 percent CIs). Statistical analysis was
performed using RevMen 5.3 and Stata 10.0. Seven studies involving 4
185 414 participants and 5094 HCV infection cases were included.
Significant associations between HCV infection and IUGR
(OR = 1.53, 95 percent CI: 1.40-1.68, fixed effect model) as well
as LBW were observed (OR = 1.97, 95 percent CI: 1.43-2.71, random
effect model). The results still indicated consistencies after
adjusting for multiple risk factors which could affect fetal growth,
including maternal age, parity, maternal smoking, alcohol abuse, drugs
abuse, coinfected with HBV/HIV and preeclampsia. Our findings
suggested that maternal HCV infection was significantly associated
with an increased risk of impaired intrauterine fetal growth. In
clinical practice, a closer monitoring of intrauterine fetal growth by
a series of ultrasound might be necessary for HCV-infected pregnant
population.
- Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/244>.]

[See Also:
Hepatitis C - USA (07): injection drug use
http://promedmail.org/post/20170523.5056188
Hepatitis C - USA (06): injection drug use, state policies
http://promedmail.org/post/20170513.5034250
Hepatitis C - USA (05): (MN) injection drug use
http://promedmail.org/post/20170430.5004619
Hepatitis C - USA (04): (MA) injecting drug use
http://promedmail.org/post/20170428.5002070
Hepatitis C - USA (03): (NH) injection drug use
http://promedmail.org/post/20170405.4949994
Hepatitis B & C - global: WHO update
http://promedmail.org/post/20170421.4985250
Hepatitis C - USA (02): (TX) reused saline flush syringes, 2015
http://promedmail.org/post/20170309.4890696
Hepatitis C - USA: (IA) http://promedmail.org/post/20170223.4860273
2016
----
Hepatitis C - USA (13): (MA,KY) injection drug use
http://promedmail.org/post/20161118.4638318
Hepatitis C - USA (12): (AK) injection drug use
http://promedmail.org/post/20161021.4576120
Hepatitis C - USA (11): (AL) injection drug use
http://promedmail.org/post/20161018.4568826
Hepatitis C - USA (10): (IN) injecting drug use
http://promedmail.org/post/20161004.4535910
Hepatitis C - USA (09): (MA) injecting drug use
http://promedmail.org/post/20160909.4477541
Hepatitis B - USA (07) :(ME) injection drug use
http://promedmail.org/post/20160907.4469090
Hepatitis C - USA (08): (AK) injecting drug use
http://promedmail.org/post/20160827.4445804
Hepatitis C - USA (07): (KY) injecting drug use, pregnant women
http://promedmail.org/post/20160808.4400600
Hepatitis B & C - USA (02): (WV) cardiac tests, expanded numbers, RFI
http://promedmail.org/post/20160619.4296498
Hepatitis B - USA (06): (ME) injection drug use
http://promedmail.org/post/20160615.4289817
Hepatitis C - USA (06): (UT) nosocomial spread
http://promedmail.org/post/20160405.4140235
Hepatitis C - USA (05): fatalities, chronic infection
http://promedmail.org/post/20160404.4136310
Hepatitis B & C - USA: (WV) cardiac tests
http://promedmail.org/post/20160329.4126017
Hepatitis B - USA (04): (NC) injection drug use, 2015
http://promedmail.org/post/20160303.4063893
Hepatitis C - USA (04): (KY) injection drug use
http://promedmail.org/post/20160202.3986782
Hepatitis C - USA (03): (IN) injection drug use
http://promedmail.org/post/20160130.3980174
Hepatitis C - USA (02): (FL) injection drug use
http://promedmail.org/post/20160110.3923357
Hepatitis C - USA (01): (UT) nosocomial spread, RFI
http://promedmail.org/post/20160108.3921477
Hepatitis B - USA (02): injection drug use, comment
http://promedmail.org/post/20160206.3999152
Hepatitis B - USA: (KY, WV, TN) injection drug use
http://promedmail.org/post/20160130.3980173]
.................................................sb/ll/ao/lxl/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php

Posted on 5/23/2017 01:06:00 PM | Categories:

PRO/EDR> Hepatitis C - USA (07): injection drug use

HEPATITIS C - USA (07): INJECTION DRUG USE
******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1] Washington State
Date: Wed 17 May 2017, 11:35 AM
Source: The Courier Herald [edited]
<http://www.courierherald.com/news/hepatitis-c-infections-spike-from-opioid-epidemic-tacoma-pierce-county-health-department/>


Viral hepatitis C may affect thousands of Pierce County residents.
National Hepatitis Awareness month calls attention to the potentially
deadly infection that can cause cirrhosis or liver cancer -- and how
to avoid it.

"Cases of acute and chronic hepatitis C in Pierce County are on a
dramatic rise, especially among young people," said Kim Desmarais,
Tacoma-Pierce County Health Department viral hepatitis coordinator.
"Before 2013, we saw up to 5 cases a year. Now we see up to 5 cases a
month." In response to the increase in cases, the health department
works with medical providers and community partners to report, test,
and manage patients with hepatitis C. The department also works to
make sure these patients understand ways to stop the spread of the
virus, and find treatment options for hepatitis and drug addiction.
Injection drug use spreads hepatitis C.

Reports the Health Department receives of new hepatitis C cases are
just the tip of the iceberg. Many with the infection may not know they
have it. The Health Department estimates the new cases reported
monthly in Pierce County represent fewer than 10 percent of the actual
total. According to the CDC, as many as 3.9 million Americans have
hepatitis C, but only half know they're infected. The number of people
who have had hepatitis C for a long time but are just now finding out
has increased because of a recommendation for doctors to routinely
test people in the baby boomer generation.

Heroin and other illegal injection drug use are factors in the
nationwide increase of hepatitis C cases, according to the CDC. Shared
drugs and syringes spread the infection. In a 2015 survey, the
University of Washington Alcohol and Drug Abuse Institute asked 77
needle exchange participants in Pierce County (referenced in the
Opioid Trends for Pierce County Report) which drugs they injected. The
majority (74 percent) said heroin, 22 percent said methamphetamine.
When the ADAI looked at survey results from 18 needle exchange
programs in the state, including Pierce County, researchers found 69
percent injected heroin and 22 percent methamphetamine.

Healthcare professionals can now treat and cure hepatitis C in as
little as 8 weeks with very few side effects. In the past, medication
was not as effective, took almost a year to work, and caused severe
side effects. For these reasons, many patients decided not to take
them. People with previously diagnosed hepatitis C should ask their
doctor for a referral to a specialist who can evaluate them for the
newer treatment.

During May 2017, people can learn their exposure risk, the
consequences if they don't get treatment and the importance of
testing. May 19 is National Hepatitis Testing Day.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

******
[2] Pennsylvania - interventions
Date: Wed 17 May 2017
Source: Governing Magazine/Tribune News Service, The Philadelphia
Inquirer report [edited]
<http://www.governing.com/topics/health-human-services/Hepatitis-C-Patients-Will-Receive-Treatment-Through-Medicaid-in-Pa.html>


Under pressure from advocacy organizations that had threatened a
lawsuit, the Wolf administration said [Tue 16 May 2017], that it would
expand Medicaid coverage for treatment of hepatitis C, a major change
that many states have put off over fear of spiraling costs. "Today's
announcement means that thousands of vulnerable Pennsylvanians will
soon have easier access to pharmaceuticals that can cure hepatitis C,"
Department of Human Services Secretary Ted Dallas said in a
statement.

Until now, state policy had been to wait until patients showed signs
of liver damage before approving treatment. Allowing earlier treatment
was recommended 1 year ago by the department's Pharmacy and
Therapeutics Committee. As time passed without a decision, observers
wondered whether the state was trying to determine how to pay for the
highly effective but costly new drugs that have made hepatitis C a
curable disease.

New hepatitis C infections tripled in 5 years, the CDC reported last
week, driven largely by the opioid epidemic. The bloodborne hepatitis
C virus is easily spread by sharing needles to inject heroin or
crushed prescription pain pills. But the virus can grow undetected for
decades before causing chronic and sometimes life-threatening liver
problems. An estimated 3 million Americans are living with chronic
hepatitis C, about half of them undiagnosed. The new website HepVu
estimated last month that 142 000 Pennsylvania residents are living
with hepatitis C antibodies and 629 died of the disease in 2014, the
latest estimates available. It said 91 000 New Jersey residents had
antibodies and 446 had died that year.

New drugs that can effectively cure hepatitis C with minimal side
effects began coming on the market several years ago but, as they cost
tens of thousands of dollars per patient, many states limited their
use to those whose disease had shown up on liver tests, and added
other restrictions -- barriers that exist for no other disease.

"Hopefully, what this means is I no longer have to tell patients that
their liver isn't sick enough," said Stacey B. Trooskin, an infectious
diseases physician and director of viral hepatitis programs for
Philadelphia FIGHT, a nonprofit health and social services
organization. Trooskin said she likely had dozens of patients who
would now qualify for coverage. She said that policymakers' fears that
many Medicaid recipients would get tested and seek treatment were
overblown. "In reality, it will be more like a trickle," she said.

Hepatitis C severity is categorized on a scale of F0 through F4, with
F4 being the most severe. Previously, only patients with scores of F2
through F4 were eligible for treatment under Pennsylvania Medicaid
unless they had other complications. Effective [1 Jul 2017], patients
with scores of F1 will be covered, the state said in its announcement,
and those with scores of F0 will be covered beginning [1 Jan 2018].

About a dozen other states have loosened restrictions in the last few
years, some under pressure from advocates. New Jersey eased its
restrictions last year but only down to F2, which has not satisfied
physicians or advocacy groups.

In his statement, Dallas thanked several organizations, including
Harvard Law School's Center for Health Law and Policy Innovation, for
their help "on finding a path forward". The center has sued or
threatened to sue several states to force decisions. It reached a
settlement with Delaware in 2016.

Kevin Costello, the center's litigation director, said that the "overt
threat of a lawsuit" had kept the pressure on Harrisburg to approve
the change. Costello said it was not likely to be nearly as costly as
some have predicted. For that reason -- as well as the tendency to
budget for the short term -- the possibility of future cuts to state
Medicaid programs as Congress considers repealing and replacing the
Affordable Care Act probably was not a significant impediment to
Pennsylvania's decision to drop restrictions on hepatitis C coverage,
he said.

The oft-quoted prices -- USD 84 000 for a typical 12-week course of
Gilead Sciences' Sovaldi, for example -- have dropped with additional
competition, Costello said, and state Medicaid programs have improved
their negotiating tactics and applied substantial discounts. Indeed, a
Gilead spokesman said in an email late [Tue 16 May 2017] that "the
average Medicaid price per bottle is now less than USD 10 000" -- a
total of USD 30 000 for 12 weeks -- "for states that provide open
access to all patients."

The Obama administration sent pointed letters to state Medicaid
programs about requirements to cover treatment, and challenged
pharmaceutical makers to lower prices.

In Pennsylvania, about 3750 people infected with hepatitis C will
likely be affected by the policy change, said Rachel Kostelac, a
spokeswoman for the Department of Human Services. "The state's annual
contribution to the Medicaid program is approximately USD 12 billion.
The fiscal impact of this policy change is well below one-half of 1
percent of the state's current costs," Kostelac said in an email
response to questions.

"The real problem here," said Gene Bishop, a retired internist and
member of the advisory committee that recommended the change on 17 May
2016, is the pharmaceutical companies, which are charging "outrageous
prices for life-saving treatment." Bishop made last the 2016 motion
recommending that the state's Medicaid program cover treatment for all
patients. It was supported by every practitioner on the committee and
opposed by every member on the payer side, she recalled, adding that
she had not expected the motion to prevail.

[Byline: Don Sapatkin]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

******
[3] Missouri
Date: Wed 17 May 2017, 6:27 PM
Source: KSHB [edited]
<http://www.kshb.com/news/local-news/hepatitis-c-rising-in-kansas-city-with-opioid-epidemic-rediscover-says>


The opioid epidemic in the United States is bringing about another
serious problem: Hepatitis C. New data from the CDC shows new Hep C
infections almost tripled in 5 years. New infections rose from 850 in
2010 to 2436 in 2015. It's taking a toll in the Kansas City metro,
where ReDiscover says 1 in 5 people who walk into its opioid treatment
clinic will be diagnosed with Hep C.

One woman calls herself an old drug addict but is now using her story
to help educate others. "I remember the exact night I got Hep C,"
Duffel said. Her drug addiction was so powerful she picked up a heroin
needle her infected husband had just used. "The next minute I'm
looking at the syringe thinking, I want that so bad, and I know if I
use his needle, it was the only one, I would get Hep C," she said. "I
remember as I was pushing it in my arm I'm going, I'm sick. I'm going
to be really sick. And I was." She is one of millions of Americans who
have Hepatitis C, a disease that destroys the liver.

The face of this disease is getting younger and younger. Sarita Wise,
a nurse at ReDiscover's drug treatment clinic, says the opioid
epidemic is to blame. Since January 2017, out of 22 new clients at the
clinic, 16 tested positive for Hep C. The CDC says the highest rates
of Hep C are among young people who inject drugs, and the same group
accounts for 75 percent of new Hep C cases a year.

The disease is highly contagious. "Dried blood, equipment used for
making drugs, whether it's snorting it or with straws, tourniquets,
cotton balls. If they're not aware there are even small amounts of
blood on it, they can infect themselves that way," Wise said.

Many of the patients that go to drug treatment clinics may be
low-income and don't go to a primary care physician regularly, so the
disease goes undetected. Wise says that's when it does real damage. "I
think that's why we're starting to see the trend in the opioid
treatment programs because we're doing that initial screening
up-front. That's also to educate them about why they should continue
to come to our programs, so they won't engage in risky behaviors,"
Wise said.

ReDiscover says while it is good news that young people are being
diagnosed early on, many people, like this woman, can't afford the Hep
C drug treatments. They can cost tens of thousands of dollars, but can
also cure the disease. ReDiscover has to rely heavily on federal
grants that can help people get access.

[Byline: Sarah Plake]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Most cases of acute hepatitis C are not recognized or reported
because they are asymptomatic or anicteric (without jaundice) so the
case numbers are likely underreported.

In the absence of a vaccine for hepatitis C (as are available for
hepatitis A and B), infection avoidance techniques such as needle
exchange programs and the need for aggressive available programs in
counseling, not criminalizing, substance addiction are vitally needed.
There is no evidence that government sponsored needle exchange
programs increase the amount of substance abuse. - Mod.LL

An additional (public health) benefit of treatment is that patients
who are cured no longer transmit hepatitis C. Thus treatment is also a
form of prevention. - Mod.LM

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/227>.]

[See Also:
Hepatitis C - USA (06): injection drug use, state policies
http://promedmail.org/post/20170513.5034250
Hepatitis C - USA (05): (MN) injection drug use
http://promedmail.org/post/20170430.5004619
Hepatitis C - USA (04): (MA) injecting drug use
http://promedmail.org/post/20170428.5002070
Hepatitis C - USA (03): (NH) injection drug use
http://promedmail.org/post/20170405.4949994
Hepatitis B & C - global: WHO update
http://promedmail.org/post/20170421.4985250
Hepatitis C - USA (02): (TX) reused saline flush syringes, 2015
http://promedmail.org/post/20170309.4890696
Hepatitis C - USA: (IA) http://promedmail.org/post/20170223.4860273
2016
----
Hepatitis C - USA (13): (MA,KY) injection drug use
http://promedmail.org/post/20161118.4638318
Hepatitis C - USA (12): (AK) injection drug use
http://promedmail.org/post/20161021.4576120
Hepatitis C - USA (11): (AL) injection drug use
http://promedmail.org/post/20161018.4568826
Hepatitis C - USA (10): (IN) injecting drug use
http://promedmail.org/post/20161004.4535910
Hepatitis C - USA (09): (MA) injecting drug use
http://promedmail.org/post/20160909.4477541
Hepatitis B - USA (07) :(ME) injection drug use
http://promedmail.org/post/20160907.4469090
Hepatitis C - USA (08): (AK) injecting drug use
http://promedmail.org/post/20160827.4445804
Hepatitis C - USA (07): (KY) injecting drug use, pregnant women
http://promedmail.org/post/20160808.4400600
Hepatitis B & C - USA (02): (WV) cardiac tests, expanded numbers, RFI
http://promedmail.org/post/20160619.4296498
Hepatitis B - USA (06): (ME) injection drug use
http://promedmail.org/post/20160615.4289817
Hepatitis C - USA (06): (UT) nosocomial spread
http://promedmail.org/post/20160405.4140235
Hepatitis C - USA (05): fatalities, chronic infection
http://promedmail.org/post/20160404.4136310
Hepatitis B & C - USA: (WV) cardiac tests
http://promedmail.org/post/20160329.4126017
Hepatitis B - USA (04): (NC) injection drug use, 2015
http://promedmail.org/post/20160303.4063893
Hepatitis C - USA (04): (KY) injection drug use
http://promedmail.org/post/20160202.3986782
Hepatitis C - USA (03): (IN) injection drug use
http://promedmail.org/post/20160130.3980174
Hepatitis C - USA (02): (FL) injection drug use
http://promedmail.org/post/20160110.3923357
Hepatitis C - USA (01): (UT) nosocomial spread, RFI
http://promedmail.org/post/20160108.3921477
Hepatitis B - USA (02): injection drug use, comment
http://promedmail.org/post/20160206.3999152
Hepatitis B - USA: (KY, WV, TN) injection drug use
http://promedmail.org/post/20160130.3980173]
.................................................sb/ll/ao/lxl/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php
Posted on 5/23/2017 12:59:00 PM | Categories:

PRO/EDR> Cholera, diarrhea & dysentery update (33): Africa

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (33): AFRICA
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Cholera - Tanzania, Angola, Mozambique
[2] Cholera - Sudan

******
[1] Cholera - Tanzania, Angola, Mozambique
Date: Tue 23 May 2017
Source: CAJ News Africa [edited]
<http://cajnewsafrica.com/2017/05/23/45-dead-in-current-cholera-outbreak/>


At least 45 people have been killed following an ongoing outbreak [of
cholera] in Southern Africa and Tanzania. Angola and Tanzania are
bearing the brunt with 20 and 15 deaths respectively. The water borne
disease is most severe in Mozambique where 2159 cases have been
recorded. As many as 4 people have died. In total, Southern Africa and
Tanzania have suffered 3848 cases according to the Joint Cholera
Initiative for Southern Africa (JCISA).

JCISA said for the last few weeks, Malawi, Mozambique, Zambia and
Zimbabwe had not recorded any cases while Angola was also reporting a
considerable reduction in incidents. However, the Tanzania outbreak,
even though considerably reduced, continued with sporadic cases
persisting in Dar-es-Salaam.

JCISA includes Tanzania in its assessment of Southern Africa owing to
its close proximity to most countries affected by cholera and the risk
associated with cross border movement. Health ministers from Malawi,
Mozambique and Zimbabwe met at the beginning of the month [May 2017]
to explore ways of addressing the cholera problem. A technical
workshop was also held in Harare last week [week 15 to 21 May 2017].

Cholera killed 291 people from over 19 000 cases in the region in
2016.

[Byline: Alloyce Kimbunga]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2] Cholera - Sudan
Date: Mon 22 May 2017
Source: All Africa, a Radio Dabanga report [edited]
<http://allafrica.com/stories/201705230146.html>


More than 10 people died of cholera and at least 39 new cases were
recorded in White Nile state last week [week 15 to 21 May 2017]. An
activist urged the declaration of the State of Emergency in order to
contain the spread of the disease in White Nile and neighbouring
Khartoum and Sennar.

On [Sun 21 May 2017], civil society activist Abdelrahman El Siddig
told Radio Dabanga from Rabak that representatives of White Nile civil
society organisations have carried out field trips to hospitals and
medical isolation centres in Asalaya, El Jezira Aba, and Rabak. "At
least 10 patients died and 35 new infections were reported in the area
of Asalaya last week. Another 4 new cases were recorded in El Gezira
Aba on [Sat 20 May 2017], he said.

According to El Siddig, the continuing spread of the infectious
disease in the area of Asalaya is caused by the pollution of water
with the wastes of the large Asalaya sugar factory. The activist
called on the authorities to declare the State of Emergency in order
to contain the large spread of the disease in White Nile state and the
neighbouring Khartoum and Sennar states. He also appealed to the World
Health Organisation, international and Sudanese health organisations
and associations to act urgently to combat the spread of cholera.

Residents of El Salam village in Asalaya have turned the Khalifa Basic
School into a field hospital for cholera patients, after 2 women and a
man died on [Sat 20 May 2017], at the health centre of the Asalaya
Sugar Factory. "The factory management closed the door for new cholera
patients for fear that the disease may spread among the factory
workers," an activist from the village told this station.

The number of people infected with cholera in neighbouring Sennar
state is increasing again since early May 2017. A total of 6 new
cholera cases were recorded in the area of El Mazmum on [Fri 19 and
Sat 20 May 2017]. Last week [week 15 to 21 May 2017], 3 cholera
patients died in the Abuareef health centre, and 2 in El Dali.

Though Sudanese medics have confirmed that the disease definitely
concerns cholera, federal health authorities continue to deny its
presence, and have instructed all medics and health workers to speak
about watery diarrhoea instead. Cholera "seems to be a stigma for the
government," a UK-based Sudanese specialist told Radio Dabanga in
January [2017]. He said he fears that the current situation will turn
into a long-lasting outbreak. Medical sources speak about thousands of
people who are infected with cholera in the country. The death toll
has climbed into the hundreds.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Contaminated water remains the major risk factor for the acquisition
of _V. cholerae_. As reported in Africa (currently particularly in the
Horn of Africa) periods of flooding and drought increase the risk of
outbreaks.

As demonstrated in Haiti and now in Yemen, the introduction of cholera
into a country with a destroyed sanitary system and no underlying
immunity can cause a major epidemic. In the classical endemic areas
such as the Indian subcontinent and other areas in Asia, rainy seasons
often accentuate the number of cases. Acute watery diarrhea is often
used as an alternative term for cholera, the primary cause of
outbreaks of watery diarrhea with fatalities in adults. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/96>.]

[See Also:
Cholera, diarrhea & dysentery update (32): Asia (Yemen)
http://promedmail.org/post/20170522.5053352
Cholera, diarrhea & dysentery update (31): Africa
http://promedmail.org/post/20170520.5045580
Cholera, diarrhea & dysentery update (30): Asia (Yemen)
http://promedmail.org/post/20170519.5047675
Cholera, diarrhea & dysentery update (29): Asia (Yemen)
http://promedmail.org/post/20170517.5043339
Cholera, diarrhea & dysentery update (28): Africa (Horn of Africa)
http://promedmail.org/post/20170517.5040909
Cholera, diarrhea & dysentery update (27): Asia (Yemen)
http://promedmail.org/post/20170515.5037318
Cholera, diarrhea & dysentery update (26): Asia (Yemen)
http://promedmail.org/post/20170514.5034914
Cholera, diarrhea & dysentery update (25): Asia (Yemen)
http://promedmail.org/post/20170513.5034230
Cholera, diarrhea & dysentery update (24): Africa, Asia
http://promedmail.org/post/20170510.5026111
Cholera, diarrhea & dysentery update (23): Asia (Yemen)
http://promedmail.org/post/20170509.5024479
Cholera, diarrhea & dysentery update (22): Asia
http://promedmail.org/post/20170508.5018280
Cholera, diarrhea & dysentery update (21): Asia (Yemen)
http://promedmail.org/post/20170506.5016310
Cholera, diarrhea & dysentery update (20) Africa, Americas
http://promedmail.org/post/20170505.5015480
Cholera, diarrhea & dysentery update (19): Africa
http://promedmail.org/post/20170504.5012967
Cholera, diarrhea & dysentery update (18): Americas (Haiti)
http://promedmail.org/post/20170503.5010507
Cholera, diarrhea & dysentery update (17): Americas (Haiti)
http://promedmail.org/post/20170428.5001853
Cholera, diarrhea & dysentery update (16): Africa (Horn of Africa)
http://promedmail.org/post/20170425.4994572
Cholera, diarrhea & dysentery update (15): Africa, Asia
http://promedmail.org/post/20170423.4989180
Cholera, diarrhea & dysentery update (14): Americas, Asia
http://promedmail.org/post/20170418.4974872
Cholera, diarrhea & dysentery update (13): Asia
http://promedmail.org/post/20170417.4974438
Cholera, diarrhea & dysentery update (12): Africa
http://promedmail.org/post/20170416.4974364
Cholera, diarrhea & dysentery update (11): Africa, Asia
http://promedmail.org/post/20170402.4942849
Cholera, diarrhea & dysentery update (10): Africa
http://promedmail.org/post/20170323.4916153
Cholera, diarrhea & dysentery update (09): Africa
http://promedmail.org/post/20170313.4898254
Cholera, diarrhea & dysentery update (08): Asia (Yemen)
http://promedmail.org/post/20170308.4887994
Cholera, diarrhea & dysentery update (07): Americas
http://promedmail.org/post/20170227.4866520
Cholera, diarrhea & dysentery update (06): Africa
http://promedmail.org/post/20170217.4846873
Cholera, diarrhea & dysentery update (05): Africa, Asia
http://promedmail.org/post/20170216.4841639
Cholera, diarrhea & dysentery update (04): Asia (Yemen)
http://promedmail.org/post/20170125.4790713
Cholera, diarrhea & dysentery update (03): Americas (Haiti)
http://promedmail.org/post/20170113.4763806
Cholera, diarrhea & dysentery update (02): Africa
http://promedmail.org/post/20170113.4751889
Cholera, diarrhea & dysentery update (01): Asia (Yemen) WHO
http://promedmail.org/post/20170105.4742075]
.................................................ll/ao/ll/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php
Posted on 5/23/2017 12:51:00 PM | Categories:

PRO/EDR> Botulism - USA (09): (CA) gas station food, nacho cheese conf, fatal

BOTULISM - USA (09): (CALIFORNIA) GAS STATION FOOD, NACHO CHEESE
CONFIRMED, FATAL
*********************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 22 May 2017 8:15 PM ET
Source: NBC News [edited]
<http://www.nbcnews.com/health/health-news/botulism-confirmed-california-nacho-cheese-outbreak-n763326>


Gas station nacho cheese that sickened 10 people and killed one of
them was contaminated with botulinum toxin, the California Department
of Public Health (CDPH) confirmed Mon 22 May 2017. "The nacho cheese
sauce was removed from sale on 5 May 2017. (The California Department
of Public Health) believes there is no continuing risk to the public,"
the agency said in a statement.

"While there are still unanswered questions about this outbreak, these
tragic illnesses are important reminders to be vigilant about food
safety," said CDPH Director Dr Karen Smith. "As we head into the
summer barbecue season, both indoor and outdoor chefs need to be on
guard against all foodborne illnesses."

Botulism is caused by toxic bacteria, usually _Clostridium botulinum_
but sometimes _C. butyricum_ and _C. baratii_. It is best known as the
illness caused by home-canned foods but is also found in honey.
Home-made potato salad served at an Ohio church picnic killed one
person and sickened 29 in 2015.

A big enough dose of the toxin can paralyze and kill people. Symptoms
of botulism include blurred vision, drooping eyelids, slurred speech,
and muscle weakness. "Botulism can be treated with antitoxin and
supportive care, often in an intensive care unit. Botulism is fatal in
about 5 percent of cases," the CDPH said.

The nacho cheese outbreak was traced to a Sacramento area service
station. The San Francisco County coroner's office said the person who
died was a 37-year-old man.

Botulism can be a silent killer, the Centers for Disease Control and
Prevention says. "Home-canned foods could be contaminated but look,
smell and taste normal," the CDC said. "If there is any doubt about
whether safe canning guidelines have been followed, do not eat the
food. Home-canned food might be contaminated if the container is
leaking, bulging, or swollen (or) the container looks damaged,
cracked, or abnormal."

[Byline: Maggie Fox]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Since no recall resulted from this cluster, it is presumed that the
contamination of the cheese sauce was a local issue. The severity of
the illnesses suggests that serotype A botulinum toxin was involved,
which tends to cause more severe and prolonged neurotoxicity. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/372>.]

[See Also:
Botulism - USA (08): (CA) gas station food, nacho cheese
http://promedmail.org/post/20170519.5047996
Botulism - USA (07): (CA) gas station food, nacho cheese
http://promedmail.org/post/20170512.5031065
Botulism - USA (06): (CA) gas station food, RFI
http://promedmail.org/post/20170508.5021002
Botulism - USA (05): deer antler herbal tea, FDA recall
http://promedmail.org/post/20170507.5018201
Botulism - USA (04): (CA) deer antler tea
http://promedmail.org/post/20170429.5003486
Botulism - USA (03): (TX) wound, drug-related, 2005-2015
http://promedmail.org/post/20170427.4999639
Botulism - USA (02): (CA) satay, risk, recall
http://promedmail.org/post/20170420.4982801
Botulism - USA: (CA) wound, non-drug-related
http://promedmail.org/post/20170402.4942916
2016
----
Botulism - USA (11): (NM) wound, drug-related
http://promedmail.org/post/20161004.4535918
Botulism - USA (10): soups, risk, recall
http://promedmail.org/post/20160911.4480731
Botulism - USA (09): (NM) wound, drug-related
http://promedmail.org/post/20160716.4350262
Botulism - USA (08): vacuum packed fish, risk, recall
http://promedmail.org/post/20160623.4302950
Botulism - USA (07): (MS) prison brew
http://promedmail.org/post/20160615.4288676
Botulism - USA (06): (NY,CA) dried salted uneviscerated fish, risk,
recall http://promedmail.org/post/20160426.4184418
Botulism - USA (05): vegetable soup, risk, recall
http://promedmail.org/post/20160421.4174551
Botulism - USA (04): (WA) fatal, conf
http://promedmail.org/post/20160302.4062476
Botulism - USA (03): (OH,CA) jarred pesto, 2014
http://promedmail.org/post/20160227.4052791
Botulism - USA (02): (WA) fatal, RFI
http://promedmail.org/post/20160221.4037933
Botulism - USA: (MN) uneviscerated fish, recall
http://promedmail.org/post/20160115.3935285]
.................................................ll/mj/lxl/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php
Posted on 5/23/2017 11:18:00 AM | Categories:

PRO/AH/EDR> Crayfish plague - Ireland: white-clawed crayfish

CRAYFISH PLAGUE - IRELAND: WHITE-CLAWED CRAYFISH
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 18 May 2017
Source: Inland Fishers Ireland [edited]
<https://tinyurl.com/ksoxvae>


All water users are being urged to take precautions after confirmation
of an outbreak of crayfish plague on a stretch of the River Suir
downstream of Clonmel to Carrick-on-Suir. It comes after large numbers
of dead freshwater crayfish were reported on the river earlier this
month [May 2017]. DNA analysis has now confirmed that the cause of
death was crayfish plague.

The kill has only impacted white-clawed crayfish and other freshwater
animals are not affected. This is a characteristic feature of the
disease which only infects species of crayfish but causes 100 percent
mortality. All agencies, including the National Parks and Wildlife
Service, Inland Fisheries Ireland, and Tipperary County Council will
be working to contain the outbreak to this stretch of the River Suir.
Given the experience of outbreaks elsewhere, a total kill of the
population is expected which will have major consequences for the
ecology of the river. Crayfish are very common in the Suir and are
important in maintaining its ecology.

Anyone using the river is being urged to observe the 'check, clean,
and dry' protocol once they leave the river and before using it again.
This means that all wet gear (boats, clothing, and equipment) should
be checked for any silt or mud, plant material, or animals before
being cleaned and finally dried. Disinfectant or hot water (over 40
deg C [104 deg F]) should be used to clean all equipment and this
should be followed by a 24 hour drying period.

The drying period is especially important in ensuring that all
equipment is clear of infectious organism, including the removal of
any water inside the boat. The crayfish plague organism can be carried
on wet equipment to new sites and containment of the outbreak is
essential to prevent spread to other unaffected populations in
Ireland.

This is the 2nd confirmed outbreak of the disease in Ireland following
one in County Cavan in 2015. There is no indication of how the disease
reached the Suir although a link to the Cavan outbreak is considered
unlikely as the disease there appears to have run its course. This
outbreak on the River Suir is of great concern as the stretch of river
affected is popular with anglers and canoeists.

The white-clawed crayfish is a globally threatened species and Ireland
holds one of the largest surviving population. It is the only
freshwater crayfish species found in Ireland and is present in lakes,
rivers, and streams over much of the island. Throughout its European
range, this species has been decimated by the impact of crayfish
plague which spread to Europe with the introduction of North American
species of crayfish.

Until 2015, Ireland was considered free of the disease and it remains
the only European country without any established non-native crayfish
species.

If crayfish plague becomes established there is a high probability
that the white-clawed crayfish, which is currently protected under
Irish Law and the EU Habitats Directive, will be eliminated from much
of Ireland. If non-native crayfish are found to be established in
Ireland, this could have a severe impact on habitats as they can
destabilise canal and river banks by burrowing. It could also impact
other freshwater species, such as salmon and trout fisheries. At this
time however, there is no evidence that non-native freshwater crayfish
have been introduced in this country.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[_Austropotamobius pallipes_, the white-clawed crayfish of Western
European streams, has become restricted in distribution over the past
century.

Crayfish fungal plague, fatal to white-clawed crayfish, has affected
many European countries. It is caused by a fungus _Aphanomyces astaci_
that was brought into Europe by the introduction of _Procambarus
clarkii_, a freshwater crayfish species of Louisiana, USA, which is
naturally infected by this pathogen, although it does not develop
clinical disease.

For a picture of a white-clawed crayfish go to
<http://en.wikipedia.org/wiki/Austropotamobius_pallipes#mediaviewer/File:Austropotamobius_pallipes.jpg>.
- Mod.PMB

Maps of Ireland can be seen at
<http://www.vidiani.com/maps/maps_of_europe/maps_of_ireland/administrative_map_of_ireland.jpg>
and <http://healthmap.org/promed/p/60540>. - Sr.Tech.Ed.MJ]

[See Also:
2015
----
Crayfish plague - Ireland (02): white-clawed crayfish, conf, OIE
http://promedmail.org/post/20150902.3617359
Crayfish plague - Ireland: white-clawed crayfish mortality
http://promedmail.org/post/20150820.3591203
2014
----
Crayfish plague - UK: (England) white-clawed crayfish
http://promedmail.org/post/20141001.2821046
Crayfish plague - Taiwan: redclaw crayfish, OIE
http://promedmail.org/post/20140219.2287217
2013
----
Crayfish plague - Israel: (HM) OIE
http://promedmail.org/post/20131216.2118609
Crayfish plague - Norway: (NT) OIE
http://promedmail.org/post/20131022.2013248
2010
----
Crayfish plague - Italy: (VN) OIE
http://promedmail.org/post/20101126.4268
Crayfish plague - UK: England
http://promedmail.org/post/20101108.4054
2008
----
Crayfish plague - UK: (England)
http://promedmail.org/post/20080808.2444]
.................................................pmb/mj/lxl/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php
Posted on 5/23/2017 10:58:00 AM | Categories:

PRO/AH/EDR> Avian influenza (103): Libya (JG) poultry, LPAI H7, OIE

AVIAN INFLUENZA (103): LIBYA (AL JABAL AL GHARBI) POULTRY, LPAI H7,
OIE
***********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 21 May 2017
Source: OIE, WAHID (World Animal Health Information Database), weekly
disease information 2017; 30(21) [edited]
<http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review?page_refer=MapFullEventReport&reportid=23843>


Low pathogenic avian influenza (poultry), Libya
-----------------------------------------------
Information received on 21 May 2017 from Dr Abdelghani Hamed, Chairman
of the National Centre for Animal Health (NCAH) Chief Veterinary
Officer, National Centre for Animal Health (NCAH), Public Authority of
Agriculture, Livestock & Fisheries, Beida, Libya

Summary
Report type: immediate notification
Date of start of the event: 8 May 2017
Date of confirmation of the event: 16 May 2017
Reason for notification: recurrence of a listed disease
Date of previous occurrence: June 2013
Manifestation of disease: clinical disease
Causal agent: highly pathogenic avian influenza [LPAI] virus
Serotype: H7
Nature of diagnosis: laboratory (advanced)
This event pertains to the whole country.

New outbreaks (1)
Summary of outbreaks
Total outbreaks: 1
Outbreak 1: Alsabta, Gharian-Abuzian, Gharyan [Al Jabal al Gharbi
district]
Date of start of the outbreak: 8 May 2017
Outbreak status: continuing (or date resolved not provided)
Epidemiological unit: farm
Total animals affected
Species / Susceptible / Cases / Deaths / Killed and disposed of /
Slaughtered
Birds / 20 / - / 1 / 19 / 0

Epidemiology
Source of the outbreak(s) or origin of infection: contact with wild
species
Epidemiological comments: As part of general surveillance carried out
for avian influenza in the whole country under FAO project, samples
from domestic poultry farms were collected by the monitoring teams in
the Western Mountains, about 97 samples of different mountain regions.
One sample was positive in Abuzian area. Migratory birds were seen a
month ago in the area.

Control measures
Measures applied: screening, quarantine, stamping out, zoning,
disinfection, vaccination prohibited, no treatment of affected
animals
Measures to be applied: no other measures

Diagnostic test results
Laboratory name and type: National Central Veterinary Laboratory,
Tripoli (national laboratory)
Species / Test / Test date / Result
Birds / antigen (Ag) detection ELISA)/ 16 May 2017/ positive
Birds / real-time PCR / 16 May 2017 / positive

Future reporting
The event is continuing. Weekly follow-up reports will be submitted.

[The location of the outbreak can be seen on the interactive map
included in the OIE report at the source URL above.]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Low pathogenic avian influenza (LPAI) occurs naturally in wild birds
and can spread to domestic birds.

Avian influenza viruses are divided by subtypes, based on 2 proteins
found in the viruses: a hemagglutinin, or "H" protein, and a
neuraminidase, or "N" protein. There are 16 H types and 9 N types
yielding a total 144 possible combinations.

The H5 and H7 subtypes are of particular concern, given the ability of
these 2 H-types to mutate from low pathogenic to highly pathogenic
strains. These 2 H-types have been known to cause serious disease and
mortality in domestic poultry
(<http://www.inspection.gc.ca/animals/terrestrial-animals/diseases/reportable/ai/fact-sheet/eng/1356193731667/1356193918453>).
- Mod.CRD

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/26620>.]

[See Also:
2015
----
Avian influenza, human (01): Libya, fatal, H5N1 susp, RFI
http://promedmail.org/post/20150101.3061029
Avian influenza, human (133): Libya, fatal, H5N1 susp
http://promedmail.org/post/20141228.3058834
2014
----
Avian influenza (39): Libya (Tubruq) HPAI H5N1, poultry, OIE
http://promedmail.org/post/20140313.2329866
Avian influenza, human (133): Libya, fatal, H5N1 susp
http://promedmail.org/post/20141228.3058834]
.................................................crd/mj/lxl/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php
Posted on 5/23/2017 10:55:00 AM | Categories: