Madagascar's plague total climbs to 849

The number of confirmed, probable, and suspected cases in Madagascar's plague outbreak has climbed to 849, 67 of them fatal, the World Health Organization (WHO) said yesterday in an update. The totals reflect increases of 165 cases and 10 deaths since the WHO's last report on Oct 12.

Of the country's new plague cases, 94 are pneumonic, putting that total at 568. The case-fatality rate also decreased again, dropping from 8.3% to 7.9% over the past few days, the WHO said. Two more of Madagascar's 114 districts reported plague cases, bringing the total to 37, though hardest hit is Antananarivo Renivohitra District, a large urban area surrounding the country's capital.

So far, 39 health workers have been infected with plague. Four plague treatment centers are in operation, and efforts are scaling up to train and equip medical teams with personal protective equipment. The WHO said the risk of spread within Madagascar is very high, while the threat to the region is moderate, and global risk low.

Oct 18 WHO situation update

Oct 13 CIDRAP News story "Plague total grows in Madagascar as response builds"

Uganda reports fatal Marburg virus cases

Uganda's health ministry is investigating as many as two deaths from Marburg hemorrhagic fever, according to media and official reports.

A report from The Ugandan, a local news web site, said the health ministry sent a team of epidemiologists to Kween district in the eastern part of the country, based on reports that two people had recently died from the disease.

In a related development, the Uganda Virus Research Institute (UVRI) said in a statement on its Facebook page that two deaths from Marburg had occurred.

Meanwhile, Reuters, citing health minister comments at a media briefing, reported today that one fatal case has been confirmed, that of a 50-year-old woman who died on Oct 11 at a hospital in eastern Uganda. She had recently cared for her 42-year-old brother, who died on Sep 25 after having similar symptoms. She also helped prepare his body for burial, according to the report, which said the man was a hunter who had been near caves where bats, thought to harbor the virus, were present.

A WHO spokesperson told Reuters that staff have been deployed to help Uganda curb the outbreak. Uganda's last Marburg virus outbreak occurred in 2014.

Oct 19 Ugandan story

Oct 19 UVRI statement

Oct 19 Reuters story

CDC updates guidance for babies born to mothers with possible Zika exposure

The US Centers for Disease Control and Prevention (CDC) announced today that it has updated its clinical guidance for caring for babies born to mothers who may have been infected with Zika virus during pregnancy. The update, which appears today in Morbidity and Mortality Weekly Report, includes the latest scientific information since the August 2016 release of earlier guidance.

Though Zika illnesses have declined since 2016, cases are still being reported, and the CDC urged clinicians to remain alert to the threat and to closely monitor babies who had possible congenital exposure to the virus.

CDC Director Brenda Fitzgerald, MD, said in a statement today, "There’s a lot we still don’t know about Zika, so it’s very important for us to keep a close eye on these babies as they develop."

New guidance defines three groups of infants, based on their symptoms or lack of symptoms, plus the mother's exposure and lab findings. The recommendations also contain new information on follow-up care. For example, some types of screening (ie, thyroid and hearing at 4 to 6 months) are no longer recommended, due to a lack of data on whether they are needed. On the other hand, guidance expands the list of potential problems in babies already known to have birth defects, to include breathing difficulty, swallowing difficulty, and hydrocephaly.

The CDC emphasized that because complex services are needed to care for infants with Zika-related birth defects, care should be given by a multidisciplinary team and an established medical home.

Oct 19 MMWR report

Oct 19 CDC press release

Blue Ribbon Panel tackles increasing animal agriculture threats

A privately funded bipartisan panel that provides expert analysis on biodefense issues yesterday warned of increasing threats to US animal agriculture and said more efforts are needed to reduce risks to the food and agricultural sectors.

The Blue Ribbon Study Panel on Biodefense said the rate of emerging and reemerging animal diseases is increasing, along with the threat of those intent on attacking food or agriculture. In a 62-page report, the team pointed to the 2015 avian influenza outbreak in the United States that affected 21 states and cost $3.3 billion in poultry losses and outbreak response.

In a press release, Tom Daschle, panel member and former Senate majority leader, said every year there are new threats that could severely impact animal agriculture. "Whether these threats arise here or abroad, we need to ensure that both domestic and international agrodefense efforts occur in concert," he added.

The report emphasizes the broad range of US government agencies with responsibilities for agricultural biodefense. The panel recommends increased coordination between the US Department of Agriculture and the FBI.

Though the nation has made great strides in biosurveillance, it still falls short on the development of new ways to detect wildlife diseases, the panel said. One of its suggestions for improving disease response is to increase funding for the National Veterinary Stockpile to boost countermeasure purchases, similar to what's done on the human health side with Project BioShield. The panel included a list of proposals for the Executive Branch and for Congress.

The panel, which was formed in 2014 and published an extensive biodefense blueprint the following year, said the new report is the first in a series of special-focus reports. The group is sponsored by the Hudson Institute, a think tank in Washington, DC.

Oct 18 Blue Ribbon Study Panel on Biodefense press release

Oct 18 Blue Ribbon Study Panel on Biodefense report

WHO, CDC establish gonococcal antimicrobial surveillance system

Global surveillance of antimicrobial-resistant Neisseria gonorrhoeae is challenging, especially in countries that carry the greatest disease burden, but a new collaboration between the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) may help, representatives of the two agencies reported yesterday in Emerging Infectious Diseases.

The goal of the new Enhanced Gonococcal Antimicrobial Surveillance Program is to keep tabs on trends in antimicrobial susceptibilities in N gonorrhoeae through standard sampling and lab protocols and to improve the timeliness and comparability of data across multiple countries, they wrote. Also, the system is set up to assess resistance patterns in highest-risk populations to help shape country-specific guidance.

Oct 18 Emerg Infect Dis report

In a related development, Danish researchers writing in Eurosurveillance today described a single rare case detected this year of multidrug-resistant N gonorrhoeae infection that involved ceftriaxone resistance and intermediate resistance to azithromycin.

The illness, treated successfully with dual antimicrobial therapy, was reported to national health authorities, but it didn't lead to a wider public health response.

Oct 19 Eurosurveill report