Urine and saliva as transmission threat?The Fiocruz Institute scientists initially announced their findings in Brazil in early February and published the full results on Jun 24 in Public Library of Science (PLoS) Neglected Tropical Diseases.Of nine patients sampled, 6 were from a group of pregnant women with rash, and 3—2 men and 1 woman—had sought care for their Zika symptoms at a Fiocruz acute care clinic. Nine urine samples and five saliva samples were collected from the patients. Tests on the samples included reverse-transcriptase polymerase chain reaction (RT-PCR), quantitative RT-PCR, nucleic acid testing (NAT), and Vero cell inoculation.Live virus was found in two samples from different patients, one from urine and one from saliva. For patients who submitted both types of sample, urine viral loads were higher than in saliva.The authors said their finding in saliva seems to confirm a case report of live virus isolated from the saliva of a patient who got sick in January after returning from the Dominican Republic to Italy, reported in March in Eurosurveillance.In April, French researchers in an early-online letter to the New England Journal of Medicine reported a sexual Zika transmission case in which they couldn’t rule out the possible of saliva as one of the ways the infected man passed the virus to his female partner.The importance of both body fluids as transmission routes isn’t clear and needs more study, the authors wrote. They noted that the acidic pH of urine might restrict viral spread.For saliva, the isolation of viable virus doesn’t always prove that the virus can transmit orally, because saliva typically contains antiviral molecules and is relatively hypotonic, meaning it can lyse enveloped viruses. They said the possibility of person-to-person spread through disruptions in oral mucosa or periodontal pockets, however, should be investigated.
A pair of studies today probing the complex antibody reactions between Zika and dengue infection have both bad news and good news: that earlier dengue infection can worsen Zika infections, but a certain antibody against dengue can also neutralize Zika virus, raising the possibility of a vaccine target.
In what may be the most accurate real-time picture of Zika activity in Puerto Rico, a sensitive test for screening blood donations shows rapidly rising levels that could result in thousands of infections in pregnant women, the US Centers for Disease Control and Prevention (CDC) warned today. At a media briefing, CDC Director Tom Frieden, MD, MPH, said high levels of Zika activity in the US territory could result in dozens to hundreds of babies born with microcephaly. Puerto Rico has been using a highly sensitive investigational test since Apr 3 to screen local blood collections. Frieden said that though it’s not a stand-in for a serologic survey and doesn’t reflect a random sample, “it gives us a window to see what’s happening with infection rates.” Illnesses probably haven’t peaked yet, and disease activity—in view of dengue and chikungunya patterns—may last through summer and into the fall.
In an update today. the CDC reported more local Zika infections in US territories and more travel-related cases in US states. Affected territories reported 135 more illnesses last week, raising the total number of local cases to 1,436. One fewer related Guillain-Barre syndrome (GBS) was reported in the territories, dropping that number to 6. In US states, 64 more travel-related Zika cases were reported, along with the recent lab-acquired case in Pennsylvania, putting the overall total at 756. The number of sexually transmitted Zika cases remained the same, at 11, and 1 more GBS cases was reported in US states, lifting that total to 3.
In yesterdays’ CDC HAN we learn that two other US samples – taken from swine – were also positive for the MCR-1 gene, and one of those was also resistant to a number of (but not all) common antibiotics. HAN messages (Alert, Advisory, Update, or Info) are designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues. An `Advisory’ is a second tier message that Provides important information for a specific incident or situation, but may not require immediate action. Due to its length, I’ve only posted some excerpts. Follow the link below to read this HAN Advisory in its entirety. Alert to U.S. Healthcare Facilities: First mcr-1 Gene in E. coli Bacteria found in a Human in the United States
WHO estimates that 508 million people are living in 31 African countries at risk for transmission of yellow fever. Therefore, the large outbreak of yellow fever in Angola is of concern with regard to the risk of introduction of the virus through viraemic travellers to countries at risk of transmission, especially in neighbouring countries. In DRC, the confirmation of the autochthonous circulation in the capital is a major concern as Kinshasa is highly populated, representing a risk of extension to Brazzaville, the capital of Congo, that is located across the Congo river. ECDC published a rapid risk assessment on 25 March 2016 and an update on 30 May. The Aedes aegypti mosquito, a competent vector for yellow fever, is not present in continental Europe but is present on the island of Madeira, an autonomous region of Portugal. Proof of vaccination is required for all travellers aged nine months and above entering Angola and DRC. WHO recommends vaccination for all travellers older than 9 months of age in areas where there is evidence of persistent or periodic yellow fever virus transmission. European citizens travelling to, or residing in, Angola should be vaccinated against yellow fever as per their national health authorities’ recommendations. The vaccine should be administered at least 10 days before travelling. Yellow fever in an urban setting is considered a public health emergency that may result in a large number of cases. Vaccination is the single most important and effective measure for preventing yellow fever. Therefore, additional cases in unvaccinated populations related to this urban outbreak should be expected, until a sufficient proportion of the susceptible population is immunised. The outbreak in Angola, DRC and Uganda is not yet under control and is currently expanding to additional provinces, challenging the ongoing mass vaccination campaign with a potential vaccine shortage in the coming months. The control of the outbreak in the three countries is needed in order to prevent further spread in the region and beyond.
Yuen Kwok-yung said, the most effective prevention method is banning sale of live poultry markets, reducing the risk of virus infection, Singapore, and Taiwan, and Japan and other neighboring countries and regions, has been implementing centralized slaughtering, and Taiwan, and Japan have mobile apps for people to order chicken, people just a phone order, delivered directly by the farm fresh chicken slaughter. The evidence that closing live-bird markets reduces the spread of the H7N9 virus (at least for now) is solid (see The Lancet: Poultry Market Closure Effect On H7N9 Transmission), making it the obvious first step in breaking the chain of transmission. The problem is, purchasing live market birds is deeply ingrained in Chinese culture, as it reassures the buyer that the bird is both fresh and healthy.
Meanwhile, it would be great if Brazil published its national numbers in a weekly report – along with confirmed numbers. The promise of the “Boletins Epidemiológicos de Dengue, Chikungunya e Zika” has not been realised with only two reports over the past 10 epidemiological weeks and no specific listing of laboratory confirmed numbers.[6]
Scientists have found dangerous drug-resistant “super bacteria” off beaches in Rio de Janeiro that will host Olympic swimming events and in a lagoon where rowing and canoe athletes will compete when the Games start early August. Key points: Super bacteria found in five of Rio’s beaches, in the Olympic Lagoon, and in a river Federal police are investigating whether Rio’s water utility Cedae is committing environmental crimes Bacteria lie dormant but attack when a healthy person falls ill for another reason The findings from two unpublished academic studies concern Rio’s most popular spots for tourists, and heighten concerns that the city’s sewage-infested waterways are unsafe.
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