Infectious disease

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Fragments of bird flu virus genome found in pasteurized milk, FDA says

avian influenza, bird flu, CDC, cows, dairy cows, fda, flu, H5N1, Infectious disease, influenza, milk, pasteurization, Science, Uncategorized / /

Milk testing —

The test cannot tell if the virus is live. The FDA still assess milk supply as safe.

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Cows being milked

Enlarge / Cows being milked

The Food and Drug Administration on Tuesday announced that genetic fragments from the highly-pathogenic avian influenza virus H5N1 have been detected in the pasteurized, commercial milk supply. However, the testing completed so far—using quantitative polymerase chain reaction (qPCR)—only detects the presence of viral genetic material and cannot tell whether the genetic material is from live and infectious viral particles or merely remnants of dead ones killed by the pasteurization process.

Testing is now ongoing to see if viable, infectious H5N1 can be identified in milk samples.

So far, the FDA still believes that the milk supply is safe. “To date, we have seen nothing that would change our assessment that the commercial milk supply is safe,” the agency said in a lengthy explanation of the finding and ongoing testing.

H5N1 made its startling jump to US dairy cows recently, with the first ever documented cases in a Texas herd confirmed on March 25. It has spread widely since then with at least 32 herds in eight states now known to be infected. The unexpected spread to bovines has raised fears that the virus is evolving to infect mammals more efficiently, and so poses a heightened risk of spread to and among humans.

But amid the alarming outbreak among the country’s dairy herds, federal agencies have appeared confident that the virus poses little risk to no risk to the safety of the milk supply.

“At this time, there continues to be no concern that this circumstance poses a risk to consumer health, or that it affects the safety of the interstate commercial milk supply because products are pasteurized before entering the market” the FDA wrote in an FAQ published Friday. “Pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk.”

In the announcement Tuesday, the FDA also highlighted that multiple studies have shown that the pasteurization process for eggs, which uses lower temperatures than what is used for milk, is effective at inactivating H5N1.

Nevertheless, the FDA, along with the Centers for Disease Control and Prevention and the US Department of Agriculture, have continued to investigate potential risks, including establishing whether pasteurization can inactivate this specific virus. The FDA noted in its announcement Tuesday that, while pasteurization is expected to kill the virus, pasteurization is “different than complete sterilization.”

As such, it carried out the qPCR tests, expecting it might find some genetic fragments in the pasteurized milk because virus has been detected in raw milk. “Based on available information, pasteurization is likely to inactivate the virus, however the process is not expected to remove the presence of viral particles,” the FDA explained. “Therefore, some of the samples collected have indicated the presence of HPAI [Highly Pathogenic Avian Influenza] using quantitative polymerase chain reaction (qPCR) testing.”

The FDA did not indicate how many samples it has tested, where the samples were collected from, or the level of viral genetic material the samples contained.

The agency is now working on assessing whether it can identify if any virus particles are infectious using egg inoculation tests, which are considered a gold-standard for determining viral viability. It added that it will release results from those tests and others in “the next few days to weeks.”

“[W]e take this current situation and the safety of the milk supply very seriously. We recognize the importance of releasing further, actionable information,” the FDA said.

Meanwhile, the agency reported that the CDC’s food safety group has been closely monitoring emergency department data and flu testing data for any unusual trends in flu-like illness, flu, or conjunctivitis, which could indicate spread of H5N1 to people. “To date, surveillance systems do not show any unusual trends or activity,” the FDA said.

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Puerto Rico declares public health emergency as dengue cases rise

Aedes aegypti, dengue, health, Infectious disease, mosquitoes, Puerto Rico, Science, viral infection / /

emergency —

Cases so far are up 140 percent compared to this point last year.

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Female Aedes aegypti mosquito as she was in the process of obtaining a

Female Aedes aegypti mosquito as she was in the process of obtaining a “blood meal.”

Puerto Rico has declared a public health emergency amid an ongoing outbreak of dengue infections, a mosquito-spread viral infection that can cause fever, aches, rash, vomiting, and, in about 5 percent of cases, a severe disease marked by internal bleeding and shock.

The US territory has tallied 549 cases since the start of the year, representing a 140 percent increase compared with cases tallied at this point last year, according to the territory’s health department. The Associated Press reported that more than 340 of the 549 cases have been hospitalized.

In 2023, the island nation of more than 3.2 million people had over 1,000 cases of dengue throughout the year.

But this year’s cases are rising rapidly, leading health officials to warn residents to be vigilant and take prevention measures. That includes wearing insect repellent and draining or treating any standing water where mosquitoes can breed. The mosquitoes that transmit dengue—Aedes aegypti—seem to prefer breeding in artificial containers, such as flower pots, buckets, water drums, vases, plastic containers of any kind, the inner rings of discarded automobile tires, and trash in general. They can breed in tiny amounts of water, such as in bottle caps.

Puerto Rico’s outbreak of dengue is part of a larger regional trend, the island’s health department noted. Last year, the Americas saw the highest number of dengue cases ever recorded, totaling 4,565,911, according to the Pan American Health Organization (PAHO), a division of the World Health Organization. So far this year, the region has reported 3,578,414 cases, including 1,039 deaths. The bulk of the cases are in Brazil, which has reported over 2.9 million cases so far. Paraguay has reported over 191,000 cases, and Argentina has reported over 134,000 cases.

In a December 2023 risk assessment, the PAHO deemed the risk to human health from dengue to be “high” in the region. The report noted that the effects of climate change are driving higher rainfall, higher temperatures, and more humidity, allowing A. aegypti to expand into new areas and increase breeding. A. aegypti are already found in much of South America, Central America, and the southeastern US.

This post was updated to include additional case tallies. 

Puerto Rico declares public health emergency as dengue cases rise Read More »

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Gastrointestinal disease explodes in Ala. elementary school; 773 kids out

Alabama, elementary school, gastrointestinal, health, Infectious disease, Norovirus, outbreak, school, Science, students / /

no, no, no —

Highly contagious norovirus is the leading suspect; four other area schools affected.

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An electron micrograph of norovirus.

Enlarge / An electron micrograph of norovirus.

Officials in Alabama have shut down an elementary school for the rest of the week and are conducting a deep clean after 773 of the school’s 974 students were absent Wednesday amid an explosive outbreak of gastrointestinal illness.

Local media reported that only 29 students were absent from Fairhope West Elementary School on Tuesday. However, the situation escalated quickly on Wednesday as word spread of a stomach bug going around the Gulf Coast school. A spokesperson for the county school district told AL.com that 773 students and 50 staff were absent Wednesday. It’s unclear how many of the absences were due to sickness or precaution.

Health officials are now investigating the cause of the gastrointestinal outbreak, collecting specimens for testing. So far, officials are working under the assumption that it is norovirus, a highly infectious gastrointestinal bug that can survive hand sanitizer and transmit easily from surfaces, food, and water. The symptoms of the unidentified illness align with norovirus: vomiting, diarrhea, abdominal cramps, and nausea.

On Wednesday, Baldwin County Schools Superintendent Eddie Tyler sent a message to parents saying that the county had decided to shut the school down for the rest of the week. “Due to the amount of staff and students who are absent, the number who are experiencing symptoms, and in an effort to help contain the contagion, we unfortunately need to shut the building down,” Tyler wrote. “While out, we will be conducting a deep cleaning of the school so when students return next week, it will be sanitized to the fullest extent.”

But local outlet WKRG reported Thursday that the outbreak has already spread beyond Fairhope West. On Thursday, 1,231 students from four other area schools were also absent, including 721 students at Fairhope East Elementary School, 136 at a third elementary school, 170 at a middle school, and 204 at a high school. These are in addition to the 974 students at Fairhope West who are out of school while it is shut down.

Norovirus activity is high across the country, with the northeastern region seeing the largest surge, according to surveillance by the Centers for Disease Control and Prevention. The agency notes that outbreaks are commonly linked to health care settings, restaurants or catered events, cruise ships, as well as schools and childcare centers. “Close quarters, shared spaces, and high-touch surfaces make it easy for norovirus to spread in schools,” the CDC points out.

In 2022, the COVID-19 pandemic flipped the script on standard norovirus outbreaks. People who were hoping to avoid close contact and share indoor air with strangers headed to the great outdoors, which led to a large outbreak of norovirus in the Grand Canyon.

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Measles erupts in Florida school where 11% of kids are unvaccinated

CDC, Florida, health, Infectious disease, measles, Science, Transmission, vaccination rate, virus / /

outbreak potential —

Over 100 children at the school are susceptible to virus.

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A child with measles.

Enlarge / A child with measles.

Florida health officials on Sunday announced an investigation into a cluster of measles cases at an elementary school in the Fort Lauderdale area with a low vaccination rate, a scenario health experts fear will become more and more common amid slipping vaccination rates nationwide.

On Friday, Broward County Public School reported a confirmed case of measles in a student at Manatee Bay Elementary School in the city of Weston. A local CBS affiliate reported that the case was in a third-grade student who had not recently traveled. On Saturday, the school system announced that three additional cases at the same school had been reported, bringing the current reported total to four cases.

On Sunday, the Florida Department of Health in Broward County (DOH-Broward) released a health advisory about the cases and announced it was opening an investigation to track contacts at risk of infection.

At Manatee Bay Elementary School, the number of children at risk could be over 100 students. According to a Broward County vaccine study reported by the local CBS outlet, only 89.31 percent of students at Manatee Bay Elementary School were fully immunized in the 2023/2024 school year, which is significantly lower than the target vaccination coverage of 95 percent. The school currently has 1,067 students enrolled, suggesting that up to 114 students are vulnerable to the infection based on their vaccination status.

Measles is one of the most contagious viruses known. It spreads via respiratory and airborne transmission. The virus can linger in air space for up to two hours after an infected person has been in an area. People who are not vaccinated or have compromised immune systems are susceptible, and up to 90 percent of susceptible people exposed to the virus will become infected. Measles symptoms typically begin around eight to 14 days after exposure, but the disease can incubate for up to 21 days. The symptoms begin as a high fever, runny nose, red and watery eyes, and a cough before the telltale rash develops. Infected people can be contagious from four days before the rash develops through four days after the rash appears, according to the Centers for Disease Control and Prevention. About 1 in 5 unvaccinated people with measles is hospitalized, the CDC adds, while 1 in 20 infected children develop pneumonia and up to 3 in 1,000 children die of the infection.

Those who are not immunocompromised and are fully vaccinated against measles (who have received two doses of the Measles, Mumps, and Rubella (MMR) vaccine) are generally not considered at risk. The two doses are about 97 percent effective at preventing measles and protection is considered to be life-long.

The DOH-Broward said it is now “identifying susceptible contacts that may be candidates for post-exposure prophylaxis through MMR or immunoglobulin.”

While the risk of measles is generally low in the US—the country declared it eliminated in 2000—the threat of large outbreaks is growing as vaccination rates slip. Many cases in the US are linked to travel from countries where the virus still circulates. But, if a travel-related case lands in a pocket with low vaccination coverage, the virus can take off. Such was the case in 2019, when the country tallied 1,274 measles cases and nearly lost its elimination status.

Health officials typically consider vaccination coverage of 95 percent or greater to protect from ongoing transmission. In the years since the COVID-19 pandemic began, vaccination rates among US kindergartners have slipped to 93 percent, and vaccination exemptions reached an all-time high in the latest data from the 2022-2023 school year. There are now at least 10 states that have vaccination exemption rates above 5 percent, meaning that even if every non-exempt child is vaccinated, those states will not have enough coverage to reach the 95 percent target.

The CDC has tallied 20 measles cases in the US so far this year. But that is the tally as of February 15; it does not include any of the Florida cases reported since Friday. In 2023, there were 58 measles cases reported to the CDC.

This story was updated to include additional information about measles infection outcomes.

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Measles is “growing global threat,” CDC tells doctors in alert message

CDC, health, Infectious disease, measles, MMR vaccines, outbreak, pandemic, Science, vaccines, WHO / /

Alert —

Since December, there have been 23 measles cases in the US, including two outbreaks.

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A baby with measles.

Enlarge / A baby with measles.

The Centers for Disease Control and Prevention is putting clinicians on alert about the growing risk of measles cases and outbreaks amid a global surge in transmission.

In an outreach message sent Thursday, the CDC told clinicians to look out for patients who have a rash accompanied by a fever and other symptoms of measles, as well as patients who have recently traveled to countries with ongoing measles outbreaks.

Between December 1, 2023, and January 23, 2024, there have been 23 confirmed measles cases in the US, including seven direct importations by international travelers and two outbreaks with more than five cases each, the CDC noted. Most of the cases were in unvaccinated children and teens.

Measles outbreaks in the US are typically sparked by unvaccinated or undervaccinated US residents who pick up the infection abroad and then, when they return, transmit the disease to pockets of their communities that are also unvaccinated or undervaccinated.

Globally and in the US, vaccination rates against measles—via the measles, mumps, and rubella vaccine (MMR)—have fallen in recent years due to pandemic-related health care disruption and vaccine hesitancy fueled by misinformation.

“The increased number of measles importations seen in recent weeks is reflective of a rise in global measles cases and a growing global threat from the disease,” the CDC’s outreach message, titled “Stay Alert for Measles Cases,” read.

According to data from the World Health Organization, the European region saw an over 40-fold rise in measles cases in 2023 as compared with 2022. The region tallied over 42,200 measles cases last year, compared with just 941 in 2022.

This week, the WHO reported a rapid escalation of measles cases in Kazakhstan (which the WHO considers part of the European region). Kazakhstan has recorded the highest incidence of measles cases in the region, with 13,677 cases in 2023. That corresponds to over 639 cases per million in the population. In the news release Tuesday, Kazakhstan’s health minister reported that there are “currently 2,167 children in hospital with measles, 27 of them in a serious condition.”

The outbreak is largely spurred by unvaccinated children who missed their routine immunizations during the pandemic. Sixty-five percent of the reported measles cases are in children under age 5, the WHO noted. The country is now trying to catch children up on their vaccines to curb the outbreak.

“Measles is highly infectious, but fortunately, can be effectively prevented through vaccination,” WHO’s Regional Director for Europe, Hans Henri P. Kluge, said in the news release. “I commend Kazakhstan for the urgent measures being taken to stop the spread of this dangerous disease.”

Meanwhile, measles is flaring up in many other places. Last week, the UK Health Security Agency warned of the potential for an ongoing measles outbreak to spread. As of January 18, there were 216 confirmed cases and 103 probable cases in the West Midlands region since October 2023. Authorities warned that any areas with low MMR vaccination rates are at risk of an outbreak.

The vast majority of Americans have received their MMR vaccines on schedule. In this case, the two standard, recommended doses are considered 97 percent effective against measles, and the protection is considered for life. But anyone who is unvaccinated or undervaccinated is at high risk of infection in the event of an exposure. The virus can linger in air space for up to two hours after an infected person leaves the area, the CDC notes, and is highly infectious—up to 90 percent of unvaccinated people exposed will fall ill. Once infected, people are infectious from four days before the telltale measles rash develops to four days afterward.

Measles is “growing global threat,” CDC tells doctors in alert message Read More »