Tag Archives: outbreaks

#UK | Prime Minister calls for ‘wake-up to the threat from #disease #outbreak’

The Prime Minister, David Cameron, will use the G7 summit in Germany to outline how the UK will step up its efforts to combat the outbreak and spread of deadly viruses with a new plan that will include more research and development and an improvement in how international health agencies respond on the ground.

In a stark warning to other G7 leaders the Prime Minister will say that the world must be far better prepared for future health pandemics that could be more aggressive and harder to contain than the recent Ebola outbreak.

More than 27,000 cases of Ebola Virus Disease (EVD) have now been reported in Guinea, Liberia and Sierra Leone, with over 11,130 reported deaths, marking it as one of the worst pandemics in modern times.

While the number of new cases has fallen drastically, experts have warned that lessons must be learnt from what happened. A more virulent disease in future – transmitted by coughing, like the flu or measles for example – would have a much more devastating impact if a better approach is not put in place.

Speaking ahead of the G7, the Prime Minister, David Cameron, said:

The recent Ebola outbreak was a shocking reminder of the threat we all face from a disease outbreak.

Despite the high number of deaths and devastation to the region, we got on the right side of it this time thanks to the tireless efforts of local and international health workers.

But the reality is that we will face an outbreak like Ebola again and that virus could be more aggressive and more difficult to contain. It is time to wake up to that threat and I will be raising this issue at the G7.

As a world we must be far better prepared with better research, more drug development and a faster and more comprehensive approach to how we fight these things when they hit.

The UK will lead the way but we need a truly global response if we are to face down this threat.

The UK plan includes:

Breakthrough drug development

The UK’s big players in drug development and research – including leading pharmaceutical companies, research centres, universities and disease experts – will come together to focus on the most serious global health threats. The UK Vaccines Research and Development Network will bring together the best expertise across the country, with £20 million invested from the outset to focus on the most threatening diseases including Ebola, Lassa, Marburg and Crimean-Congo Fever, with additional investment from the private and research sector.

More transparency, greater co-operation

Given the seriousness of the threat, the UK will be the first country in the world to require clinical trials and disease control operations to be fully transparent. From now on any UK-funded research, data or operation will be made openly available and the UK will look to develop an international agreement – via the G7 – that would see the publication of results of all clinical trials of vaccines for relevant diseases. Ebola showed us that when data on disease outbreaks is not shared quickly, the disease can get out of control. The UK’s Chief Medical Officer will now work with the World Health Organisation to develop a new, more advanced system to share data on a disease with health agencies and doctors and nurses on the frontline.

Rapid reaction unit

The UK will establish a new group of 6 to 10 expert staff – mainly epidemiologists, infection control specialists and infection control doctors – who will be on permanent standby, ready to deploy to help countries respond to disease outbreaks. When deployed, the team will act as ‘disease detectives’, to understand what the disease is; how it is spreading; how fast it is spreading; and what response is required. A ‘reservist force’, including hundreds of doctors, nurses and public health experts, will be ready for call-up if the outbreak is not contained at an early stage.

New South Wales #NSW | Travellers reminded to get #flu vax after #outbreaks aboard cruise ships

NSW Health is urging anyone thinking of taking a holiday cruise to be vaccinated against influenza at least two weeks prior to departure, following several recent outbreaks on board ships arriving in Sydney.

NSW is experiencing markedly increased flu activity this year. Obtaining the annual flu vaccination is sound advice for all members of the community whether they are planning to travel by sea or air.

Particular care should be taken by cruise passengers who may be at increased risk due to the large numbers of people frequently mingling from all parts of the world, for longer periods of time and in close proximity to another.

Dr Vicky Sheppeard, Director, Communicable Diseases Branch, NSW Health, said since 1 February 2015, about 533 passengers and crew arriving in Sydney on board cruise ships have been recorded as having an influenza-like illness.

“Cruise ships have strong protocols in place for assessing, treating and isolating passengers and crew with suspected influenza, but the best form of prevention is vaccination,” Dr Sheppeard said.

“We strongly recommend that people who are planning to take a cruise make it a priority to visit their doctor and have the influenza vaccination at least two weeks before departure,” she said.

“This is especially important for pregnant women, the elderly and anyone who is at increased risk of pneumonia or other serious complications if they contract influenza,” she said.

On average, flu notifications over the first four months of this year have been more than double that of previous years.

“If you are showing symptoms of having influenza, it is very important that you take steps to avoid spreading it. This includes covering your face when you cough or sneeze and throwing used tissues in a rubbish bin. Wash your hands thoroughly and often, and for at least 10 seconds or use an alcohol-based hand rub.”

Influenza is a highly contagious respiratory illness caused by influenza viruses. There are three main types of influenza virus that cause infection in humans – types A, B and C – and many sub-types or strains. Influenza can occur throughout the year but influenza activity usually peaks in winter.

The 2015 seasonal influenza vaccines for Australia have been updated to match the new strains of influenza A/H3N2 and influenza B that have been circulating during the Northern Hemisphere winter and which circulated in NSW during the 2014 season.

NSW Health is currently working with the cruise ship industry to promote the recommendation for influenza vaccination prior to travel among booked passengers.

For more information on the NSW Cruise Ship Health Surveillance Program, visit http://www.seslhd.health.nsw.gov.au/Public_Health/CruiseShipProgram/surv.asp

For more information on influenza outbreaks in travel groups, visit http://www.health.nsw.gov.au/Infectious/factsheets/Pages/Influenza_outbreaks_in_travel_groups.aspx

Minnesota #MN | More than three million birds affected by #outbreaks of #HPAI #H5 avian influenza

The Minnesota Department of Public Safety Homeland Security Emergency Management  Division (HSEM) activated the State Emergency Operations Center (SEOC) to coordinate the state’s ongoing response to avian influenza.

HSEM will coordinate resource needs with several state agencies including the Minnesota Board of Animal Health and the Minnesota Department of Agriculture.

Additional HPAI cases in Minnesota
The USDA today confirmed the presence of H5N2 HPAI in six additional flocks. The following Minnesota counties were affected:

  • Chippewa – 1st detection in county (68,000 turkeys)
  • Kandiyohi – 11th*, 18th and 19th detections (42,900 turkeys and 67,000 turkeys)
  • Redwood – 4th detection (24,300 turkeys). The 3rd flock in Redwood County (11,100 turkeys) was identified as a dangerous contact and will be euthanized as a preventative measure.
    *A delay in confirmatory testing resulted in late announcement of the 11th detection in Kandiyohi County.
Animal health officials are currently investigating possible additional cases of HPAI in Minnesota flocks. As flocks are confirmed by NVSL, the Board will provide information on its website at www.mnairesponse.info.
Current Situation
Total number of farms – 55
Total number of counties – 18
Total number of birds affected in Minnesota – 3,114,232
All affected farms remain under quarantine.
Visit the USDA’s website for information on all HPAI findings in the United States.
Current Incident Response Personnel
  • Minnesota Board of Animal Health and Department of Agriculture 85
  • U.S. Department of Agriculture 139
  • Total number of incident responders 224
To date, animal health officials have completed the following response zone activities:
  • Visited with individuals on over 11,000 premises to provide education and information on avian influenza
  • Conducted surveillance testing on 583 backyard flocks falling within the control areas of infected flocks
  • Completed depopulation of 49 flocks
Water Delivery
  • Large amounts of water are needed in foaming systems being used as part of euthanasia efforts, which are in place to control further spread of avian influenza virus.
  • The Minnesota National Guard is delivering water for use in the disease containment effort. Forty-one soldiers and 15 water trucks are available to supply water. The Guard provided 16 thousand gallons of water in Kandiyohi County today. The Guard began its mission on Monday and will continue to provide support until civilian contractors become available. The soldiers and equipment are from the Willmar-based 682nd Engineer Battalion and the Brooklyn Park-based A Company, 134th Brigade Support Battalion.
  • The Minnesota Department of Transportation supported foaming operations on Sunday. Three MnDOT tanker trucks, two 6,500 gallon trucks and one 4,500 gallon truck, moved water from Evansville to Paynesville. The trucks were from MnDOT facilities in Baxter, St. Cloud and the Twin Cities.
No Public Health Risk
The Minnesota Department of Health (MDH) reports that no human infections with this strain of the virus (H5N2) have been detected in Minnesota or elsewhere in the U.S. However, in some cases certain HPAI H5 viruses can infect people and it is important to prevent infections.
In general, avian influenza viruses are spread to people through direct contact with infected birds or their environments, including contaminated bedding, feed or water. Person-to-person spread of avian influenza viruses is rare and limited.
This is not a public health risk or a food safety risk. The potential risk is for those who have direct contact with infected birds.
Poultry Workers
MDH is monitoring the health of workers, who have had contact with infected poultry, and providing guidance on infection control, the use of personal protective equipment, and providing support for any other health-related aspects of response.
People who had close, unprotected contact with infected flocks are recommended to receive an antiviral drug called Tamiflu. MDH does not issue the drug directly. Rather, MDH facilitates getting the prescription for the workers by working with the company occupational health departments or the health care providers for those individuals.
Workers are then contacted daily for 10 days and monitored for development of respiratory symptoms.
As of today, MDH has completed follow-up contacts for 48 flocks.
MDH is currently monitoring 86 poultry personnel for potential symptoms of infection, such as development of an eye infection or respiratory symptoms.
The MDH 10-day monitoring period has been completed for 74 people associated with 17 flocks; no infections with this virus were detected.
No Positives Found in Wild Birds in Minnesota
The Minnesota Department of Natural Resources (DNR) has collected more than 2,300 samples from wild waterfowl. Of those samples, nearly 1,000 test results have been received and none have tested positive for H5N2. The DNR’s goal is to collect and test 3,000 samples from affected areas.
Twenty-one wild bird carcasses of various species have been sampled. Of the eight test results received so far, none have tested positive for H5N2. The DNR is also testing hunter-harvested wild turkeys from Swift, Stearns, Pope, Meeker and Kandiyohi counties. Eighteen hunter-killed turkeys have been tested, but no results have been received yet. The goal is to collect 300 samples from hunter-killed turkeys by the end of the six-week wild turkey hunting season.

For the Record | CDC Telebriefing on Measles in the United States – January 29 2015

OPERATOR: Welcome and thank you all for standing by. At this time all participants are in a listen-only mode until the question and answer section of the conference. Today’s call is being recorded.  If you have objections, please disconnect. I would like to turn the call over to Benjamin Haynes.

BENJAMIN HAYNES:  Thank you Holly. Thank you for joining us on the briefing on the U.S. measles outbreak. We are joined by Dr. Anne Schuchat, the assistant surgeon general, United States Public Health Service and director of CDC’s National Center for Immunization and Respiratory Diseases. Dr. Schuchat will provide opening remarks before taking your questions.  I will now turn it over to Dr. Schuchat.

ANNE SCHUCHAT:  Thank you so much for joining us this afternoon. I want to talk to you today about measles and here’s why. It’s only January and we have already had a very large number of measles cases. As many cases as we typically have all year in typical years. This worries me and I want to do everything possible to prevent measles from getting a foothold in the United States and becoming endemic again. I want to make sure that parents who think that measles is gone and haven’t made sure that they or their children are vaccinated are aware that measles is still around and it can be serious. And that MMR vaccine is safe and effective and highly recommended.  From January until January 1 until January 28, 2015, a total of 84 people in 14 states have been reported as having measles. Most of these cases are part of an ongoing large multistate outbreak linked to the Disneyland theme parks in California. CDC is working with state and local health departments to control this outbreak which started in late December.  Many of you know that in 2014, the U.S. experienced the highest number of measles cases we had reported in 20 years, over 600. Many of the people who got measles last year were linked to travelers who had gotten measles from the Philippines, where an extremely large outbreak of over 50,000 cases was occurring. Although we aren’t sure exactly how this year’s outbreak began, we assume that someone got infected overseas, visited the parks and spread the disease to others. Infected people in this outbreak here in the U.S. this year have exposed others in a variety of settings including school, day cares, emergency departments, outpatient clinics and airplanes. The information that we have is preliminary and the data are changing. We will be updating our website every Monday with the latest total counts. However, based on what we know now, we’re seeing more adults than we have seen in a typical outbreak. Children are also getting measles. The majority of the adults and children that are reported to us for which we have information did not get vaccinated or don’t know whether they have been vaccinated.  This is not a problem with the measles vaccine not working. This is a problem of the measles vaccine not being used.  Measles can be a very serious disease and people do need to be protected.  Measles spreads quickly among unvaccinated people and can spread quickly from state to state or around the world. We must insure that vaccination rates remain high among children as well as insure that adults receive MMR vaccine if they’re not already protected against this virus. I want to briefly review the national measles situation this year and remind you about measles around the world as well as briefly go through the main recommendations for the vaccine.  Thanks to the strong immunization system that we have and high vaccination rate here in the u.s. we declared measles eliminated.  Measles continues to be brought into the country by people who get the disease when they’re traveling elsewhere. They can spread the disease to others which can lead to outbreaks.  For several years after measles elimination, our numbers were very low.  Between 2001 and 2010, we saw a median of 60 reported cases of measles each year. In recent years, we have had a higher number of reported cases and as you can see in January alone we have had more cases and was the median for the last decade.  Measles is still common around the world and we estimate about 20 million cases each year. In 2013, about 145,700 people died of measles across the world.  Measles can come into our country easily through visitors or when Americans travel abroad and bring it back. It can be a serious disease for people of all ages, even in developed countries like the U.S. for every thousand children who get measles, one to three of them die despite the best treatment.  In the U.S., 28% of young children who had measles had to be treated in the hospital.  Measles can also result in complications. In children they can develop pneumonia, lifelong brain damage or deafness. Of course measles spreads when an infected person breathes, coughs, or sneezes and people don’t always know they are infectious because you can spread the disease before the rash is evident.  Measles is so contagious that if one person has it, 90% of the people close to the person who aren’t immune will also be infected. You can catch it just by being in the same room as a person with measles even if that person left the room because the virus can hang around for a couple of hours. This year so far as I mentioned from January 1 through 28, 84 cases of measles have been reported to us at the CDC from 14 states. There are an estimated 67 cases since December 28, 2014, that are linked to the outbreak — that are linked to the Disney land reports theme parks.  State and local health departments are investigating the large multistate outbreak related to the theme parks and the initial cases reported visiting the resorts between December 17th and 20th, 2014.  So far we know of 67 confirmed cases of measles linked to the outbreak and they have occurred in California and six other states.  We don’t know exactly how this outbreak started but we do think it’s likely a person who was infected with measles overseas visited the Disney parks in December while they were still infectious. This reminds us that measles exposures can happen in this country in many settings and insuring age appropriate vaccination for all U.S. residents is very important.  Maintaining high vaccination coverage is very important and it’s the best protection we have against disease outbreaks. I’m urging all health professionals to think measles.  Health care professionals do need to know the guidelines for infection control and reporting of measles and they should work that their patients are getting the best protection possible which is on time MMR vaccination to protect them from acquiring this virus whether at home or abroad.  The news this year is concerning and serves as a warning that measles is still coming into the united states and that unvaccinated people can get exposed. These outbreaks the past couple of years have been much harder to control when the virus reaches communities where numbers of people have not been vaccinated and of course when the virus comes into the country and exposing people at venues where many people gather, the chances of exposure are greater. One in 12 children in the United States is not receiving their first dose of MMR on time.  That makes them vulnerable to get measles and spread measles.  9 5% of children are recommended to have received the measles vaccine on time. 17 states have less than 90% of children having received at least one dose.  This sets them up for risk of spread of disease in their communities and in their schools. It’s not just young children that need to be up to date on their vaccines and we are starting to see more adults get measles and spread it. For adults out there, if you’re not sure if you have had measles vaccine or not or if you have ever had measles, we urge you to contact your doctor or nurse and get vaccinated.  There is no harm in getting another MMR vaccine if you have already been vaccinated.  I do want to remind you that unvaccinated people put themselves others at risk for measles for complications. Young babies cannot get this vaccine but they are very vulnerable to measles and complications. Pregnant women and people with compromising conditions like leukemia can’t get the vaccination and they are depending on others to have been vaccinated.  We hope pregnant women have been vaccinated as children but we are learning of some who have not been vaccinated so they have to be protected through other means.  This is not just to protect ourselves and our families but to protect the vulnerable people in our community. If a pregnant woman gets infected it increases the chance of many complications.  We don’t recommend pregnant women receive the vaccination but they need to be vaccinated before pregnancy.  For travel abroad, we don’t have the cut off of one year, but we recommend children six months and over get MMR vaccine before international travel to make sure they are protected when they go to parts of the world where measles is still circulating widely.  A key reminder about the routine MMR vaccinations.  The routine ones are for children to get their first dose at 12 months of age and a second dose between four and six years of age.  But it’s fine for the second dose to be given earlier and doesn’t need to wait until the four to six years of age.  And again for those adults and over that age, two doses are recommended for a full series.  This is a wake-up call to make sure we keep measles from regaining a foothold in our country protecting our most vulnerable babies and others by assuring everyone who can be protected from measles is appropriately vaccinated.  The very large outbreaks we have seen around the world often started with a small number of cases.  I have told you before that France went from about 40 cases a year to over 10,000 cases in a year.  It’s only January and we have already had 84 cases.  Let’s work together to keep these numbers down and to keep measles from returning to plague our communities.  Operator, i think we can go to the questions now.

OPERATOR:  Thank you.  If you would like to ask a question, please unmute your phone, press star 1 and regard your full name clearly when prompted.  To withdraw your question press star two.  First question is from Eben Brown with Fox News Radio.  Go ahead your line is open.

EBEN BROWN: Thank you very much for doing the call today.  Doctor, what are — a couple questions. One, how are our hospitals ready for this and did the need to further prepare hospitals during the Ebola situation late last year, will we have learned something from that with regard to taking care of measles parents should it become more prevalent? And how frustrating is it that there are these groups of people in the united states who question the effectiveness of the vaccine or potential side effect of vaccines and they don’t vaccinate their kids or themselves when they grow up? And you know, because as you have mentioned, herd immunity aspects that seems to be working counter to that and there seems to be more and more people getting more and more air time if you will about not vaccinating your kids.

ANNE SCHUCHAT:  Thank you for those questions. We are so interconnected and the Ebola problem in West Africa has reminded Americans about health problems around and world and that our best protection is to fight outbreaks where they originate. The efforts to improve hospital preparedness do have relevance for measles. The importance of taking the travel history when people present with febrile illnesses. It’s not just measles and Ebola. Very important to ask about travel history in anyone with fever or rash. A second issue is infection control.  We know with the Ebola concern and with measles that we really need strong infection control in hospitals. That starts with a clinical suspicion of illness, that illness can be spread from infected patients.  And we have seen times where there is hospital spread of measles and a huge effort is needed in the case of hospitals to make sure their workers are protected and to reduce the risk of spread whether it’s in emergency departments or on the wards.  But you know there’s a huge difference between Ebola and measles.  In measles we have a very safe and very effective vaccine that has been given for more than 50 years so there’s an easy way for us to protect our hospitals and communities and I strongly recommend appropriate on time vaccination with the MMR.  It is frustrating that some people have opted out of vaccination. I think it’s very important for people to have good information they can rely on about the safety and effectiveness of vaccines and for our system to serve people in making it easy, efficient, and convenient to get vaccines. But we do have a number — really a generation that has not seen these diseases. So whether it’s clinicians who have never taken care of measles before or parents who wonder whether this disease still exists, I think it’s important for us to educate them and remind them that we have safe and effective vaccines. Most parents are trying to do the best thing they can for their kids and most parents are vaccinating their children against all the recommended conditions.  But some parents have questions and those questions I hope we can answer and I do hope people can realize these viruses and other germs are out there still and our vaccines really are still needed.  Next question?

OPERATOR:  Our next question comes from Anna Edney from Bloomberg News.

ANNA EDNEY:  Hi.  Thanks for taking my question. Are you concerned that the outbreak could get a lot worse with the super bowl coming up in Arizona? We know there are cases there and people have been exposed that might not know it yet?

ANNE SCHUCHAT:  We have cases of measles right now reported from 14 states so it’s important for people everywhere to be on their guard. Very important for people to make sure their kids are vaccinated and if they are traveling abroad to make sure that they have been appropriately protected. Measles can spread in any setting, especially in places where many people are unvaccinated. I wouldn’t expect the super bowl to be a place where many unvaccinated people are congregated. I know it’s a highlight that many people are looking forward to this weekend.

ANNA EDNEY:  Are there any special precautions that you are taking just because it is a large event?

ANNE SCHUCHAT:  No — no.  I think the main thing is that if people are having fever or rash, they need to let their doctor or nurse know about that and that clinicians caring for people with fever or rash need to think measles at this point and take a travel history and take appropriate steps.  I think people really need to know that you can get measles anywhere.  It’s invisible.  And we have importations every year.  As i mentioned, 20 million measles cases around the year in the world. So measles is being acquired in a lot of different contexts. We happen to know that there was transmission at the large entertainment venue in California but we know that measles is also being acquired in the community, schools, and elsewhere. What we can do about that is make sure that people are being vaccinated appropriately.

OPERATOR: Our next question comes from Maggie Fox from NBC News.

MAGGIE FOX:  Thanks so much. Can you tell me a little bit about the hard epidemiology that is being done right now?  How many people are you doing contact tracing on?

ANNE SCHUCHAT:  Thank you for that question. I don’t have the actual numbers of the work in progress because I think that the people doing the work in progress are so busy they haven’t had a chance to put those numbers together this is a reminder that we are so dependent on the state health work force. They are diligently following up suspect illness to the laboratories are testing people to figure out whether it is measles or not and they are following up the contacts and trying to protect them if they recognize the context within a short period of time. They may be able to make sure they’re vaccinated or that appropriate other therapies. This is a huge effort.  It’s a big effort with 84 cases being followed up. We really don’t want that number doubling and tripling or adding digits to it. So we really want people to be thinking about this now and if there are any questions whether your child is up to date or not, make that appointment.

OPERATOR:  Our next question comes from Erik German with Retro Report. Go ahead your line is open.

ERIK GERMAN:  Thank you. I just wanted to confirm you said at the top that there are 84 cases in 14 states but then later said there are 67 that can be definitely linked to the Disneyland theme park. I just wanted to know if the other additional cases are from somewhere else or if they just — the link has not been established yet.

ANNE SCHUCHAT:  It’s a mixture there are some that might be linked when further investigation is completed.  In a number of instances, we know of travel history or exposure to travelers from a number of other countries. So — that have another source that is not the Disneyland theme park.  So I would say that so far this year we have a smattering of importations which is actually a greater number of importations than we usually would have in January, but the largest number is linked to the outbreak in California.

ERIK GERMAN:  And that number is 67?

ANNE SCHUCHAT:  Yes and let me clarify. The 67 people associated with the California outbreak includes Californians and people from six other states but it also goes back to December 28th, so it includes a handful of cases from 2014. 84 people i mentioned is the count from January 1.

ERIK GERMAN:  Thank you.

OPERATOR:  Our next question comes from Mike Stobbe with Associated Press. Go ahead your line is open.

MIKE STOBBE: Hi. Thank you, doctor for doing this. Back on the numbers. Let me finish that off. You said there’s two time frames here. Of the 84 this year, how many of them are related to the California outbreak and also could you say a little bit more about the 67 confirmed cases? Were any of them in a country that had a recent measles outbreak? You mentioned there are more adult cases than usual. Could you say how many of the 67 were adult versus children and what proportion of the 67 were vaccinated? Did you say there were pregnant woman and how many pregnant women? What proportions have been hospitalized?

ANNE SCHUCHAT: Thank you. The reality is I won’t have the answer to most of those questions. The ones that I can answer I would like to get correct. In terms of the outbreak that is related to the Disneyland resorts theme parks in 2015, there are 56 cases that are related to that and in 2014 there were 11. That’s where the 67 comes together for the Disneyland issue. The adult and children issue, we don’t have all of the details yet about the ages and so there is quite a bit that’s pending. I think we will be…of course it is going to be important to put this together. The median age of cases has been increasing. It’s over 20 right now. In terms of the hospitalization, so far for the information that we have, which is not on all 84 of these cases, 15 percent have required hospitalization and that is not that different than what we would typically see. I think it’s too soon for us to know whether the whole clinical spectrum and severity for this outbreak for this year is going to be different because of the larger number of adults. You know, one question we get is why are we seeing it in adults? I think a good answer is most children are vaccinated. There are a lot more adults than children and adults travel a whole lot more than children do in general. But we will need to wait for the full statistics to come through. As you know, 50 years ago we didn’t have a measles vaccine. Those of us who are over 50 were almost universally exposed to measles and got measles and became immune to it. Since then we have had more and more people in the U.S vaccinated and protected. We may be seeing a change in the epidemiology over the next few years and it’s an important question. We do have an easy way to not have to get into those questions by just making sure that people are vaccinated and in particular we don’t let ourselves get large communities with high levels of unimmunized people where the disease could be harder to control.

MIKE STOBBE: What about if any of the 67 have been to a country with a recent outbreak?

ANNE SCHUCHAT: The 67 — we don’t — I guess your question is do we know a travel history that will help us understand where measles came from to get into Disneyland whether it’s from an American traveling abroad or somebody from abroad visiting Disneyland. We don’t have that information. We do know that the genotype of the virus that’s associated with the Disneyland outbreak is causing outbreaks in 14 different countries around the world. So the genotyping won’t tell us the specific source yet. But — and we don’t have a travel history from the early case. There may be someone who was here and gone and will never know. But I think the investigation is ongoing. Next question.

OPERATOR: Our next question comes from Dan Childs with ABC News. Go ahead your line is open.

DAN CHILDS: Thank you very much for taking my question. It’s sort of a two-part question. We took a look at MMR vaccination rates in the U.S. throughout the decade and they have stayed pretty stable throughout the last few years and definitely higher rates than we saw in the 90s. We saw that California doesn’t have a rate — they are not that far below the national average in terms of MMR. To what extent is this wholly attributed to the pockets of under vaccination and is it that these pockets are getting worse?

ANNE SCHUCHAT: That’s a great question. The national estimates hide what’s going on state to state. The state estimates hide what’s going on community to community. And within communities there may be pockets. I think we do have some communities with many who have not received vaccines and the — five of those cohorts are increasing. It’s one thing if you have a year where a number of people are not vaccinating, but year after year in terms of the kids that are exempting, you do start to accumulate. We may have a number of communities, but this also may just be that there was a big — a whole lot of people around the virus in Disneyland and started quite a few individual chains that need to be followed up. We track coverage at the state level and the states track school entry MMR coverage. And things generally look good, but there are some schools and some school districts where things are a problem. I really appreciate the states that have been posting their school coverage data and their school exception data so community members have a chance to see what’s going on. But as you see, the overall picture has been getting better, not worse. It’s just the micro communities that we think make us vulnerable.

DAN CHILDS: And just one follow up if it’s okay. Should we in light of this be revisiting the notion of non-medical exemptions and whether they should be allowed? Also, if we have time, I would like to know what the 14 states are where measles has occurred so far in 2015.

ANNE SCHUCHAT: For the states I think we can get you that in follow-up. It may not be efficient for me to read them off. We will get you them. In terms of the non-medical exemptions, medical exemptions are absolutely essential. A six-year-old with leukemia can do not get the vaccine. But when she is well enough to go back-to-school we really want to make sure that she’s not going to get sick from others in the school. There is a reason for medical exemptions. It’s just absolutely essential in terms of not doing harm to a child. A number of states do have other types of exemptions. I know state by state they have been revisiting that sometimes states have made the exemption opportunities easier, sometimes they’ve made them harder. We know the easier it is to exempt, the more people will exempt. When states make it easier to get vaccinated than to exempt, we see higher rates of vaccination. I think it’s just important for us to know that vaccines protect individuals and they also protect the vulnerable people around the people who have been vaccinated. Next question?

OPERATOR: Our next question comes from Rosanna Xia with LA Times. Go ahead your line is open.

ROSANNA XIA: Hi Dr. Schuchat. Thank you for taking our question. Real quick for the other non-Disney related 67 cases, are there any links that you have identified or are they individual cases per state from international travel?

ANNE SCHUCHAT: I believe most of what we are seeing is individuals. You know, of course these are active investigations, but and the incubation periods may not have been followed because it is only January 29th. It may be too soon whether they will be related cases. At this point California’s Disneyland related outbreak is the one we’re following closely.

ROSANNA XIA: In your experience from looking at outbreaks, is the number of cases right now state to state from one specific epicenter like Disneyland, is this rate right now concerning? It seems slower than what a typical outbreak would be. Could you talk a little bit about how well officials are containing this outbreak or whether or not they should be doing more.

ANNE SCHUCHAT: We have had outbreaks that are of variable sizes. If we look at the outbreaks going back to 2008, you know, a number of the outbreaks were only 20 or 30 cases total and we have already got 67 cases from this and we know the number is going to be somewhat larger at least.  The largest outbreak we had in recent years in the U.S. was related to the Amish community in Ohio.  That was quite unusual because it was a large population where vaccine use was very low at the time.  In most of these other settings, we are not seeing the virus introduced into a very large population with hardly any vaccination.  So, the situation here is that we know that already, a number of states are following up cases related to this and we really don’t want chains of transmission to begin in those states or gain a foothold.  We don’t expect this to be like thousands but we don’t want to give it an opportunity to become that.  And again this cautionary tale that there are countries where they have started with 40 to 50 a year and gone to the many thousands in just another year.  We don’t want to let that happen here.  We want people to realize they should be checking vaccine records and thinking about this before they travel. Next question.

OPERATOR: Next question comes from Betsy McKay from the Wall Street Journal.

BETSY MCKAY: Hi and thanks.  I have a couple of questions.  One is, again, on the cases which are not part of the Disneyland resorts outbreak that you said were — looked like a smattering of importations.  Do you know what countries those are from and in particular, I’m wondering if the — what you’re see something more from the Philippines if that outbreak is still going on.  The second question or if not, is there a big outbreak going on someplace else in the world that is causing a larger number to come into the states right now.  And the other question was about vaccines.  There is a pretty sizable percentage it looks like in Disneyland outbreak who were vaccinated including something like 13% in California who had had two doses of the vaccine so I’m wondering, is there any indication or are you looking into at all into the possibility that vaccine effectiveness or immunity may wane with age?

ANNE SCHUCHAT: Thank you.  Let me read a few countries where we have a history to links of recent measles case with a different country of origin, not to say that the person was of origin of the other country but there was a travel history.  Indonesia, India and Dubai at a minimum and there is probably some additional ones that are under investigation.  That’s for the 2015 importations.  So we don’t have a definite Philippines travel history in any of our 2015 cases.  Of course last year there were a number of importations that were associated with the Philippines last year.  Now in terms of the vaccine history, the coverage of MMR is very high and the higher the coverage that you have, the more chances that you will have some fully vaccinated people get measles even though the vaccine is highly effective.  We think two doses is probably like 97 percent effective but if you have really, really high coverage, if 95 percent or more are protected you will get some people who are two-dose failures.  We’re at too early a stage to measure whether there is a problem of waning immunity or some unexpected vaccine efficacy but based on what we have seen so far we are not suspecting that.  We like to keep an open mind and fully investigate but so far what we are seeing is consistent with a highly effective vaccine and a number of people that have not been vaccinated.  Next question?

OPERATOR: Our next question comes from Matthew Stucker with CNN.  Go ahead your line is open.

MATTHEW STUCKER: Thank you.  Can you tell me how many people have been quarantined or isolated in this outbreak and of those people, how many did have measles or became infected or who didn’t become infected and also if there are still in people in quarantine or isolation?  And also just to go back to the super bowl thing, there is tons of contacts that are still being watched.  It didn’t seem like a place where people with measles would be congregating, but i don’t think that the people that went to Disneyland expected to get measles.  I’m wondering why there is no precautions being taken there, especially in phoenix where they are still trying to track down 200 people from that hospital.

ANNE SCHUCHAT: Thanks.  I don’t have the number of people who are being followed up and interventions that are being recommended for those people.  What i can say is that if you have been vaccinated appropriate to age and are exposed to someone with measles, there is no special steps that need to be taken.  So the easiest thing for the public health departments and families who are traveling is to be appropriately vaccinated and to have documentation of that.  Certainly these are ongoing investigations in terms of what is being done.  We — we don’t have those numbers.  Now in terms of the super bowl, what i can say is that it’s — there are large public gathering in many places and they are cherished and valued events.  The important thing in terms of our usual recommendations is if you’re ill, we recommend you not travel that you don’t get on an airplane if you’re sick or having fever.  Of course it’s flu season.  We’re seeing an enormous amount of people with illness right now and we are trying to suggest that people who are ill rest and stay away from others so that others can enjoy festivities.  And just a reminder with an event like the super bowl going on that good vaccination can keep you healthy and able to go to these kinds of events.  I think we have time for two more questions.

OPERATOR: Our next question comes from Jodie Tillman with Tampa Bay Times.

JODIE TILLMAN: the cases where the patients were not vaccinated, were some of them on the so-called alternative schedule where they didn’t get their second dose — had their first dose but delaying their second dose for whatever reason?  If so if you could talk a little bit about the risks of that strategy?  You do hear it sometimes from some of the parents.

ANNE SCHUCHAT: Thank you.  We do know that some of the reported measles cases this year had exempted from vaccines.  We don’t have all the details yet to know what proportion had delayed vaccine.  We just, you know, had not yet gotten around to it yet versus who didn’t want it.  We do know that the measles cases we have been seeing have generally been in people who have been unvaccinated and many of them not vaccinated due to personal belief exemptions.  We do have some cases where people were at the doctor’s office and didn’t get the vaccine because of another illness or something.  We recommend you should get vaccinated unless you have a severe illness.  In 2014, 79 percent of the unvaccinated cases of measles in the U.S. were unvaccinated due to personal belief exceptions.  Whether that data will hold up this year we don’t know.

JODIE TILLMAN: Do you know, if they have got their children —

ANNE SCHUCHAT: That’s a great question.  Because i have spoken to parents who think, oh, you know, 12 months, do i really want to get my baby vaccinated at that age?  Can’t i just wait?  The reason that the MMR vaccination is recommended routinely at that age is because babies are vulnerable to measles and complications of measles and 12 months is the age where it reliably works well.  We would give it routinely earlier if it were highly effective at much earlier ages for instance, less than six months.  Between six and 12 months, measles vaccine will protect but it doesn’t last that long and you need to give two more doses so we recommend in the setting of outbreaks or if you are traveling internationally babies between six and 12 months babies get a vaccine they will just need two more doses.  People who think my baby is too young to be vaccinated, that’s when your baby is at a vulnerable stage.  The concerns that people had about whether the vaccine may not be safe or linked to autism have not borne out at all.  The MMR vaccine, very safe, very effective, really necessary.  And the 12 month routine first dose we strongly recommend.  As we look through cases we have seen a lot of cases in infants and toddlers who were planning to get it but didn’t want to get it at the 12 month period and i would revisit that if that’s your children that I’m talking about.  Last question?

OPERATOR: Last question comes from Lenny Bernstein from the Washington Post.

LENNY BERNSTEIN: I wanted to follow up on the 79 percent  Do you have any good data of the number of people, the percentage of people in the United States who have chosen not to get the vaccine?  Not the medical reason?  Personal beliefs?

ANNE SCHUCHAT: No.  In terms of the general population, we don’t.  We have been tracking a number of things over time.  One of the things we have been tracks something the percent of infants and toddlers who get no vaccines at all.  There is a misunderstanding that when we talk about vaccine acceptance that everybody is dropped out of the system.  We continue to have less than 1% of toddlers in the u.s. have received no vaccines at all.  Almost every toddler is getting vaccinated with some vaccine most of the time.  We don’t have data on, for the whole nation on exemptions.  We do track kindergarten entries every state.  And we report that every summer.  Our website has that information.  So state by state you can see what percent of kindergartners have gotten MMR vaccine as recommended and what percent are exempting due to medical or other exemptions.  That is a number that we are following.  Our effort has been to make the data easier to compare state to state and year to year.  Measles is still around with 20 million cases around the world and this year we’re off to a bumper start.  I strongly recommend people make sure their children are appropriately vaccinated and that they are vaccinated before travel or are protected against measles.  Thank you for following the story and we will be updating our website on a weekly basis with the latest numbers.  And thank you to the state and local health departments that are working day and night to follow up on all of the cases.

BEN HAYNES: Thank you. This is going to conclude today’s briefing.

Europe | H5N8 bird flu continues to spread in poultry – Outbreaks in Italy, the Netherlands and Germany

Vital signs:

  • Highly Pathogenic Avian Influenza (HPAI) H5N8
  • New outbreaks reported in Italy, the Netherlands, and Germany
  • Ongoing outbreaks in Japan and the Republic of Korea
  • No cases of H5N8 in human beings

On 16 December 2014, the World Organization for Animal Health (OIE) was notified of an outbreak of HPAI H5N8 on a turkey farm in Porto Viro in northeastern Italy. Over 1200 birds had been infected and had died. Culling started as of 16 December. Restriction zones were established, and control measures (disinfection, culling and movement control) are ongoing. Genetic analyses are currently under way to confirm that this virus is similar to those observed in other European outbreaks.

A new outbreak of HPAI H5N8 was reported in the week beginning 15 December 2014 on a poultry farm in Niedersachsen, Germany, prompting the culling of birds at this location, as well as on a neighbouring turkey farm. It was confirmed that the virus was similar to that of the November outbreak.

According to the OIE, two more outbreaks of HPAI H5N8 have been reported in the Netherlands. As of 3 December 2014, several disease control measures were applied in protection and surveillance zones surrounding the outbreaks, including culling, disinfection, control of wildlife reservoirs and movement control.

No further outbreaks of H5N8 have been reported in the United Kingdom since November and the protection zone around the previous outbreak was lifted on 12 December 2014. There remains only the larger surveillance zone, where disease control measures are still applied.

In addition to the cases in poultry in Europe, widespread outbreaks of HPAI H5N8 were reported earlier in the Republic of Korea and Japan, some of which are still ongoing. In the United States of America, HPAI H5N8 was detected in a captive wild bird last week but has not been found in poultry.

Risk to the general public?

No cases of H5N8 in human beings are known, and the risk to the general public is extremely low. Nevertheless, national authorities are taking appropriate precautions, as some avian influenza viruses can infect humans and other H5 viruses, such as H5N1, have affected humans in the past. The H5N8 virus in Europe appears to be highly pathogenic, meaning that it is highly likely to cause disease and death in poultry. People in close contact with live poultry should watch for any signs of illness in their flocks and immediately inform their veterinarians if they notice any cause for concern. It is safe to eat properly cooked poultry products.

What authorities are doing

Veterinary and public health authorities are working together in line with national, European Union and WHO guidelines, and have taken every reasonable precaution. For example, a protection zone and a surveillance zone have been put in place around affected premises to prevent the spread of disease. The poultry affected by the outbreak are being culled by personnel wearing personal protective equipment. Such personnel and anyone working on a farm who might have been exposed are being monitored and offered antiviral medication as a precaution. Their contacts are also being monitored for 10 days.

New York | Measles outbreaks reaching highest numbers in years – Vax importance emphasized

With the number of measles outbreaks for the first four months of 2014 at the highest level since 1996, Governor Andrew M. Cuomo and the State Department of Health today alerted New Yorkers about the importance of being vaccinated to protect against the dangerous disease.  

“Measles is a serious, highly contagious disease that is not just limited to young children,” Governor Cuomo said. “While many New Yorkers have likely already received measles vaccinations, with the number of outbreaks at a higher level in years the State is taking the opportunity to urge New Yorkers check with their healthcare provider to make sure they and all of their family members’ immunizations are up-to-date.”

The Centers for Disease Control and Prevention (CDC) reports that measles has infected 129 people in 13 states in 2014, the most in the first four months of any year since 1996; 29 of those infections have been in New York. In 2013, an outbreak of 58 cases in New York City was the largest reported localized outbreak of the measles in the U.S. since 1996.

About Measles

Measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune will also become infected with the measles virus   It is spread by contact with nasal or throat secretions of infected people. You can be infected by measles virus suspended in the air for an hour or more after the infected person has left the room. The most common complications of measles are diarrhea, pneumonia, and ear infection, but it may also cause brain damage and rarely death. It is particularly harmful to persons with immunosuppression, pregnant women and very young children.

Measles symptoms usually appear in 10 to 12 days, but can occur as late as 18 days after exposure. Symptoms generally appear in two stages:

  • In the first stage, which lasts two to four days, the individual may have a runny nose, cough and a slight fever. Eyes may become reddened and sensitive to light while the fever gradually rises each day, often peaking as high as 103° to 105° F. Small bluish white spots surrounded by a reddish area may also appear on the gums and inside of the cheeks.
  • The second stage begins on the third to seventh day, and consists of a red blotchy rash lasting five to six days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities. Although measles is usually considered a childhood disease, it can be contracted at any age.

The single best way to prevent measles is to be vaccinated. Most New Yorkers have been vaccinated, but if unsure, they should check with their healthcare provider.  Individuals should receive 2 doses of Measles, Mumps, and Rubella (MMR) vaccine to be protected.  The first dose should be given at 12-15 months of age and the second dose is routinely given at 4 to 6 years of age, but may be given as soon as 28 days after the first dose. Anyone at any age who is not immune to measles, and has no condition that would prohibit receiving the vaccine, should receive 2 doses of MMR vaccine at least 28 days apart.

Individuals are not at-risk of contracting measles if they are immune. A person is considered immune if he or she has received two doses of MMR vaccine, or if he or she was born before January 1, 1957, or has a history of laboratory-confirmed measles, or has a blood test confirming measles immunity. Any of the above confers immunity.

It is also important to note that travelers should be up-to-date on their vaccinations; since January 2014 there have been 34 cases of measles reported in the United States from travelers to foreign countries.

More information about measles can be found at: http://www.health.ny.gov/diseases/communicable/measles/fact_sheet.htm.

More information about vaccine safety and the importance of vaccines can be found at:

Denmark | Salmonella Enteritidis and Shigella sonnei in connection with vacation travels to Turkey in 2013

Since June, Statens Serum Institut has recorded an increasing number of patients who have been infected with Salmonella Enteritidis during vacation travels to Turkey. Concurrently, an outbreak at a hotel in Alanya was shown to have been caused by several pathogenic gastrointestinal bacteria including S. Enteritidis and Shigella sonnei.

In the course of the summer, subtyping of Salmonella Enteritidis has identified an increase of four closely related subtypes. By 3 September, bacterial strains had been received from a total of 81 persons who had been diagnosed with one of these four subtypes of S. Enteritidis since June 2013. Among these, 47 persons had known previous travels to Turkey. In the same period in 2010-2012, between 27 and 39 persons were recorded with S. Enteritidis infection after having travelled to Turkey. Interviews with the patients have shown that they lived in different towns and at different hotels in Turkey. Poor hygiene at a single hotel, restaurant or other establishment can therefore not explain the observed cases.

Additionally, over the course of the summer, cases of Shigella sonnei have been recorded in Denmark and in other Nordic countries in patients who had returned from Turkey. A joint Nordic epidemiological study – including all persons who have lived at a certain hotel in Alanya – is currently on-going aiming to identify the source of this probable outbreak. In a limited number of patients with gastroenteritis who had stayed at the hotel in question, other pathogenic gastrointestinal bacteria than Shigella sonnei were detected, including: S. Enteritidis and verocytotoxin-producing Escherichia coli (VTEC).

On this basis, Salmonella, Shigella and VTEC infections should be suspected in patients with symptoms that are consistent with bacterial gastroenteritis following travel to Turkey. For Shigella and VTEC, specific guidelines are in place for persons in sensitive occupations EPI-NEWS 50/03. General travel advice for the prevention of food-borne diseases is avaliable at the SSI’s website.


Previously, S. Enteritidis was the most frequently occurring salmonella type in Denmark. However, over the past 15 years, the number of S. Enteritidis infections has decreased steadily, EPI-NEWS 12/13. Since Danish chickens and egg-layers were declared salmonella-free, the majority of the recorded cases of infection have been acquired abroad, and the latest recorded outbreak of S. Enteritidis associated with a Danish source occurred in 2009, EPI-NEWS 36/09.

In Denmark, the country of infection of all salmonella cases has been monitored through telephone interviews since 2008. In the 2008-2012-period, a total of 37% of all salmonella cases with known country of infection were acquired abroad. In the same period, however, a total of 60% of all S. Enteritidis cases with known country of infection were acquired abroad. Since 2010, more than 75% of all S. Enteritidis cases with known country of infection have been acquired abroad.

Every summer sees an increase in the number of S. Enteritidis patients who have become infected during travels to Turkey, Figure 1. The numbers for 2013 were not included in the figure as the country of infection has yet to be established in a considerable number of cases. It remains unclear if the currently observed increase in S. Enteritidis cases from Turkey indicates a higher than normal level of food safety issues at the destinations, or if the cause is increased travelling activity to destinations in Turkey. Unfortunately, the total number of Danish tourists who have visited Turkey annually over the years is not known.

(S. Gillesberg Lassen, S. Ethelberg, and L. Müller, Department of Infectious Disease Epidemiology, M. Torpdahl and S. Persson, Microbiological Monitoring and Research)