Communicable Diseases Communiqué

Transcription

1 Communicble Diseses Communiqué MARCH 2018, Vol. 17(3) CONTENTS Pge 1 ZOONOTIC AND VECTOR-BORNE DISEASES An updte on rbies in South Afric 2 2 VACCINE PREVENTABLE DISEASES Mesles outbrek in KwZulu-Ntl Province declred over 2 3 SEASONAL DISEASES Mlri: Ester trvel lert 3 b Influenz - prepring for the 2018 seson 4 4 CURRENT OUTBREAKS An updte on the outbrek of Listeri monocytogenes, South Afric 4 5 FOOD AND WATER-BORNE DISEASES An updte on the choler cse from Umkhnykude District, KwZulu-Ntl Province 6 b Heptitis A cluster in Hessequ Sub-district, Eden District, Western Cpe Province 6 6 AN UPDATE ON THE OUTBREAK OF SKIN LESIONS AMONG MINE WORKERS AT A GOLD MINE IN GAUTENG PROVINCE 7 7 BEYOND OUR BORDERS 9 8 WHO-AFRO: OUTBREAKS AND EMERGENCIES 10 1

2 1 ZOONOTIC AND VECTOR-BORNE DISEASES An updte on rbies in South Afric Rbies ws confirmed in three-yer-old boy who died in mid-februry The child ws exposed to stry ct on 1 Jnury 2018 t Blythedle Bech, KwZulu-Ntl Province. He sustined ctegory III exposure for which no medicl intervention ws sought. The child fell ill t the end of Jnury Upon dmission to hospitl erly Februry, he ws pyrexil, confused, hllucinting, twitching nd vomited coffee-ground substnce. The child lso becme ggressive nd reportedly bit nd scrtched one of his prents nd helthcre workers t the hospitl. Rbies ws considered s prt of the differentil dignosis of virl encephlitis but nte-mortem testing (including RT-PCR on sliv, cerebrospinl fluid nd nuchl biopsy) were ll negtive for rbies. Ante-mortem investigtions for rbies re often problemtic nd negtive findings do not exclude the dignosis of rbies. For exmple, it is required to collect sliv smples t different time points to increse the sensitivity of investigtions, s the virus is shed intermittently in the sliv. Post-mortem investigtion on brin smple using the direct fluorescent ntibody test, the gold stndrd for rbies testing, confirmed the clinicl dignosis of rbies. Guidelines for the submission of clinicl specimens for rbies investigtions in ptients suspected to hve rbies disese re vilble from the NICD website: In ddition, probble cse of rbies ws reported from the Estern Cpe Province. A nine-yer-old boy, who ws bitten by ct in Jnury 2018, died in erly Mrch 2018 fter showing signs nd symptoms comptible with the dignosis of rbies. The child ws from Elliotdle nd the exposure occurred t Tfelohshe in the Estern Cpe Province. The history of rbies post-exposure prophylxis (PEP) is uncler, but it ppers tht prtil PEP ws received fter the bite occurred. Lbortory confirmtion of this cse ws not possible. For 2018 to dte, totl of three lbortoryconfirmed nd one probble cse of humn rbies hve been reported. In ddition to the confirmed cse reported here, the other confirmed cses were reported from the Estern Cpe nd KwZulu-Ntl provinces, respectively. Ongoing investigtions re lso underwy for two suspected cses of rbies from KwZulu-Ntl Province. Both ptients died with clinicl disese comptible with the dignosis of rbies nd hd exposures to potentilly rbid nimls before they developed illness. Rbies is preventble through PEP fter possible exposure hs occurred. For more informtion on rbies PEP visit Dog nd ct vccintion cmpigns re ongoing in mny of the ffected res. Pet owners re urged to ensure tht their dogs nd cts re vccinted ginst rbies. Source: Centre for Emerging Zoonotic nd Prsitic Diseses, NICD-NHLS; jnuszp@nicd.c.z 2 VACCINE-PREVENTABLE DISEASES Mesles outbrek in KwZulu-Ntl Province declred over The mesles outbrek in ethekwini district of Kw- Zulu-Ntl (KZN) Province which strted in 2017 ws declred over on 20 Februry There were 42 cses in ethekwini, with 21 cses detected in six other districts of KZN, giving totl of 63 cses; 62 lbortory-confirmed nd one epidemiologiclly linked (Figure 1). The 5-9 yer old ge group ws most ffected (17 cses). Severl communiction chnnels were used to rise wreness of mesles mong helth cre personnel nd the communities. This resulted in high numbers of suspected mesles cses (SMCs) reported to the Ntionl Institute for Communicble Diseses (NICD) through routine rsh-bsed surveillnce nd the notifible medicl conditions (NMC) pthwys. Most cses in KZN occurred in communities with groups of unvccinted popultions. Intensive community enggement ctivities were crried out by the KZN provincil deprtment of helth nd the helth district tems in collbortion with the Islmic Medicl Assocition. The Western Cpe nd Guteng provinces hd mesles outbreks in 2017 with predominnce of cses from similr communities. Mesles vccines re sfe nd effective in preventing infection. Administrtion of mesles vccine in South Afric occurs first t 6 months then t 12 months in the public sector. The trget for mesles elimintion in South Afric is 2020 nd this cn be chieved by mintining high vccintion coverge. Helth cre workers should notify ll SMCs nd collect blood smple to be sent for lbortory confirmtion. SMCs re ptients who presents with febrile rsh nd either cough, conjunctivitis or coryz. Source: Centre for Vccines nd Immunology, NICD-NHLS; melinds@nicd.c.z 2

3 Figure 1. Lbortory-confirmed mesles cses per week tested t privte lbortories nd/or NICD by dte of onset of symptoms (or dte of specimen collection) in KwZulu-Ntl Province, 1 My 2017 to 14 Jnury 2018 (n=62) 3 SEASONAL DISEASES Mlri: Ester trvel lert Mlri trnsmission is ongoing in South Afric nd its neighbouring countries. The number of mlri cses is expected to rise s result of trvelrelted exposure during the Ester holidys, nd the recent widespred rinfll cross prts of southern Afric tht fvours vector mosquito breeding. All residents of, nd trvellers to nd from mlri trnsmission res (in South Afric this includes the north-estern prts, especilly Mopni nd Vhembe districts of Limpopo Province, the lowveld of Mpumlng Province, including the Kruger Ntionl Prk nd surrounds, nd the northern KwZulu- Ntl Province-Mozmbique border), should be wre of the risk of mlri. Trvellers to high trnsmission res in South Afric, s well s to neighbouring countries prticulrly Mozmbique, re dvised to tke precutions ginst being bitten by mosquitoes through the meticulous use of repellents contining DEET, covering bre skin fter drk if outdoors, closing insect screens on doors nd windows, nd using fns or ir conditioners, if vilble. Trvellers cn lso consult their doctors, clinics or phrmcists for ntimlril chemoprophylxis. Current recommended chemoprophylctic medictions include doxycycline or tovquone-progunil, which re vilble without prescription, but the helthcre worker needs to dvise the best option for ech individul. It should be noted tht whilst these medictions re very good t preventing mlri, they re not 100% effective. All trvellers, whether trvelling to low- or high-risk res, re dvised to be wre of the mlri symptoms of fever, chills, swets, hedches, nuse nd vomiting, body ches nd generl mlise; nd to report to their nerest helth fcility or doctor if they suspect tht they my hve contrcted mlri, even if they hve used the preventive mesures listed bove. Ntionl guidelines for mlri prevention re vilble on the NICD website ( content/uplods/2017/09/guidelines-south-africn- Guidelines-for-the-Prevention-of-Mlri finl.pdf Source: Centre for Emerging Zoonotic nd Prsitic Diseses, NICD-NHLS; (johnf@nicd.c.z) 3

4 b Influenz - prepring for the 2018 seson In Europe, influenz ctivity remins high in most countries. Although influenz B is the predominnt subtype, ll sesonl subtypes co-circulte cross the region. Influenz-relted hospitlistions remined high in Englnd, lthough influenz illness indictors ppered to hve peked in Irelnd nd the United Kingdom. Although influenz ctivity in the USA remins high, ctivity ppers to hve peked. In Cnd influenz ctivity remins high, but the proportion of smples testing positive for influenz hs decresed. In South Afric, influenz remins t inter-sesonl levels, with spordic detections in trvellers. The 2018 Southern Hemisphere influenz vccine is now vilble. Influenz vccine is recommended for individuls t risk of severe complictions of influenz nd include pregnnt women (including the post-prtum period), persons ged <5 yers or 65 yers, nd those with chronic medicl underlying conditions. Source: Centre for Respirtory Diseses nd Meningitis, NICD-NHLS; (cherylc@nicd.c.z) 4 CURRENT OUTBREAKS An updte on the outbrek of Listeri monocytogenes, South Afric The source of the Listeri outbrek hs been identified s redy-to-et processed met products mnufctured t Enterprise Foods Polokwne production fcility. The recll of implicted food products ws nnounced on 04 Mrch However, it is expected tht new outbrek-relted cses will continue to be reported, for the following resons: the incubtion period of listeriosis cn be up to 70 dys; the implicted food products hve long refrigertion shelf life, nd it is possible tht despite the recll some products were not removed from retil or home settings, nd consumption of contminted food might yet occur; the possibility of cross-contmintion of other types of foods in the retil or home setting my result in dditionl cses. As of 26 Mrch 2018, totl of 982 lbortoryconfirmed listeriosis cses hs been reported to NICD since 01 Jnury 2017 (Figure 2). Most cses hve been reported from Guteng Province (59%, 576/982) followed by Western Cpe (12%, 121/982) nd KwZulu-Ntl (7%, 71/982) provinces. Cses hve been dignosed in both public (65%, 634/982) nd privte (35%, 348/982) helthcre sectors. Listeri monocytogenes ws most commonly isolted/detected on blood culture (72%, 711/982), followed by CSF (21%, 207/982). Where ge ws reported (n=943), ges rnge from birth to 93 yers (medin 22 yers) nd 41% (404/982) re neontes ged 28 dys. Of neontl cses, 96% (389/404) hd erly-onset disese (birth to 6 dys). Femles ccount for 56% (531/950) of cses where gender is reported. Finl outcome dt is vilble for 70% (687/982) of cses, of which 28% (189/687) died. Outcome by ge group is shown in Figure 3. All helthcre workers re requested to complete cse investigtion forms (CIFs vilble on the website) for cse-ptients with listeriosis, nd submit these to the NICD (outbrek@nicd.c.z). Clinicl listeriosis mngement guidelines re vilble on the website ( Where clinicins suspect listeriosis but specimens (including CSF nd blood) re culture negtive, polymerse chin rection (PCR)-bsed test cn be performed t the NICD. PCR cn lso be performed on plcent smples for investigtion of stillbirths/miscrriges. Plese contct the Centre for Enteric Diseses on (011) for further detils. The NICD continues to operte its 24-hour hotline for helthcre workers. Cvet: Cse dt is the best vilble t time of publiction. Due to chllenges with NHLS lbortory informtion system dt (since epidemiologicl week 47) nd possible lg in reporting s result of the upcoming public holidys, cse numbers re likely to chnge nd trends must be interpreted with cution. 4

5 Figure 2. Epidemic curve of lbortory-confirmed listeriosis cses by epidemiologicl week nd dte of smple collection nd province, South Afric, 01 Jnury to 26 Mrch 2018 (n=982) Source: Centre for Enteric Diseses, nd Division of Public Helth Surveillnce nd Response, NICD Provincil Epidemiology Tems; NICD-NHLS; Provincil CDCs; Figure 3. Outcom e by ge ctegory of lbortoryconfirmed listeriosis cses South Afric, 01 Jnury 2017 to 26 Mrch 2018 (where ge is known, n=943). 5

6 5 FOOD- AND WATER-BORNE DISEASES An updte on the choler cse from Umkhnykude District, KwZulu- Ntl Province Following the confirmtion of choler in n dult femle ptient in Umkhnykude District, KwZulu- Ntl Province in Februry 2018 (Februry 2018 Communique), severl mesures to control the disese nd prevent further spred were instituted, including: Helth eduction/promotion with emphsis on good hygiene prctices nd the need to purify wter from informl sources (rivers, boreholes, strems, dms, wells nd tnks etc.); Helthcre worker sensitistion, cse investigtion nd ctive cse finding; Wter qulity monitoring testing of environmentl wter smples. To dte, no dditionl cses of choler hve been reported in the re. A definitive source of the ptient s infection could not be identified. Heightened surveillnce is ongoing. Public helth uthorities re on high lert to ensure erly detection of cses nd prevent further trnsmission since there is lwys possibility tht infected persons could introduce Vibrio cholere into informl wter sources. Provision of potble wter nd proper disposl of humn wste to void contmintion of wter sources remin crucil mesures to reduce choler trnsmission. However, these mesures my be difficult to implement or mintin due to unvilbility of clen wter nd/or indequte snittion fcilities. To reduce the likelihood of further spred the following is dvised: where sfety of wter is not known, wter cn be mde sfe for use by boiling nd llowing it to cool. Wter should then be stored in suitble, clen continer with lid. Alterntively, mix 1 tespoon or cpful of household blech with litres of wter nd let it stnd for t lest 2 hours (preferbly overnight). Furthermore, people re dvised not to defecte in or ner rivers or other wter sources. Source: Umkhnykude District Deprtment of Helth; Ntionl Deprtment of Helth; Centre for Enteric Diseses nd Division of Public Helth Surveillnce nd Response, NICD-NHLS; (outbrek@nicd.c.z) b Heptitis A cluster in Hessequ Sub-district, Eden District, Western Cpe Province On 21 Februry 2018, the Hessequ Sub-district in the Western Cpe Province reported suspected outbrek of heptitis A in the town of Heidelberg. Retrospective review of lbortory-confirmed cses from Heidelberg reveled one cse in 2016, 3 cses in 2017, nd 17 cses in 2018 (Figure 4). The significnt increse in the number of cses prompted further investigtions nd preventtive nd control mesures. Between 2 Jnury nd 28 Februry 2018, 17 lbortory-confirmed heptitis A cses were detected; 14 cses t Heidelberg Clinic, two cses t Riversdl Hospitl, nd one cse t generl prctitioner. The mjority of cses were mles (n=15; 88%), nd the ges rnged from 3 to 20 yers. Fifty-three percent (53%) of the heptitis A cses occurred in the 5-10 yer ge group. Nine of the 17 cses ttended the sme primry school Heidelberg, the others ttended locl high schools nd crèches in the re. One ptient ws n employed dult. The helthcre workers conducted interviews with cses nd their cre-givers, did contct investigtions, nd heightened surveillnce nd reporting of suspected cses in Heidelberg. An wreness cmpign in Heidelberg nd surrounding res/communities, schools nd crèches were conducted from 26 Februry to 22 Mrch 2018 focussing on informtion on heptitis, personl hygiene, hnd wshing nd food sfety. This wreness reched lerners. The wter, food sfety, snittion nd hygiene conditions in the Heidelberg community, schools nd crèches re being ssessed. Further investigtions nd response ctivities re on going. Source: Western Cpe Provincil Deprtment of Helth; NICD Provincil Epidemiology Tem, Division of Public Helth Surveillnce nd Response, NICD-NHLS; outbrek@nicd.c.z 6

7 Figure 4. Epidemic curve for Heptitis A cses in Heidelberg, Hessequ Sub-district, Western Cpe, Jnury 2016 Mrch AN UPDATE ON THE OUTBREAK OF SKIN LESIONS AMONG MINE WORK- ERS AT A GOLD MINE IN GAUTENG PROVINCE An outbrek of Stphylococcus ureus skin lesions mong mine workers t gold mine in Guteng Province: n updte NICD ws notified of n outbrek of skin lesions mong workers employed t gold mine locted south of Krugersdorp in Guteng province in November 2017 nd reported in the December 2017 Communique (see We conducted medicl record review on 6 Februry A rndom smple of 50 medicl files (primry helth cre nd occuptionl files for ech mine worker) ws selected from study popultion of 203 workers who ttended the on-site mine clinic for tretment of skin lesions from Jnury through to September Only 47 (94%) medicl files were vilble for review becuse two workers no longer worked t the mine nd one worker ws contrctor. Upon record review, we found tht the 47 workers hd ttended the clinic for tretment of multiple episodes of skin lesions (dt were collected on ll episodes from 14 Jnury 2011 to 15 Jnury 2018). Mine workers hd medin of two episodes ech (IQR, 1-3 episodes). In totl, we recorded 130 episodes, of which 27 (21%) nd 84 (65%) episodes occurred during 2016 nd 2017 respectively. Forty-seven (36%) were first episodes nd 83 (64%) were recurrent episodes. The medin durtion of symptoms before presenttion to the clinic ws three dys (IQR, 2-6 dys). Mine workers presented with skin lesions on vrious res of their bodies (Tble 1). For episodes with recorded tretment history, 62 (52%) miners were surgiclly treted, 101 (83%) were treted with combintion orl ntibiotics, 48 (40%) received topicl ntibiotics nd 78 (65%) received dressings. For the episodes of skin lesions with recorded outcome (n=47), 46 (98%) resolved with medin durtion of resolution of 12 dys (IQR, 9-17 dys) (Tble 1). From 17 November 2017 through to 22 Februry 2018, 25 pus spirte specimens were received by the NICD for processing. Of these, we cultured Stphylococcus ureus from 21 (84%), Stphylococcus epidermidis from one nd no bcteril growth for three. Of the 21 S. ureus isoltes, 20 (95%) were PCR-positive for the gene encoding for the Pnton-Vlentine leukocidin (PVL). All 21 S. ureus isoltes were susceptible to cloxcillin. Seventeen (81%) S. ureus isoltes were susceptible to clindmycin but resistnt to penicillin. Three (14%) S. ureus isoltes were susceptible to both clindmycin nd penicillin, while one isolte ws resistnt to clindmycin nd penicillin. We hypothesise tht there hs been person-toperson trnsmission of S. ureus mong miners working in close confined conditions; strin genotyping dt re pending. Fungi were cultured from ten (40%) pus spirtes lthough none of these were considered cliniclly significnt. All 25 pus spirtes were negtive for cid-fst bcilli using the urmine-o stin. Recommendtions on ntibiotic tretment were provided to the mine clinic bsed on these dt. On 21 Februry 2018, we lso 7

8 conducted fce-to-fce interviews with mine workers to identify possible exposures, n underground visit with environmentl smpling nd bio-risk ssessment of communl fcilities on the surfce of the mine (dt re being nlysed nd re not presented here). Source: Centre for Helthcre-ssocited infections, Antimicrobil Resistnce nd Mycoses, NICD-NHLS; (neleshg@nicd.c.z) Tble 1. Mngement of skin lesions from 47 mine w orkers t gold mine in Guteng Province, 6 Februry Episodes of skin lesions n=130 Episode chrcteristics n/n % Yer / / / / / / / /130 2 Medin durtion of symptoms before presenttion in dys (medin, IQR) $ 3 (2-6) Recurrence Incident skin lesions 47/ Recurrent skin lesions 83/ Site of skin lesions Lower limbs 41/ Upper limbs 31/ Hnds 24/ Fce 16/ Buttocks nd perinl 7/130 5 Trunk nd bck 6/130 5 Groin 2/130 2 Other 2/130 2 Hed nd neck 1/ Tretment Incision & dringe 62/ Orl ntibiotics^ 101/ Metronidzole 79/ Amoxicillin/mpicillin 50/ Cloxcillin 46/ Clindmycin 14/ Amoxicillin-clvulnic cid 2/122 2 Doxycycline 2/122 2 Topicl ntibiotics 48/ Dressings 78/ Other, e.g. specilist referrl 1/ Resolved # 46/47 98 Medin durtion of episode before resolution in dys (medin, IQR)* 12 (9-17) Footnotes: IQR Interqurtile rnge $ Durtion of symptoms could only be clculted for 60 episodes; ^ Mine workers often received combintion of ntibiotics t the sme time; # Resolution of lesions ws unknown for 83 episodes; * Durtion of episode could only be clculted for 24 episodes 8

9 7 BEYOND OUR BORDERS The Beyond our Borders column focuses on selected nd current interntionl diseses tht my ffect South Africns trvelling brod. Numbers correspond to Figure 5 on pge Choler: Mozmbique On 27 October 2017, the Ministry of Helth in Mozmbique notified WHO of n outbrek of choler. From 14 August 2017 through 11 Februry 2018, cses nd one deth (cse ftlity rte = 0.06%) of choler were reported from the two provinces of Nmpul (1 580 cses) nd Cbo Delgdo (219 cses). The outbrek strted in Memb district in the north-estern province of Nmpul nd spred to Erti district by 15 October By 19 November, the outbrek hd spred to Ncro nd Nmpul city. Cse incidence peked in mid- November with 252 cses reported in one week; this pek ws followed by rpid decrese in reported cses. A slow increse in the number of cses reported hs been observed since lte December On 5 Jnury 2018, the first cses were reported from Pemb City in Cbo Delgdo Province which is north of Nmpul. In 2018 so fr, the weekly number of cses hs fluctuted between 30 nd 60 cses. 2. Circulting vccine-derived poliovirus type 2: Somli Circultion of vccine-derived poliovirus type 2 (cvdpv2) hs been confirmed in Somli. Three cvdpv2s strins were isolted from environmentl smples collected on 4 nd 11 Jnury 2018, in Bndir Province (Mogdishu). These ltest isoltes re geneticlly linked to cvdpv2 strins collected from environmentl smples in the sme province on 22 October nd 2 November No ssocited cses of cute flccid prlysis (AFP) hve been detected. 3. Middle Est respirtory syndrome coronvirus (MERS-CoV): Omn, Sudi Arbi On 4 Mrch 2018, the ntionl IRH focl point of Omn reported one new cse of Middle Est respirtory syndrome coronvirus (MERS-CoV). Prior to this ptient, the lst lbortoryconfirmed cse of MERS-CoV from Omn ws reported in November Globlly, lbortory-confirmed cses of MERS-CoV, including t lest 750 relted deths, hve been reported to WHO. 4. Circulting vccine-derived poliovirus: Democrtic Republic of Congo DRC hs hd cses of vccine-derived polioviruses (VDPVs) documented since After n outbrek of 30 circulting VDPV type 2 (cvdpv2) cses during , only five VDPV2 cses were reported during As of 8 Mrch 2018, 25 VDPV cses were reported in three provinces in DRC. Source: ( nd the World Helth Orgniztion ( Figure 5. Current outbreks tht my hve implictions for trvellers. Numbers correspond to text bove. The red dot is the pproximte loction of the outbrek or event. 9

10 Communicble Diseses Communiqué 8 MARCH 2018, Vol. 17(3) WHO-AFRO: OUTBREAKS AND EMERGENCIES Figure 6. The W eek ly W HO Outbrek nd Em ergencies B ulletin focuses on selected public helth emergencies occurring in the WHO Africn Region. The Africn Region WHO Helth Emergencies Progrmme is currently monitoring 52 events, of which 43 re outbreks nd 9 humnitrin crises. For more informtion see link: 10