Date: Mon 18 Feb 2019
Source: Independent [edited]
<https://www.independent.ie/irish-news/health/rare-strain-of-meningitis-on-rise-but-current-vaccines-fail-to-give-immunity-37825487.html>

A rare form of deadly meningitis is on the rise in Ireland following a pattern seen in other countries, disease specialists have revealed.  The number of cases of the [_Neisseria meningitidis_ serogroup] W strain has increased from one in the year 2014 to 12 last year [2018]. There has also been an increase in [meningococcal] meningitis [serogroup] Y over the same period, up from 3 to 8 (See:  <http://www.hpsc.ie/news/newsarchive/2019newsarchive/title-18757-en.html>).

Neither strain is currently included in the vaccines to protect against meningitis [that] are commonly given to children.

The increase follows a similar trend in the Netherlands and the United Kingdom, which has in turn led to the MenACWY vaccine now being offered by health services to teenagers and college and university students.

No such vaccination programme has been introduced here yet, but the rise in cases will have to be examined by the group of experts which advises the HSE [Health Service Executive] on what jabs should be given free to various groups of patients.

Like other forms of the disease, it can be very serious if not treated quickly with antibiotics. Without emergency treatment, it can lead to life-threatening blood poisoning, and result in permanent brain or nerve damage.

The report [source?] from the Health Protection Surveillance Centre, the country's disease watchdog, said that during January [2019] there were 17 cases of different forms of meningitis. Four of these involved the W and Y strains. Two people died from meningitis during January [2019]. Overall, the incidence of meningitis in Ireland has fallen in the past 2 decades.

In the past, the meningitis B and C strains presented the highest risk, but the introduction of vaccines for both has led to a fall in circulation of both.

The report pointed out that in 2000, the meningitis C vaccine began to be routinely given to children, which went along with a catch-up programme for teenagers. Since the introduction of the meningitis C vaccine, the annual incidence of the strain has decreased substantially from 135 cases in 1999 to 20 last year [2018].

A vaccine to protect against meningitis B was introduced in recent years, but only for children born after October 2016, leaving parents of older children to pay Euro 300 [USD 340] to have the jab privately. The annual incidence of meningitis B has also reduced considerably from 292 cases in 1999 to 46 cases in 2018.

The report said that changing trends in the incidence of the infection have been reported in other European countries in recent years. In Italy, the number of meningococcal W cases has been increasing since 2013. "The Netherlands has also seen an increase in reported cases of meningococcal W cases, which had been very rare prior to 2015. Between 2010 and 2014, an average of 4 cases of meningococcal W were reported annually but increased substantially over the following years to 80 cases in 2017. "This rapid upsurge in meningococcal W in the Netherlands has been attributed to a meningococcal W," it added.

The report said that 17 cases and 2 related deaths were reported from 1-29 Jan this year [2019]. "This was slightly less than in the same period last year when 19 cases -- and 2 related deaths -- were notified. "Amongst the 17 cases notified from 1-29 Jan 2019, different strains were reported, and different age groups were affected."

The report added that although meningitis notifications have been stable in the 1st 4 weeks of 2019 compared to the previous year [2018], ongoing monitoring of trends is needed "to assess the circulation, distribution and evolution of specific control strategies, particularly preventive vaccination programmes, and to inform national vaccination policy."  [Byline: Eilish O'Regan]
========================
[A recent (23 Jan 2019) report from the Health Protection Surveillance Centre (HPSC) gives numbers of cases that are slightly different from the news report above for a similar period of time (<http://www.hpsc.ie/news/newsarchive/2019newsarchive/title-18757-en.html>): "Twenty meningococcal cases were notified to HPSC in Ireland between 24 Dec 2018 and 22 Jan 2019, compared with 19 cases in the same period last year [2018]. There is not an outbreak. Meningococcal disease is known to have increased incidence in winter and early spring. Among the 20 cases, different age groups were affected, different strains were reported (B,C,W,Y), different regions of the country reported the cases and there were no links found between the cases. Sadly, 3 of the cases have died; none was caused by meningococcal strains that are covered by the vaccines in the national childhood programme (the strains were not B or C)."

_Neisseria meningitidis_ only infects humans; there is no animal reservoir, and the organism dies quickly outside the human host. _N. meningitidis_ colonizes the mucosal membranes of the nose and throat; up to 5-10 percent of a population may be asymptomatic nasopharyngeal carriers, but the carrier rate may be higher in epidemic situations. Droplets of nasopharyngeal secretions from these carriers are responsible for the spread of the disease. Close and prolonged contact with an infected person or a carrier facilitates the spread of the disease.

Several meningococcal vaccines are available. Immunity following use of a meningococcal polysaccharide vaccine is specific for the type of capsular polysaccharide that the vaccine contains, with no cross-protection against infection due to other meningococcal polysaccharide groups. Although there are at least 13 _N. meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W are most common.

There are vaccines that contain capsular polysaccharide (A, C, Y, W), either alone or conjugated to protein. Conjugate vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines. Serogroup B vaccines are based upon meningococcal B protein antigens, because group B polysaccharide is poorly immunogenic in humans and is a potential auto-antigen.

Following the mass introduction into the population of a vaccine specific for one particular serogroup, the incidence of disease due to that serogroup has been found to fall dramatically, e.g., serogroup C disease in several countries (e.g., UK, Netherlands, and Australia) following the introduction of conjugate C vaccine and serogroup A in the African Meningitis Belt following conjugate A vaccine, only to be followed by the emergence of a "replacement" pathogen, e.g., serogroup W. in subsequent years.

Because of the continuing rapid increase in the UK in serogroup W disease, the UK replaced the adolescent meningococcal C conjugate vaccine for 13-14-year-olds with the quadrivalent ACWY conjugate vaccine in the autumn of 2015. In addition, catch up campaigns were set up to give the ACWY vaccine to all 13-18-year-olds and new university admissions during 2015 to 2017 (<https://www.rivm.nl/bibliotheek/rapporten/2017-0031.pdf>).

Neither B nor ACWY vaccinations were included in the Dutch National Immunisation Programme. However, as of May 2018, the meningococcal ACWY vaccination replaced C vaccination at age 14 months and from October 2018, 13-14 year olds were offered ACWY vaccination (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915972/>). A detailed discussion of these issues in the Netherlands appears in a publication "Meningococcal disease in the Netherlands. Background information for the Health Council. RIVM Report 2017-0031 M.J.Knol et al," which is available at <https://www.rivm.nl/bibliotheek/rapporten/2017-0031.pdf>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Ireland: <http://healthmap.org/promed/p/39>]
Date: Sat 12 Jan 2019
Source: Food Safety News [abridged, edited]
<http://www.foodsafetynews.com/2019/01/uk-and-ireland-investigate-norovirus-oyster-outbreak/>

Authorities in the United Kingdom and Ireland are investigating a foodborne outbreak suspected to be caused by norovirus in live oysters.  The oysters are thought to have come from Ireland and been purified in the UK, and it is believed they are no longer on the market.  Harvesting records and purification operations at the unnamed implicated business in Ireland have been checked with nothing proving that oysters harvested at the time were contaminated. A number of people fell ill in England, and the investigation has pointed towards a potential norovirus outbreak linked to one restaurant.

The Food Safety Authority of Ireland (FSAI) told Food Safety News that it has sought detailed clarification on traceability and delivery channels.  "We have started investigations in relation to this notification from the Rapid Alert System for Food and Feed. It is not yet certain if the oysters that were consumed by the people who became ill were actually from Ireland," said a spokeswoman.

Nevertheless, at the request of the FSAI, the Sea-Fisheries Protection Authority (SFPA) checked the harvesting records and purification operations at the implicated business in Ireland. There is nothing to demonstrate that any oysters harvested at that time were contaminated. There are also no other reports of illness. The FSAI and the SPFA are continuing inquiries."

High risk factors for shellfish-related norovirus include cold weather (low water temperatures), high prevalence of norovirus gastroenteritis in the community, and high rainfall (potentially leading to sewage system overflows). There is no regulatory limit for norovirus relating to shellfish.

The Food Standards Agency (FSA) advised consumers not to change their choice of eating out as a result of the outbreak.  "We are working with Public Health England to investigate why a number of people have reported digestive symptoms after eating out," a spokeswoman told Food Safety News. This is being investigated as a potential norovirus outbreak linked to one restaurant. We're working to determine the actual cause of the illnesses and which producer or supplier may be implicated."

Norovirus can contaminate food and water and can also spread through contact with the feces or vomit of an infected person. It causes an estimated 3 million cases of diarrhea and vomiting each year and is estimated to be the 3rd most common cause of foodborne illness in the UK.

Although symptoms can be unpleasant, it is considered a mild infection because it is usually short lived, and most people get better without medical treatment. Outbreaks have been caused by infected oysters and fresh produce such as berries and salad.
======================
[Note that norovirus has not yet been confirmed in the UK and Ireland, but appears likely. Both norovirus and paralytic shellfish poisoning are associated with shellfish, however, norovirus is a highly infectious virus, and paralytic shellfish poisoning is caused by a biotoxin produced by algae.

Researchers analyzed the genetic sequences of 1077 samples of noroviruses found in oysters. Some sequences had been stockpiled in genetic databases since 1983. The scientists found that 80 percent of the known human noroviruses matched those found in oysters. The majority of the matches were in oysters from coastal waters, more likely to be contaminated with human sewage.

Noroviruses mutate very quickly, as do influenza viruses, and big outbreaks usually begin after a new strain emerges. There was a "convergence" between new strains circulating in oysters and those circulating in humans, the researchers also found.

Yongjie Wang, a food science specialist at Shanghai Ocean University and lead author of the study, concluded that oysters were an important reservoir for human noroviruses, a place where they can hide between outbreaks and mutate. They also can be transmitted back to humans, presumably when oysters are eaten raw.

Citation. Yongxin Yu, et al. Molecular Epidemiology of Oyster-Related Human Noroviruses and Their Global Genetic Diversity and Temporal-Geographical Distribution from 1983 to 2014. Applied and Environmental Microbio. 81(21): 7615-7624. DOI: 10.1128/AEM.01729-15

See also:
<https://www.nytimes.com/2015/09/08/health/oysters-may-serve-as-link-in-transmission-of-norovirus.html>. - ProMED Mod.LK]

[HealthMap/ProMED maps available at:
United Kingdom: <http://healthmap.org/promed/p/40>
Ireland: <http://healthmap.org/promed/p/39>]
Date: Sat 29 Dec 2018
Source: Osburn Oracle [abridged, edited]
<https://tinyurl.com/ya3ed7qo>

The Health Service Executive (HSE) is dealing with a measles outbreak in Dublin's North Inner City, which has seen 13 cases in both children and adults since July this year [2018].

The organisation said the transmission of the disease has occurred in hospitals and homes in Dublin due to "poor vaccine uptake" and has urged the public to vaccinate themselves against the virus.

The Department of Public Health has notified all emergency departments and GPs in Wicklow, Dublin, and Kildare of the outbreak and has sent them additional information on the disease.

The Dublin outbreak comes in light of an ongoing measles outbreak in Europe, with 31 people across the continent succumbing to the disease in 2018. Most of the cases in the EU in 2018 were reported in Romania, France, Greece, and Italy.

This week, Irish holidaymakers were warned to take precautions as new WHO figures revealed that European cases of measles this year [2018] reached an 8-year high. The number of cases of the highly infectious disease during 2018 have already outstripped any year since 2010.

The HSE has warned that most people who contract measles while on holidays do not know they were exposed to the virus until they develop the disease. They have identified airports, planes, and concerts as areas where an unrecognised exposure to the measles virus can occur.
********************************
Ireland
Date: Sun 30 Dec 2018
Source: The Journal [abridged, edited]
<https://www.thejournal.ie/measles-ireland-4350055-Dec2018/>

The number of reported measles cases in Ireland more than trebled this year. Seven in 10 of the confirmed cases involved people who were not vaccinated.

There were 85 reported cases as of 17 Dec [2018], up from just 25 for the whole of 2017. The majority of these cases -- 73 -- were confirmed, while 12 were deemed to be probable or possible cases. The last confirmed case was in October [2018]. Seven in 10 of the confirmed cases (51; 69%) involved people who were not vaccinated.

When taking into consideration only confirmed cases among people aged 12 months and older (all of whom are eligible for vaccination as part of the national programme), there were 64 cases, of whom 43 individuals were not vaccinated (67%).

Males accounted for 53 of the confirmed cases, while 32 females were affected. Children aged 4 and under were the group most affected, with 24 cases. There were 13 cases among people aged 15-19 years and 11 cases among both the 20-24 and 35-44 age groups.

The HSE released a number of warnings about the condition during the year [2018] after a spike in reported cases.

The majority of the cases this year [2018] involved onward transmission in hospital and community sessions (that is, the condition spreading after a person with measles came into contact with others).

At least 5 of the 85 cases were related to people returning to Ireland after being exposed to a person with measles while abroad.

The rate of measles infections across Europe reached a record high this year [2018]: more than 41 000 children and adults were infected with measles in the 1st 6 months of 2018, according to the World Health Organization.

There have been 72 measles-related deaths in Europe this year [2018], twice as many as in 2017, but none in Ireland.

Here's a geographical breakdown of where the measles cases occurred here:
East: 29
Midwest: 33
Southeast: 15
South: 4
West: 3
Northeast: 1
There were no confirmed cases in the midlands.

Dr Suzanne Cotter, specialist in public health medicine at the Health Protection Surveillance Centre (HPSC), said the worst outbreak originated in the midwest after a person who had been exposed to measles abroad returned to Ireland.

She said this particular case "resulted in a very large outbreak," which spread to the west and southeast following onward transmission in community and healthcare settings. "Not being vaccinated is the main risk factor," Cotter said. She said there is "a certain amount of vaccine-hesitancy" among some groups, due in part to misinformation being spread about vaccines. [See URL above for advice from the Department of Health in relation to the MMR vaccine. - ProMED Mod.LK]  In recent years, the uptake rate for the MMR vaccine has remained quite stable. The uptake rate among children aged 24 months was 92% in the 2nd quarter of 2018, unchanged from the same period last year [2017]. Cotter said these figures are "good but not good enough," adding that the goal is to reach at least 95%.

Cotter said many of the adults who contracted measles "assumed they were immune" but "didn't know if they had measles as a child or didn't know if they had the vaccine."  "People frequently don't have their vaccine records; there was no automated system in previous decades," she said. Cotter said some people's parents "chose to delay vaccination years ago and then completely forgot about it," adding that "Those individuals are really hard to identify."  She noted that some individuals may have intended to get the vaccine but genuinely forgot and have the attitude of, "I've survived this long without having measles; do I need to worry about it now?"  A substantial proportion of individuals with measles were hospitalised this year [2018]. It's not a mild illness and can be quite severe.
Date: Thu 15 Nov 2018 14:28 GMT
Source: RTE Ireland [edited]
<https://www.rte.ie/news/connacht/2018/1115/1011103-hse-mumps/>

The Health Service Executive [HSE] has reiterated a warning to parents in the west, following an increase in the number of cases of mumps in the region in recent weeks. Parents of students at a school in Claregalway [County Galway] have been notified that a number of children have developed mumps-like symptoms. It follows an increase in the number of cases of the condition in the area, mainly among those aged between 15 and 29.

The HSE says immunisation though the MMR vaccine provides the best protection for people, and it is urging those who have not had 2 doses of the vaccine to seek an additional dose. People who are uncertain if they have had 2 doses are also being advised to get vaccinated as soon as possible, because it can take up to 28 days for the antibodies to take effect.

Children who develop symptoms should be kept out of school for at least 5 days after the onset of neck swelling.  [byline: Pat McGrath]
============================
[About 1 month ago, 45 people were diagnosed with mumps in the western counties across Galway, Mayo, and Roscommon over a period of 7 weeks. Those affected by the viral outbreak were mainly between the ages of 15 and 29, as referred to above. (<https://www.galwaydaily.com/news/hse-warns-of-mumps-outbreak-in-the-west-of-ireland/>). - ProMED Mod.LK]

[Maps of Ireland:
<http://smartraveller.gov.au/Countries/europe/northern/Pages/ireland.aspx#modal-country>
and <http://healthmap.org/promed/p/64659>.]
Date: Mon 5 Nov 2018
Source: Xpose.ie [edited]
<https://www.virginmediatelevision.ie/xpose/article/news/280234/Irish-parents-URGED-to-look-out-for-signs-of-HIGHLY-contagious-virus-thats-spreading-rapidly>

Irish parents be warned: hand-foot-mouth disease [HFMD] cases are on the rise. With children back at school, there is a rapid increase in cases, and parents are being urged to look out for the signs.

HFMD is a common, mild illness caused by a type of virus called an enterovirus. It gets its name from the non-itchy rash that develops on the palms of your hands and soles of your feet. It can also cause ulcers in your mouth and make you feel generally unwell, although some people have no symptoms.

According to the Health Service Executive (HSE), the disease is very contagious and is common in children under 10 years of age. However, adolescents and adults can also be affected. The 1st symptoms of HFMD include fever and feeling unwell, loss of appetite, sore throat, and small red spots in the mouth, throat, and skin. Later symptoms include the following:

Mouth lesions
After 1-2 days, red spots in the mouth will develop into painful ulcers, particularly around the tongue, gums, and inside of the cheeks. It may be difficult to eat, drink, and swallow.

Skin rash
Any red spots on the skin will turn into a non-itchy rash over the following 1-2 days. The spots are flat or raised, sometimes with blisters, and smaller than chickenpox sores. The rash develops on the palms of the hands, the soles of the feet, and between the fingers and toes. In some cases, spots also develop on the buttocks and genitals.

To prevent HFMD,
- Always wash your hands after going to the toilet and handling nappies, and before preparing food. If your child has HFMD, encourage them to wash their hands regularly;
- Avoid sharing utensils with people who are infected with HFMD; and
- Make sure that shared work surfaces are clean.
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