Date: Mon 3 Feb 2020
Source: Centers for Disease Control and Prevention [edited]
<https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm>

When hearing about hepatitis A, many people think about contaminated food and water. However, in the United States, hepatitis A is more commonly spread from person to person. Since March 2017, CDC's Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks spread through person-to-person contact. The hepatitis A vaccine is the best way to prevent HAV [hepatitis A virus] infection.

The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:
- people who use drugs (injection or non-injection);
- people experiencing unstable housing or homelessness;
- men who have sex with men (MSM);
- people who are currently or were recently incarcerated; and
- people with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C.

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% sero-protection in healthy individuals for up to 11 years.

Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.
=======================
[Overall, the 5 states with the most HAV cases remain Kentucky, Florida, Ohio, Tennessee, and West Virginia, with the numbers in Florida still rising notably. In these states, the case fatality rates are Kentucky 1.2%, Florida 1.5%, Ohio 0.5%, Tennessee 0.9%, and West Virginia 0.8%.

As the numbers of cases continue to rise in a number of states and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED-mail post http://promedmail.org/post/20190104.6241686 by a Kentucky official -- "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" -- is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations in our midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and in directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
United States: <http://healthmap.org/promed/p/106>]
Date: Fri 31 Jan 2020
Source: The Atlanta Journal-Constitution [edited]
<https://www.ajc.com/news/local/animals-test-positive-for-rabies-cobb-county/G6QPNAIlzo2GW2bshHsrdK/>

A kitten and 2 raccoons have tested positive for rabies in Cobb and Douglas counties, and some people and pets were exposed to the animals. The Cobb and Douglas Public Health Department said Thursday [30 Jan 2020] that tests confirm all 3 animals -- one kitten and raccoon in Cobb and another raccoon in Douglas -- were all carrying the virus. The kitten was found by a couple in the 300 block of Baskin Drive in Marietta on 15 Jan [2020], according to Cobb County spokesman Ross Cavitt.

The kitten scratched the husband and wife, who took the animal to a veterinary clinic, where it also bit 2 technicians, Cavitt said. On 21 Jan [2020], a raccoon attacked a family dog in the 3700 block of Tommy Drive in Powder Springs. Cavitt said the dog was current on its rabies vaccination, but there was possible exposure to the family "because the husband killed the raccoon, and there was saliva and blood from the raccoon on the dog."

In Douglas County, spokesman Rick Martin said a raccoon tested positive after attacking a dog 16 Jan [2020] in the area of Bomar and Pope roads. The dog that was attacked, as well as another dog who may have been exposed, are under a 45-day quarantine. Valerie Crow, spokeswoman with the Cobb & Douglas Public Health Department, said humans exposed to the virus have received treatment.

Treatment typically includes the human rabies immune globin shot and rabies vaccine, according to the Centers for Disease Control and Prevention. Animals and humans can get the virus if they are bitten or scratched by an infected animal. The virus, which affects the central nervous system, is "nearly 100% fatal without proper care following exposure," the department said. "Because survival is so rare following clinical signs of the virus, individuals exposed to or suspecting exposure from an animal bite should receive immediate medical attention to assess the need for vaccination and report the exposure to local animal control."

Health department officials encourage residents to take the following steps to reduce their chances of coming in contact with a rabid animal:
- Vaccinate all dogs, cats, and ferrets against rabies. You should also consider vaccinating livestock and horses, and other animals that have frequent contact with humans.
- Pet owners should not allow animals to roam free to reduce their chances of catching rabies; spaying or neutering your pet also cuts down on chances of animals roaming.
- Do not feed pets outdoors since empty bowls and stray food could attract wild animals.
- Keep garages securely covered.
- Avoid keeping wild animals like bats, raccoons, or foxes as pets.
- Teach children to never handle unfamiliar animals.
- Report wild animals acting aggressively and any animal bites to animal control officers. Cobb residents call 770-499-4136 and Douglas residents can dial 770-942-5961.

You can learn more about rabies by visiting the Centers for Disease Control and Prevention's website on rabies or the Department of Public Health's website.  [Byline: Kristal Dixon]
========================
[Rabies virus remains a deadly disease that is preventable by vaccination. Take your pets for vaccination. It helps protect you too. There are very few people who have ever survived this disease, and their lives post-rabies is difficult, to say the least. Please protect yourself. Please protect your pets by getting vaccinations.

Pets without vaccinations who may get bitten or get in a fight with a wild animal may well be euthanized out of precaution to keep people safe. It is a painful way to lose a companion. Even young puppies and kittens can be infected with rabies.

The rabies virus infects the central nervous system. If a person does not receive the appropriate medical care after a potential rabies exposure, the virus can cause disease in the brain, ultimately resulting in death. Rabies can be prevented by vaccinating pets, staying away from wildlife, and seeking medical care after potential exposures before symptoms start.

After a bite or other rabies exposure, the rabies virus has to travel through the body to the brain before it can cause symptoms. This time between the exposure and the appearance of symptoms is called the incubation period, and it may last for weeks to months. The incubation period may vary based on the location of the exposure site (how far away it is from the brain), the type of rabies virus, and any existing immunity.

The 1st symptoms of rabies in human beings may be very similar to those of the flu, including general weakness or discomfort, fever, or headache. These symptoms may last for days.

There may also be discomfort or a prickling or itching sensation at the site of the bite, progressing within days to acute symptoms of cerebral dysfunction, anxiety, confusion, and agitation. As the disease progresses, the person may experience delirium, abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia. The acute period of disease typically ends after 2-10 days. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive. To date, less than 20 cases of human survival from clinical rabies have been documented, and only a few survivors had no history of pre- or postexposure prophylaxis.

If you have been bitten or scratched by an animal, wash the bite/scratch with copious amounts of soap and water. Seek medical attention.

Postexposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. For people who have never been vaccinated against rabies previously, PEP should always include administration of both HRIG and rabies vaccine. The combination of HRIG and vaccine is recommended for both bite and non-bite exposures, regardless of the interval between exposure and initiation of treatment.

People who have been previously vaccinated or are receiving preexposure vaccination for rabies should receive only vaccine.

Adverse reactions to rabies vaccine and immune globulin are not common. Newer vaccines in use today cause fewer adverse reactions than previously available vaccines. Mild, local reactions to the rabies vaccine, such as pain, redness, swelling, or itching at the injection site, have been reported. Rarely, symptoms such as headache, nausea, abdominal pain, muscle aches, and dizziness have been reported. Local pain and low-grade fever may follow injection of rabies immune globulin.

The vaccine should be given at recommended intervals for best results. Talk to your doctor or state or local public health officials if you will not be able to have your shots at the recommended interval. Rabies prevention is a serious matter, and changes should not be made in the schedule of doses. Patient-assistance programs that provide medications to uninsured or underinsured patients are available for rabies vaccine and immune globulin.

People cannot transmit rabies to other people unless they themselves are sick with rabies. PEP will protect you from developing rabies, and therefore you cannot expose other people to rabies. You can continue to participate in your normal activities. <https://www.cdc.gov/rabies/index.html>  - ProMED Mod.MHJ]

[HealthMap/ProMED-mail maps:
Cobb County, Georgia, United States:
<http://healthmap.org/promed/p/31582>
Douglas County, Georgia, United States:
<http://healthmap.org/promed/p/39385>]
Date: Sun, 26 Jan 2020 21:47:53 +0100 (MET)

Washington, Jan 26, 2020 (AFP) - US health authorities said Sunday there are now five confirmed cases of the coronavirus in the United States and more are expected.   Nancy Messonnier, head of the respiratory disease section at the Centers for Disease Control and Prevention, said around 100 people in 26 states are being investigated for the virus, which originated in the Chinese city of Wuhan.

Of the confirmed cases, all five people had travelled to Wuhan, Messonier said during a conference call with reporters.   "Every case we have had in the United States is someone who has had direct contact in Wuhan," she said.   Messonier said there are two cases in California and one each in Arizona, Illinois and Washington state. Until now the toll was three.   While Chinese officials have launched an extraordinary emergency response, Messonier insisted that the health risk for Americans in general remains low "at this time."
Date: Tue, 21 Jan 2020 22:23:22 +0100 (MET)
By Issam Ahmed with Helen Roxburgh

Washington/Beijing, Jan 21, 2020 (AFP) - The United States on Tuesday announced its first case of a new virus that has claimed six lives in China and sickened hundreds, joining countries around the world in ramping up measures to block its spread.   The man, a US resident in his 30s who lives near Seattle, is in good condition, according to federal and state officials, and approached authorities himself after reading about the SARS-like virus in news reports.   He is "currently hospitalized out of an abundance of precaution, and for short term monitoring, not because there was severe illness," said Chris Spitters, a Washington state health official.  "This is an evolving situation and again, we do expect additional patients in the United States and globally," added Nancy Messonier, a senior official at the Centers for Disease Control and Prevention (CDC), but stressed that the overall risk to Americans remained low.

The man entered the country on January 15 after traveling to Wuhan, two days before the US began deploying health officials at major airports to screen passengers arriving from that central Chinese city which is at the heart of the outbreak. The efforts are to be extended now to a total of five US airports.   It came as countries ramped up measures to block the spread of the virus -- known by its technical name 2019 Novel Coronavirus or 2019-nCoV -- as the number of cases surpassed 300, raising concerns in the middle of a major Chinese holiday travel rush.

Fears of a bigger outbreak rose after a prominent expert from China's National Health Commission confirmed late Monday that the virus can be passed between people.   That conclusion is shared by the CDC, which said "person-to-person spread is occurring, although it's unclear how easily the virus spreads between people," even as the World Health Organization (WHO) adopted a more cautious approach, saying it is still investigating.   The UN agency will hold an emergency meeting Wednesday to determine whether to declare a rare global public health emergency over the disease, which has also been detected in Thailand, Japan and South Korea and Taiwan.

- Holiday rush -
Authorities previously said there was no obvious evidence of person-to-person transmission and animals were suspected to be the source, as a seafood market where live animals were sold in Wuhan was identified as the center of the outbreak.   Hundreds of millions of people are criss-crossing China this week in packed buses, trains and planes to celebrate the Lunar New Year with relatives.

More than 80 new cases have been confirmed, bringing the total number of people hit by the virus in China to 315, with the vast majority in Hubei, the province where Wuhan lies, according to officials.   But cases have also been confirmed around the country, including Beijing and Shanghai.   The first case on the self-ruled island of Taiwan was also confirmed Tuesday, with a woman taken to hospital on arrival at the airport from Wuhan.   Wuhan mayor Zhou Xianwang told state broadcaster CCTV Tuesday that the death toll had risen from four to six.   The coronavirus has caused alarm because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

- Fever checks -
At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   In Hong Kong, authorities said they were on "extreme high alert," with passengers from Wuhan required to fill out health declarations and face possible jail time if they do not declare symptoms.   Enhanced screening measures have also been set up at airports in Australia, Bangladesh, Nepal, Singapore and Russia, Malaysia and Vietnam.   A man showing symptoms of the disease who had travelled to Wuhan has been put in isolation in Australia as health officials await test results, authorities said Tuesday.   In China, the government announced it was classifying the outbreak in the same category as SARS, meaning compulsory isolation for those diagnosed ith the disease and the potential to implement quarantine measures on travel.

In Wuhan, authorities banned tour groups and police were conducting spot checks for animals in vehicles leaving and entering the city, state media said.   It added that city health authorities had scheduled 800 beds to be made available in three hospitals and 1,200 more would soon be ready, and passengers were being screened for fever at the airport, railway stations and bus terminals.   Doctors at the University of Hong Kong released a study on Tuesday estimating that there have been 1,343 cases of the new virus in Wuhan.   The WHO has only called a global public health emergency a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.
Date: 15 Jan 2020
Source: Fox News [edited]
<https://www.foxnews.com/health/ohio-teen-rare-polio-like-illness-paralyzed-from-waist-down>

CDC is facing criticism over its response to a polio-like illness. The Centers for Disease Control and Prevention has confirmed 10 additional cases of acute flaccid myelitis.  An Ohio teen is determined to walk again despite doctors' warnings that she may not after she contracted a rare polio-like illness that's left her paralyzed from the waist down.  IK, a catcher on her middle school's softball team, said it started with what felt like a cramp in her leg on Christmas. "I just thought, 'Oh gosh, it's just growing pains or a Charley horse,'" NK, the 13-year-old's mother, told News 5 Cleveland.  But the next day, IK couldn't stand on her own, and her worried parents rushed her to Akron Children's Hospital, where she was diagnosed with acute flaccid myelitis (AFM). It's a rare but serious condition that affects the nervous system, specifically the grey matter of the spinal cord, which weakens the body's muscles and reflexes.

Health officials have noticed an increase of cases in children occurring every 2 years since 2014, according to the Centers for Disease Control and Prevention (CDC). And while it often is referred to as a "polio-like" illness, tests so far have tested negative for poliovirus.  Symptoms typically begin with sudden onset of arm or leg weakness and loss of muscle tone and reflexes, but can also include facial droop or weakness, difficulty moving eyes, drooping eyelids, difficulty swallowing,  slurred speech, and pain in the arms and legs.  Severe symptoms may include respiratory failure, or serious neurological complications, according to the CDC. Parents are encouraged to seek medical care right away if a child is suspected of developing any symptoms

Since her diagnosis, IK has been working in physical therapy and has received steroid treatments as well as multiple plasma exchange, according to the news outlet. Her mother said it's been like "a bad dream" for the family as they watch her struggle to gain strength.  "It's a lot, but I just try to go with the flow, just to push through," IK, who has received support from her teammates, classmates and members of the community, told News 5 Cleveland.  [Byline: Alexandria Hein]
======================
[Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.

In 2019, there were 33 total confirmed cases in 16 US states
[<https://www.cdc.gov/acute-flaccid-myelitis/cases-in-us.html>].

The case definition for AFM is based on clinical and lab criteria
[<https://c.ymcdn.com/sites/www.cste.org/resource/resmgr/2017PS/2017PSFinal/17-ID-01.pdf>]:

Clinical Criteria: An illness with onset of acute flaccid limb weakness.
Laboratory Criteria:
Confirmatory Laboratory Evidence: a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to grey matter and spanning one or more vertebral segments. Supportive Laboratory Evidence: cerebrospinal fluid (CSF) with pleocytosis (white blood cell count over 5 cells/mm3) Case Classification:
- Confirmed: Clinically compatible case AND Confirmatory laboratory evidence: MRI showing spinal cord lesion largely restricted to grey matter and spanning one or more spinal segments.
- Probable: Clinically compatible case AND Supportive laboratory evidence: CSF showing pleocytosis (white blood cell count over 5 cells/mm3)

With the high number of cases reported in 2018 and 2019, CDC enhanced AFM surveillance through collection of data at the national level by encouraging healthcare providers to recognize and report to their health departments all patients whom they suspect may have AFM; health departments are being asked to send this information to CDC to help us understand AFM activity nationwide. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
United States: <http://healthmap.org/promed/p/106>]
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