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Clinical Infectious Diseases
NEWS
Donald Kaye, Section Editor
Yellow Fever Kills 600 Monkeys in
Brazil’s Atlantic Rainforest
8 February 2017 (Reuters [Anthony
Boadle])—An outbreak of yellow fever
has claimed the lives of more than 600
monkeys and dozens of humans in
Brazil’s Atlantic rainforest region, threatening the survival of rare South American
primates, a zoologist said.
The monkeys, mostly brown howlers
and masked titis, are falling out of trees
and dying on the ground in the forests of
Espirito Santo state in Brazil’s southeast.
The howler’s sounds closely resemble
grunts or barks. It was the silence that fell
on the forests that first alerted farmers
that something was amiss, sparking specialists to investigate.
The masked titi is considered as “vulnerable” by the Swiss-based International
Union for Conservation of Nature
(IUCN), which has placed it on its Red
List of Threatened Species.
No evidence has so far surfaced of
the affliction felling woolly spider monkeys, considered one of the world’s most
endangered by the IUCN.
Brazil is suffering the worst yellow
fever outbreak in decades that has killed
at least 69 humans, nearly all in central state of Minas Gerais, where the
problems began.
Most people recover from yellow fever
after the first phase of infection, which usually involves fever, headache, shivers, loss of
appetite and nausea or vomiting, according
to the World Health Organization.
Millions of Brazilians have been vaccinated as health authorities scramble to
prevent the outbreak from turning into
an epidemic. There is no such protection
available for monkeys.
Copyright © 2017 Reuters Limited. All rights reserved.
Editorial comment. Brazil has been
successful at eliminating urban yellow
fever transmitted by the Aedes mosquito, but has never eliminated sylvan
yellow fever transmitted by Haemagogus
and Sabethes mosquitoes. The extensive
deaths of monkeys demonstrated how
active the sylvan cycle is at present.
Bolivia Reports First Yellow Fever
Case in a Decade
13 February 2017 (Reuters [Daniel Ramos
and Caroline Stauffer])—Bolivia’s government said a Danish tourist had tested
positive for yellow fever, its first case in a
decade, after he visited a jungle area in the
far west of the landlocked Andean country.
After an initial stay at a Bolivian hospital, National Health Director Rodolfo
Rocabado said the stricken tourist traveled on to Chile for treatment.
Brazil experienced an outbreak in a
rural area earlier this year. Brazil has not
had an urban outbreak of yellow fever
since 1942.
Copyright © 2017 Reuters Limited. All rights reserved.
Editorial comment. This is another
example of sylvan yellow fever and a
reminder of the need for yellow fever
immunization in visitors to endemic sites.
Immunization is critical not only to protect the visitor but also to prevent introduction of the virus into the urban cycle
(ie, Aedes mosquitoes) with large numbers of cases and a high case fatality rate.
Diseased Rat Urine Kills New
Yorker in Outbreak of Rare Illness
16 February 2017 (Reuters [Jonathan
Allen])—Diseased rat urine has killed at
least 1 person and sickened 2 others in
New York City in an outbreak of a rarely
seen infection, prompting calls from city
officials for a renewed effort to cull the
rodent population.
The outbreak of leptospirosis began in
December and all 3 cases were traced to
a single block in the Bronx, New York’s
northernmost borough. City officials said
it was the first ever “cluster” of cases in
the city’s history.
Two people were diagnosed in
December and the third in February, the
department said. While 1 died, the other
2 have since recovered. The department
did not say how it thought the 3 people
were exposed to the infected rat urine.
Typically, humans get infected through
contact with tainted water.
One of the people who fell sick lived
in an apartment building on the block
that city officials said was known for its
rat infestations, while the other 2 were
known to frequently visit the block. City
workers cleared out garbage, plugged
holes, and set traps in the infested apartment building.
The death prompted Ruben Diaz, the
Bronx borough president, to lament the
city’s centuries-old efforts to curtail its
persistent rat population.
“It is unfathomable to me that in this
day and age, in one of the most expensive cities in the world and at our most
technologically advanced point as a civilization, the city cannot mitigate the rat
problem,” Diaz said in a statement.
The US Centers for Disease Control
and Prevention estimates there are 100
to 200 cases of leptospirosis each year
in the country. New York City only
sees 1 to 3 cases a year, the city’s health
department said.
Copyright © 2017 Reuters Limited. All rights reserved.
Editorial comment. In addition to rats,
leptospirosis can be acquired from the
urine of dogs, mice, and other mammals
by the organism entering through small
breaks in the skin or a mucosal membrane. Although rat control can bring
down populations, it is very difficult to
have a lasting effect on rats in major cities; they are everywhere. For example,
the “Big Dig” (the Central Artery/Tunnel
Project) in Boston displaced huge numbers of rats that then roamed the streets.
Sewer workers are regularly exposed to
water contaminated with rat urine.
NEWS • CID 2017:64 (15 May) • i
China Bird Flu Deaths Surge
in What Could Be the Worst
Season Ever
15 February 2017 (Reuters [Ryan Woo,
Josephine Mason, Nick Heath, Christian
Shepherd, Dominique Patton, Lusha
Zhang, and Venus Wu])—As many as 79
people died from H7N9 bird flu in China
in January 2017, the government said,
stoking worries that the spread of the virus
this season could be the worst on record.
January’s fatalities were up to 4 times
higher than the same month in past years,
and brought the total H7N9 death toll to
100 people since October, data from the
National Health and Family Planning
Commission showed.
Authorities have repeatedly warned
the public to stay alert for the virus, and
cautioned against panic in the world’s
second-largest economy.
But the latest bird flu data has sparked
concerns of a repeat of previous health
crises, like the 2002 outbreak of severe
acute respiratory syndrome (SARS).
The People’s Daily, the official paper
of the ruling Communist Party, warned
people in a social media post to stay away
from live poultry markets, saying it was
“extremely clear” that poultry and their
excrement were the cause of the infections.
China, which first reported a human
infection from the virus in March 2013,
has seen a sharp rise in H7N9 cases since
December. The official government total
is 306 since October, with 192 reported
last month.
But others believe the number of infections is higher.
The Center for Infectious Disease
Research and Policy (CIDRAP) at the
University of Minnesota last week estimated China had at least 347 human
infections so far this winter, eclipsing the
record of 319 seen 3 years ago.
ii • CID 2017:64 (15 May) • NEWS
“An important factor in the past waves
of H7N9 cases among humans in China
has been rapid closure of live poultry
markets,” said Ian Mackay, a virologist at the University of Queensland in
Australia.
Copyright © 2017 Reuters Limited. All rights reserved.
Editorial comment. The actual number of cases must be much higher than
reported, as asymptomatic and mild
infections are not uncommon. The major
concern for international health is the
danger of mutation or recombination
with other influenza strains to produce a
more easily transmittable virus with the
potential to start a pandemic.
China has ordered closure of its live
poultry markets in areas where H7N9
human cases have occurred. As a result,
we will likely see a rapid decrease in new
human cases.
In a very recent development, 6 isolates of H7N9 (2 from humans and 4
from poultry) have demonstrated mutations that may make them more pathogenic for poultry. Until now, H7N9 has
been of low pathogenicity for poultry.
A different human isolate demonstrated
similar changes, but in addition, there
was a mutation in the neuraminidase
protein that may suggest resistance
to neuraminidase inhibitors such as
oseltamivir.
US Shuts High-Security Labs Over
Concerns About Air Hose Safety
17 February 2017 (Reuters [Julie
Steenhuysen])—The US Centers for
Disease Control and Prevention (CDC)
has closed down its highest-security laboratories after discovering that hoses that
supply air to scientists wearing special
protective suits were never approved for
that use.
Stephan Monroe, associate director for
laboratory science and safety at the CDC,
said he was confident that scientists were
not exposed to pathogens because the air
they breathed passed through HEPA filters. The suits they wear also use positive
air pressure to prevent pathogens from
entering the suit.
CDC is now conducting safety tests to
determine whether the scientists might
have been exposed to harmful chemicals
that passed through the air hoses.
The problem stems from the original
construction in 2005 of the Biosafety
Level 4 laboratories, in which scientists
handle the most dangerous biological
agents.
The air hoses are part of the building’s
infrastructure. They drop down from different ports within the laboratory, and
scientists plug the hoses into their suits
from different work stations.
CDC officials learned about the problem when they were ordering replacement hoses, and were told by the
manufacturer that they were not certified
for breathing air.
Monroe said the CDC routinely tests
the air quality in the tank that feeds the
hoses to ensure it meets standards set
by the Occupational Safety and Health
Administration.
“We’ve been testing the air in the tank.
Not the air as it comes out of the hose,”
he said.
CDC will now test air from the old
tubing to check for any toxic chemicals,
but Monroe said there is no evidence
that breathing air from the hoses caused
any ill effects. The agency has ordered
replacement tubing and plans to bring
the labs back online next week.
Published by Oxford University Press for the Infectious
Diseases Society of America 2017. DOI: 10.1093/cid/cix190