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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