From Polio to Plague: Don't Forget Other Bugs
Ebola isn't the only pathogen causing outbreaks around the world.
While the world's focus has been on Ebola, other pathogens have not taken a holiday, according to the World Health Organization (WHO).
Ebola gets the spotlight because of thesize and impact of the West African epidemic, but smaller outbreaks -- from plague to polio -- are also underway.
In Madagascar, 119 cases of plague -- caused by the bacterium Yersinia pestis and spread by infected fleas -- have claimed 40 lives since early September, the agency reported at the weekend.
Most have been bubonic, but 2% of the cases are the highly dangerous pneumonic form, in which the bacteria reach the lungs and can then be spread in droplets through coughing.
Cases have been reported in seven of the country's 22 regions. The capital city, Antananarivo, has had two cases and one death, the agency said, raising the possibility of rapid spread there owing to a dense population and a weak healthcare system.
The situation in the island nation is complicated by widespread resistance among fleas to the pesticide deltamethrin, the WHO said in a statement.
Meanwhile, after a quiet summer, cases of Middle East coronavirus infection have increased in Saudi Arabia, which has been the center of that outbreak.
The Saudi Ministry of Health reported 18 lab-confirmed cases of the virus so far this month, after 31 in October and 12 in September.
All told, the ministry reported a total of 810 cases and 346 deaths since 2012, when the virus was first identified. Thirteen patients are currently being treated and 451 have recovered.
Several dozen cases of the virus have also been reported outside the country, and the WHO said it has been formally notified of 909 laboratory-confirmed cases of infection.
The early symptoms of MERS are nonspecific, the agency noted and healthcare workers need to apply standard precautions consistently, adding droplet precautions when patients have acute symptoms and contact precautions and eye protection when MERS infection is probable or confirmed.
Patients with diabetes, renal failure, chronic lung disease, or a compromised immune system are considered to be at high risk of severe disease if infected with MERS.
In China, the H7N9 avian flu continues to cause illness, although not at the alarming pace seen in 2013 and early 2014.
In the past 3 months, China reported seven cases and two deaths from the virus.
The novel avian flu strain was first identified in February 2013 and caused some 135 cases that spring. A second wave, starting in September, included another 220 cases to mid-February.
The case-fatality rate over the two waves was about 31%.
The virus is the first H7 strain to cause serious illness in humans; previous outbreaks of flu with a similar hemagglutinin gene -- the 'H' in H7N9 -- have mostly caused mild disease, such as conjunctivitis.
H7N9 is regarded as a low-pathogenic avian strain -- it doesn't cause sickness and death in birds, making it difficult to track in poultry, which appear to be the reservoir for the virus.
That's a sharp contrast with the highly pathogenic H5N1 avian influenza, long regarded as a pandemic threat, which causes large die-offs among domestic birds.
The WHO is also reporting separate events in South Sudan and Madagascar of circulating vaccine-derived polio viruses.
In South Sudan, investigation of two cases of acute flaccid paralysis in September found they were caused by vaccine-derived type 2 viruses.
Both cases are from an internally displaced persons camp in Unity state, which has been affected by civil unrest that, in turn, has led to declining vaccination coverage, the agency said.
In Madagascar, a type 1 vaccine-derived virus was isolated from a patient with acute flaccid paralysis and from three healthy contacts in September.
Such viruses are "rare but well-documented" and can arise in populations that are inadequately immunized, the WHO said. They are associated with the live attenuated oral vaccine.
A recent randomized trial found that vaccination programs that combine an inactivated vaccine with the live attenuated oral vaccine improve immunity.
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