CDC expert: Meningitis outbreak a 'unique situation' in US ( So. Florida)

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Source: http://www.miamiherald.com/news/breaking-news/story/1014181.html

CDC expert: Meningitis outbreak a 'unique situation' in U.S.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com

The outbreak of the W135 form of meningitis that has killed four people in South Florida is a ''unique situation,'' an expert at the U.S. Centers for Disease Control and Prevention said Thursday morning.

''We've never had a transmission like this in the United States,'' said Amanda Cohn, a physician who specializes in studying meningitis.

The CDC has seen individual cases in the United States of the deadly, fast-moving strain, and there have been outbreaks in other parts of the world, including one that hit Muslims on the pilgrimage to Mecca and in the African country of Burkina Faso, Cohn said.

But the CDC has never seen a case in which four people have died and eight others made ill during a six-month period in one area, as has happened in South Florida.

They're particularly puzzled because there are no obvious connections between the patients. ''This is very interesting,'' said Cohn, an Atlanta-based researcher. ``We don't know what's happening.''

The strain can kill within hours, and anyone experiencing severe headache, fever, nausea, vomiting and stiff neck should see a doctor immediately, health officials warned.

''It's a very scary disease,'' when someone gets it, said Cohn, but ``people don't need to be scared. . . . It's not incredibly infectious. You're not going to see hundreds and hundreds of cases.''

W135 is one of the strains covered by the meningitis vaccine, but Cohn said she saw no need for the general population to rush to get a shot. If there are certain subgroups that are at high risk and need to be vaccinated, the local health departments would make that announcement.

Many people may carry one of 13 strains of meningitis within them but not get sick.

''We don't understand why some people develop the disease,'' Cohn said. People with colds or the flu might be more susceptible, but the connections are still unclear.

Fifteen or 20 percent of those who get the W135 strain will die, Cohn said. ``That's high. This is a very serious disease.''

Miami-Dade health officials revealed the W135 problem at a hastily called news conference Wednesday. They said the strain could be curable with antibiotics -- but only if patients seek treatment quickly.


Related Content

* Meningitis outbreak 'stumps' Miami-Dade health officials

Meningitis: Know the symptoms

Q. How serious is it?

A. The strain county officials are warning about -- W135 -- is very serious. It can kill within hours. So health officials urge those with symptoms to see their doctors immediately -- going to emergency rooms if they can't contact their own doctors.

Q. What are the symptoms?

A. Severe headache, nausea, vomiting, coughing, difficulty looking into bright lights, stiff neck.

Q. Is it treatable?

A. If caught quickly, it can be stopped with antibiotics.

Q. Has it spread to public or private schools?

A. No, say health officials.

Q. How is it spread?

A. Coughing, kissing, sharing drinking utensils, touching hard surfaces previously touched by someone who is infected. Dr. Gordon Dickinson, chief of infectious diseases at the University of Miami School of Medicine, says the strain can live up to two days on a hard surface.

Q. How contagious is it?

A. It's contagious but less so than, say, the flu. Some people can have it without becoming ill.

Q. How can I keep from getting meningitis?

A. Avoid those with symptoms, wash your hands frequently, clean hard surfaces around those who are infected.

Q. What number should I call for information?

A. The Miami-Dade Health Department phone number is 305-324-2400. After business hours, the line is answered by poison control specialists. The Broward County Health Department's phone number is 954-467-4700. The Palm Beach County Health Department can be reached at 561-840-4500.

 

[Shiloh]

Re: CDC expert: Meningitis outbreak a 'unique situation' in US ( So. Florida)

Source: http://www.mlive.com/newsflash/heal...ional-2/1240531482298550.xml&storylist=health

Experts baffled by deadly outbreak of meningitis
4/23/2009, 7:39 p.m. EDT
The Associated Press
(AP) ? By Fred Tasker and John Dorschner
McClatchy Newspapers

MIAMI ? Local, state and national health experts are baffled as to how a rare and deadly strain of meningitis killed four people and infected eight others in South Florida since December, an unprecedented outbreak in the United States.

The cases of the W135 strain of meningitis were disclosed Wednesday by Miami-Dade health officials. On Thursday, they were recommending vaccinations for those in high-risk groups ? mainly those living in close and crowded situations such as college dorms or military barracks.

"We're stumped," Dr. Vincent Conte, senior physician at the Miami-Dade Health Department, said Thursday. "There doesn't seem to be any pattern. We have cases in North Dade, South Dade, East Dade and West Dade. There's no cluster. It's everywhere."

"We've never had a transmission like this in the United States," said Amanda Cohn, an Atlanta physician with the U.S. Centers for Disease Control and Prevention who specializes in meningitis.

The most recent reported case was earlier this month, a British tourist who died April 7. Though the county would not reveal names or specific details about any of the cases beyond age or gender, family members verified that the victim was Jade Thomas, a schoolteacher from Nottingham, England. She died while on vacation in Florida to celebrate her 26th birthday.

People in South Florida kept their cool despite news that the W135 strain of meningitis can have a mortality rate as high as 20 percent. Local family doctors reported only a trickle of calls from families, mostly asking if their vaccinations were up to date.

"We had a couple of phone calls," said Dr. Norman Goldberg, a Baptist Hospital pediatrician. "I don't think the news has fully resonated yet."

Page 2 of 3

The CDC has seen individual cases in the United States of the deadly, fast-moving strain, and there have been outbreaks in other parts of the world, including one that hit Muslims on the pilgrimage to Mecca and in the African country of Burkina Faso, Cohn said. But the CDC has never seen a case in which 12 people have been infected in six months in one area, as happened in South Florida.

The strain can kill within hours of symptoms, and anyone experiencing severe headache, fever, nausea, vomiting and a stiff neck should see a doctor immediately, health officials warned.

"It's a very scary disease," Cohn said, "but it's not incredibly infectious. You're not going to see hundreds and hundreds of cases."

Dr. Kimberley Shoaf, associate director of the UCLA Center for Public Health and Disasters, called the W135 strain "incredibly rare."

"There has not been a single outbreak over the last five years in the U.S.," she said. Particularly puzzling is the demographic characteristics of the victims, she said. Usually W135 has been found among adolescents, which is why health officials recommend vaccination among incoming middle-schoolers.

The South Florida victims ranged in age from 2 to 85.

The disease usually is found in institutional settings such as college dormitories, jails and mental hospitals, Shoaf said.

Of the 12 South Florida cases, 10 were in Miami-Dade County ? including the British tourist. Broward and Palm Beach counties had one victim each.

Conte said Miami-Dade is working with epidemiologists from the Florida Department of Health to investigate the infections. Experts from the CDC are monitoring the situation, but the outbreak has not yet reached a level at which the CDC will send a team to South Florida, he said.

Meningitis is an infection of the fluid of the spinal cord and the fluid that surrounds the brain. Besides death, the disease can lead to brain damage or amputation of the limbs if not caught in time.

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A vaccine is available that will protect people from the W135 strain of meningitis. But it's not the routinely given Hib meningitis vaccination that is required of students entering kindergarten in public schools. The W135 vaccine is called MCV4, made by Sanofi Pasteur. It costs about $150, most of which is paid by many insurance plans.

Both national and local officials saw no need for the general population to seek vaccinations. The MCV4 vaccine is recommended by the CDC for youths ages 11 or 12 entering middle school, although the schools do not require it.

One pediatrician, Dr. Charles Mitchell at the University of Miami School of Medicine, said some parents have shunned the vaccination for their children. He blamed "a popular misconception and an unwarranted concern about vaccines as a cause of autism."

Conte recommended it for college students, military recruits and others living or working in crowded situations. The disease is spread by kissing, coughing and touching surfaces touched by those who are infected.

MCV4 is FDA-approved only for people 2 to 55 years of age. Sanofi Pasteur is studying it for those older than 55 but does not yet have FDA approval.

Outside that age group, two groups of people are particularly vulnerable, Weber said: health workers who come into contact with spinal fluid, and people who have compromised spleens.

___

(Staff writers Carol Marbin-Miller and Ana Veciana-Suarez contributed to this report.)

___

(c) 2009, The Miami Herald.

Visit The Miami Herald Web edition on the World Wide Web at http://www.herald.com/

 

[Shiloh]

Re: CDC expert: Meningitis outbreak a 'unique situation' in US ( So. Florida)

Source: http://www.miamiherald.com/news/miami-dade/v-fullstory/story/1016746.html

MENINGITIS
South Florida links to 'Patient Zero' sought in meningitis outbreak
Health investigators try to find connections between patients who contracted a rare and deadly strain of meningitis.
BY FRED TASKER
ftasker@MiamiHerald.com

''Patient Zero,'' the first victim to come down with the rare strain of meningitis that has killed four and infected eight others in South Florida since December, was a South Florida resident who was sickened in December but has since recovered, health department officials said Friday.

Citing medical privacy laws, officials won't identify the person any more closely. But investigators now are trying to find links among the victims.

''We've looked at where they ate, where they shopped, where they socialized, their personal habits. We haven't uncovered the link yet,'' said Dr. Vincent Conte, senior physician for the Miami-Dade Health Department.

But since the W135 strain is so rare, health officials believe there is some connection by which it was passed on from Patient Zero to the other 11 victims.

''Based on epidemiological principles, to see this many W135s [the strain of meningitis] in such a short period of time, all identical biologically, it points to a common thread,'' Conte said.

The W135, which accounts for about 3 percent of all meningitis strains, can kill within hours of symptoms. Anyone experiencing severe headache, fever, nausea, vomiting and a stiff neck should see a doctor immediately, health officials warned.

Local and state epidemiologists now working the case don't know where Patient Zero caught it. He or she hadn't traveled outside the United States recently -- not even outside South Florida, Conte said.

Neither had any of the other victims except for one dead patient who was a British tourist identified by family and U.K. newspapers as Jade Thomas, 26.

Among the South Florida cases:

? Eight were female.

? Seven were white Hispanic, four were black non-Hispanic and one was white non-Hispanic.

? Of those who died, two were 20 to 30 and two were older than 50.

? Ages of the victims included one infant, four between the ages of 50 to 70 and three over 70.

That puzzles health officials, because they say meningitis cases usually are late teenagers or early adults. Miami-Dade health officials have sent official advisories to 7,000 physicians and 32 hospitals in South Florida, asking them to report immediately any new meningitis cases and to submit samples from such cases to the state laboratory near Jackson Memorial Hospital.

Staff from the U.S. Centers for Disease Control and Prevention are monitoring the situation but probably will not send help to South Florida unless the cases reach epidemic proportions. That would require 250 cases, Conte said, based on a proportion of the Miami-Dade population of 2.9 million.

``If we get more cases, they will become more active.''

Health officials in Broward are also working closely with the Miami-Dade office, said spokeswoman Candy Sims. ''We're in contact with them every day,'' she said.

NO PROGRAMS PLANNED

No special vaccination programs are planned now in public schools, Conte said.

``Schools have comprehensive health division monitors. If they get sick kids, the principals will notify us immediately. There is a heightened sense of surveillance all around. They're calling schools to make sure there are no kids who aren't reported.''

One problem is that South Florida schools have some of the state's lowest rates of compliance, even for vaccinations required to enter school -- including those against Hib meningitis, polio, measles, mumps, rubella, tetanus, diphtheria, pertussis and chicken pox. None of those shots, including the one for Hib meningitis, protects against the W135 meningitis bacteria.

For the 2007-08 school year, the most recent data available, overall vaccination rates in Miami-Dade were 90.8 percent for kindergarten and 83.5 percent for seventh-graders. In Broward it was 90.9 percent for kindergarten and 91.8 percent for seventh grade.

The MCV4 vaccination that protects against the W135 strain of meningitis is recommended by the CDC and by many doctors for youths 11 and 12 going into middle school but not required for entrance to schools.

Because of that, Conte estimated the rate of MCV4 vaccination in local schools at no more than 50 or 60 percent. That's far below the 90 percent vaccination rate needed to create ''herd immunity,'' in which the proportion of students vaccinated keeps the illness at a low enough level that unvaccinated students are unlikely to catch it.

BROWARD VIGILANT

Broward schools also are in a watchful waiting mode.

''They have issued no advisories,'' said Keith Bromery, a spokesman for the Broward School District. ``We're in constant contact with them.''

Miami-Dade health officials also are tapping into their ''ESSENCE'' program of electronic surveillance at 18 of the biggest of the 32 local hospitals.

``Every patient who shows up in any emergency room is entered into this system, and they analyze every one of them. If they see trends or cases of meningitis or something similar, they call us.

Bigger hospitals also have ''infection control investigators'' -- nurses, usually, who monitor all admissions for signs of meningitis, he said.

So far, however, no hospital or private physician has reported anything significant.

''We have no new cases,'' Conte said. ``We're just in a surveillance mode awaiting anything new that pops up.''

Miami Herald staff writers Kathleen McGrory and Patricia Mazzei contributed to this report.

 

[Shiloh]

Re: CDC expert: Meningitis outbreak a 'unique situation' in US ( So. Florida)

Source: http://www.miamiherald.com/news/miami-dade/v-fullstory/story/1016746.html

MENINGITIS
South Florida links to 'Patient Zero' sought in meningitis outbreak
Health investigators try to find connections between patients who contracted a rare and deadly strain of meningitis.
BY FRED TASKER
ftasker@MiamiHerald.com

''Patient Zero,'' the first victim to come down with the rare strain of meningitis that has killed four and infected eight others in South Florida since December, was a South Florida resident who was sickened in December but has since recovered, health department officials said Friday.

Citing medical privacy laws, officials won't identify the person any more closely. But investigators now are trying to find links among the victims.

''We've looked at where they ate, where they shopped, where they socialized, their personal habits. We haven't uncovered the link yet,'' said Dr. Vincent Conte, senior physician for the Miami-Dade Health Department.

But since the W135 strain is so rare, health officials believe there is some connection by which it was passed on from Patient Zero to the other 11 victims.

''Based on epidemiological principles, to see this many W135s [the strain of meningitis] in such a short period of time, all identical biologically, it points to a common thread,'' Conte said.

The W135, which accounts for about 3 percent of all meningitis strains, can kill within hours of symptoms. Anyone experiencing severe headache, fever, nausea, vomiting and a stiff neck should see a doctor immediately, health officials warned.

Local and state epidemiologists now working the case don't know where Patient Zero caught it. He or she hadn't traveled outside the United States recently -- not even outside South Florida, Conte said.

Neither had any of the other victims except for one dead patient who was a British tourist identified by family and U.K. newspapers as Jade Thomas, 26.

Among the South Florida cases:

? Eight were female.

? Seven were white Hispanic, four were black non-Hispanic and one was white non-Hispanic.

? Of those who died, two were 20 to 30 and two were older than 50.

? Ages of the victims included one infant, four between the ages of 50 to 70 and three over 70.

That puzzles health officials, because they say meningitis cases usually are late teenagers or early adults. Miami-Dade health officials have sent official advisories to 7,000 physicians and 32 hospitals in South Florida, asking them to report immediately any new meningitis cases and to submit samples from such cases to the state laboratory near Jackson Memorial Hospital.

Staff from the U.S. Centers for Disease Control and Prevention are monitoring the situation but probably will not send help to South Florida unless the cases reach epidemic proportions. That would require 250 cases, Conte said, based on a proportion of the Miami-Dade population of 2.9 million.

``If we get more cases, they will become more active.''

Health officials in Broward are also working closely with the Miami-Dade office, said spokeswoman Candy Sims. ''We're in contact with them every day,'' she said.

NO PROGRAMS PLANNED

No special vaccination programs are planned now in public schools, Conte said.

``Schools have comprehensive health division monitors. If they get sick kids, the principals will notify us immediately. There is a heightened sense of surveillance all around. They're calling schools to make sure there are no kids who aren't reported.''

One problem is that South Florida schools have some of the state's lowest rates of compliance, even for vaccinations required to enter school -- including those against Hib meningitis, polio, measles, mumps, rubella, tetanus, diphtheria, pertussis and chicken pox. None of those shots, including the one for Hib meningitis, protects against the W135 meningitis bacteria.

For the 2007-08 school year, the most recent data available, overall vaccination rates in Miami-Dade were 90.8 percent for kindergarten and 83.5 percent for seventh-graders. In Broward it was 90.9 percent for kindergarten and 91.8 percent for seventh grade.

The MCV4 vaccination that protects against the W135 strain of meningitis is recommended by the CDC and by many doctors for youths 11 and 12 going into middle school but not required for entrance to schools.

Because of that, Conte estimated the rate of MCV4 vaccination in local schools at no more than 50 or 60 percent. That's far below the 90 percent vaccination rate needed to create ''herd immunity,'' in which the proportion of students vaccinated keeps the illness at a low enough level that unvaccinated students are unlikely to catch it.

BROWARD VIGILANT

Broward schools also are in a watchful waiting mode.

''They have issued no advisories,'' said Keith Bromery, a spokesman for the Broward School District. ``We're in constant contact with them.''

Miami-Dade health officials also are tapping into their ''ESSENCE'' program of electronic surveillance at 18 of the biggest of the 32 local hospitals.

``Every patient who shows up in any emergency room is entered into this system, and they analyze every one of them. If they see trends or cases of meningitis or something similar, they call us.

Bigger hospitals also have ''infection control investigators'' -- nurses, usually, who monitor all admissions for signs of meningitis, he said.

So far, however, no hospital or private physician has reported anything significant.

''We have no new cases,'' Conte said. ``We're just in a surveillance mode awaiting anything new that pops up.''

Miami Herald staff writers Kathleen McGrory and Patricia Mazzei contributed to this report.