Tag Archives: Outbreak

Health official warns Zika virus could spread across U.S. Gulf

The New York State Department of Health unveiled a Zika Prevention Kit for pregnant women during the rollout of a Zika Information hotline and

By Chris Prentice

(Reuters) – One of the top U.S. public health officials on Sunday warned that the mosquito-borne Zika virus could extend its reach across the U.S. Gulf Coast after officials last week confirmed it as active in the popular tourist destination of Miami Beach.

The possibility of transmission in Gulf States such as Louisiana and Texas will likely fuel concerns that the virus, which has been shown to cause the severe birth defect known as microcephaly, could spread across the continental United States, even though officials have played down such an outcome.

Concern has mounted since confirmation that Zika has expanded into a second region of the tourist hub of Miami-Dade County in Florida. Miami’s Wynwood arts neighborhood last month became the site of the first locally transmitted cases of Zika in the continental United States.

“It would not be surprising we would see additional cases perhaps in other Gulf Coast states,” Dr. Anthony Fauci, director of the allergy and infectious diseases unit of the National Institutes of Health (NIH), said in an interview on Sunday morning with ABC News.

Fauci noted that record flooding this month in Louisiana – which has killed at least 13 people and damaged some 60,000 homes damaged – has boosted the likelihood Zika will spread into that state.

“There’s going to be a lot of problems getting rid of standing water” that could stymie the mosquito control efforts that are the best way to control Zika’s spread, he said.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies. The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed 1,835 cases of microcephaly that it considers to be related to Zika infections in the mothers.

On Friday, Florida Governor Rick Scott confirmed that state health officials had identified five cases of Zika believed to be contracted in Miami Beach.

The U.S. Centers for Disease Control and Prevention told pregnant women they should avoid the trendy area and suggested those especially worried about exposure might consider avoiding all of Miami-Dade County.

NIH’s Fauci on Sunday said the conditions of most of the country make it unlikely there would be a “diffuse, broad outbreak,” even though officials need to prepare for that possibility.

He compared it with diseases such as Dengue, which is endemic in certain tropical and subtropical regions of the world but rarely occurs in the continental United States. In Miami’s Wynwood area, experts have seen “substantial” knockdowns of mosquito populations.

Still, its containment is more complicated because Zika can be sexually transmitted, Fauci said.

“This is something that could hang around for a year or two,” he said.

The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

(Reporting by Chris Prentice in New York; Editing by Alan Crosby)

Florida health department investigates possible local Zika transmission

Mosquito being studied for Zika

(Reuters) – Florida health officials said on Tuesday they are investigating a case of Zika virus infection that does not appear to have stemmed from travel to another region with an outbreak.

The statement from the Florida Department of Health did not specify whether the Zika case was believed to have been transmitted via mosquito bite, sexual contact or other means.

The department said the case was reported in Miami-Dade County and that it is working with the U.S. Centers for Disease Control and Prevention on an epidemiological study.

The department also reiterated guidance to Florida residents on protecting themselves from mosquitoes that may carry the virus.

“Zika prevention kits and repellant will be available for pickup … and distributed in the area under investigation,” the health department said in a statement. “Mosquito control has already conducted reduction and prevention activities in the area of investigation.”

Zika, which can cause a rare birth defect and other neurological conditions, has spread rapidly through the Americas. A small number of cases of Zika transmitted between sexual partners have also been documented.

There has yet to be a case of local transmission by mosquitoes in the continental United States, though more than 1,300 people in the country have reported infections after traveling to a Zika outbreak area.

U.S. officials have predicted local outbreaks to begin as the weather warms, particularly in southern states such as Florida and Texas.

(Reporting by Michele Gershberg in New York; Editing by Matthew Lewis and Bernard Orr)

Congo almost runs out of yellow fever vaccine amid epidemic

Residents read newspapers with reports on Yellow Fever

By Aaron Ross

KINSHASA (Reuters) – Democratic Republic of Congo has almost run out of yellow fever vaccine in Kinshasa, in the same week that the government declared an epidemic of the disease in the packed capital and two other provinces.

Some local people have complained they were denied immunization due to the shortage, despite queueing for a shot. More supplies have been promised, but health officials in the impoverished country say they have to choose between the high cost of flying them in, or a long wait for shipment by sea.

The mosquito-borne hemorrhagic virus is a major concern in Kinshasa, a city of about 12 million people which has poor health services, a humid climate beloved of the insects and much stagnant water where they can breed owing to pour drainage.

Health minister Felix Kabange said on Monday that 67 cases had been confirmed in Kinshasa, Kongo Central and Kwango provinces and that over 1,000 more suspected cases are being monitored. Five people have died from the disease.

The government and international health organizations vaccinated more than 2 million people, about half of them in Kinshasa, between May 26 and June 4.

But there is no more vaccine left, aside from a small number of doses left in reserve in Kongo Central and some being administered by a government agency at Kinshasa’s central hospital, airport and river crossing with neighboring Congo Republic, health officials said.

The agency is charging $35 for the doses it administers, a hefty sum in a country whose gross national income per person is estimated by the World Bank at $380 a year.

Eugene Kabambi, the World Health Organization (WHO) spokesman in Congo, said that the International Coordinating Group on vaccine provision has promised Congo more than a million more doses.

“That requires either a cargo flight, in which case it would come very quickly but cost a lot, or if it’s by boat, it could take a few weeks,” he told Reuters.

The Coordinating Group brings together the WHO and United Nations Children’s Fund (UNICEF) with the International Federation of Red Cross and Red Crescent Societies plus the medical charity Médecins sans Frontières.

The global stockpile of yellow fever vaccine has already been depleted twice this year to immunize people in Angola, Uganda and Congo. It stands at 6 million doses, but this may not be enough if there are simultaneous outbreaks in a number of highly-populated areas, experts warn.

Almost 18 million doses have been distributed for emergency vaccination campaigns so far in the three African countries.

QUEUES FOR VACCINES

Congo has extensive experience of dealing with outbreaks of tropical diseases and the Ebola virus was first identified in the central African country.

It earned plaudits in 2014 for quickly containing a local Ebola outbreak that killed 49 people in the country. By contrast an Ebola epidemic killed more than 11,300 as it swept through West Africa from 2013.

Of the cases confirmed in the latest yellow fever outbreak, seven were locally transmitted in Congo. Another 58 were imported from Angola, where it began, and two came from remote forested areas not linked to the current outbreak.

Symptoms of the disease include fever, body aches and nausea, although most people recover.

In Kinshasa’s Ndjili commune, a maze of narrow alleys and one of the health zones in the city targeted for vaccination in late May, many residents were unable to receive an injection before stocks ran out.

“Everyone started coming, even from other districts. Near the end we realized that the vaccine was insufficient,” said Murphy Nzuzi, a doctor at a dimly-lit health center in Ndjili with only a few small treatment rooms. He added that fights had broken out among people waiting in line.

In a nearby market where trash collected in a small stream, residents said that some people had received vaccination papers while waiting in line but never got a shot.

“When you present yourself, they give you the card that gives you access to the vaccine, but then there wasn’t enough vaccine for everyone,” said local resident Mama Mavungu.

The current method for making vaccines, using chicken eggs, takes a year. Health authorities are considering using a fifth of the standard dose of vaccine – enough to immunize temporarily but not to give lifelong immunity – to maximize its availability, but no final decision has been made.

(Editing by Tim Cocks and David Stamp)

Zika Spreading in Puerto Rico

A health worker prepares insecticide before fumigating a neighborhood in San Juan

By Julie Steenhuysen

SAN JUAN (Reuters) – The United States faces its first real challenge with the Zika virus on the island territory of Puerto Rico, a part of the nation that is perhaps least prepared to cope with what is expected to be its worst outbreak.

Zika is spreading rapidly in Puerto Rico and is expected to peak in late summer and early fall. By year’s end, public health officials estimate, hundreds of thousands of people will have been infected.

It is the only part of the country that is experiencing a major local outbreak, but the virus is expected to reach southern U.S. states within weeks with warmer temperatures and rising mosquito populations.

Health officials from across the United States are gathering today at the headquarters of the Centers for Disease Control and Prevention in Atlanta to outline a national strategy for combating Zika. In a measure of the concern surrounding the outbreak in Puerto Rico, CDC director Tom Frieden toured the island, meeting with top health officials and local experts last month to assess the situation first-hand.

Puerto Rico is beset with problems already hampering the response: abundant mosquitoes, high levels of insecticide resistance and economic woes that have left vector control in shambles.

“We don’t have good surveillance” here, Frieden said in an interview at the Puerto Rican health department in San Juan during his tour. “We don’t have good control measures.”

First detected in Brazil last year, the Zika outbreak is spreading through the Americas. The World Health Organization declared a global health emergency last month because of growing evidence that Zika can cause microcephaly, a rare birth defect defined by an unusually small head. In adults, the virus has been linked to the typically rare autoimmune disorder, Guillain-Barre syndrome.

EARLY LESSONS

Fighting Zika in Puerto Rico is complicated by the toll of a decade-long recession. Nearly half of its 3.5 million residents live in poverty, and mosquitoes are an accepted nuisance. Puerto Rico has seen repeated outbreaks of dengue and more recently, chikungunya. Both viruses are carried by Aedes aegypti, the same species of mosquito that carries Zika.

“Here in Puerto Rico, we’re really starting from square one,” said Audrey Lenhart, a CDC vector control expert in an interview at the CDC’s Emergency Operations Center in San Juan.

In its latest report, the Puerto Rican health department said there are now 350 confirmed cases of Zika infection, including 40 pregnant women.

“We have a very serious combination of problems,” said Dr. Alberto de la Vega, an obstetrician specializing in high-risk pregnancies at San Juan’s University Hospital at the Puerto Rico Medical Center.

“If you don’t have access to money to buy repellent, to sleep with an air conditioner on so mosquitoes won’t bite you, to have mosquito nets around you and you live in areas where there’s more stagnant water, obviously you have higher risks,” he said.

To mitigate the risk of microcephaly among newborns, the CDC and the Puerto Rican government are distributing Zika protection kits to pregnant women that include condoms to prevent sexual transmission from an infected partner, insect repellent, bed nets and larvicide tablets for standing water that cannot be drained.

De la Vega says many locals are resigned to the idea that everyone in Puerto Rico will be infected. He said he won’t accept that people are “surrendering like that.”

NO VECTOR CONTROL

Government mosquito abatement resources are scarce, with fewer than a dozen trucks equipped with insecticide sprayers. Of the municipalities that do have trucks, most are used to kill nuisance mosquitoes that bite but do not carry disease, said Manuel Lluberas, a Puerto Rico-born entomologist who works at H.D. Hudson Manufacturing, a maker of spraying equipment.

Lluberas, who advises the WHO and the World Bank on vector control programs, said there are a few municipalities that spray insecticide once every seven to 10 days or once every few weeks. Spraying “needs to be done a lot more frequently” to be effective, he said.

Scientists at CDC’s Dengue Laboratory in San Juan have been testing insecticides on mosquitoes gathered from 17 sites on the island. Frieden said in one of the experiments, mosquitoes placed in bottles coated with a commonly effective insecticide “were happily flying around.”

Eliminating Zika will require spraying insecticide indoors on walls, under beds, behind furniture and inside closets, where Aedes aegypti hide. So far, only two insecticides – deltamethrin and bifenthrin – are approved for indoor residual spraying, and researchers have found high levels of resistance to bifenthrin in Puerto Rico.

Mosquito experts have found similar resistance in parts of Texas and California.

“You find resistance in mosquitoes in one locale, and 20 miles away they are not resistant,” said Joseph Conlon, technical advisor for the American Mosquito Control Association, which represents researchers, public health officials and pesticide makers.

Dr. Janet McAllister, a CDC entomologist, said indoor spraying campaigns will be carried out by local contractors, who will target only areas where the mosquitoes hide instead of coating entire walls, as is typically done to control mosquitoes that carry malaria. “People would not really be coming into direct contact with those surfaces,” McAllister said.

She said the CDC does not plan to use experimental methods, including genetically modified mosquitoes, such as those from Intrexon’s Oxitec now being tested in Brazil, or those infected with Wolbochia bacteria that prevent Zika transmission.

Given the urgency of the outbreak, health officials need to focus on known methods of curbing mosquitoes “rather than doing research on things that may or may not work,” she said.

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Girion)

Race for Zika vaccine gathers momentum as virus spreads

(Reuters) – Companies and scientists are racing to create a Zika vaccine as concern grows over the mosquito-borne virus that has been linked to severe birth defects and is spreading quickly through the Americas.

Zika is now present in 23 countries and territories in the Americas. Brazil, the hardest-hit country, has reported around 3,700 cases of the devastating birth defect called microcephaly that are strongly suspected to be related to Zika.

The Geneva-based World Health Organization (WHO), stung by criticism that it reacted too slowly to West Africa’s Ebola epidemic, is convening an emergency meeting on Monday to help determine its response to the spread of the virus.

The U.S. Centers for Disease Control and Prevention has activated an emergency operations center staffed around the clock to address Zika, agency officials told Reuters.

On Thursday, the WHO forecast that as many as 4 million people in the Americas may become infected by Zika, lending new urgency to research efforts already under way. Vaccine developers made clear that a vaccine for widespread public use is at least months, if not years, away.

The closest prospect may be from a consortium including drugmaker Inovio Pharmaceuticals Inc that could have a vaccine ready for emergency use before year-end, according to one of its lead developers. Inovio’s share price jumped as much as 13 percent on Friday.

Canadian scientist Gary Kobinger told Reuters on Thursday the first stage of testing on humans could begin as early as August. If successful, the vaccine might be used during a public health emergency by October or November, said Kobinger, who helped develop a trial vaccine for the Ebola virus.

Privately owned vaccine developer Hawaii Biotech Inc said it began a formal program to test a Zika vaccine last fall as the virus started to gain traction in Brazil, although it has no timetable yet for clinical trials.

“Right now, we are in the pre-clinical stage, as I suspect everyone is,” Chief Executive Dr. Elliot Parks told Reuters.

Another private vaccine developer, Boston-based Replikins Ltd, said it was preparing to start animal studies on a Zika vaccine in the next 10 days. Data from the trials on mice and rabbits would likely be out in the next couple of months, Replikins Chairman Samuel Bogoch told Reuters.

“No one has the $500 million on hand to take it (a vaccine) all the way to human trials. Somewhere along the course we hope to have big pockets join us,” Bogoch said.

‘FIGHT THE MOSQUITO’

Zika had been viewed as a relatively mild illness until Brazilian health officials identified it as a matter of concern for pregnant women. While a direct causal relationship has not been established, scientists strongly suspect a link between Zika and thousands of children born in Brazil with abnormally small heads, brain defects and impaired vision.

There is no treatment for Zika infection. About 80 percent of those infected experience no symptoms, making it difficult for pregnant women to know whether they have been infected.

Efforts to combat Zika are focused on protecting people from being bitten and on eradicating mosquitoes, a tough task in many parts of Latin America, where people live in poverty and there are plentiful breeding grounds for the insect.

“We do not have a vaccine for Zika yet. The only thing we can do is fight the mosquito,” Brazilian President Dilma Rousseff said on Friday, reiterating her call for a national eradication effort.

Rousseff said tests for the development of a vaccine would begin next week at the Butantan Institute, one of Brazil’s leading biomedical research centers in Sao Paulo.

Zika has hit Brazil just as it prepares to host the Olympic Games in Rio de Janeiro on Aug. 5-21, an event that draws hundreds of thousands of athletes, team officials and spectators. The International Olympic Committee (IOC) assured teams on Friday the Olympics would be safe from Zika, but urged visitors to carefully protect themselves.

U.S. lawmakers have begun to press the Obama administration for details of its response to Zika. At least 31 people in the country have been infected, all of them after travel to affected countries.

“We need to ensure that federal agencies are working closely together and with the international community to stop its rapid spread,” said Republican Ron Johnson, chairman of the U.S. Senate Homeland Security and Governmental Affairs Committee.

The United States has two potential vaccine candidates and may begin human clinical trials by the end of 2016, U.S. officials said, but there will not be a widely available vaccine for several years.

(Reporting by Natalie Grover and Amrutha Penumudi in Bengaluru; Additional reporting by Julie Steenhuysen in Chicago, Karolos Grohmann in Berlin, Anthony Boadle in Brasilia, Jeffrey Dastin in New York; Writing by Frances Kerry; Editing by Will Dunham)

CDC has new questions about 39-state salmonella outbreak

Health officials have new questions about a deadly salmonella outbreak that has sickened nearly 900 people nationwide, the Centers for Disease Control and Prevention (CDC) said this week.

Since the beginning of July, the CDC says 888 people in 39 states have been affected by the outbreak, which has been blamed on contaminated cucumbers that were imported from Mexico.

The outbreak has killed at least four people and sent 191 people to the hospital, the CDC said.

After an investigation, Andrew & Williamson Fresh Produce and Custom Produce Sales each initiated cucumber recalls in the first half of September as a result of possible contamination.

However, the CDC’s latest update on the outbreak said 106 people have fallen ill after Sept. 24, when all of the recalled cucumbers should have been either off the shelves or spoiled. That includes 50 people who have gotten sick since Nov. 19, when the CDC last issued an update.

The CDC said an investigation into the new illnesses is ongoing, and officials are trying to determine if cross-contamination from the recalled cucumbers could be to blame.

The organization is encouraging anyone who might have bought or sold recalled cucumbers to wash and sanitize drawers, shelves, crates or reusable grocery bags where the vegetables were stored.

The CDC has not yet determined any other food item that could be causing people to get sick.

Illnesses have been reported in every state except Maine, Massachusetts, Rhode Island, Vermont, New Jersey, Delaware, Michigan, West Virginia, North Carolina, Georgia and Mississippi.

While the rate of reported illnesses has dropped since the recalls were issued, the CDC says it’s still above what is expected for this time of year. And the latest update indicated one person got sick in Tennessee, a state that had not previously reported any illnesses tied to the outbreak.

Salmonella usually triggers a mild illness that can cause fever, diarrhea and abdominal cramps, the CDC says, and most people recover within a week without any treatment. But children, older adults and those with weak immune symptoms are particularly at risk of severe infections.

According to the CDC, an estimated 1.2 million people in the United States get sick from salmonella every year. About 19,000 of them are hospitalized and about 450 of them die.

California has reported the most illnesses tied to this outbreak, with 241 people getting sick there. The CDC said that three of them died, though salmonella likely wasn’t a factor in two cases. The outbreak is also being blamed for one death apiece in Arizona, Oklahoma and Texas.

WHO warns Zika to spread across Americas, spurring vaccine hunt

GENEVA/LONDON (Reuters) – The mosquito-borne Zika virus, which has been linked to brain damage in thousands of babies in Brazil, is likely to spread to all countries in the Americas except for Canada and Chile, the World Health Organization said on Monday.

Zika has not yet been reported in the continental United States, although a woman who fell ill with the virus in Brazil later gave birth to a brain-damaged baby in Hawaii.

Brazil’s Health Ministry said in November that Zika was linked to a fetal deformation known as microcephaly, in which infants are born with smaller-than-usual brains.

Brazil has reported 3,893 suspected cases of microcephaly, the WHO said last Friday, over 30 times more than in any year since 2010 and equivalent to 1-2 percent of all newborns in the state of Pernambuco, one of the worst-hit areas.

The Zika outbreak comes hard on the heels of the Ebola epidemic in West Africa, demonstrating once again how little-understood diseases can rapidly emerge as global threats.

“We’ve got no drugs and we’ve got no vaccines. It’s a case of deja vu because that’s exactly what we were saying with Ebola,” Trudie Lang, a professor of global health at the University of Oxford, said on Monday. “It’s really important to develop a vaccine as quickly as possible.”

Large drugmakers’ investment in tropical disease vaccines with uncertain commercial prospects has so far been patchy, prompting health experts to call for a new system of incentives following the Ebola experience.

“We need to have some kind of a plan that makes (companies) feel there is a sustainable solution and not just a one-shot deal over and over again,” Francis Collins, director of the U.S. National Institutes of Health, said last week.

The Sao Paulo-based Butantan Institute is currently leading the research charge on Zika and said last week it planned to develop a vaccine “in record time”, although its director warned this was still likely to take three to five years.

RIO CONCERNS

The virus was first found in a monkey in the Zika forest near Lake Victoria, Uganda, in 1947, and has historically occurred in parts of Africa, Southeast Asia and the Pacific Islands. But there is little scientific data on it and it is unclear why it might be causing microcephaly in Brazil.

Laura Rodrigues of the London School of Hygiene and Tropical Medicine said it was possible the disease could be evolving.

If the epidemic was still going on in August, when Brazil is due to host the Olympic Games in Rio de Janeiro, then pregnant women should either stay away or be obsessive about covering up against mosquito bites, she said.

The WHO advised pregnant women planning to travel to areas where Zika is circulating to consult a healthcare provider before traveling and on return.

The clinical symptoms of Zika are usually mild and often similar to dengue, a fever which is transmitted by the same Aedes aegypti mosquito, leading to fears that Zika will spread into all parts of the world where dengue is commonplace.

More than one-third of the world’s population lives in areas at risk of dengue infection, in a band stretching through Africa, India, Southeast Asia and Latin America.

Zika’s rapid spread, to 21 countries and territories in the Americas since May 2015, is due to the prevalence of Aedes aegypti and a lack of immunity among the population, the WHO said in a statement.

RISK TO GIRLS

Like rubella, which also causes mild symptoms but can lead to birth defects, health experts believe a vaccine is needed to protect girls before they reach child-bearing age.

Evidence about other transmission routes, apart from mosquito bites, is limited.

“Zika has been isolated in human semen, and one case of possible person-to-person sexual transmission has been described. However, more evidence is needed to confirm whether sexual contact is a means of Zika transmission,” the WHO said.

While a causal link between Zika and microcephaly has not yet been definitively proven, WHO Director-General Margaret Chan said the circumstantial evidence was “suggestive and extremely worrisome”.

In addition to finding a vaccine and potential drugs to fight Zika, some scientists are also planning to take the fight to the mosquitoes that carry the disease.

Oxitec, the UK subsidiary of U.S. synthetic biology company Intrexon, hopes to deploy a self-limiting genetically modified strain of insects to compete with normal Aedes aegypti.

Oxitec says its proprietary OX513A mosquito succeeded in reducing wild larvae of the Aedes mosquito by 82 percent in an area of Brazil where 25 million of the transgenic insects were released between April and November. Authorities reported a big drop in dengue cases in the area.

(Editing by Mark Trevelyan)

Dole recalls packaged salads after multi-state listeria outbreak

Dole is temporarily shutting down one of its production facilities and recalling all of the salads that were made there because the facility has been linked to a multi-state outbreak of listeria.

The recall notice was posted on the Food and Drug Administration website on Friday.

The Centers for Disease Control and Prevention (CDC), which has been investigating the outbreak, said 12 people in six states have been hospitalized since July. One person died.

The CDC determined that salads produced and packaged at Dole’s facility in Springfield, Ohio, were likely behind the illnesses. Dole initiated the recall and decided to temporarily suspend production at the facility “out of an abundance of caution,” according to the recall notice.

The salads in question were sold under a variety of different brand names — including Dole, Fresh Selections, Simple Truth, Marketside, The Little Salad Bar and President’s Choice, the CDC said. However, they all have the letter ‘A’ at the beginning of a product code that appears on the upper-right-hand corner of the package, according to Dole’s recall notice.

Dole said none of its other products or facilities are affected by the recall, and added that packaged salads that have ‘B’ or ‘N’ at the start of their product codes aren’t being recalled. Those salads were produced at different facilities, and the CDC added that it doesn’t currently have any evidence suggesting those salads are linked to the outbreak.

Dole said the recalled salads were sold in Alabama, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Michigan, Massachusetts, Maryland, Minnesota, Missouri, Mississippi, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and Wisconsin, as well as the Canadian provinces of Ontario, New Brunswick and Quebec.

The company encouraged consumers and stores who still have packaged salads with product codes beginning with ‘A’ to throw them out without eating them.

According to the CDC, listeria is a bacteria that can lead to listeriosis, a rare but life-threatening condition that is often contracted by eating contaminated food. The organization estimates that listeriosis sickens about 1,600 people annually in the United States, killing about 260 of them.

Newborns, older adults people with weak immune systems and pregnant women are generally at risk, the CDC says, and the bacteria can lead to miscarriages or stillbirths. Common symptoms include fever and muscle aches, though the disease can also cause convulsions in certain people.

This particular outbreak sickened people in Michigan, Indiana, Pennsylvania, New York, New Jersey and Massachusetts, according to the CDC, and killed a person from Michigan.

Liberia declared Ebola-free, though threat of flare-ups remain

MONROVIA (Reuters) – Liberia was declared free of the Ebola virus by global health experts on Thursday, a milestone that signaled an end to an epidemic in West Africa that has killed more than 11,300 people.

But the World Health Organisation (WHO) warned there could still be flare-ups of the disease in the region, which has suffered the world’s deadliest outbreak over the past two years, as survivors can carry the virus for many months and could pass it on.

Health specialists cautioned against complacency, saying the world was still underprepared for any future outbreaks of the disease.

Liberia was the last affected country to get the all-clear, with no cases of Ebola for 42 days, twice the length of the virus’s “incubation period” – the time elapsed between transmission of the disease and the appearance of symptoms.

“All known chains of transmission have been stopped in West Africa,” the WHO, a U.N. agency, said on Thursday.

The other affected countries, Guinea and Sierra Leone, were declared Ebola-free late last year. There were cases in seven other countries including Nigeria, the United States and Spain, but almost all the deaths were in the West African nations.

“It is the first time since the start of the … epidemic in West Africa two years ago that the three hardest-hit countries had zero cases for at least 42 days,” said WHO’s Liberia representative Alex Gasasira.

The WHO announcement on Thursday is a major step in the fight against a disease that began in the forests of eastern Guinea in December 2013 before spreading to Liberia and Sierra Leone. It overwhelmed medical infrastructure in the region which was ill-equipped to deal with the outbreak, and at its height in late 2014 sparked global fears among the general public.

However the agency urged caution – Liberia had previously twice been declared virus-free, in May and September of 2015, but each time a fresh cluster of cases unexpectedly emerged.

Its capital Monrovia was badly hit during the worst of the epidemic. Inadequate care meant patients lay strewn on the streets or pavements waiting hours for tests and treatment; medical holding pens became growth centers for the disease.

With those memories still fresh, and society and the economy still reeling from the outbreak, the reaction to Thursday’s announcement was muted. There was no signs of celebration such as the “Ebola free” T-shirts that people wore after previous WHO announcements.

“After the first declaration, people were dancing in the street,” said Vivian Lymas Tegli, child protection officer for UNICEF in Monrovia. “But I don’t think there will be any celebrations today. People are tired of Ebola. They feel it is here to stay.”

‘WORLD UNDERPREPARED’

Experts said progress had been made in the region’s response to Ebola, with new cases having dwindled due to public health campaigns, efforts to trace and isolate potential sufferers and the safe treatment and burial of patients and victims.

But it said the countries would still struggle to deal with any future large outbreak of Ebola, which is passed on through blood and bodily fluids and killed around 40 percent of those who contracted the virus.

Hundreds of healthcare workers in both urban and rural communities were among those killed by the disease, a major blow to medical systems in countries which already had among the lowest numbers of doctors per head of population in the world.

“Today’s WHO announcement is welcome news but we must learn from Ebola’s devastating impact and ensure we are better prepared for infectious disease outbreaks,” said Dr Seth Berkley, head of Gavi, the Vaccine Alliance, an organization that aims to increase access to vaccines in poor countries.

“The world is still worryingly underprepared for potential future health threats and a change of mind-set is required to ensure we invest in research and development today to protect ourselves in years to come.”

Experts also warned other tropical diseases posed future threats, including the previously little known mosquito-borne Zika virus, which has been linked to head-related birth defects and is spreading in South America.

Hilde de Clerck, a doctor with Medecins Sans Frontieres who has assisted with five Ebola outbreaks including in Congo, Uganda and the latest epidemic in West Africa, said vigilance was crucial to prevent the re-emergence of the disease, for which there is no proven drug treatment, although researchers have developed a vaccine.

“I think we should not forget about the risk of other outbreaks,” she said. “I am most concerned about some of the basics: hygiene, equipment and training.”

While WHO and other health specialists say another outbreak of this magnitude is unlikely, and much has been learned in terms of monitoring patients and responding to outbreaks, problems remain, including with simple hygiene, such as not washing hands.

“I do really believe that there is a much better understanding, an acceptance that this is a real disease, and what the cause is of this disease, and that is much more embedded in society than before,” said Peter Graaff, head of Ebola operations at the WHO’s headquarters in Geneva.

Mohammed Kamara, who lives in Monrovia, lost two relatives and a friend to Ebola in 2014. “I know exactly what it means to have the disease in the country,” he said.

“We must be grateful to God and then to the government and its partners for the country to be declared free of Ebola. I only hope that it is the last time that we experience Ebola.”

(Additional reporting by Keiran Guilbert, Stephanie Nebehay, Tom Miles, Emma Farge, Matt Mpoke Bigg, Kate Kelland and Ben Hirschler; Writing by Edward McAllister; Editing by Jeremy Gaunt and Pravin Char)

California, Minnesota Health Officials Warn of Norovirus Outbreaks

Public health officials in California and Minnesota are warning about norovirus outbreaks, cautioning that the intestinal disease could sicken lots of people in those states this winter.

The California Department of Public Health announced last week that there had been 32 confirmed outbreaks of the disease since October, a number that greatly exceeds the total reported in the same window last year. Hundreds likely fell ill from the disease, officials said.

In Minnesota, the state Department of Health cautioned that the arrival of a new strain of the disease could cause some additional norovirus illnesses this winter. The department said it has investigated at least 20 outbreaks of the GII.17 Kawasaki strain since September. The strain is the same one that spurred many outbreaks in Asia last winter, officials said in a news release.

“Every few years, a new strain of norovirus emerges and causes many illnesses,” Amy Saupe, a foodborne disease epidemiologist with the department, said in a statement. “We don’t know yet if this new strain will lead to an increase in the number of outbreaks reported, but it could.”

According to the Centers for Disease Control and Prevention (CDC), norovirus is the top cause of stomach flu in the United States. The highly contagious virus sickens between 19 million and 21 million people, hospitalizes 56,000 to 71,000 and kills between 570 and 800 every year. Common symptoms include fever, diarrhea and vomiting. Most people recover within 1 to 3 days.

People get norovirus from eating tainted food or touching contaminated surfaces, making it relatively easy for the disease to spread in places like schools, daycares and nursing homes.

The Boston Globe reported a sick employee came to a Chipotle restaurant in the city earlier this month and 136 people — including some Boston College students — fell ill. There were some initial fears that outbreak was linked to an E. Coli outbreak at Chipotle restaurants in nine states, but the paper reported health officials ultimately determined that norovirus was at fault.

The CDC and other public health officials say proper disinfection, hand hygiene and food-handling techniques are vitally important to help prevent norovirus from spreading.

“One of the most important things you can do to avoid norovirus and other illnesses this holiday season is to wash your hands frequently with soap and running water for at least 20 seconds,” Dr. Karen Smith, the director of the California Department of Public Health, said in a statement. “This is especially important after using the bathroom, changing diapers, and before preparing or eating food. Hand sanitizers are not effective against norovirus.”