Colombia Announces End of Zika Outbreak

Jul 27, 2016 | Alejandra Ramirez-Cardenas | Outbreak News

On 25th July 2016, Colombia was the first country in Latin America to declare the end of their Zika outbreak. This comes 10 months after the first case of Zika was detected in the country [1].  Since then, there have been a total of 99,721 cases in Colombia, along with 21 confirmed Zika-linked microcephaly births [2]. However, more cases of Zika-linked microcephaly are expected in the coming months, when pregnant women infected at the peak of the epidemic will give birth [6, 7]. At the peak of the outbreak in February, more than 6,000 cases were reported over the course of a single week [7]; that number has now fallen to less than 600 reported cases per week.

 

The end of the outbreak in Colombia comes much sooner than predicted by British researchers, which indicated that the outbreak would last in Latin America for an additional two to three years, until enough people gained immunity and the virus burned out [3, 4].  Once infected with the Zika virus, it is believed that people acquire immunity; however, it usually takes several years for enough of the population to acquire immunity for a virus like Zika to die out [3,7]. Some researchers are skeptical about this being the true end of the outbreak; one researcher at the University of Minnesota claims that there is no evidence to support the declaration by the Colombian government [7]. Others believe that this may just be a seasonal decline [7] – as the rainy season approaches its end, there is less stagnant water available for the Aedes agypti mosquito to use as breeding grounds.

 

Despite the announcement of the end of the epidemic, Colombian authorities still advise that residents continue partaking in preventative measures [5]. Zika is now considered endemic to the country, meaning that the virus will always circulate in Colombia to some degree [7]. 

 

After Brazil, Colombia has reported the most Zika infections in Latin America [7].

 

[1] http://www.eluniversal.com.mx/articulo/mundo/2016/07/25/colombia-declara...

[2] https://noticias.terra.com.co/colombia/colombia-da-por-cerrada-epidemia-de-zika,c7088388c83f37402b4cbe5804046768s0hqmn9n.html

[3] http://science.sciencemag.org/content/early/2016/07/13/science.aag0219

[4] http://www.reuters.com/article/us-health-zika-immunity-idUSKCN0ZU29N

[5] http://www.bbc.com/mundo/noticias-america-latina-36889211

[6] http://www.foxnews.com/health/2016/07/25/colombia-declares-end-to-zika-epidemic-inside-country.html

[7] https://www.statnews.com/2016/07/25/colombia-zika-virus-epidemic/

Vector Control: Our Best Chance in the Fight Against Zika

Jul 25, 2016 | Alejandra Ramirez-Cardenas | Outbreak News

Aedes aegypti in the Americas

Latin America is currently fighting to prevent the diseases transmitted by the Aedes aegypti mosquito: Zika, Dengue, and Chikungunya. There are significant and ongoing outbreaks of these diseases in Latin America, including Brazil, Mexico, Argentina, Peru, and Colombia, to name a few [1-5]. Anyone who has watched the news recently knows that Brazil is the epicenter of the Zika virus outbreak; additionally, dengue is endemic to the country. However, they are not alone - other countries in Latin America are fighting simultaneous outbreaks. Countries in Latin America are taking a variety of approaches to fight and prevent A. aegypti from proliferating in these already endemic areas. Techniques employed range from environmental sanitation, chemical control, physical control, to educational campaigns. Additionally, given the seriousness of the situation, novel approaches are being considered, such as genetic modification or radiation of the A. aegypti mosquitos.

 

Environmental Sanitation

The main mode of prevention for these diseases is to limit mosquito contact through vector control [6]. This is primarily done by eliminating habitats that favor the procreation and proliferation of the mosquito [7]. It is important to note that the exception to this is the Zika virus where it has been discovered that sexual (person-to-person) transmission may play a greater role than previously thought [8].  A. aegypti is a “container breeder” and will breed wherever water accumulates [10], even very small amounts, therefore elimination of open sources of stagnant water is the main preventative measure used. Health departments in affected municipalities often form sanitation brigades that go out into the community and visit homes to eliminate or modify sources of stagnant water such as potted plants, toilets, and water leaks. Solid waste such as old tires, open water bottles, and discarded containers are also a hazard because they have the potential to accumulate water and must be eliminated. Water storage containers in homes are fitted with tight lids or mesh screens by the brigades to prevent mosquitos from laying eggs [7, 9, 10,].

 

Chemical Control

The life cycle stage of the A. aegypti mosquito determines the type of chemical control measure that can be used.  Larvicides, such as Temefos, are used to kill the mosquito in its immature, larval, stages in water containers that cannot be eliminated [6]. During emergency situations, like those that many communities in Latin America are currently experiencing, targeted outdoor residual space spraying is employed. In communities where homes are not adequately screened or air-conditioned, residual indoor spraying is recommended with ultra low volume doses of adulticides, such as deltamethrin and bifenthrin [11]. Finally, in extreme outbreak situations, widespread outdoor space spraying of pesticides is used. This is used as a last-resort measure with rapidly effective treatment in order to reach wide areas. To do the widespread spraying, ultra low volume dose machines are mounted onto trucks and/or aircrafts and the pesticides are dispersed in an aerosol of ultrafine droplets [6, 11]. However, in order for this technique to be effective, the pesticide must come into direct contact with the mosquitoes.

 

Physical Control

Physical control measures for the A. aegypti mosquito include both physical methods to catch the mosquitos, as well as physical barrier methods. A physical control method is placing oviposition, egg-laying medium on sticky traps in homes to lure female mosquitos and trap them. Some barrier methods include installing screens on windows in the home, wearing protective clothing, like long sleeve shirts and pants, and installing bed nets. Bed nets can be treated with insecticide such as Permethryn to prevent mosquitos from making contact and to kill them at the same time.

 

Educational Campaigns

Educational campaigns are used concurrently with the environmental sanitation chemical control, and physical control methods in order to inform members of the community of ways to safely protect themselves and rid their communities of the A. aegypti mosquito. In these campaigns, city health departments, in conjunction with sanitation brigades, go out into the community to teach residents and students about the A. aegypti life cycle, how the mosquito reproduces, and ways to eliminate breeding habitats [12]. Some locations such as Rosario, Argentina have dedicated “days of sanitation” or “overhaul weekends” like the one that that Dominican Republic conducted at the end of June 2016. During these sanitation days, everyone works together to eliminate vector-breeding sites in the community and is involved in education campaigns at the same time [13, 14]. The aim of these campaigns is to assist and teach the communities how to eliminate the vector so that they can know the importance of sanitation in disease control, and continue the efforts on their own.

 

Novel Approaches

There are several novel approaches being discussed as an effort to fight the A. aegypti mosquito. An approach that has been come up a lot recently is the genetic modification (GM) of the male A. aegypti mosquito. The GM male mosquito carries a dominant lethal gene, which is then passed down to its offspring upon mating. The gene causes the mosquito larvae from maturing and thus breaking the mosquito’s life cycle [15, 16]. This approach was successfully tested in the Cayman Islands in 2010 [15] and in June of 2016 was reintroduced in order to prevent Zika and dengue outbreaks [17]. In 2012, Brazil established a farm for GM A. aegypti mosquitos (18) as an effort to reduce dengue outbreaks, and is using this approach in certain areas to fight the current Zika outbreak [19]. According to the United States Food and Drug Authority (FDA) the use of genetically modified mosquitos is safe [20] and Key West, Florida may soon be the first location in the US to test these GM mosquitos [20]. Sterilization through radiation of the male A. aegypti mosquito is another novel approach that has been utilized [15, 21], however it has been shown to not be as effective as the GM mosquitos [22]. Similar to the GM approach, radiation sterilizes male mosquitos so that when they mate, none of the eggs laid would be viable.

 

It is important to note that no one method by itself is completely effective. Vector control is most effective through a combination of all of these methods [7].

 

[1] http://espanol.cri.cn/2786/2016/06/23/1s386644.htm

[2] http://larepublica.pe/impresa/sociedad/778842-se-han-reportado-22-mil-casos-de-dengue-este-ano

[3] http://www.diariouno.com.ar/para-reducir-el-dengue-insisten-el-trabajo-la-temporada-invernal-20160619-n967250

[4] http://www.elpais.com.co/elpais/cali/noticias/esperamos-300-casos-microcefalia-asociados-zika-este-ano-ins

[5] http://www.unionjalisco.mx/articulo/2016/06/17/salud/guadalajara/jalisco-es-septimo-en-casos-de-dengue

[6] http://www.cdc.gov/chikungunya/resources/vector-control.html

[7] http://www.who.int/denguecontrol/control_strategies/control_strategy_vector/en/

[8] http://www.cdc.gov/zika/transmission/sexual-transmission.html

[9] http://www.who.int/denguecontrol/control_strategies/environmental_management/en/

[10] http://www.who.int/emergencies/zika-virus/articles/mosquito-control/en/

[11] http://www.cdc.gov/zika/public-health-partners/vector-control-us.html

[12] https://www.diariodemorelos.com/noticias/ense%C3%B1an-en-escuelas-contra-brotes-de-dengue-zika-y-chikungunya

[13] http://www.listindiario.com/puntos-de-vista/2016/06/30/425071/las-necesarias-jornadas-contra-el-zika

[14] http://www.lacapital.com.ar/un-dia-darle-pelea-al-dengue-todo-rosario-n965372

[15] https://journosdiary.com/2016/02/05/novel-approaches-to-fight-aedes-aegypti-mosquito/

[16] http://www.theatlantic.com/technology/archive/2016/04/genetically-modified-mosquitoes-zika/479793/

[17] https://actualidad.rt.com/actualidad/212778-mosquitos-mutantes-islas-caiman-combatir-zika

[18] http://www.healthmap.org/site/diseasedaily/article/brazil-rolls-out-gm-m...

[19] http://www.cbsnews.com/news/brazilian-piracicaba-town-using-genetically-modified-mosquitoes-to-fight-zika/

[20] http://www.nbcnews.com/storyline/zika-virus-outbreak/fda-says-test-genetically-modified-mosquitoes-safe-n536861

[21] http://www.breitbart.com/national-security/2016/02/24/brazil-to-sterilize-zika-mosquitoes-with-radiation/

[22] http://www.nature.com/nature/journal/v244/n5415/abs/244368a0.html

 

 

 

Over 1,000 Deaths from H1N1 Outbreak in Brazil

Jul 12, 2016 | Kara Sewalk | Outbreak News

As of July 1st, 2016, the Ministry of Health in Brazil confirmed that there have been 1,233 deaths linked to the ongoing H1N1 influenza outbreak in the country [1].

By comparison, the years of 2014 and 2015 saw only 163 and 36 deaths from H1N1 influenza, respectively. The vast proportion of the deaths this year has emerged from the region of Sao Paolo, where 517 deaths were reported. Rio Grande do Sul, Brazil’s southernmost state, has the second highest proportion of influenza deaths -- 142. Other strains of influenza have claimed an additional 93 lives in Brazil. Complications from H1N1 infection include severe acute respiratory syndrome (SARS), of which 6,569 have been registered across the country [1]. 

This is the largest outbreak of H1N1 influenza in Brazil since the 2009 pandemic, where the country saw 2,060 deaths from the virus [1].

Rising rates of H1N1 deaths sparked the Ministry of Health in Brazil to conduct a mass vaccination campaign to prevent an influenza outbreak from April 30th to May 20th, which provided free flu shots with the aim to immunize 48.9 million people [5,2]. The typical flu season in Brazil spans during the southern hemisphere’s winter months of May to July. The Ministry of Health reported that the mass vaccination campaign reached 95.5% of its target demographic, which includes young children, pregnant women, women who recently gave birth, and the elderly. It is estimated that a total of 1.7 million people in Sao Paolo were vaccinated against influenza during the vaccination campaign [2,3]. Despite a successful mass vaccination campaign, the H1N1 outbreak has continued to rise, bringing the reported death toll to 1,233 to date.

In April 2016, the BBC reported that there had been 230 deaths due to H1N1 influenza in Brazil [3]. However, rates have significantly increased in recent weeks, with as many as 122 deaths from H1N1 influenza occurring over the course of one week [4]. There is no clear explanation yet as to why this phenomenon is happening, however there is a suspicion that the outbreak could be attributed to increased travel to and from Brazil over the past year [5]. 

Additionally, there remains sparse information regarding this year’s H1N1 outbreak, despite its scale and fatality rate – across both English language media outlets and media outlets within Brazil. There is a severe lack of sources that contain detail about why the H1N1 outbreak is occurring. 

Panama, another Latin American country, has also experienced a major H1N1 outbreak this year, and has declared a national health alert with a reported 22 deaths and 671 hospitalizations from H1N1 influenza infection. This occurred in the midst of Panamanian Health Minister Francisco Javier Terrientes’ resignation [6].

The results of the H1N1 influenza outbreak in Brazil has the potential to impact the 2016 Olympic Games, which will take place in Rio de Janeiro in only a few short weeks. To date, Rio de Janeiro has registered 47 deaths from the H1N1 outbreak [1]. The Center for Disease Control and Prevention recommends all travelers to the Olympic Games be up to date with routine vaccinations, including the influenza vaccine [7].

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Sources

[1]http://g1.globo.com/bemestar/noticia/2016/07/h1n1-ja-matou-1233-pessoas-no-brasil-em-2016-segundo-ministerio.html

[2]http://www.brasil.gov.br/saude/2016/04/campanha-nacional-de-vacinacao-contra-a-gripe-comeca-no-sabado

[3]http://www.bbc.com/news/world-latin-america-36145181

[4]http://outbreaknewstoday.com/brazil-reports-nearly-1000-influenza-deaths-in-first-five-months-sao-paulo-sees-400-h1n1-deaths-42236/

[5]http://www.cctv-america.com/2016/04/14/first-zika-now-a-fatal-h1n1-outbreak-in-brazil

[6]http://outbreaknewstoday.com/panama-h1n1-outbreak-health-minister-terrientes-resigns-as-death-toll-ris

es-44527/​

[7] http://wwwnc.cdc.gov/travel/notices/alert/2016-summer-olympics-rio 

Zika-linked Microcephaly Cases in Cape Verde

Jun 28, 2016 | Emily Cohn | Outbreak News

On 23rd of June, Cape Verde’s Ministry of Health reported that there had been 11 cases of Zika virus-linked microcephaly on the small African nation [1].  This count is a significant jump from the previously reported three cases as of the beginning of June [2]. The first case in Cape Verde, confirmed on 15th March in the area of Praia [3], was diagnosed while much about Zika virus and its suspected-to-be-associated microcephaly remained unknown. It was not until the end of March 2016 that the World Health Organization (WHO) announced that there was enough evidence to scientifically link Zika virus and microcephaly in infants exposed to the virus in utero [4]. 

The confirmation of Zika virus-linked microcephaly cases in Cape Verde is of particular importance due to the location and timing of the outbreak. Zika virus outbreaks have been confirmed in African countries since it was serologically confirmed in humans in Uganda in 1948 [5].  The virus was confirmed by serological evidence in multiple locations in Asia, but it was not until 2007 on Yap Island that it was confirmed as a clinical illness outbreak outside of Africa [5]. From there, outbreaks were then confirmed in French Polynesia and other Pacific Islands [6]. Genetic studies of the virus from the affected populations revealed three distinct Zika virus strains or genotypes: one from West Africa, one from East Africa, and one from Asia [6].  Given Cape Verde’s location, 350 miles off the coast of West Africa, there was little debate or speculation as to what strain its outbreak belonged – the focus remained on the 7500 suspected cases in the country and the outbreak swiftly spreading through the Americas. 

Prior to the outbreak in the Americas, Zika virus was considered a ‘nuisance disease’ – causing only a short/mild illness. It was not until the cases of microcephaly, Guillain Barre Syndrome (GBS) and other neurological complication emerged, that the disease became of greater concern [7].  The first cases of GBS appearing in conjunction with Zika virus infection occurred in French Polynesia between 2013 and 2014 [8]. During that outbreak, the largest of its time, 42 patients were diagnosed with GBS – a retrospective case control study provided the evidence necessary to link Zika infection with the neurological condition [8]. 

Genetic sequencing revealed that the strain of Zika virus to blame for the outbreak in the Americas was the Asian strain – closely resembling the virus at its state during the French Polynesian outbreak [9].  The study authors, from the University of California at Los Angeles (UCLA), highlight the dangerous developments in the virus during this outbreak: “We don’t know why Zika infection was not associated with serious human disease, especially in newborns, until recently … We hoped that taking a closer look at the virus’ genetic changes over time would reveal clues to this mystery” [9].  Significant mutations were found, further segregating the Asian strain from the African strains, and mutations have had other effects on its clinical disease. The author of the study explains, “We suspect these mutations could help the virus replicate more efficiently, evade the body’s immune response or invade new tissues that provide a safe harbor for it to spread” [9]. These mutations may explain why the ‘serious human disease’ of the outbreak in the Americas may have suddenly cropped up.  

On 20th of May, it was confirmed that it was Asian strain of Zika virus responsible for the outbreak and cases of microcephaly in Cape Verde – the first time the strain responsible for ‘serious human disease’ has been reported in Africa [10]. This makes sense, given its recent reports of microcephaly – approximately nine months after the first reports of infection, in late September of 2015 [11]. Much uncertainty remains regarding a mother’s Zika virus infection timing and its risk to the unborn fetus – some studies report that there is no risk during the third trimester, others report that there has been a connection to increased rates of sudden miscarriage [12, 13]. Much of these unknowns are a result of the fact that we do not yet know the breadth of the Zika-virus syndrome in newborns exposed in utero. Research now suggests “serious joint problems, seizures, vision impairment, trouble feeding and persistent crying can be added to the list of risks from Zika exposure in the womb” [14]. It may be months or years before we understand all complications, both congenital and developmental, in this cohort of newborns. 

It remains unclear why we are only now seeing these severe outcomes from the Asian strain of the Zika virus. Early findings, published in Nature Immunology, suggest that previous exposure to the vectorborne dengue virus may increase the potency of Zika [15]. The mechanism for this increased potency is suggested to be a result of  “some dengue antibodies can recognize and bind to Zika due to the similarities between the two viruses, but that these antibodies may also amplify Zika infection in a phenomenon called antibody-dependent enhancement” [15]. It is proposed that this may be why this outbreak is resulting in ‘serious human disease’ – it’s occurring in regions previously affected by dengue outbreaks.  

When we think of dengue virus outbreaks – we typically think of Southeast Asia and South America, primarily Brazil. So what about Cape Verde? Does the previous-dengue-infection-exacerbating-Zika-virus theory hold up? In 2009, the Cape Verde Ministry of Health reported over 13,000 suspected cases of dengue [16]. The outbreak was the first dengue outbreak for the country and, at the time, the biggest outbreak recorded in Africa [16]. Given Cape Verde’s previous exposure to dengue, it is plausible that the new theory on Zika virus infection for the current outbreak holds up – and might explain the new cases of microcephaly being reported. Only time will tell what can be done to mitigate risks and outcomes. 

 

[1] http://www.rtp.pt/noticias/mundo/cabo-verde-regista-11-casos-de-microcef...
[2] http://www.rtp.pt/noticias/mundo/cabo-verde-regista-tres-casos-de-microc...
[3] http://www.rtp.pt/noticias/mundo/cabo-verde-regista-primeiro-caso-de-mic...
[4] http://www.npr.org/sections/thetwo-way/2016/03/31/472607576/health-agenc...
[5] http://wwwnc.cdc.gov/eid/article/15/9/09-0442_article
[6] http://wwwnc.cdc.gov/eid/article/22/5/16-0065_article
[7] http://www.usnews.com/news/politics/articles/2016-04-11/us-officials-the...
[8] http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00562-6.pdf
[9] http://newsroom.ucla.edu/releases/ucla-scientists-unravel-the-genetic-ev...
[10] http://reliefweb.int/report/cabo-verde/who-confirms-zika-virus-strain-im...
[11] http://www.who.int/csr/don/21-december-2015-zika-cape-verde/en/
[12] http://www.nejm.org/doi/full/10.1056/NEJMoa1604037
[13] http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html
[14] http://www.scientificamerican.com/article/list-of-possible-zika-birth-de...
[15] http://www.reuters.com/article/us-health-zika-dengue-idUSKCN0Z921O
[16] http://www.doctorswithoutborders.org/news-stories/field-news/cape-verde-...

Elizabethkingia Spreads to Illinois

May 2, 2016 | Cheryl Lang Colleen Nguyen | Outbreak News

Outbreaks of the mysterious bacteria, Elizabethkingia, has been reported in Wisconsin and most recently, in Illinois. Yet, it has recently been discovered that the Elizabethkingia strain in Wisconsin is different than the strain documented in all, but one of the cases, in Illinois (1). As of April 20th, Illinois has reported ten confirmed cases, including six deaths attributed to Elizabethkingia (1). These reported deaths were over the age of 65 and all had unrelated, but severe health complications alongside the infection (1). Therefore, it is unknown whether the cause of these deaths were due to the infection of the bacteria, the underlying health conditions, or a combination of both (1).

Why is this outbreak unusual?

Perhaps the most unusual part of this outbreak is that Elizabethkingia rarely causes infections in humans (1). The bacteria, Elizabethkingia anophelis, is generally found in water sources including rivers, reservoirs, and soils (1). Many of the previously documented infections of Elizabethkingia have occurred within the context of health care facilities but this new cluster of cases in Illinois seems to be occuring within the community (2). However, the means in which individuals have become infected also remains unknown (1).

What is Elizabethkingia?

Elizabethkingia often tends to be a bloodstream infection, but in some cases it has been found to infect other sites such as the respiratory system or joints (3). Diagnoses of cases are conducted through blood tests (4). Symptoms of the infection include fever, shortness of breath, chills, and swelling and redness of the skin (1). The bacterial infection often manifests itself as meningitis in newborns or meningitis, and blood or respiratory infections in immunocompromised adults (1). Elizabethkingia is treatable, however it is resistant to many antibiotics (5). Doctors in this recent outbreak have identified a few antibiotics that have been successful in treating the infection, which include fluoroquinolones, rifampin, and trimethoprim/sulfamethoxazole (5). Hopefully these antibiotics can be used to treat more cases and prevent any additional deaths attributed to this outbreak.

Illinois Response to the Outbreak

The Illinois Department of Public Health is quite busy with determining the source of the outbreak, while also treating the people who have already contracted the infection. The agency is urging health care workers to test anyone who presents with similar symptoms of Elizabethkingia for infection (6). The agency is also trying to establish a link between the confirmed cases while investigating the source of the bacteria, why and how people are getting infected, and the exact effect that the bacteria has on a person’s health (6). Hopefully, Illinois will discover the cause of this outbreak in order to effectively treat and prevent further cases of this bacterial infection.

 

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Sources

  1. Rhodes, D. (2016, April 20). 10 Illinois residents infected with Elizabethkingia. Chicago Tribune. Retrieved April 26, 2016, from http://www.chicagotribune.com/news/local/breaking/ct-elizabethkingia-inf...
  2. Meyers, S. L. (2016, March 9). A Crash Course In Elizabethkingia, The Rare Bacterial Infection Spreading Across Wisconsin. Wisconsin Public Radio. Retrieved April 26, 2016, from http://www.wpr.org/crash-course-elizabethkingia-rare-bacterial-infection....
  3. Goldschmidt, D. (2016, April 13). Elizabethkingia outbreak spreads; source still a mystery. CNN. Retrieved April 26, 2016, from http://www.cnn.com/2016/04/12/health/elizabethkingia-illinois-bacterial-...
  4. Elizabethkingia. (2016). Retrieved April 26, 2016, from http://www.cdc.gov/elizabethkingia/about/index.html
  5. Rettner, R. (2016, April 20). 5 Things to Know About Elizabethkingia. Discovery News. Retrieved April 26, 2016, from http://news.discovery.com/human/health/5-things-to-know-about-elizabethk...
  6. Bair, D., & Czink, K. (2016, April 20). Concerns grow over Elizabethkingia. WGN Tv. Retrieved April 26, 2016, from http://wgntv.com/2016/04/20/concerns-grow-over-elizabethkingia/
Yellow Fever Deaths Reach 250 in Angola

Apr 26, 2016 | Cheryl Lang Colleen Nguyen | Outbreak News

Currently, there is a particularly worrisome yellow fever outbreak in Angola due to the increasing number of cases, a vaccine shortage, and another simultaneous mosquito-disease epidemic. Angola is experiencing its worst yellow fever outbreak in the last 30 years (1). So far, the yellow fever death toll in Angola has reached 250, with the number of reported cases has reached 1,908 as of April 20th (6, 7). The virus has hit 16 of the 18 provinces in Angola and is continuing to spread to other provinces and countries (1). Imported cases of the virus from Angola have been reported in China, the Democratic Republic of Congo, and Kenya (2).

 

What is Yellow Fever?

Yellow Fever is mosquito-borne virus that is endemic in tropical areas of Latin America and Africa (5). The virus is transmitted by two types of mosquitoes, the Aedes aegypti and Haemagogus mosquitoes (5). The Aedes aegypti is the same mosquito that transmits Zika virus and dengue fever (2). The mosquitoes contract the virus primarily from monkeys and then are able to transmit the virus to humans (5). “Yellow” in ‘Yellow Fever’ refers to the jaundice that occurs in some patients as a result of the virus (5).

Upon initial infection, the virus incubates in the body for 3-6 days. The virus occurs in two phases -- the first phase is the “acute” phase and causes symptoms of fever, muscle pain, back pain, headache, shivers, lack of appetite, and nausea or vomiting (5). The majority of people affected by the acute phase improve and recover after 3-4 days from the onset of symptoms (5).

However, 15% of infected patients do not improve from the acute phase and enter into the second and more dangerous phase of the virus -- the toxic phase (5). This phase occurs within 24 hours of the initial remission of the virus (5). Common symptoms of the toxic phase include high fever, jaundice, abdominal pain and vomiting, kidney function deterioration, and bleeding from the mouth, nose, eyes, or stomach (5). When this bleeding happens, bloody vomit and feces can also occur (5). Only 50% of patients who reach the toxic phase of the virus survive and those who do not survive, die within 10-14 days (5). Those who are lucky enough to survive can recover without severe organ damage (5).

There is no specialized treatment for Yellow Fever (5). A patient can receive supportive care that treats dehydration, respiratory failure, and fever but this is often not readily available in poorer areas (5). The most important measure to prevent the outbreak of this virus is vaccination (5). The Yellow Fever vaccine has found to be 90% effective in people within 10 days of receiving the vaccination and 99% effective in people within 30 days of receiving the vaccination (5). Mosquito control and epidemic preparedness and response are also necessary methods of control and prevention. However, lack of effective mosquito control and appropriate epidemic preparedness and response have been major contributing factors to the alarming outbreak in Angola.

 

The Vaccine Shortage

The current outbreak began in the province of Luanda, the capital of Angola and the majority of the cases are still being reported within that area (2). To control this epidemic, Angola’s Ministry of Health and the World Health Organization launched an emergency vaccination campaign in Luanda province in February with plans to vaccinate 6.5 million people (3,4). Vaccination is the best known method of prevention of Yellow Fever and is necessary to stop this continuous outbreak.

However, an extreme shortage of the vaccine has been a major concern for this epidemic. The World Health Organization exhausted its emergency stockpile of the Yellow Fever vaccine and still needed to vaccinate 1.5 million people in Luanda alone (2). Additionally, there are only four facilities globally that produce the yellow fever vaccine (4). These four facilities will be challenged to effectively meet the continuing supply and demand of the vaccines needed to address this outbreak. With the emergency stockpile completely empty, more emphasis on producing the yellow fever vaccine has been prioritized (4). Some studies have shown that using one-fifth or one-tenth of the current vaccination dose may protect people against the disease, which could provide an alternative solution to the vaccine shortage issue (4). The effectiveness of that possible solution remains to be determined, but may be a better alternative for prevention and protection.

Given the recent vaccination shortage and the continuous spread of the virus to other countries, many health experts fear this outbreak will become uncontrollable (4). The virus’ spread to Asia is the most alarming concern because there may not be enough vaccines to treat Angola’s population and other possible outbreaks in Africa and Asia. Vaccine manufacturers are attempting to increase productivity in the making of the vaccine and will continue to ship vaccines where they are needed (2). Additionally, Angola has put a ban on visitors aged 9 months and older allowed into the country without proper vaccination (3). People who wish to travel to Angola during this time must show proof of proper vaccination.

 

Replenishment of the Emergency Supply

Thankfully, at the end of March 2016, the emergency vaccine supply was replenished to include 10 million vaccines available to prevent yellow fever (6). This new supply will greatly contribute to effectively controlling the further spread of yellow fever in Angola. However, there is still a concern with regards to potential spread in other parts of Africa and Asia and whether further vaccination production, in addition to the replenished supply, should be prioritized.

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Sources

  1. Gaffey, C. (2016, April 16). Angola: Yellow Fever Death Toll Rise to 225 Amid Vaccine Shortage. Newsweek. Retrieved April 25, 2016, from http://www.newsweek.com/angola-yellow-fever-death-toll-rise-225-amid-vac...
  2. Goldschmidt, D. (2016, March 25). Yellow fever vaccine shortage as outbreak in Angola spreads. CNN. Retrieved April 25, 2016, from http://www.cnn.com/2016/03/25/health/yellow-fever-vaccine-shortage-angola/
  3. Yellow Fever in Angola. (n.d.). Retrieved April 25, 2016, from http://wwwnc.cdc.gov/travel/notices/alert/yellow-fever-angola
  4. Kupferschmidt, K. (2016). Angolan yellow fever outbreak highlights dangerous vaccine shortage. Science. doi:10.1126/science.aaf4082
  5. Yellow fever. (n.d.). Retrieved April 25, 2016, from http://www.who.int/mediacentre/factsheets/fs100/en/
  6. Angola' health officials extend vaccination campaign for yellow fever to Huambo and Benguela provinces. (2016, April 21). News Medical. Retrieved April 25, 2016, from http://www.news-medical.net/news/20160421/Angola-health-officials-extend-vaccination-campaign-for-yellow-fever-to-Huambo-and-Benguela-provinces.aspx
  7. Yellow fever outbreak in Angola: Vaccination campaigns to extend to Huambo and Benguela provinces. (2016, April 20). Outbreak News Today. Retrieved April 25, 2016, from http://outbreaknewstoday.com/yellow-fever-outbreak-in-angola-vaccination...
Months After 2014 Outbreak Ends, Ebola Flares Up in Guinea

Mar 30, 2016 | Shannon Smith Colleen Nguyen | Outbreak News

At least five people have died since 29 February 2016 due to a new flare up of Ebola virus disease (EVD) in Guinea [1]. The first two confirmed cases of the virus were detected in the village of Korokpara and involved a mother and her five-year-old son. These are the first cases of Ebola in Guinea since the World Health Organization (WHO) declared the country free of the disease in December 2015. This declaration came two years after an outbreak that began in 2013 killed approximately 2,500 people in Guinea and over 11,000 in West Africa [2]. The WHO had warned that Guinea, as well as the neighboring countries of Liberia and Sierra Leone, are at risk for ongoing smaller outbreaks due to persistence of the virus in some previously infected individuals [3]. Guinea’s 90-day heightened surveillance period was set to end in late March [4].

Ebola virus disease is an often-fatal illness caused by a virus in the Filoviridae family. The first symptoms of the disease can appear 2-21 days after exposure and typically include fatigue, fever, and muscle pain. This is followed by more severe symptoms including vomiting, diarrhea, and, in some cases, internal bleeding and multi-organ failure. The virus is transmitted to human populations through close contact with the bodily secretions of infected animal hosts, such as fruit bats, chimpanzees, gorillas, and forest antelopes [5]. This typically happens during the hunting and butchering processes involved with food preparation of “bushmeat” [6]. The virus is also capable of spreading from person-to-person through contact with infected bodily fluids. Many healthcare workers have been infected with Ebola while treating EVD patients, and transmission can occur during burial ceremonies as bodies remain highly infectious even after death [5].

The first outbreak of Ebola occurred in 1976 in Zaire--now the Democratic Republic of the Congo-- where 318 people were infected and 280 (88%) died. Several smaller outbreaks have occurred since then, mostly in Central Africa [7]. High case fatality rates are common during these outbreaks, ranging from 25% to 90% with an average of about 50% [5]. In March 2014, an outbreak of febrile illness in Guinea that had already killed 59 people was confirmed to be caused by EVD. Further investigation reveled that the first case was a two-year-old child in Guéckédou, Guinea in December 2013. The outbreak spread to Liberia and Sierra Leone and caused mass illness and death in these countries, with additional cases reported in Senegal and Nigeria as well as the United States and Europe [8]. Countries most impacted by EVD have fairly weak health infrastructure, making it difficult for governments to keep the spread of the disease under control. This also contributed to the inability to deliver proper care and isolation for infected individuals. As of 20 March 2016, an estimated 28,644 people have been infected worldwide during this outbreak and 11,320 people have died, making it significantly larger than all previous outbreaks combined [9].

Even though it was declared to be over in December 2015, it is clear that the 2014 outbreak of Ebola continues to impact the most heavily affected countries of Guinea, Sierra Leone, and Liberia. Initial tests performed on the new cases in Guinea suggest that they are part of a previously known transmission chain of the virus. This reveals that the flare up resulted from contact with survivors from the 2014 outbreak in whom the virus had persisted, and it is not believed that the current flare-up was caused by a new introduction of the virus from an animal [10]. A similar flare-up occurred in January 2016 in Sierra Leone, which had been previously declared free of Ebola in November 2015. After 42 disease-free days (two incubation periods) this outbreak was declared over by the WHO on 17 March, the same day that the first case was confirmed in Guinea [11].

Several measures have been taken so far in an attempt to contain the outbreak. The WHO deployed surveillance experts and contact tracers to Guinea on 18 March 2016 after the confirmation of two additional cases and reported that additional personnel would be sent in the coming weeks [4]. So far, the Guinean government has quarantined 816 people because of potential contact with the infected individuals. They will be kept in their homes during the 21-day incubation period of the virus and will be released if they are not exhibiting symptoms after this time [12]. Over 100 of these individuals are considered high-risk for developing the virus [10]. Additionally, Liberia has closed its border with Guinea in response to the outbreak [13]. If the reaction to this current flare-up in Guinea is as swift and effective as it was to the outbreak in Sierra Leone in January, it is likely that this outbreak will be successfully contained. This will require maintaining vigilant surveillance as well as practicing hygiene both at home and in healthcare facilities to prevent transmission of the virus [11].

 

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Sources

1. http://www.timeslive.co.za/sundaytimes/stnews/international/2016/03/22/At-least-5-dead-in-Guinea-Ebola-flare-up-health-officials

2. http://news.sky.com/story/1662070/two-cases-of-ebola-confirmed-in-guinea

3. http://www.the-scientist.com/?articles.view/articleNo/45630/title/WHO--Ebola-Confirmed-in-Guinea/

4. http://mynews4.com/news/health/who-sends-specialists-in-response-to-guinea-ebola-flare-up

5. http://www.who.int/mediacentre/factsheets/fs103/en/

6. http://www.cdc.gov/vhf/ebola/pdf/bushmeat-and-ebola.pdf

7. http://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html

8. http://www.theguardian.com/world/2014/oct/15/ebola-epidemic-2014-timeline

9. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html

10. http://www.cidrap.umn.edu/news-perspective/2016/03/guinea-ebola-cluster-likely-part-known-transmission-chain

11. http://www.who.int/mediacentre/news/statements/2016/end-flare-ebola-sierra-leone/en/

12. http://www.newsweek.com/ebola-guinea-quarantine-816-people-latest-flare-439376

13. http://www.theguardian.com/world/2016/mar/23/ebola-deaths-in-guinea-prompt-liberia-to-close-border

Food Insecurity in Eastern and Southern Africa due to El Niño

Mar 23, 2016 | Kara Sewalk | Commentary

The United Nations Children’s Fund has stated that approximately 11 million children in eastern and southern Africa face hunger, disease and water shortage due to this year’s unusually extreme El Niño season [1]. In November, the United Nations warned that the nations in the Horn of Africa, which includes Djitbouti, Eritrea, Ethiopia and Somalia, are at a heightened risk for food insecurity, due to the extreme droughts that have occurred over recent months [2].

Despite concerns from the United Nations, the Eritrean President Isaias Afwerki stated that “the country will not face any crisis in spite of reduced agricultural output” and further, “Isaias praised the government's judicious policy and approaches of bolstering its strategic food reserves” [2].

Interestingly, Eritrea has long been known to reject UN food aid and prefers a policy of self-reliance, with Isaias stating that he was not worried. Consequently, the UN has limited access to the country and many foreign aid agencies are not allowed to operate there [2]. While Eritrea may claim that it will not face food insecurity this year, the surrounding region faces crop reduction by 50-90%. In neighboring Ethiopia, there is upwards of 10 million people in need of food aid, a number that is expected to rise to 18 million by the end of 2016 [2].

In this region, food insecurity and malnutrition have become an even more heightened problem within the last year. The World Food Programme published a report in December 2015 that highlights the expected outcomes and impacts of El Niño across the globe. Most of East Africa has already seen the end of the rainy season and is now dealing with the repercussions of a stunted growing season. Ethiopia faces a major drought emergency and Sudan faces a shortage of rainfall and poor pastor production [3]. The Horn of Africa is expected to experience wetter than average conditions, with flood warnings throughout Kenya and Somalia. However, a benefit of the wet conditions is that the increase in water could help recover pastoral areas [3]. With a warming climate and fluctuations of extreme rains and droughts, El Niño also brings a greater susceptibility to infectious diseases [7]. Wet and warming temperatures are an ideal breeding ground for mosquitos that transmit vector borne diseases such as malaria, dengue, yellow fever and Zika virus as well as waterborne diseases such as cholera. In the last year, Tanzania and Somalia have both experienced major cholera outbreaks, which government officials say have been caused by the pooling of groundwater due to El Niño rains [8,9].

Leila Gharagozloo-Pakkala, UNICEF Regional Director for Eastern and Southern Africa, reports that "the El Niño weather phenomenon will wane, but the cost to children - many who were already living hand-to-mouth - will be felt for years to come. Governments are responding with available resources, but this is an unprecedented situation. Children’s survival is dependent on action taken today" [1].

Malawi is experiencing its worst food crisis in nine years, with approximately 2.8 million people facing hunger (15% of the population). UNICEF cites that from December 2015 to January 2016, cases of "severe acute malnutrition" have more than doubled in Malawi[4].

Due to extreme droughts brought on by El Niño, South Africa has also experienced its driest year in over a century, and will be importing at least half of its required maize crop. Food prices have drastically increased because of reduced production and availability [4].

In response to the emergency situation, many nations have contributed funds to implement food insecurity interventions. Italy, for example, has allocated one million euros between the World Food Programme and the United Nations Food and Agriculture Organization to aid in curbing food insecurity in Ethiopia [5].

Below is a list of the UNICEF humanitarian appeals in El Niño-affected countries [1]:

§  $US 26 million in Angola

§  $US 87 million in Ethiopia

§  $US 3 million in Lesotho

§  $US 11 million in Malawi

§  $US 15 million in Somalia

§  $US 1 million in Swaziland

§  $US 12 million in Zimbabwe

In order to prevent years of production failure, food insecurity and malnutrition, countries across the globe need to raise funds now to protect against the devastating impacts of El Niño. The European Union has allocated 12 million euros to provide food assistance to countries of southern Africa, including Angola, Zimbabwe, Malawi, Swaziland, Lesotho and Madagascar, and allocated an additional five million euros to southern Africa in 2016 to support disaster risk reduction activities and protect against the impact of natural disasters such as drought, floods and cyclones that frequently affect Mozambique, Malawi and Madagascar [6].

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Sources

[1] http://www.unicef.org/media/media_90252.html

[2] http://reliefweb.int/report/eritrea/eritrea-president-dismisses-food-cri...

[3] http://documents.wfp.org/stellent/groups/public/documents/ena/wfp280227.pdf

[4] https://www.rt.com/news/332733-children-malnourished-el-nino/

[5] http://reliefweb.int/report/ethiopia/ethiopia-italy-contribute-1-million...

[6] https://ec.europa.eu/jrc/en/news/el-nino-devastating-impact-southern-afr...

[7] http://www.who.int/globalchange/publications/climatechangechap6.pdf

[8] http://allafrica.com/stories/201512311089.html

[9] http://reliefweb.int/report/united-republic-tanzania/tanzania-cholera-em...

Elizabethkingia spreads throughout Wisconsin Healthcare Facilities

Mar 22, 2016 | Shannon Smith Colleen Nguyen | Outbreak News

A mysterious outbreak of an extremely rare bloodstream infection has been ongoing in Wisconsin for at least four months, and public health officials are unsure of the cause. The Wisconsin Department of Health has reported that 54 cases of Elizabethkingia anophelis infection have occurred since 1 November 2015. Elizabethkingia, an opportunistic pathogen that is abundant in the environment, has caused infections in at least 12 counties throughout the state and has been identified to be linked primarily to healthcare facilities. Symptoms of Elizabethkingia infection include fever, shortness of breath, and cellulitis [1]. The majority of cases during this outbreak have been in patients over the age of 65, and all cases have had previously diagnosed underlying illnesses [2]. To date, 17 deaths have been associated with the outbreak [1], and a case has also been confirmed in western Michigan [3].

The outbreak has created unique challenges for the Centers for Disease Control and Prevention (CDC) and for local health departments. In the past, infections from the bacteria had been so rare that they were not closely monitored, making it difficult to determine how many people are usually affected [2]. Wisconsin typically only sees one or two cases per year according to University of Wisconsin infection control director Dr. Nasia Safdar. The CDC laboratory in Atlanta is currently the only laboratory in the United States that can distinguish E. anophelis from a different, more common species in the same genus, E. meningoseptica. Thus, samples often need to be sent to the CDC lab before cases can be officially confirmed [4].

At this point, the source of the unprecedented spread of the bacteria is unknown, making it difficult for health departments to prevent future infections. Five CDC “disease detectives” have been sent to Wisconsin for an investigation of the outbreak, which will involve reviewing medical records and interviewing patients to determine if a connection exists between the cases [5]. Exposure from contaminated food and water had been identified as a potential risk factor, since the bacteria is so widely present in the environment. However, the water supply has been ruled out as a potential source of the infection after it tested negative for the presence of Elizabethkingia. No pattern of medical treatment or device usage has emerged among the cases, so it is not clear if a relationship exists between infection and specific type of treatment [4].

Another problem presented by Elizabethkingia anophelis is that it is difficult to treat with antibiotics [6]. However, despite its multi-drug resistance, Elizabethkingia is not considered a true “superbug” as Wisconsin health officials have identified antibiotics to which the bacteria are susceptible. Dr. Safdar has said that the general public should not be concerned about the bacteria as it causes disease only in the small proportion of the population with compromised immune systems. Elizabethkingia is not known to be spread from person to person, and infection is believed to occur as a result of contact with contaminated medical equipment, though this has not been confirmed. Control of the outbreak will rely on diligent reporting from healthcare workers as well as the investigative efforts by public health officials [4]. A rapid identification of cases occurred after the Wisconsin Department of Health Services initially provided guidance to health workers about identifying and reporting cases. This has led to an improvement in outcomes for patients as healthcare workers begin to administer proper treatment [1].

 

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Sources

1. https://www.dhs.wisconsin.gov/disease/elizabethkingia.htm

2. http://www.wpr.org/crash-course-elizabethkingia-rare-bacterial-infection-spreading-across-wisconsin

3. http://www.mlive.com/news/grand-rapids/index.ssf/2016/03/bacteria_outbreak_in_wisconsin.html

4. http://outbreaknewstoday.com/elizabethkingia-outbreak-what-we-know-so-far-86330/

5. http://outbreaknewstoday.com/elizabethkingia-outbreak-is-very-worrisome-to-cdc-besser-32199/

6. http://time.com/4257603/wisconsin-disease-elderly-elizabethkingia/

Mumps: Making a Comeback

Mar 17, 2016 | Tessa Runels, Cheryl Lang, Colleen Nguyen | Outbreak News

Mumps are making a comeback on college campuses nationwide. On Friday, February 25, there were two lab-confirmed cases and three probable cases of mumps reported in New Hampshire [1]. All cases were members of the St. Anselm College hockey team [1]. On the 29th of February, two cases of mumps were diagnosed at Harvard University in Massachusetts. The following week on March 2, Harvard administration reported four additional cases among their student body [2]. On March 14th, the University of San Diego in California reported five mumps cases among their students [9]. Most recently, three cases were confirmed among undergraduate students at Boston University in Massachusetts on March 16th [10].

 

Symptoms and Spread of Mumps

After initial exposure to the mumps virus, paramyxovirus, it takes around 16-18 days for symptoms to present [1, 3]. However, symptom onset can range from around 12 to 25 days after infection [1, 3]. Not everyone infected with the virus exhibits symptoms and, if symptoms do present, they are often nonspecific. Symptomatic cases generally report: fever, headache, muscle aches, loss of appetite and tender and/or swollen salivary glands [4]. These symptoms often resolve on their own, but in rare instances can cause complications in adults [4]. Serious complications include inflammation of the brain, the tissue covering the brain and spinal cord, ovaries and breasts (in females) and testicles (in males) [4]. Another rare adult complication is deafness [4]. The hallmark of mumps is noticeable swelling of the single or both parotid salivary glands in the cheek and jaw area [3]. This swelling can be differentiated from that of swollen lymph nodes of the neck because instead of swelling in the neck, mumps causes swelling that completely covers the jaw-line and causes the ears to protrude[4]. Mumps is spread through the saliva or mucus of an infected individual, with people often becoming infected through inhalation of the saliva droplets after sneezing or coughing [4,5].

 

I Thought There Was a Vaccine for That?

Mumps is a vaccine-preventable disease that most of us are vaccinated against. The Centers for Disease Control and Prevention (CDC) advises that all infants be vaccinated with a combination vaccine (MMR) 12 to 15 months after birth, and with a booster at 4 to 6 years of age [6]. Nevertheless, these are just guidelines, as immunizations that are required for enrollment and attendance at a child care facility or school are established and enforced at the state level. After completion of the two-dose series, the vaccine is estimated to be approximately 88 percent effective [1]. Now, some of you may be asking, “Doesn’t vaccination mean that I’m protected?” Unfortunately, vaccination doesn’t guarantee that a sufficient immune response, and therefore protection, is triggered. In other words, just because you are vaccinated doesn’t mean that you will be fully immune from infection.

In New Hampshire, there is no law requiring vaccines prior to entering college. Each college or university is permitted to establish their own rules surrounding required immunizations prior to enrollment at a given institution [7]. On the other hand, in the state of Massachusetts there are established laws regarding immunization for college and university students. In Massachusetts, all health science and full-time students are required to have two documented doses of the MMR vaccine [8]. As shown by the differences between regulations in these two states, vaccination laws for college-age students vary on a state-by-state basis.

For additional information on the MMR vaccine and what this means for mumps in the future, please read:

http://www.healthmap.org/site/diseasedaily/article/just-vax-please-mumps...

 

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 Sources

1.   Tranchemon, C. (2016, February 27). Health and human services warns of college campus mumps outbreak. WCVB NewsCenter 5. Retrieved March 14, 2016, from http://www.wcvb.com/news/health-and-human-services-warns-of-college-camp...

2.  Freyer, F. J. (2016, March 3). Four more Harvard students get mumps. Boston Globe. Retrieved March 14, 2016, from https://www.bostonglobe.com/metro/2016/03/02/four-more-harvard-students-...

3.  Center for Disease Control. Mumps: For Healthcare Providers. (2016). Retrieved March 14, 2016, from http://www.cdc.gov/mumps/hcp.html#virus

4.  Center for Disease Control. Transmission of Mumps. (2015). Retrieved March 14, 2016, from http://www.cdc.gov/mumps/about/transmission.html

5.  Mayo Clinic. Diseases and Conditions: Mumps. (2015, August 12). Retrieved March 14, 2016, from http://www.mayoclinic.org/diseases-conditions/mumps/basics/causes/con-20...

6.  Center for Disease Control. For Parents: Vaccines for Your Children. (2012). Retrieved March 14, 2016, from http://www.cdc.gov/vaccines/parents/record-reqs/immuniz-records-child.html

7.  National Vaccine Information Center. New Hampshire State Vaccine Requirements. (2016, January 22). Retrieved March 14, 2016, from http://www.nvic.org/vaccine-laws/state-vaccine-requirements/new-hampshir...

8.  Massachusetts Department of Public Health. Massachusetts School Immunization Requirements for School Year 2015-2016. (n.d.). Retrieved March 14, 2016, from http://www.mass.gov/eohhs/docs/dph/cdc/immunization/guidelines-ma-school...

9. University of San Diego reports five mumps cases. (2016, March 14). Outbreak News Today. Retrieved March 16, 2016, from http://outbreaknewstoday.com/university-of-san-diego-reports-five-mumps-...

10. Brown, J. (2016, March 16). Three Mumps Cases Found at BU. BU Today. Retrieved March 16, 2016, from http://www.bu.edu/today/2016/cases-of-mumps/

 

 

 

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