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The CDC Epidemic Intelligence Service Provides Updated Research on Emerging Infectious Diseases at Recent Conference

Yuri P. Springer, PhD, and his research team identified a novel species of Orthopoxvirus in an Alaska resident who had not recently traveled outside the state, and they advise healthcare professionals to test patients who have poxvirus-infection-like illness for Orthopoxvirus.
In September 2015, the Alaska Division of Public Health investigated a report of a patient living in the interior Alaska woods who was sick with an Orthopoxvirus-like infection. The investigators interviewed the patient and cultured swabs from a papulovesicular back lesion, sequenced DNA fragments by quantitative real-time polymerase chain reaction (qPCR) and compared them with fragments from known Orthopoxviruses. They tested sera from the patient and contacts for Orthopoxvirus antibodies; they swabbed household surfaces, clothing and personal effects; and they tested small mammal feces by qPCR.
The patient had not recently traveled outside Alaska, and the qPCR confirmed a novel Orthopoxvirus species. Consistent with recent Orthopoxvirus infection, the patient’s serum was positive for IgM and IgG. Sera from all 4 contacts were IgM-negative, and sera from 2 contacts who had been vaccinated for smallpox were IgG-positive. Wild rodents lived outside the home and occasionally entered it, but none of the 23 environmental samples tested positive and no additional human cases were identified.
In Guinea, where community members and health facilities report all deaths and affected Ebola cases to either a local telephone alerts system at prefecture health offices or to a national toll-free call center established in November 2014, Christopher T. Lee, MD, and his group found that the local system worked better than the national call center to detect new Ebola cases.
The authors linked the 8,667 alerts from the passive surveillance databases of the four prefectures that had Ebola cases from April 2015 through August 2015 with the 9,454 records from the viral hemorrhagic fever (VHF) database. To determine sensitivity, they calculated the proportion of confirmed cases in the VHF database with a match found in each passive surveillance database.
Overall, 221 confirmed cases of Ebola were reported in the VHF database. Linking the two surveillance databases with the VHF database identified 5,006 matches, of which 120 were confirmed cases. Of these, 113 cases originated locally (sensitivity 51.1%; positive predictive value [PPV] 1.6%); 7 originated from the national call center (sensitivity 3.2%; PPV 0.4%); and the rest were detected through contact tracing or Ebola treatment units. In all four prefectures, the local alerts had higher sensitivity than the national call center.

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