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New Zealand Public Health Surveillance Report March 2015: Covering October to December 2014

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New Zealand Public Health Surveillance Report March 2015: Covering October to December 2014 Volume 13 Issue 1 ISSN 1176-2888 (Print) ISSN 1178-8313 (Online) New Zealand Public Health Surveillance Report March 2015: Covering October to December 2014 Contents & Highlights 1. Editorial This Quarter’s Outbreaks • 2014 outbreaks of enterovirus D68 in United States and Canada: Notification and outbreak data in this issue are drawn from the October an alert for New Zealand to December quarter of 2014. The outbreak map on this page consists of all outbreak information, final and interim. The total number of 2. Notifiable Disease Surveillance outbreaks and cases by region and outbreaks by pathogen are reported, Significant Increases in 12-Monthly Notification Rate as notified up to 20 January 2015. Outbreaks reporting exposures in • Chikungunya Fever more than one geographic location are assigned to the district health • Dengue Fever board with the most cases. One outbreak involved more than one • Gastroenteritis (acute) pathogen therefore individual pathogen outbreak numbers may not sum • Hepatitis (not otherwise specified) to group totals. • Measles • Toxic Shellfish Poisoning 60 outbreaks; 759 cases (pathogens: 25 ‘gastroenteritis’; • Yersiniosis 21 norovirus; 7 Giardia; • Zika Fever 1 outbreak; 22 cases 2 Campylobacter; (pathogen: norovirus) 2 Cryptosporidium; Northland 1 Mycobacterium tuberculosis; Significant Decreases in 12-Monthly Notification Rate 1 Salmonella; 1 Yersinia) 21 outbreaks; 77 cases • Cryptosporidiosis (pathogens: 8 Campylobacter; 5 ‘gastroenteritis’; • Meningococcal Disease 4 Giardia; 2 Cryptosporidium; 2 Yersinia) Waitemata 6 outbreaks; 154 cases • Pertussis Auckland (pathogens: 4 norovirus; 3 outbreaks; 29 cases Counties • Salmonellosis (pathogens: 2 ‘gastroenteritis’; 1 norovirus) 1 ‘gastroenteritis’; Manukau 1 toxic shellfish poisoning) 4 outbreaks; 50 cases 3. Other Surveillance Reports (pathogens: 2 norovirus; 1 sapovirus; Waikato • Hospital-based rotavirus surveillance begins in 2015 1 rotavirus; 1 Salmonella) Bay of Plenty • Tuberculosis epidemiology, 2013 Tairawhiti 9 outbreaks; 124 cases Lakes (pathogens: 3 ‘gastroenteritis’; 3 rotavirus; 1 measles virus; 1 norovirus; 1 Shigella) 4. Outbreak Surveillance Hawke’s 3 outbreaks; 20 cases Taranaki Whanganui Bay • 184 outbreaks (2456 cases) notified in this quarter (pathogens: 2 ‘gastroenteritis’; 1 Giardia) • 146 final reports (2169 cases); 38 interim reports (287 cases) • 14.9 cases per outbreak on average 19 outbreaks; 320 cases (pathogens: 12 norovirus; 4 ‘gastroenteritis’; MidCentral • 17 hospitalisations, 3 deaths 1 Escherichia coli O157:H7; 1 Giardia; 1 Salmonella) Capital and Coast Wairarapa 5. Outbreak Case Reports 6 outbreaks; 88 cases Hutt 2 outbreaks; case details (pathogens: 5 norovirus; not available • No reports this quarter 1 ‘gastroenteritis’) Nelson Marlborough (pathogens: 2 ‘gastroenteritis’) West Coast 6. Laboratory Surveillance 6 outbreaks; 126 cases (pathogens: 4 norovirus; 1 Campylobacter; • Antimicrobial susceptibility and molecular epidemiology of 1 rotavirus) extended-spectrum β-lactamase producing Enterobacteriaceae 12 outbreaks; 329 cases Canterbury (pathogens: 5 norovirus; 4 ‘gastroenteritis’; 1 Campylobacter; 1 rotavirus; 1 Varicella zoster virus) South Canterbury 1 outbreak; 4 cases (pathogen: Cryptosporidium) The latest reports from 14 outbreaks; 213 cases Sexually Transmitted Infections (pathogens: 9 ‘gastroenteritis’; 3 norovirus; Surveillance, Antimicrobial Southern 1 Clostridium perfringens; 1 rotavirus) Resistance, Virology and Enteric 17 outbreaks; 141 cases (pathogens: 5 ‘gastroenteritis’; 5 rotavirus; 3 norovirus; Reference Laboratories are 2 Salmonella; 1 Campylobacter; 1 sapovirus) available at www.surv.esr.cri.nz www.surv.esr.cri.nz 1. Editorial 2014 outbreaks of enterovirus D68 in United States and Canada: an alert for New Zealand During 2014 the United States (US) and Canada reported CDC have also reported a number of cases of unexplained nationwide outbreaks of enterovirus D68 (EV-D68). The neurologic illness in children, some of whom have tested outbreaks followed earlier reports of spikes in severe respiratory positive for EV-D68. By late October 2014, 64 cases of acute illness due to EV-D68 in several children’s hospitals in the US neurologic illness with focal limb weakness in children beginning in August 2014.1 and unknown aetiology had been reported to CDC from 28 5 EV-D68 is one of the less commonly identified and reported different states. A case definition for acute flaccid myelitis non-polio enteroviruses. EV-D68 was isolated and identified was developed and from 2 August 2014 to 14 January 2015, from four children in California in 1962. It is reported to cause CDC have verified reports of 107 cases in 34 states that have mild to severe respiratory illness and reported deaths have met this case definition. CDC is looking into possible linkages 1 been rare. Outbreaks of EV-D68 in Asia, Europe and the US between these cases and the recent EV-D68 outbreak. reported during 2008–2010 had similar clinical characteristics Neurologic illness with paralytic manifestations in cases but were not as large or widespread as this current outbreak. with confirmed EV-D68 has also been reported in Canada (3 It is likely that the full spectrum of EV-D68 illness has not children and 2 adults in British Columbia), however it remains been well-defined because testing for EV-D68 is targeted to unclear whether there is a causal link. Paralytic cases in several the most severe cases, thus resulting in a detection bias of the other provinces are also being investigated for association observed severity of disease. Typically enteroviruses circulate with EV-D68.1 A case with acute flaccid paralysis following in temperate climates with a summer-fall seasonal pattern, EV-D68 infection was reported in France in September 2014. with outbreaks usually occurring in several year cycles. EV-D68 This case had features in common with cases reported in the clusters have generally been detected within or later than the US including: (i) respiratory illness preceding the neurological typical enterovirus season in the areas from which the cases symptoms, (ii) a local cluster of EV-D68 detection in children are reported.2 admitted to hospital for respiratory infections, and (iii) 6 Between mid-August 2014 and 15 January 2015, 1153 cases of detection of EV-D68 in respiratory samples from the case. EV-D68 were confirmed in the US in the District of Columbia A cluster of cases was reported in New Zealand in 2010. and 49 states. The majority of cases reported were in children, EV-D68 was detected in 15 samples submitted to the National many of whom had asthma or a history of wheezing. Some Poliovirus and Enterovirus Identification Reference Laboratory children required admission to intensive care and mechanical as part of the New Zealand enterovirus surveillance network. ventilation. The virus was also detected in 14 patients who The majority of cases were aged less than 2 years, were of died but a causal relationship has not been established. The Maori or Pacific ethnicity and presented with a range of Centers for Disease Control and Prevention (CDC) received more respiratory symptoms (cough, coryza, stridor, bronchiolitis or specimens than usual for enterovirus testing during 2014, of asthma).7 Although further cases have not been identified in which 33% tested positive for EV-D68.3 Only 79 confirmed New Zealand since 2010, the recent outbreaks overseas are EV-D68 cases were reported to the National Enterovirus a reminder there is potential for a similar outbreak in this Surveillance System during 2009–2013.4 country. The association of EV-D68 with severe respiratory The current outbreak in Canada was first reported on illness and possible link to neurologic illness with paralytic 15 September 2014, when Alberta Health Services reported manifestations, means that further clusters of disease in this 18 cases among hospitalised patients, all aged <18 years. By country would be of concern to New Zealand. December, more cases had been reported from most regions References 1. National Collaborating Centre for Infectious Diseases 2015. Disease debrief: EV-D68. of the country, with 214 specimens confirmed in the National NCCID, Winnipeg, Manitoba. Available at: http://www.nccid.ca/disease-debrief-ev-d68 Microbiology Laboratory, and further cases reported from [accessed 3 February 2015]. provinces that perform their own testing. These include 221 2. Centers for Disease Control and Prevention 2011. Clusters of acute respiratory illness associated with human enterovirus 68 – Asia, Europe and United States, 2008–2010. cases confirmed by the British Columbia Centre for Disease MMWR 60(38):1301–04. Control (BCCDC) and 111 cases confirmed by Alberta Health 3. Centers for Disease Control and Prevention 2014. Enterovirus D68 in the United States, Services. BCCDC undertook enhanced surveillance between 2014. CDC, Atlanta. Available at: http://www.cdc.gov/non-polio-enterovirus/outbreaks/ 1 September and 31 December, 2014. Of the 221 cases reported ev-d68-outbreaks.html [accessed 3 February 2015]. 4. Centers for Disease Control and Prevention 2014. Severe respiratory illness associated by BCCDC, at least 140 required hospitalisation and two-thirds with enterovirus D68 – Missouri and Illinois, 2014. MMWR 63(36):798–99. were in children aged ≤10 years. Cases occurred in all regions 5. British Columbia Centre for Disease Control 2014. Enterovirus D68 (EV-D68), United of the province, with the majority reported after 1 October States and Canada. Emerging
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