Acute Flaccid #Myelitis #Cluster (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

News From the Centers for Disease Control and Prevention / June 11, 2019

Acute Flaccid Myelitis Cluster

Bridget Kuehn, MSJ

JAMA. 2019;321(22):2156. doi:10.1001/jama.2019.7349



A cluster of 6 cases of acute flaccid myelitis paralysis (AFM) in children was reported in Minnesota in the fall of 2018, according to a CDC report. It was the largest cluster reported in the state to date and part of an uptick in cases across the country.


Keywords: AFM; AFP; USA; Minnesota.


#Environmental #Sampling #Survey of #H5N2 Highly Pathogenic #Avian #Influenza-Infected Layer Chicken #Farms in #Minnesota and #Iowa (Avian Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Avian Dis. 2018 Dec;62(4):373-380. doi: 10.1637/11891-050418-Reg.1.

Environmental Sampling Survey of H5N2 Highly Pathogenic Avian Influenza-Infected Layer Chicken Farms in Minnesota and Iowa.

Lopez KM1, Nezworski J2, Rendahl A1, Culhane M1, Flores-Figueroa C3, Muñoz-Aguayo J3, Halvorson DA1, Johnson R1, Goldsmith T1, Cardona CJ4.

Author information: 1 College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. 2 Blue House Veterinary, 145 West Yellowstone Trail, Buffalo, MN 55314. 3 Mid-Central Research and Outreach Center, University of Minnesota, 1802 18th St. Northeast, Willmar, MN 56201. 4 College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108,


Abstract in English, Spanish

Respiratory secretions, feces, feathers, and eggs of avian influenza-infected hens provide ample sources of virus which heavily contaminate barn and farm environments during a disease outbreak. Environmental sampling surveys were conducted in the Midwestern United States on affected farms during the 2015 H5N2 highly pathogenic avian influenza (HPAI) outbreak to assess the degree of viral contamination. A total of 930 samples were obtained from various sites inside and outside layer barns housing infected birds and tested with real-time reverse transcriptase PCR. The distribution and load of viral RNA in barns in which most birds were dead at the onset of depopulation efforts (high-mortality barns) were compared with those of barns in which birds were euthanatized before excess mortality occurred (normal-mortality barns). A statistically significant difference was seen between cycle threshold (Ct) values for samples taken of fans, feed troughs, barn floors, barn walls, cages, manure-associated locations, barn doors, egg belts, and the exterior of high-mortality vs. normal-mortality barns. In high-mortality barns, sample sites were found to be the most to least contaminated in the following order: cages, manure-associated locations, barn floors, egg belts, feed troughs, barn doors, barn walls, fans, exterior, and egg processing. Significant changes in Ct values over time following HPAI detection in a barn and depopulation of birds on an infected farm were observed for the manure-associated, barn floor, barn wall, and fan sampling sites. These results show that high mortality in a flock as a result of HPAI will increase contamination of the farm environment. The results also suggest optimal sampling locations for detection of virus; however, the persistence of RNA on highmortality farms may delay the determination that adequate sanitization has been performed for restocking to take place.

KEYWORDS: barn; contamination; disinfection; egg layers; environmental sampling; highly pathogenic avian influenza; virus

PMID: 31119921 DOI: 10.1637/11891-050418-Reg.1

Keywords: Avian Influenza; H5N2; Poultry; USA; Minnesota; Iowa.


Estimating within-flock #transmission #rate parameter for #H5N2 highly pathogenic #avian #influenza virus in #Minnesota #turkey flocks during the 2015 #epizootic (Epidemiol Infect., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Epidemiol Infect. 2019 Jan;147:e179. doi: 10.1017/S0950268819000633.

Estimating within-flock transmission rate parameter for H5N2 highly pathogenic avian influenza virus in Minnesota turkey flocks during the 2015 epizootic.

Ssematimba A1, Malladi S1, Hagenaars TJ2, Bonney PJ1, Weaver JT3, Patyk KA3, Spackman E4, Halvorson DA1, Cardona CJ1.

Author information: 1 Secure Food Systems Team,College of Veterinary Medicine,University of Minnesota,1971 Commonwealth Avenue,Saint Paul,MN 55108,USA. 2 Department of Bacteriology and Epidemiology,Wageningen Bioveterinary Research,P.O. Box 65,8200AB Lelystad,The Netherlands. 3 United States Department of Agriculture,Animal and Plant Health Inspection Service, Veterinary Services, Science, Technology, and Analysis Services, Center for Epidemiology and Animal Health, Natural Resources Research Center,Bldg. B MS-2W4, 2150 Centre Avenue, Fort Collins, CO 80526,USA. 4 Exotic and Emerging Avian Viral Diseases Unit,US National Poultry Research Center,USDA-ARS,934 College Station Rd. Athens,GA 30605,USA.



Better control of highly pathogenic avian influenza (HPAI) outbreaks requires deeper understanding of within-flock virus transmission dynamics. For such fatal diseases, daily mortality provides a proxy for disease incidence. We used the daily mortality data collected during the 2015 H5N2 HPAI outbreak in Minnesota turkey flocks to estimate the within-flock transmission rate parameter (β). The number of birds in Susceptible, Exposed, Infectious and Recovered compartments was inferred from the data and used in a generalised linear mixed model (GLMM) to estimate the parameters. Novel here was the correction of these data for normal mortality before use in the fitting process. We also used mortality threshold to determine HPAI-like mortality to improve the accuracy of estimates from the back-calculation approach. The estimated β was 3.2 (95% confidence interval (CI) 2.3-4.3) per day with a basic reproduction number of 12.8 (95% CI 9.2-17.2). Although flock-level estimates varied, the overall estimate was comparable to those from other studies. Sensitivity analyses demonstrated that the estimated β was highly sensitive to the bird-level latent period, emphasizing the need for its precise estimation. In all, for fatal poultry diseases, the back-calculation approach provides a computationally efficient means to obtain reasonable transmission parameter estimates from mortality data.

KEYWORDS: Analysis of data; avian flu; mathematical modelling; veterinary epidemiology

PMID: 31063119 DOI: 10.1017/S0950268819000633

Keywords: Avian Influenza; H5N2; Poultry; USA; Minnesota.


Notes from the Field: Six Cases of #AFM in #Children — #Minnesota, 2018 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Notes from the Field: Six Cases of Acute Flaccid Myelitis in Children — Minnesota, 2018

Weekly / April 19, 2019 / 68(15);356–358

Heidi Moline, MD1; Anupama Kalaskar, MD2; William F. Pomputius III, MD2; Adriana Lopez, MHS3; Janell Routh, MD3; Cynthia Kenyon, MPH4; Jayne Griffith, MA, MPH4

Corresponding author: Heidi Moline,

Affiliations: 1 Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, University of Minnesota Medical School, Minneapolis, Minnesota; 2 Division of Infectious Disease, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; 3 National Center for Immunization and Respiratory Diseases, CDC; 4 Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health.

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Moline H, Kalaskar A, Pomputius WF III, et al. Notes from the Field: Six Cases of Acute Flaccid Myelitis in Children — Minnesota, 2018. MMWR Morb Mortal Wkly Rep 2019;68:356–358. DOI:



During September 14–October 1, 2018, the Minnesota Department of Health (MDH) was notified of six children hospitalized in the Minneapolis-St. Paul region with symptoms consistent with acute flaccid myelitis (AFM). A confirmed case of AFM is defined as acute onset of flaccid limb weakness with magnetic resonance image indicating spinal cord lesions largely restricted to gray matter and spanning one or more vertebral segments (1). All six cases were confirmed by CDC. After a cluster of three cases occurred in 2014, an average of fewer than one AFM case per year had been reported to MDH.

Keywords: AFM; EV-D68; Minnesota; USA.


Spatial #transmission of #H5N2 highly pathogenic #avian #influenza between #Minnesota #poultry premises during the 2015 #outbreak (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Spatial transmission of H5N2 highly pathogenic avian influenza between Minnesota poultry premises during the 2015 outbreak

Peter J. Bonney , Sasidhar Malladi, Gert Jan Boender, J. Todd Weaver, Amos Ssematimba, David A. Halvorson, Carol J. Cardona

Published: September 21, 2018 / DOI:



The spatial spread of highly pathogenic avian influenza (HPAI) H5N2 during the 2015 outbreak in the U.S. state of Minnesota was analyzed through the estimation of a spatial transmission kernel, which quantifies the infection hazard an infectious premises poses to an uninfected premises some given distance away. Parameters were estimated using a maximum likelihood method for the entire outbreak as well as for two phases defined by the daily number of newly detected HPAI-positive premises. The results indicate both a strong dependence of the likelihood of transmission on distance and a significant distance-independent component of outbreak spread for the overall outbreak. The results further suggest that HPAI spread differed during the later phase of the outbreak. The estimated spatial transmission kernel was used to compare the Minnesota outbreak with previous HPAI outbreaks in the Netherlands and Italy to contextualize the Minnesota transmission kernel results and make additional inferences about HPAI transmission during the Minnesota outbreak. Lastly, the spatial transmission kernel was used to identify high risk areas for HPAI spread in Minnesota. Risk maps were also used to evaluate the potential impact of an early marketing strategy implemented by poultry producers in a county in Minnesota during the outbreak, with results providing evidence that the strategy was successful in reducing the potential for HPAI spread.


Citation: Bonney PJ, Malladi S, Boender GJ, Weaver JT, Ssematimba A, Halvorson DA, et al. (2018) Spatial transmission of H5N2 highly pathogenic avian influenza between Minnesota poultry premises during the 2015 outbreak. PLoS ONE 13(9): e0204262.

Editor: Huaijun Zhou, University of California Davis, UNITED STATES

Received: May 7, 2018; Accepted: September 4, 2018; Published: September 21, 2018

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: The data underlying the findings of this study are not publicly available due to legal and security concerns. Requests for access may be made by email to Dr. Jonathan Zack of the United States Department of Agriculture; Animal and Plant Health Inspection Service; Veterinary Services; Surveillance, Preparedness, and Response Services at

Funding: This work was completed under the cooperative agreement between the United States Department of Agriculture, Animal Plant Health Inspection Service, Veterinary Services and the University of Minnesota for risk assessments to support national preparedness planning for animal health emergencies (14-9208-0365CA). Authors who received this funding include PB, SM, AS, DH, and CC. The funders reviewed the manuscript prior to publication.

Competing interests: The authors have declared that no competing interests exist.

Keywords: H5N2; Avian Influenza; Poultry; USA; Minnesota.


A Case of #Lassa Fever Diagnosed at a Community #Hospital – #Minnesota 2014 (Open Forum Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Open Forum Infect Dis. 2018 Jul 16;5(7):ofy131. doi: 10.1093/ofid/ofy131. eCollection 2018 Jul.

A Case of Lassa Fever Diagnosed at a Community Hospital-Minnesota 2014.

Choi MJ1, Worku S2, Knust B3, Vang A4, Lynfield R1, Mount MR2, Objio T4, Brown S3, Griffith J1, Hulbert D2, Lippold S4, Ervin E3, Ströher U3, Holzbauer S1, Slattery W2, Washburn F4, Harper J1, Koeck M1, Uher C2, Rollin P3, Nichol S3, Else R2, DeVries A1.

Author information: 1 Minnesota Department of Health, St. Paul, Minnesota. 2 Mercy Hospital, Allina Health, Coon Rapids, Minnesota. 3 Viral Special Pathogens Branch, Atlanta, Georgia. 4 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.




In April 2014, a 46-year-old returning traveler from Liberia was transported by emergency medical services to a community hospital in Minnesota with fever and altered mental status. Twenty-four hours later, he developed gingival bleeding. Blood samples tested positive for Lassa fever RNA by reverse transcriptase polymerase chain reaction.


Blood and urine samples were obtained from the patient and tested for evidence of Lassa fever virus infection. Hospital infection control personnel and health department personnel reviewed infection control practices with health care personnel. In addition to standard precautions, infection control measures were upgraded to include contact, droplet, and airborne precautions. State and federal public health officials conducted contract tracing activities among family contacts, health care personnel, and fellow airline travelers.


The patient was discharged from the hospital after 14 days. However, his recovery was complicated by the development of near complete bilateral sensorineural hearing loss. Lassa virus RNA continued to be detected in his urine for several weeks after hospital discharge. State and federal public health authorities identified and monitored individuals who had contact with the patient while he was ill. No secondary cases of Lassa fever were identified among 75 contacts.


Given the nonspecific presentation of viral hemorrhagic fevers, isolation of ill travelers and consistent implementation of basic infection control measures are key to preventing secondary transmission. When consistently applied, these measures can prevent secondary transmission even if travel history information is not obtained, not immediately available, or the diagnosis of a viral hemorrhagic fever is delayed.

KEYWORDS: Lassa fever; contact tracing; infection control; sensorineural hearing loss

PMID: 30035149 PMCID: PMC6049013 DOI: 10.1093/ofid/ofy131

Keywords: Lassa fever; USA; Minnesota.


#Historical and Recent Cases of #H3 #Influenza A Virus in #Turkeys in #Minnesota (Avian Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Avian Dis. 2016 May;60(1 Suppl):408. doi: 10.1637/0005-2086-60.01s1.408.

Historical and Recent Cases of H3 Influenza A Virus in Turkeys in Minnesota.

Guo X1, Flores C2, Munoz-Aguayo J2, Halvorson DA1, Lauer D3, Cardona CJ1.

Author information: 1 A College of Veterinary Medicine, University of Minnesota, St Paul, MN 55108. 2 B Mid-Central Research and Outreach Center, Willmar, MN 56201. 3 C Minnesota Poultry Testing Laboratory, Minnesota Board of Animal Health, Willmar, MN 56201.



Subtype H3 influenza A viruses (IAVs) are abundant in wild waterfowl and also infect humans, pigs, horses, dogs, and seals. In Minnesota, turkeys are important and frequent hosts of IAV from wild waterfowl and from pigs. Over 48 yr of surveillance history, 11 hemagglutinin (HA) subtypes of IAV from waterfowl, as well as two HA subtypes from swine, H1 and H3, have infected turkeys in Minnesota. However, there have only been two cases of avian-origin H3 IAV infections in turkeys during this 48-yr period. The first avian-origin IAV infection was detected in seven breeder and commercial flocks in 1982 and was caused by a mixed H3H4/N2 infection. In 2013, an avian-origin H3H9/N2 outbreak occurred in five flocks of turkeys between 15 and 56 wk of age. Phylogenetic analysis of the HA gene segment from the 2013 isolate indicated that the virus was related to a wild bird lineage H3 IAV. A meta-analysis of historical H3 infections in domesticated poultry demonstrated that avian-origin H3 infections have occurred in chickens and ducks but were rare in turkeys. H9N2 virus was subsequently selected during the egg cultivation of the 2013 H3H9/N2 mixed virus. A growth curve analysis suggested that passage 3 of A/Turkey/Minnesota/13-20710-2/2013(mixed) had a slightly lower replication rate than a similar avian-origin H3N2. The challenge studies indicated that the infectious dose of avian-origin H3N2 for turkey poults was greater than 10(6) 50% egg infective dose. Considered together, these data suggest that avian-origin H3 introductions to turkeys are rare events.

KEYWORDS: Avian influenza; H3; Minnesota; Turkey; domesticated avian species; pathogenesis

PMID: 27309087 DOI: 10.1637/0005-2086-60.01s1.408

[Indexed for MEDLINE]

Keywords: Avian Influenza; USA; Minnesota; Poultry; H3N2; H9N2.


#Outbreak of highly pathogenic #avian #influenza in #Minnesota in 2015 (J Vet Diagn Invest., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Vet Diagn Invest. 2017 Jan 1:1040638716682058. doi: 10.1177/1040638716682058. [Epub ahead of print]

Outbreak of highly pathogenic avian influenza in Minnesota in 2015.

Fitzpatrick A1,2, Mor SK1,2, Thurn M1,2, Wiedenman E1,2, Otterson T1,2, Porter RE1,2, Patnayak DP1,2, Lauer DC1,2, Voss S1,2, Rossow S1,2, Collins JE1,2, Goyal SM1,2.

Author information: 1Veterinary Diagnostic Laboratory (Fitzpatrick, Mor, Thurn, Wiedenman, Otterson, Porter, Patnayak, Rossow, Collins, Goyal). 2University of Minnesota, St. Paul, MN; and Minnesota Poultry Testing Laboratory, Willmar, MN (Lauer, Voss).



The incursion of highly pathogenic avian influenza (HPAI) into the United States during 2014 resulted in an unprecedented foreign animal disease (FAD) event; 232 outbreaks were reported from 21 states. The disease affected 49.6 million birds and resulted in economic losses of $950 million. Minnesota is the largest turkey-producing state, accounting for 18% of U.S. turkey production. Areas with concentrated numbers of turkeys in Minnesota were the epicenter of the outbreak. The first case was presumptively diagnosed in the last week of February 2015 at the Minnesota Veterinary Diagnostic Laboratory (MVDL) and confirmed as HPAI H5N2 at the National Veterinary Services Laboratories on March 4, 2015. A total of 110 farms were affected in Minnesota, and the MVDL tested >17,000 samples from March to July 2015. Normal service was maintained to other clients of the laboratory during this major FAD event, but challenges were encountered with communications, staff burnout and fatigue, training requirements of volunteer technical staff, test kit validation, and management of specific pathogen-free egg requirements.

KEYWORDS: Chickens; diagnostic challenges; diagnostic laboratory; highly pathogenic avian influenza; turkeys

PMID: 28176609 DOI: 10.1177/1040638716682058

[PubMed – as supplied by publisher]

Keywords: Avian Influenza; USA; Poultry; H5N2.