NEWS SCAN: H5N1 in Cambodia, designer flu proteins as antivirals, US West Nile cases, HFMD in Vietnam

first_img Cambodia reports H5N1 deathCambodia’s health ministry has announced that a 10-year-old girl died from H5N1 avian influenza, the World Health Organization (WHO) said today in a statement. The girl, from Kampong Speu province in central Cambodia, got sick May 20 and was treated in her village before admission to a hospital on May 25. The Pasteur Institute in Cambodia confirmed the presence of H5N1 on May 26, and the girl died on May 27, despite intensive treatment, according to the WHO. An investigation into the source of her infection found that recent poultry deaths were reported in her village and that the girl had prepared sick chicken for food before she became ill. The girl is Cambodia’s 21st H5N1 case since 2005 and its 19th death from the disease. So far this year Cambodia has reported three H5N1 infections, all involving children and all fatal. The new case pushes the WHO’s global H5N1 count to 604 infections and 357 deaths.May 29 WHO statementMay 29 WHO global H5N1 case count Researchers estimate 3 million US West Nile infections, 780,000 casesExtrapolating from surveillance data, US researchers estimate that, from 1999 through 2010, more than 3 million Americans were infected by West Nile virus (WNV), which resulted in 780,000 illnesses and more than $800 million in medical costs. Writing in Epidemiology and Infection yesterday, researchers from the Centers for Disease Control and Prevention (CDC), Fargo, N.D., San Francisco, and Madison, Wis., noted that the nationwide ArboNET surveillance system has detected 12,823 cases of West Nile neuroinvasive disease (WNND) since 1999. They point out that a 2012 study in Emerging Infectious Diseases on blood donors in North Dakota suggested that, for every WNND case detected, 213 to 286 infections likely occurred. From these statistics, the investigators estimated that almost 2.8 million WNV infections occurred in the study period in adults. They note that estimates of infection rate vary for children, but, if they assume the rate to be similar to the adult rate, the number of US WNV infections grows to about 3.2 million. Assuming that 26% of infections lead to clinical disease, they estimated about 780,000 cases of WNF, for a total acute-care medical cost of about $832 million.May 28 Epidemiol Infect abstractApril Emerg Infect Dis report on WNND cases Scientists develop flu proteins that may disable multiple flu strainsUS researchers have developed a method for designing influenza proteins as antivirals that have proved potent against an array of flu strains, according to a preliminary study in Nature Biotechnology. The team used computer-aided design to engineer proteins that targeted vulnerable hemagglutinin sites on the flu virus, according to a news release from Michigan State University (MSU). The scientists then optimized those proteins by comprehensively mapping the mutations that gave the proteins a strong advantage when attacking the viruses’ targeted areas. The team improved their proteins through a process called “DNA deep sequencing” to simultaneously sequence millions of variants of the manufactured proteins and identify and keep the beneficial mutations. “By taking only the best mutations, we can reprogram our proteins to burrow into viruses at key locations and render them harmless,” said lead author Tim Whitehead, PhD, of MSU, in the release. “The most potent of these,” the authors write, “a 51-residue protein, is broadly cross-reactive against all influenza group 1 hemagglutinins, including human H2, and neutralizes H1N1 viruses with a potency that rivals that of several human monoclonal antibodies.” Whitehead added in the news release, “Our work demonstrates a new approach to construct therapeutic proteins, which we hope will spur development of new protein drugs by the biopharmaceutical industry.”May 27 Nature Biotech abstractMay 27 MSU news release CDC alerts travelers to Vietnam of HFMD outbreakIn a May 25 update for travelers, the CDC warned of a widespread outbreak of hand, foot, and mouth disease (HFMD) in Vietnam that began in January. The agency said that, as of Apr 29, nearly 40,000 people had become ill from the HFMD virus and that 20 have died, all children younger than 5 years old. Hai Phong province in the north has reported the most cases, followed by Bac Can, Yen Bai, and Lao Cai provinces. “The Vietnam Ministry of Health is taking steps to control the outbreak,” the CDC said. The agency encouraged travelers to practice healthy personal hygiene such as washing hands and to avoid contact with HFMD patients, adding that packing alcohol-based hand sanitizer might be a good idea. In a May 15 update, the WHO, using data through May 6, said that Vietnam had 43,196 cases in 2012, including 22 deaths. China has had more than 99,000 cases this year, compared with 34,709 at this time last year, the WHO reported.May 25 CDC updateMay 15 WHO update May 29, 2012last_img read more

FAO, OIE declare war on foot-and-mouth disease

first_img “Recent FMD outbreaks around the globe demonstrate that animal diseases have no boundaries, can have a devastating impact, and require a global response,” Hiroyuki Konuma, FAO regional representative for Asia and the Pacific, said in an FAO release. The strategy will rely on the strengthening of veterinary services and collaboration and support from many groups, the two agencies said in press releases. The plan was endorsed today by officials from more than 100 countries at the second FAO/OIE Global Conference on Foot-and-Mouth Disease Control in Bangkok, according to an OIE statement. FMD is endemic in most of sub-Saharan Africa, the Middle East, and Asia, the FAO statement said. Its annual global cost, including production losses and vaccination expense, has been estimated at $5 billion. For poor farmers who depend on just a few animals, FMD can bring hunger and economic ruin, the agencies said. However, the FAO-OIE statement does not cite an explicit goal of eradicating FMD, only bringing it under control. Besides rinderpest, only one other disease—smallpox—has been eradicated through human efforts. Officials said the FMD strategy combines two tools developed by the OIE and FAO. The OIE tool, called the Performance of Veterinary Services Pathway (PVS), involves evaluating national veterinary services with the aim of bringing them into compliance with OIE quality standards. Reliable veterinary services ensure the quality and safety of livestock production, thereby protecting food sources, trade, and animal health, the agencies said. FAO developed the Progressive Control Pathway for Foot-and-Mouth Disease, the PCP-FMD, which guides countries through a series of steps to better manage FMD risks, beginning with active surveillance to determine what types of FMD virus strains are circulating in the country and neighboring areas, officials said. A crucial part of the process is coordination of control efforts with neighboring countries. Many countries are in the earliest stages of FMD control, the FAO said. The PCP-FMD is designed to bring countries to the point where they apply to the OIE for recognition of their control program and FMD-free status. Jun 29 OIE press release “The successful eradication of rinderpest, a joint effort by scientists, governments, donors, veterinarians and farmers, clearly shows that we can reduce and even eliminate the threat of major diseases,” said Juan Lubroth, DVM, PhD, FAO’s chief veterinary officer, in the FAO release. Rinderpest, another highly contagious cattle disease, was declared eradicated in May 2011. FMD can cause high mortality in newborn and young animals, weight loss, reduced milk yields, and lower fertility, the agencies noted. The United Kingdom had a severe FMD outbreak in 2001, with direct and indirect costs estimated at up to $30 billion, and Taiwan lost about $15 billion in a 1997 outbreak. See also: The campaign will include developing regional vaccine banks and centers for quality control and improving surveillance systems, laboratory capacity, vaccine quality control, and movement control of animals, the OIE said. The OIE said 66 of its 178 member countries are free of FMD. The goals of the new campaign are to control FMD in most countries and eliminate it in some, improve veterinary services and infrastructure, and enhance prevention and control of other major livestock diseases, the agency said. Jun 29, 2012 (CIDRAP News) – The United Nations Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) have announced a global campaign to control foot-and-mouth disease (FMD), a highly contagious livestock disease that does not threaten humans but can be economically devastating. Jun 27 FAO press release May 25, 2011, CIDRAP News story “OIE declares rinderpest eradicated” CIDRAP FMD overviewlast_img read more

Study: Flu likes weather cold and dry or humid and rainy

first_img Flu epidemics strike during the winter in temperate regions, but the seasonality of flu is less clear in the tropics, where outbreaks tend to occur during rainy seasons or year-round. The findings suggest that rain and humidity are key factors in tropical regions, while adding further evidence that cold and dryness are important in temperate areas. They fit with previous research showing that flu viruses survive longer in dry air. But the statement cautioned that climate is just one of several factors that influence flu seasonality. “Further work should focus on examining the role of population travel and other factors in influenza transmission,” said Mark Miller, MD, director of the Fogarty Center’s Division of International Epidemiology and Population Studies, who wasn’t involved in the study. See also: Feb 28 CIDRAP News item on link between humidity and flu virus infectivity The team identified a specific climatic threshold that separated sites with “cold-dry” and “humid-rainy” flu peaks, according to their report. In places where monthly specific humidity dropped below about 11 to 12 grams of water per kilogram of air and temperatures sank below 18º to 21ºC for at least a month, flu activity peaked in winter. The researchers used a fairly new global database that contains information on flu peaks at the 78 sites around the world, the report says. The locations range from 1 to 60 degrees latitude, and 39% are in the tropics. The flu data were gleaned from 85 studies conducted from 1975 to 2008, with a median duration of 2 years. In most cases they focused on a city rather than a province or region. Tamerius JD, Shaman J, Alonso WJ, et al. Environmental predictors of seasonal influenza epidemics across temperate and tropical climates. PLoS Pathogens 2013 Mar 7 [Full text] Mar 7 NIH press release To provide an independent check on the findings, the team also used epidemiologic data from nine countries participating in the World Health Organization’s global flu surveillance program, FluNet. The countries—Spain, Tunisia, Senegal, Philippines, Vietnam, Colombia, Paraguay, South Africa, and Argentina—each provided several years’ worth of data. . Mar 8, 2013 (CIDRAP News) – If peak influenza activity is an accurate measure, flu viruses prefer the weather either cold and dry or humid and rainy, according to an analysis of climate variables and flu patterns around the world. Researchers from several US universities and the National Institutes of Health (NIH) reached this conclusion primarily by studying flu and climate data from 78 sites in 40 countries. Sponsored in part by the NIH, the study was led by geographer James D. Tamerius, PhD, of Columbia University as first author. Viboud said the findings could be used to refine flu transmission models, target surveillance efforts, and improve the timing of seasonal flu vaccine delivery, according to the release. Although specific humidity was found to be a good predictor of flu peaks overall, this was mainly due to its performance in higher latitudes, the authors write, adding, “In low latitudes, precipitation was a stronger predictor of the timing of influenza activity.” They also note that peak flu activity was harder to predict in low-latitude places, some of which do not have well-defined flu seasons. The report also says that the predictions of the climate-based models compared favorably with the epidemiologic information collected from the nine countries involved in FluNet. The scientists gathered data on temperature, relative humidity, and precipitation for each of the sites. They used the temperature, relative humidity, and atmospheric pressure to calculate the average monthly specific (absolute) humidity, meaning the ratio of water vapor to air. “The models we used predicted the timing of peak influenza activity with 75 to 87 percent accuracy,” senior author Cecile Viboud, PhD, of the NIH’s Fogarty International Center, said in the release. By comparing the flu patterns and climate data, the researchers found that temperature and specific humidity were the best individual predictors of peak flu activity, the NIH release said. They determined that in temperate regions, flu was more common 1 month after periods of the lowest specific humidity, which coincided with the coldest months. “For sites where specific humidity and temperature do not decrease below these thresholds, seasonal influenza activity is more likely to peak in months when average precipitation totals are maximal and greater than 150 mm [about 6 inches] per month,” the report says. “In contrast, sites that maintained high levels of specific humidity and temperature were generally characterized by influenza epidemics during the most humid and rainy months of the year,” the NIH said. “The paper, published in PLoS Pathogens, presents a simple climate-based model that maps influenza activity globally and accounts for the diverse range of seasonal patterns observed across temperate, subtropical and tropical regions,” the NIH said in a press release yesterday. Feb 25, 2010, CIDRAP News story “Study says humidity is key factor in US flu outbreaks”last_img read more

News Scan for Sep 19, 2014

first_imgSaudi audit finds 16 earlier MERS cases; 1 new case reportedAn independent audit of MERS-CoV data in Saudi Arabia yesterday identified 16 more infections with illness onsets before Jun 3 and has reclassified a handful of previously reported cases, the country’s Ministry of Health (MOH) announced yesterday.It said the review is part of an ongoing effort to ensure that MERS-CoV (Middle East respiratory syndrome coronavirus) data are accurate.Many of the new cases were found during a review of patient records at hospitals that conduct on-site lab testing, and all but three of the cases are from Jeddah. The health ministry said it has shared the new data with the World Health Organization (WHO).In addition, among the previously reported cases, one duplicate was found and deleted and two cases reported on Jun 9 and Aug 26 were identified as false-positives and have been deleted from the case total.Records were updated for 21 cases, with 18 changed from active to recovered and 3 changed from active to deceased.Sep 18 MOH statementIn a related development, the Saudi MOH today reported one new MERS case, in a 65-year-old man from Taif who is hospitalized with symptoms and is in stable condition. It said the man had animal exposure and has an underlying health condition. The MOH said he is not a healthcare worker.The health ministry has confirmed seven MERS cases since Sep 8, five of which involved intensive care.The new case, plus the 16 retrospective cases and deaths, push Saudi Arabia’s number of MERS-CoV infections to 749 and its death total to 316.Sep 19 MOH update Sep 17 CIDRAP News Scan on previous case FSMA revisions aim to give flexibility to producers and suppliersRevised provisions to four proposed rules that fall within the Food Safety Modernization Act (FSMA) were announced today by the US Food and Drug Administration (FDA) in a news release.Taking comments on revised proposals before arriving at final rules is “a very unusual step” that shows the agency’s “determination to get the rules right,” a Food Safety News (FSN) story quoted FDA deputy commissioner for foods and veterinary medicine Michael Taylor as saying.FSMA focuses on preventing food-related problems rather than responding to them after the fact, the FDA said. Today’s revisions address rules on produce safety, preventive controls for both human and animal food, and foreign-supplier verification. The revisions were developed in response to thousands of comments from farmers, consumers, the food industry, and academic experts after the rules’ initial issuance.Specifically, the changes address:Water quality testing rules so they account for natural variations in water sourcesAdjustments in regulations about the use of manure and compostThe definition of which farms are subject to produce-safety rulesUse of spent grains, which are byproducts of brewing and distilling that are fed to animalsMore flexibility in foreign-supplier verification based on risk and historyThe changes in the proposed rules are open for comment for 75 days. Comments can be made beginning Sep 29 at www.regulations.gov. Sep 19 FDA news release with links to proposed revisionsSep 19 FSN article WHO: Mixing error in measles vaccine that killed Syrian childrenThe WHO announced today that 15 Syrian children died this week after being vaccinated with measles vaccine that mistakenly contained a muscle relaxant, according to a Reuters story. A measles vaccination campaign that began Monday in war-torn northern Syria with support from the WHO and the UN Children’s Fund (UNICEF) was promptly halted while the event is investigated.The vaccine, from an unnamed manufacturer, was reportedly shipped in powder form along with a dilutant to a hub in Syria where the two ingredients were refrigerated before shipment to vaccine sites. The refrigerator apparently also contained the muscle relaxant Atracurium, said WHO spokesperson Christian Lindmeier said at a news briefing in Geneva, according to the story.The vaccine powder appears to have been packed with ampules of Atracurium instead of the dilutant for delivery to vaccination facilities in the Zor and Idliv provinces, where the two were then mixed for use within 6 hours.Some 50,000 children received the incorrectly mixed vaccine. Lindmeier is quoted as saying, “Both at the packing and at the unpacking there had to be gross negligence.”Atracurium is normally administered as an anesthetic for surgery with the dosage calculated by weight. The children who died were all under age 2, and older children, who presumably weighed more, experienced vomiting, diarrhea, and anaphylactic shock.It is not clear yet whether the error occurred inadvertently or by intent. “It seems very clear that it was not the manufacturer’s fault, not that the vaccine is contaminated, but it’s a fault on the ground . . . whether it’s human error or deliberate,” said Lindmeier. Reports earlier this week raised the possibility of sabotage in relation to vaccine contamination in northern Syria.Sep 19 Reuters story Sep 17 CIDRAP News scan on reports of vaccine contamination International group suggests premature death targetsWith the United Nations (UN) planning later this month to discuss replacing Millennium Development Goals (MDGs), which expire next year, a global group of researchers today proposed a more specific health goal, one involving infectious diseases. The team published its findings in The Lancet.The UN will be looking at 17 “Sustainable Development Goals,” effective between 2016 and 2030. The new health goal is to “ensure healthy lives and promote well-being for all ages.”To come up with their more specific goals, experts looked at death patterns from various causes over the past decades. The more specific goals they call for include targets for each country geared toward reducing premature deaths before age 70 by 40%. The goal would build on causes already targeted by MDGs, as well as other noncommunicable disease and injury causes of early death.Looking back at death patterns, they found that the risk of premature deaths has been dropping in all countries, except those carrying high HIV and political disturbance burdens. The most striking change from 2000 to 2010 they found was a drop in childhood deaths from vaccine-preventable diseases.Their proposed targets include a two-thirds reduction in child and maternal deaths from HIV, tuberculosis, and malaria. They predicted that moderately accelerating the overall achievements seen from 2000 to 2010 would achieve 2030 disease-specific reductions, at least in areas not affected by war, political conflict, or new epidemics.Sep 19 Lancet study CDC business publication focuses on coming flu seasonThe latest edition of the CDC Foundation’s quarterly Business Pulse publication focuses on influenza, offering employers and workers resources and information on the upcoming flu season, said a news release yesterday from the Centers for Disease Control and Prevention (CDC).Challenges faced by businesses in relation to influenza are addressed, and a Q and A feature and an interactive infographic are offered.Through Business Pulse, CDC intends to help businesses and workers protect themselves against both chronic and emergency health threats that could lessen productivity, says the release. Each issue focuses on a different topic. Sep 18 CDC news release Business Pulse flu prevention issuelast_img read more

DHS boosts screening for travelers from Ebola outbreak nations

first_imgIn a step to further tighten checks on travelers from Ebola-stricken countries, the US Department of Homeland Security (DHS) announced today that all travelers whose flights originate in Guinea, Liberia, or Sierra Leone must enter the United States through one of five airports that are currently doing enhanced screening for the disease.The new measures go into effect tomorrow at five airports that account for 94% of all travelers from the three outbreak countries: New York’s JFK, Newark, Dulles, Atlanta, and Chicago O’Hare.Though there are no direct, nonstop flights to the United States from the three outbreak countries, federal officials estimate that about 150 people from those locations fly into the United States each day.Entry screening enhancementsThe DHS said it already has a system to identify and screen anyone at land, sea, and airport entries to the United States who it believes has been in Guinea, Liberia, or Sierra Leone in the preceding 21 days.DHS Secretary Jeh Johnson said in a statement that the department is working closely with airlines to implement the restrictions with minimal disruption. If airlines haven’t made the changes to travelers’ itineraries, a few passengers might have to contact the airlines for rebooking.”We are continually evaluating whether additional restrictions or added screening and precautionary measures are necessary to protect the American people and will act accordingly,” Johnson said in the statement.Several members of Congress, both Democrats and Republicans, have called for a ban on travel to and from the affected region. Federal officials, however, have said a total ban may have unintended consequences, such as slowing outbreak response activities and the flow of needed supplies to West Africa.Yesterday at a media briefing, US Centers for Disease Control (CDC) Director Tom Frieden, MD, MPH, said banning travel could undermine the ability to track people from the countries once they enter the United States. He has said, though, that government officials have an open mind to any ideas to enhance protection. “Protecting Americans is our top priority,” Frieden said.Federal health officials have specified that exit screening from affected countries is the best way to prevent travel-linked Ebola cases, and the CDC has helped the three countries set up departure screening, and the agency monitors its use.WHO convenes emergency panel, posts checklistThe World Health Organization (WHO) said today that its emergency committee on Ebola will meet tomorrow for the third time to review the latest developments and assess if changes need to be made to current recommendations. In an e-mail to journalists, the WHO said it expects the discussions to last a day or two and that it will brief the media at the end of the meeting.In early August, based on the committee’s recommendation, WHO Director-General Margaret Chan, MD, MPH, declared that West Africa’s Ebola outbreak is a public health emergency of international concern (PHEIC) under International Health Regulations. The group met for a second time on Sep 22, recommending that temporary recommendations from August be kept in place and identifying areas where more attention was needed.In other WHO developments, the agency recently released an Ebola preparedness checklist for countries, based on input from global health groups, including the CDC. The WHO said all countries should be prepared to handle Ebola illnesses, especially those in the top two tiers of its four-tired risk group stratification.The checklist covers 10 key components, with tasks to be completed by 30, 60, and 90 days from the Oct 17 publication of the list. The list of components includes, for example, rapid response teams, infection prevention and control, case management, and contact tracing.Texas and Ohio newsIn ongoing contact screening related to three Ebola infections in Texas, 15 more people have completed their 21-day monitoring period, bringing the total to 60, according to an update today from the Texas Department of State Health Services (TDSHS).There are still 112 people who are being monitored for symptoms, according to the TDSHS. All have links to Thomas Eric Duncan, a Liberian man who died from Ebola at a Dallas hospital on Oct 8, and two of his nurses, whose illnesses were confirmed on Oct 11 and Oct 15.Both nurses are being treated at infectious disease specialty units outside of Texas: Nina Pham at the National Institutes of Health Clinical Center in Bethesda, Md., and Amber Joy Vinson at Emory University Hospital in Atlanta.In other Texas developments, Texas Health Presbyterian Hospital in Dallas, where Duncan was treated and the two nurses were infected and originally treated, announced yesterday the end of diversion for ambulance traffic. Health officials ordered the diversion in the wake of the Ebola cases, but it did not affect emergency department visits that didn’t involve ambulance transport.The hospital’s parent company, Texas Health Resources, posted a letter on its Web site apologizing to the community for mistakes it made in handing Duncan’s case. The Oct 19 letter, written by chief executive officer Barclay Berdan, said that although the institution is grateful to its care teams, it made mistakes in handling a difficult challenge, which includes not diagnosing Duncan’s symptoms as Ebola on his first visit.Berdan said the hospital had begun Ebola preparedness activities but had not fully deployed them when Duncan sought care.He added that the investigation is still under way into what led to the nurses’ infections, but so far indications show that the staff was following CDC recommendations that were in place at the time. He said in the meanwhile, the hospital is making all changes that are needed to make the environment safer for workers.Meanwhile, the Ohio Department of Health (ODH) has identified 17 more people for Ebola contact tracing, raising the total to 159, according to an update today. The people may have had contact with Vinson, the second infected Dallas nurse. She had traveled by air to the Akron area in the days before her fever developed and may have had her first symptoms before she departed the state.The number of people who are quarantined in Ohio remains at three.Other developmentsEmory University Hospital announced yesterday that a patient admitted for Ebola treatment on Sep 9 was discharged from the hospital on Oct 19. It said in a statement that tests showed that the man is free of the virus and doesn’t pose a public health threat. It said he asked to remain anonymous, left the hospital for an undisclosed location, and will make a statement at a later date. The patient, the third to be treated for Ebola at Emory’s special unit, is thought to be an American doctor who got sick with the virus while working for the WHO in West Africa.Health officials from a Firestone rubber plantation in Liberia and their collaborators from the CDC today described how the company’s health system responded to the Ebola outbreak, an experience that may yield lessons for other groups. The report appeared today in Morbidity and Mortality Weekly Report (MMWR). The company’s plantation, located in Margibi County, employs 8,500 people in Liberia. The plantation’s first Ebola case was detected at the end of March in a woman who had cared for a sick family member outside the plantation. Her illness triggered the company health group’s incident management system to handle the response, which ranged from case identification to integrating recovered patients back into society. The plantation experienced a spurt of infections starting in early August. By Sep 23, 71 Ebola cases had been reported, 39 of them fatal. The authors wrote that Firestone’s quick response limited the spread of the disease, and that several unique elements of the response might be useful in other settings—for example, managing contacts based on their exposure and allowing voluntary quarantine while providing educational materials, personal protective gear, and waste disposal equipment.See also:Oct 21 DHS statementOct 17 WHO Ebola preparedness checklistOct 21 TDSHS updateOct 20 Texas Health Resource statement on end to ambulance diversionOct 19 Texas Health Resource letterOct 21 ODH contact updateOct 20 Emory University Hospital statementOct 21 MMWR reportlast_img read more

News Scan for Sep 18, 2015

first_imgPossible Ebola treatment ZMapp receives FDA fast-track statusMapp Biopharmaceuticals announced yesterday that its experimental Ebola treatment ZMapp received fast-track status to gain US Food and Drug Administration (FDA) approval.The San Diego, Calif.–based company has been administering ZMapp in West African clinical trials, though with Liberia reporting no new Ebola cases since July and case incidence declining in Sierra Leone and Guinea, ZMapp’s effectiveness has been difficult to test.The FDA grants fast-track status to pharmaceuticals that potentially address unmet needs and treat serious conditions. The new status may allow Mapp Biopharmaceuticals and its commercial division, LeafBio, Inc., to more quickly file a Biologics License Application for marketing ZMapp in the United States.ZMapp was administered to the first two American Ebola patients, who survived. The drug is made with three lab-engineered monoclonal antibodies designed to attack Ebola surface proteins. Antibodies are grown in tobacco plants by Kentucky BioProcessing.Currently, no drug has been approved to treat Ebola, which since last year has caused 28,220 cases and 11,291 deaths, primarily in West Africa.Sep 17 MAPP Biopharmaceuticals press release Addition of inactivated polio vaccine enhances immunogenicityA study of poliovirus immunization among newborns found that use of inactivated poliovirus vaccine (IPV) increased seroconversion rates when added to a trivalent or multi-dose bivalent oral poliovirus vaccine schedule, according to findings yesterday in The Lancet.The open-label, randomized controlled trial followed 782 newborns at four hospitals in India. Research was funded by the World Health Organization (WHO), which began recommending an immunization schedule comprising three or four doses of bivalent type 1 and type 3 oral poliovirus vaccine (bOPV) and one dose of inactivated poliovirus vaccine (IPV) in January 2014.Healthy newborns were assigned to one of five immunization groups: group 1 (163 babies receiving trivalent OPV), group 2 (153 babies receiving trivalent OPV and IPV), group 3 (155 babies receiving bOPV), group 4 (156 babies receiving bOPV and IPV), and group 5 (155 babies receiving bOPV and two doses of IPV).OPV was administered at birth, 6 weeks, and 14 weeks; IPV was given intramuscularly at 14 weeks. Seroconversion against poliovirus was measured at 18 weeks.The immunologic response to IPV was greater than expected for poliovirus type 1 and type 3 and as expected for poliovirus type 2. The combination of trivalent OPV and IPV was significantly superior to the use of trivalent OPV alone (P < 0.0008), with 98% of newborns in the IPV group converting against type 1, 100% against type 2, and 99.3% against type 3.The combination of bOPV and IPV was superior to the use of bOPV alone (P = 0.0153), with 99.4% of newborns in the IPV group seroconverting against type 1, 68.6% against type 2, and 99.4% against type 3.The findings suggest that the newly recommended vaccination schedule and the addition of IPV to the regiment greatly improves immunogenicity of the poliovirus vaccine, especially against poliovirus type 3, the authors conclude.Sep 17 Lancet study Another biolab breach noted as Pentagon says probe overAs part of its ongoing investigation into Pentagon labs, USA Today reported yesterday that a senior Army lab researcher in Utah in 2007 tossed out a test tube containing live anthrax spores and sent the tested batch to other labs. A separate story noted that the Army has completed its probe into biosecurity lapses without releasing details.The 2007 incident involved a principal investigator (PI) at a Dugway Proving Ground facility that has been at the center of a probe into the shipping of live Bacillus anthracis, which causes anthrax, around the country and to at least nine other nations, as well as other safety and security breaches.Twelve pages of redacted documents released to USA Today by the Department of Health and Human Services' Office of Inspector General account the incident. The PI was using chlorine dioxide to inactivate B anthracis—which was deemed a scientifically acceptable method at the time—even though Dugway didn't have a standard operating procedure for using the chemical.The researcher found that a colony of the bacteria grew in a cell culture in one test tube, indicating that the chlorine dioxide kill step did not work. Instead of investigating further, the PI simply threw the test tube with the live culture away and shipped the remaining samples in the batch."The PI's notes do not explain why the viable colony grew, whether the inactivation procedure was performed properly, or why the remaining tubes were not retested for viability," one of the documents notes.Sep 17 USA Today story on testing misstepMeanwhile, the emergency probe into biosecurity breaches at Department of Defense (DoD) labs is now completed, though the shuttering of nine high-security Army labs will remain for now, USA Today reported in a separate story yesterday."Once the review results are compiled, the US Army will develop a plan to address any deficiencies," Lt. Col. Jesse Stalder, an Army spokesman, said in a statement. "This process will take some time and, once complete, more information will be made available."In addition to B anthracis, samples of Yersinia pestis, which causes plague, and encephalitis viruses might also have been improperly shipped from DoD labs.Sep 17 USA Today story on completion of probe Spanish study finds no genetic risk for severe pH1N1 diseaseA study of severe and mild 2009 H1N1 (pH1N1) found no significant host genetic factors that might cause or aggravate severe disease, according to findings published yesterday in PLoS One.In an effort to determine why pH1N1 caused severe disease in people without prior risk factors, researchers analyzed 547,296 genome-wide single nucleotide polymorphisms (SNPs) from a sample of 49 people with severe pH1N1 disease, 107 mild cases, and 549 members of the general population.Samples from case-patients with severe pH1N1 infections in 2009 and 2010 were obtained from three hospitals in Spain, samples from patients with mild disease came from the Spanish Influenza Case-Control Study, and the general population SNPs were retrieved from the nation's CeGen-PRB2-ISCIII genotyping database.Researchers found no significant genetic factor that could explain why pH1N1 affected some people more severely than others. The one SNP that tested above significance level encodes an enzyme that, in rats, regulates neural development and has no connection to immunologic or inflammatory activity. Identification of the SNP as significant was assumed to be a false-positive.Limitations of the study include its low sample size and its applicability only to a population of primarily European ancestry, the researchers said.Sep 17 PLoS One study Danish study finds human MRSA risk related to livestock proximityA Danish study found that human infections with methicillin-resistant Staphylococcus aureus (MRSA) have been increasing steadily in the country and are associated with exposure to livestock and contact with livestock workers, according to a study yesterday in Eurosurveillance.Livestock, particularly swine, are a reservoir for the recently derived MRSA CC398-IIa, which is responsible for 40% of new MRSA cases in Denmark, the Netherlands, and Germany. The first MRSA CC398-IIa infection in Denmark was reported in 2004.Researchers from Denmark's Statens Serum Institut analyzed MRSA isolates collected from 1999 to 2011 by the national MRSA registry and repository; the registry has been mandatory since 2007.Of 7,429 MRSA samples identified in the registry, 416 were MRSA CC398-IIa. More than half of MRSA CC398-IIa isolates (237, or 57%) were multidrug resistant. After asymptomatic carriers were excluded, 148 samples came from people with infections, 51 of whom had no exposure to livestock.Incidence of MRSA CC398-IIa infections rose steadily in Denmark from 2004 to 2011, showing a linear annual increase of 66% (incidence rate ratio [IRR], 1.7; 95% confidence interval [CI], 1.5 to 1.9; P < 0.00001).Infected people who were not exposed to livestock tended to live within 5 kilometers of livestock workers. The risk of MRSA CC398-IIa infections among people not exposed to livestock was significantly higher in the 25 Danish municipalities where exposed patients lived compared with the rest of Denmark (IRR, 2.5; 95% CI, 1.1 to 5.7; P = 0.041).Researchers said that, given the recent increase of MRSA CC398-IIa infections in Denmark, spillover from livestock to the community via livestock workers is likely occurring and highlights the need to closely monitor infection rates, especially in municipalities at greater risk.Sep 17 Eurosurveillance studylast_img read more

Rapid malaria tests tied to increased antibiotic use

first_imgRapid diagnostic tests (RDTs) for malaria have helped reduce overprescribing of antimalarial drugs in parts of the world where the parasitic disease is endemic and healthcare resources are scarce. That’s a good thing, given that development of resistance to antimalarials is one of the greatest threats to malaria control.But since malaria-endemic countries in Africa and Asia started using the small devices—which can quickly detect the presence of specific antigens produced by malaria parasites from a pinprick of blood—there has been concern among some public health professionals about the potential for an unintended consequence: increased use of antibiotics to treat patients who’ve tested negative for malaria.That’s because, in settings with little healthcare infrastructure, treating febrile illness often amounts to “educated guesswork,” according to the authors of a new study in the British Medical Journal (BMJ).To determine if this concern has been borne out, an international research team led by Heidi Hopkins, MD, a professor of malaria and diagnostics at the London School of Hygiene and Tropical Medicine, reviewed nine observational and randomized studies in Africa and Asia. The papers compared antibiotic prescribing in trial groups who had received RDTs with control groups, and in patients with negative test results compared with those who tested positive for malaria.The results of that analysis, Hopkins told CIDRAP News, suggest that “these concerns are well-founded in many settings.”Antibiotic prescriptions climb 21%The studies, conducted from 2007 through 2013 in a mix of urban and rural settings in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda, included more than 500,000 children and adults with acute febrile illness. The analysis of the studies found that antibiotics were prescribed to 53% of patients in control groups and 59% of patients in groups who had received RDTs. A meta-analysis of the studies showed that the risk of antibiotic prescription was 21% higher in places where RDTs were introduced.When the researchers compared patients who had negative tests results with patients who tested positive, they found that antibiotics were prescribed to 69% of patients with a negative test results and 40% of those who tested positive for malaria. In most settings where the tests were used, patients with malaria-negative test results were more likely to receive the four most common antibiotic classes—penicillins, trimethoprim-sulfamethoxazole, tetracylines, and metronidazole—than those who tested positive.Hopkins said that while she and her colleagues weren’t surprised to find an increase in antibiotic use among patients who had undergone rapid diagnostic testing, the size of the increase stood out. “We expected to find only a marginal increase in antibiotic prescription for patients with negative malaria test results, but in many settings it appears to be significant,” she said.While these studies don’t reveal whether the patients who tested negative for malaria actually had a bacterial infection, Hopkins said studies done in similar settings have shown that relatively few patients have infections that require antibiotics. “Based on those studies, we can estimate that just a small proportion of patients with fever are likely to need antibiotics—almost certainly fewer than the 69% who had negative malaria test results and who received antibiotics in our analysis.”The challenge in any setting is to know which patients do, and don’t, require antibiotics,” she said.Educated guessworkThe challenge for health workers treating patients with fever in tropical, low-resource settings is even greater. The lack of access to facilities that can confirm diagnoses and identify pathogens, Hopkins explained, means health workers often have to prescribe treatment without knowing the exact cause of illness. And many patients who present with fever expect to receive antibiotics.But as Hopkins and her colleagues note in the study, case management guidelines for limited-resource settings do not recommend empirical antibiotics for non-severe febrile illness when the cause of the illness is unclear.To address this shift toward overuse of antibiotics, Hopkins said further studies are needed to identify some of the reasons health workers prescribe antibiotics for patients who test negative for malaria. In addition, the treatable or preventable causes of non-malaria febrile illness need to be identified so that health workers don’t have to rely on guesswork.Hopkins also believes that the development of easy-to-use RDTs for other infectious diseases could improve treatment in low-resource settings. “Such tests should prove very useful in the future—but we should take advantage of lessons learned from malaria RDT implementation so that we can introduce new tests in a way that optimizes use of medicines and patient outcomes,” she said.See also:Mar 29 BMJ studylast_img read more

WHO: 9 more Ebola cases in DRC, 29 total

first_imgThe Ebola outbreak in the Democratic Republic of the Congo (DRC) grew by nine more cases, according to the World Health Organization (WHO) African region’s situation report posted today.There are now 29 total cases, with 2 cases confirmed, 2 probable, and 25 suspected. With the three deaths from the deadly virus previously reported, the case-fatality rate is now 10%.The nine new cases were identified in Ngayi and Azande, both located in the Likati health district. In contrast to previously published maps, Azande is now placed in northern DRC, away from the border with South Sudan.No health workers have been infected so far, according to the report, and most patients have presented with fever, vomiting, and bloody diarrhea. The WHO said scientists are now following 416 contacts, up from yesterday’s 400.Two mobile labs set upThe report noted that two mobile labs have now been set up in Likati, and 30 biological samples collected in Likati health zone will be tested in these labs today and tomorrow. One of the labs will also test 13 samples collected from suspected Ebola cases in Banalia.Though the WHO said the global risk posed by this outbreak is still low, seven countries have now begun screening at airports and ports of entry (Kenya,  Nigeria,  Rwanda,  South  Africa,  Tanzania,  Zambia, and  Zimbabwe). HHS director in LiberiaIn other news, US Health and Human Services (HHS) Secretary Tom Price, MD, traveled to Liberia today to address global health security concerns. It was the first stop on a three-nation tour. Liberia was the nation hardest hit during the 2014-2016 West African Ebola outbreak.Price toured an Ebola treatment center and laid a wreath on the grave of an unknown Ebola victim.According to an HHS press release, “Ebola survivors who met with the Secretary described the significant stigma associated with the virus and the continuing discrimination they face. Secretary Price shook hands with survivors, an important public gesture.”See also:May 18 WHO situation reportMay 19 HHSpress releaselast_img read more

Vaccine Scan for Feb 26, 2018

first_imgFDA working with CMS to look for new clues on flu vaccine protectionUS Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, today weighed in on steps the FDA it taking to improve the effectiveness of seasonal flu vaccines, which includes collaborating with partners at the Centers for Medicare and Medicaid Services (CMS) to use a large database that includes information on flu vaccines given to 4 million people.In a statement, he said an analysis of the data is still underway, but it may have some clues on effectiveness of cell-based and egg-based vaccines and may shed light on effectiveness of high-dose and adjuvanted version of the vaccines in seniors, as compared to standard flu vaccine. “What we learn about the differences in efficacy between these different vaccines might reveal information that can inform why overall effectiveness against H3N2 was lagging,” Gottlieb said.One theory is that people may require a higher amount of H3N2 antigen to prompt a better immune response, he said, adding that preliminary CMS data has suggested that cell-based flu vaccine might be somewhat more effective than egg-based vaccine. FDA scientists are combing through the data to see if there are any other reasons for the drop in vaccine effectiveness against H3N2 and are working with scientists inside and outside the government to understand the findings.Earlier this month, US scientists released interim effectiveness estimates for this season’s vaccine, which found that protection against H3N2 was 25%, less than hoped and similar to what some other countries have recently  found. The gap in protection has been especially problematic over the past few seasons, and scientists say the issue likely stems from a combination of factors, but especially an egg-adaptation that has been identified in the vaccine strain used to make egg-based vaccines.The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets on Mar 1 to discuss the World Health Organization’s (WHO’s) recently announced recommendations for the Northern Hemisphere’s 2018-19 flu season.Feb 26 FDA statement FDA VRBPAC meeting information WHO approves Shanchol cholera vaccineShantha Biotechnics, an India-based subsidiary of Sanofi, announced today that the WHO has approved its oral cholera vaccine Shanchol, the first of its kind that can be stored and distributed outside of the traditional cold chain, The Economic Times, an English-language paper based in India, reported today.Shanchol is the second vaccine approved for mass campaigns to prevent and control cholera outbreaks. According to the report, the vaccine can be kept for a single period of up to 14 days at a temperature of up to 40°C just before administration, as long as it hasn’t expired and the vaccine vial monitor hasn’t reached the discard point.The WHO prequalified Shanchol in 2011, and since then, 12 million doses have been sent to 25 countries, including the Democratic Republic of Congo, Haiti, Mozambique, and South Sudan.Feb 26 Economic Times story PAHO emphasizes yellow fever vaccine for travelers to affected areasThe Pan American Health Organization (PAHO) recently reiterated its recommendation that international travelers be vaccinated against yellow fever at least 10 days before visiting areas where the disease is circulating, according to a Feb 23 statement.Between Jan 2016 and Jan 2018, seven countries or territories in the Americas have reported yellow fever cases: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Suriname. However, most of the illnesses have been reported from Brazil, with cases reported from areas where the disease hasn’t been found in several decades, including Sao Paulo and Rio de Janeiro states. The WHO recommends vaccination for international travelers for 21 Brazilian states, and the group is closely monitoring for signs that new areas are at risk.So far urban transmission via Aedes aegypti mosquitoes has not been documented, and human infections have been linked to two types of forest-dwelling mosquitoes that can spread the disease, Haemagogus and Sabethes. PAHO said travelers to affected countries should also take steps to avoid mosquito bites and seek immediate medical care if they become sick during or after their trips.Feb 23 PAHO statementlast_img read more

Stewardship / Resistance Scan for Feb 08, 2019

first_imgStudy: Inadequate drug-susceptibility tests linked to poor TB treatmentThe accuracy of tuberculosis (TB) drug-susceptibility testing in high-burden countries was inadequate, and inaccurate test results led to inadequate treatment that contributed to higher mortality in patients with drug-resistant forms of the disease, an international team of researchers reported yesterday in The Lancet Infectious Diseases.In a multicenter cohort study conducted in seven high-burden countries (Cote d’Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand), researchers collected tuberculosis isolates from patients aged 16 years and older and compared the results of drug-susceptibility testing done locally with results from gold-standard phenotypic drug-susceptibility testing conducted in a Swiss reference laboratory. They then examined mortality in patients who had concordant and discordant test results.Drug-susceptibility tests of isolates from 634 patients at the reference lab found that 394 isolates (62%) were pan-susceptible, 45 (7%) were resistant to one drug, 163 (26%) were multidrug-resistant (MDR), and 30 (5%) were pre-extensively or extensively drug-resistant (pre-XDR or XDR). A comparison of the results from the local and reference laboratories showed that they were concordant for 513 (81%) of 634 patients and discordant for 121 (19%) of 634, resulting in an overall sensitivity of 90.8% (95% confidence interval [CI], 86.5 to 94.2) and specificity of 84.3% (95% CI, 80.3 to 87.7).Mortality ranged from 6% (20 of 336) in patients with pan-susceptible strains and concordant test results who were treated according to World Health Organization (WHO) guidelines to 57% (8 of 14) in patients with resistant strains who were under-treated. More than half the people with misdiagnosed drug-resistant tuberculosis who received inadequate therapy died. In logistic regression models, compared with concordant drug-susceptibility test results, the adjusted odds ratio of death was 7.33 (95% CI, 2.70 to 19.95) for patients with discordant results who were under-treated.The authors of the study say the results support the idea that rapid molecular drug-susceptibility testing at treatment initiation, preferably using whole-genome sequencing, is required to improve outcomes in patients with MDR and pre-XDR/XDR TB, though they acknowledge that much work is required to make that approach feasible and affordable in lower-income countries.They conclude, “In the meantime, the capacity for the phenotypic and molecular drug-susceptibility testing recommended by WHO should be increased to ensure the most adequate treatment of drug-resistant tuberculosis in these settings.”Feb 7 Lancet Infect Dis study UK releases new guidance on antibiotic prescribing for acute coughThe UK National Institute for Health and Care Excellence (NICE) yesterday issued new clinical guidance aimed at reducing antibiotic prescribing for adults and children with acute cough.The guidance advises against offering antibiotics to treat patients with acute cough associated with either an upper respiratory tract infection or with acute bronchitis who are not systematically unwell. Clinicians are also advised to explain to patients why an antibiotic is not necessary, how long acute coughs lasts, how to manage symptoms with self-care (honey, herbal remedies, and over-the-counter cough medicine), and when to seek further medical help.For patients who appear systematically unwell at a face-to-face examination, the guidance recommends an antibiotic be offered immediately. For patients with a higher risk of complications, the guidance suggests clinicians consider offering an antibiotic.The guidance recommends doxycycline as the first-choice antibiotic for adult patients, and amoxicillin as the first-choice agent in children under the age of 18. Feb 7 UK NICE acute cough guidancelast_img read more