News Scan for Dec 13, 2018

News brief

Measles clusters expand in New York and New Jersey

The number of cases in New York and New Jersey measles clusters sparked by international travelers continues to grow, according to updates from county and state health departments.

In Brooklyn, where an outbreak is centered in an Orthodox Jewish neighborhood, 42 cases have now been reported since October, NYC Health reported in a recent update. The total reflects an increase of 13 cases since CIDRAP's last update on Nov 28. The initial case-patient was a child who contracted the infection during a visit to Israel, which is experiencing a large outbreak. The report notes cases also include other unvaccinated children who were exposed in Israel.

Elsewhere in New York, Rockland County, in lower Hudson Valley, yesterday reported 91 cases, an increase of 11. The illnesses are clustered in eastern Ramapo, but health officials said the county is small and exposure to measles could occur anywhere in the county.

Orange County, part of the New York City metropolitan area, has now confirmed five cases, two of them involving school children, according to a local media report that cited the county health department. And Erie County, which includes Buffalo, yesterday reported one case in an international traveler who visited multiple locations and may have exposed others.

Two New Jersey counties—Ocean and Passaic—have also reported measles cases. In an update yesterday, Ocean County said 19 cases have been confirmed and 1 more is under investigation. The New Jersey Department of Health (NJDH) said three cases have been confirmed in a Passaic County household and that the patients have a direct epidemiological link to Ocean County's outbreak.
NYC Health measles page
Dec 12 Rockland County update
Dec 12 Times-Herald story
Dec 12 Erie County Department of Health press release
Dec 12 Ocean County Department of Health statement
NJDH measles page

Another MERS case announced in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) today recorded a second case of MERS-CoV for epidemiologic week 50.

Similar to a case recorded yesterday, the patient is a 45-year-old man who is hospitalized with MERS-CoV (Middle East respiratory syndrome coronavirus). The man is from Sajir, a city in the Riyadh region (yesterday's case was in Najran). The man in Sajir had camel contact, a known risk factor for MERS transmission.

This is the second case the MOH recorded in December; in November, the MOH noted eight MERS cases, including two fatalities.

The new case raises the global total since the virus was first detected in humans in 2012 to 2,277, at least 806 of them fatal.
Dec 13 MOH update

Europe sees small drop in Listeria, Salmonella, Campylobacter cases

Cases of Listeria, Salmonella and Campylobacter all decreased slightly in the European Union last year, but officials from the European Centre for Disease Prevention and Control (ECDC) expressed concern yesterday in their annual report on zoonotic diseases that recent progress against these diseases has plateaued.

Cases of listeriosis declined by only 29 last year, from 2,509 in 2016 to 2,480 in 2017. Over the most recent 5 years, however, cases have jumped from 1,883 in 2013 to 2,480, a 32% increase.

Listeria is also the deadliest pathogen highlighted in the ECDC report, with a case-fatality rate (CFR) of 13.8%. That compares with 0.50% for Shiga toxin–producing Escherichia coli, 0.25% for Salmonella, and 0.04% for Campylobacter. (Of the zoonotic pathogens not related to food that were assessed in the report, West Nile viruses was most deadly, with a CFR of 12.0%, followed by Q fever [1.35%] and brucellosis [0.78%].)

Campylobacteriosis cases were by far the most numerous. They dropped from 246,917 in 2016 to 246,158 in 2017. Salmonellosis cases declined from 94,425 cases in 2016 to 91,662, but the downward trend that began in 2008 has stalled in recent years.

"After years of significant progress in reducing the burden of food-borne illnesses in the EU, especially Salmonella, the situation has now stalled. Increased efforts are needed to push the figures further down," Marta Hugas, PhD, chief scientist with the European Food Safety Authority, said in an ECDC news release.

"The fall in the number of outbreaks is to be welcomed, but we still saw an average of 100 food- and waterborne outbreaks per week in 2017, some of which affected several countries," said Mike Catchpole, MB BS, ECDC's chief scientist. "These infections are a substantial cause of human illness in the EU. The rising trend of listeriosis, which continues to cause deaths in vulnerable groups, needs to be reversed."
Dec 12 ECDC news release
Dec 12 ECDC full report

Merck, Brazil institute announce collaboration on new dengue vaccines

Merck has partnered with Brazilian nonprofit Instituto Butantan to develop new tetravalent (four-strain) dengue vaccines, according to a press release from Merck.

Instituto Butantan's dengue vaccine candidate, TV003, is currently being tested in a phase 3 study in Brazil. The partnership would develop other live attenuated tetravalent vaccines, and ensure that the two parties share information, including clinical data.

"By sharing data from our ongoing vaccine development programs, Instituto Butantan and Merck are better positioned to achieve our goal of reducing the significant human and economic toll of dengue virus in Brazil and around the world," said Dimas Covas, MD, director of Instituto Butantan, in the release. "We look forward to collaborating with Merck, an established global leader in vaccine development."

According to the press release, Instituto Butantan will receive a $26 million up front from Merck and is eligible to receive up to $75 million during the development of vaccines, as well as potential royalties on sales.

In 2016 and 2017, Sanofi Pasteur released the world's first dengue vaccine, Dengvaxia. Though initial results from clinical trials on the vaccine were promising, subsequent trials and real-world applicatoin showed that use of the vaccine could lead to severe dengue in dengue-naive recipients, including children.
Dec 12 Merck press release

Flu Scan for Dec 13, 2018

News brief

New flu burden estimate offers more detailed demographic picture

A new estimate of disease burden due to flu, the most detailed demographic analysis of its kind so far, found that lower respiratory tract infections (LRTIs) due to flu are linked to about 145,000 deaths each year across all age groups. Researchers from the Global Disease Burden 2017 Influenza Collaboration published their findings yesterday in The Lancet Infectious Diseases.

For the study, they looked at flu incidence, hospitalizations, and deaths for every country and select subnational areas by age and year from 1990 to 2017 as part of ongoing global disease study. For the flu death estimate of 145,000, the 95% confidence interval (CI) was 99,000 to 200,000.

Not surprisingly, deaths from flu were highest in those older than 70 years. The highest rate of deaths for all ages was in Eastern Europe.

Regarding hospitalizations, the team estimated that flu accounts for 9,459,000 (95% CI, 3,709,000–22,935,000) each year and that of all LRTIs, flu is linked to 11.5% of episodes, which reflects 54,481,000 illnesses (95% CI, 38,465,000–73,864,000), about 8,172,000 of them severe infections (95% CI, 5,000,000–13,296,000).

"Although preparedness planning will be important for potential pandemics, health loss due to seasonal influenza LRTIs should not be overlooked, and vaccine use should be considered. Efforts to improve influenza prevention measures are needed," the authors concluded.
Dec 12 Lancet Respir Med abstract

Study: Stockpiled H5N1 vaccine shows no drop in immunogenicity

H5N1 vaccine that has been stored in the nation's Strategic National Stockpile since 2005 is still safe and immunogenic, according to a study published yesterday by researchers from the US Department of Health and Human Services (HHS) Biomedical Advanced Research and Development Authority (BARDA) and collaborators at St Jude Children's Hospital in Memphis.

In a blog post today, BARDA said in 2015 it asked researchers to conduct clinical trials to assess antigen against the H5N1 influenza A/Vietnam/1203/2004 strain that has been stored since 2005 and MF59 adjuvant that had been in the stockpile for more than 5 years. The team assessed the immunogenicity of two doses of the inactivated monovalent vaccine in people ages 18 to 64, an age group that would likely comprise healthcare workers and frontline responders in a pandemic setting.

The stockpiled pre-pandemic vaccine was well-tolerated, with or without the adjuvant. Participants experienced routine injection-site soreness or redness, but no serious adverse events were reported. No drop in immunogenicity was seen, even in the oldest stockpiled vaccine. As expected, the adjuvanted vaccine was linked to a greater immune response compared the unadjuvanted version, and the stockpiled H5N1 vaccine prompted cross-reactive antibody responses, signaling the potential to prevent infections against other H5N1 strains.

BARDA said the results from the study are useful for its ongoing work to assess prime-boost pandemic vaccination strategies.
Dec 12 Vaccine abstract
Dec 13 ASPR blog post