NEWS SCAN: Return to work after flu, cost of kids' flu, UK H1N1 numbers, phage-based E coli prevention, recurrent TB

Mar 16, 2011

Findings cast doubt on CDC guidance for return to work after H1N1 flu
A study from Seattle calls into question the Centers for Disease Control and Prevention's (CDC's) recommendation that healthcare personnel (HCP) infected with the 2009 H1N1 virus can safely return to work once they have been free of fever for 24 hours without antipyretic medication. The study, published by Emerging Infectious Diseases (EID), focused on a group of medical residents who contracted the virus while attending a work-related, weeklong retreat in September 2009. Sixteen of 32 HCP who attended the entire retreat got sick afterward with confirmed H1N1 flu and participated in the study. The participants recorded their temperature and provided nasal wash specimens daily for 2 weeks after symptom onset. The specimens were tested using polymerase chain reaction (PCR) and culture. When the residents met the CDC criteria for returning to work, 12 of 16 (75%) still had virus detectable by PCR, and 9 of 16 had virus detectable by culture. "HCP might shed virus when meeting CDC exclusion guidelines," the report says. "Further research is needed to clarify the association between viral shedding, symptoms, and infectiousness."
Mar 16 EID report

Study: Kids' flu proves costly, mostly owing to parents' lost wages
Italian researchers found that the cost of a case of seasonal influenza in children is roughly $180 more than a case of a similar influenza-like illness (ILI), but the cost increases with children younger than 5 years old. The researchers attributed most of the cost to parents' lost wages from tending to their children. The prospective study in the Journal of Infection examined 6,988 children who experienced ILI from Nov 1, 2008, through Apr 30, 2009, a period that precluded pandemic H1N1 in Italy. Of those cases, 2,143 were confirmed to be influenza, with 82% influenza A and 18% influenza B. When comparing cost of care for flu cases versus non-flu ILI, the authors found that each flu case cost 130 euros ($180) more, a statistically significant difference. They also found that influenza A cases cost significantly more than influenza B, which they say is not surprising, given that the predominant A strain that year was H3N2, which typically causes more serious illness. The researchers also found that children younger than 5 had significantly more expensive care than older children. They conclude that their findings support the use of influenza vaccines.
Mar 15 J Infect abstract

Survey suggests UK H1N1 pandemic was bigger than previously thought
Findings from an online survey suggest that UK residents grew less likely to seek medical care for ILI during the course of the 2009 H1N1 flu pandemic, indicating that the UK's H1N1 case count was higher than previously estimated, according to a BMC Infectious Diseases report. Researchers from the London School of Tropical Medicine and Hygiene analyzed data from a national online flu survey that ran from mid-July 2009 through March 2010. Participants were asked to complete a background questionnaire when they registered and then to provide weekly information on any symptoms and whether they sought medical care. There were 5,738 participants, 54% of them female. Forty percent of the weekly reports listed at least one symptom, and 1,522 reports matched the ILI definition. The share of participants who sought medical care for ILI dropped from 43% at the beginning of the epidemic to 32% by the end. On this basis, the authors estimate that there were 1.1 million symptomatic H1N1 cases in England, or 40% more than the Health Protection Agency estimate of 780,000. By combining this revised estimate with reported deaths, they estimated the case-fatality rate at 17 per 100,000 population, or 35% lower than the official estimate of 26 per 100,000.
Mar 16 BMC Infect Dis abstract

FDA clears phage-based treatment for ground beef
Intralytix, Inc., a Baltimore-based biotechnology company, announced yesterday it has receive US Food and Drug Administration (FDA) regulatory clearance for EcoShield, its phage-based product designed to protect food from Escherichia coli O157:H7 contamination. In a press release the company said the FDA's clearance covers use of the product on red meat parts and trim that are intended for ground beef. It said data included in its FDA application show that EcoShield can reduce E coli O157:H7 in ground beef by 95% to 100%. John Woloszyn, the company's chief executive officer, said in a statement that bacteriophages are viruses that are harmless to humans, animals, and plants, but can destroy bacteria. He said phages provide a natural, nontoxic, and safe way to reduce or eliminate harmful bacteria on foods. The company has developed a similar product to combat Listeria monocytogenes and is working on others that are effective against additional foodborne pathogens.
Mar 15 Intralytix press release

Study says treatment for recurring TB often fails
The standard approach for retreating tuberculosis (TB) in low- and middle-income countries fails more than 20% of the time, according to a study funded by the Wellcome Trust and published in PLoS Medicine. Between 10% and 20% of patients treated for TB each year face a recurrence of the disease, and an estimated 1 million patients undergo an 8-month retreatment regimen of five drugs, the Wellcome Trust said in a press release. In the study, conducted in Kampala, Uganda, the regimen failed in 26% of a group of 140 HIV-infected patients and in 20% of 148 HIV-free patients. Twenty-three percent of the patients died, and 6% faced another TB recurrence. Lead author Dr. Edward Jones-Lopez of Boston University School of Medicine, called the failure rate "uacceptably high." Among the factors associated with retreatment failure were poor compliance with the drug regimen, the presence of drug-resistant forms of TB, higher age, and, in HIV patients, a poor CD4 T-cell count and poor access to antiretroviral therapy. The study reinforces the need for directly observed therapy in TB patients and suggests that HIV patients need rapid diagnosis and improved therapies.
Mar 16 Wellcome Trust press release
Mar 15 PLoS Med report

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