NEWS SCAN: Weakened smallpox vaccine, Chagas disease in Europe, polio in Afghanistan, pedicure infections

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Sep 16, 2011

Japanese attenuated smallpox vaccine looks good in US trial
An attenuated smallpox vaccine that was developed in Japan in the 1970s compared well with a conventional smallpox vaccine in a phase 1-2 clinical trial in the United States, according to a report yesterday in the Journal of Infectious Diseases. The vaccine, called LC16m8, consists of vaccinia virus weakened by deletion of the B5R protein. It was tested extensively in Japan and has been used to vaccinate some military personnel there. In the double-blind US trial, 154 young adult volunteers at five centers were randomly assigned to receive LC16m8 or the conventional vaccine, Dryvax, and were monitored for immune response and adverse events. Local and systemic reactions to the vaccines were similar in the two groups. In immunogenicity testing, serum samples from both groups generated neutralizing antibody titers greater than 1:40 against vaccinia (the vaccine virus), smallpox (variola), and monkeypox viruses. The attenuated vaccine also generated "robust cellular immune responses" that trended higher than the Dryvax responses by one measure but lower by another. The authors concluded that the vaccine was well tolerated, that it "may have efficacy in protecting individuals from smallpox," and that it warrants further development. The US Department of Health and Human Services is in the process of adding 20 million doses of another attenuated smallpox vaccine, Imvamune, to its Strategic National Stockpile.
Sep 15 J Infect Dis abstract

Chagas disease cases increasing in Europe
Increasing numbers of Chagas disease cases have been reported in Europe in recent years, with an estimated 80,000 between 1999 and 2009, according to one of several reports on the disease in today's issue of Eurosurveillance. The disease is widespread in Central and South America and is spread by the parasite Trypansonoma cruzi, which has its reservoir in mammals such as cats, dogs, and rodents but is spread to humans by insects. The 15 core clinical sites of the European Travel Medicine Network identified 124 chronic Chagas disease cases in 2008 and 2009, out of 13,349 people who presented at the sites. Ninety-six percent of these patients were immigrants from Bolivia, and all but one were treated as outpatients. "Considering that Chagas disease can be transmitted outside endemic regions and that there is effective treatment for some stages of the infection, all migrants from Latin America (excluding the Caribbean) should be questioned about past exposure to the parasite and should undergo serological testing if infection is suspected," the report says. Another Eurosruveillance article, focusing on Chagas disease surveillance, says the disease is underdiagnosed by 94% to 96%.
Eurosruveillance report on imported Chagas disease cases
Eurosurveillance report on Chagas disease surveillance

Afghanistan ramps up polio control efforts
Afghanistan is boosting efforts to cut the number of polio cases using four main strategies, according to Arshad Quddus, who heads the World Health Organization (WHO) polio program in the country. Quddus was quoted yesterday in a report from Integrated Regional Information Networks (IRIN), part of the United Nations (UN) Office for the Coordination of Humanitarian Affairs. Quddus said the priorities include getting vaccine to children in conflict-affected areas, maintaining polio-free status in virus-free areas, targeting vaccine to refugees and other mobile groups, and communicating closely with Pakistan to prevent cross-border spread. So far this year 13 polio cases, mostly in children younger than 2 years old, have been reported in three Afghan provinces, according to IRIN. Though polio vaccination efforts have faced some setbacks this year in some areas due to poor security, Afghanistan's President Hamid Karzai is launching a new national campaign that launches tomorrow. Quddus said the campaign is community based, featuring roles for mullahs, teachers, and elders.
Sep 15 IRIN story

Study finds mycobacterial furunculosis afoot in pedicure salons
Systematic surveillance for pedicure-associated nontuberculous mycobacterial furunculosis in two North Carolina counties from 2005 through 2008 found that 13 salons likely led to 40 cases of this boil-producing skin infection. North Carolina scientists confirmed 40 pedicure-related cases in the study period, with the responsible organisms being Mycobacterium chelonae or M abscessus in 91% of isolates (30 of 33). They then collected environmental samples at the 13 implicated salons and 11 control salons and cultured an assortment of nontuberculous mycobacteria from footbaths. They found, however, no association between the species distribution of the environmental isolates and the human infections. They did find evidence of inadequate cleaning in at least one footbath for 11 of 13 implicated salons and 4 of 11 control salons. They conclude, "Suboptimal footbath cleaning may have contributed to these infections" but add that as-yet unidentified host-specific or procedure-related factors may have been involved.
Oct 15 Clin Infect Dis abstract

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