NEWS SCAN: Tamiflu-resistant H1N1, pandemic lab capacity, Crimean-Congo hemorrhagic fever virus, dengue in Sri Lanka

Dec 29, 2011

Tamiflu-resistant pH1N1 reportedly on rise in Australia
Australian researchers today reported on increased transmission of oseltamivir (Tamiflu)-resistant 2009 H1N1 in a New South Wales community during the past Southern Hemisphere's flu season. They detailed their findings in a letter in the New England Journal of Medicine, after an initial report of 25 viruses appeared in August on ProMED Mail, the online reporting system of the International Society for Infectious Diseases. In the latest report, 29 (16%) viruses containing the H275Y substitution were found during an analysis of 182 patients who were treated for 2009 H1N1 infections in the Hunter New England region between May and August. All were resistant to adamantanes as well as oseltamivir but sensitive to zanamivir (Relenza). Genetic analysis of the strains found they were similar to the vaccine strain and closely related, suggesting transmission of a single variant, the group reported. Only 1 of the 29 patients had been treated with oseltamivir. Most of the patients lived within a 30-mile radius of Newcastle, and some were household contacts or shared a short car ride. The authors urged clinicians in the Northern Hemisphere to be on guard for similar clusters. A recent report from the US Centers for Disease Control and Prevention (CDC) found that low-level community transmission of the oseltamivir-resistant 2009 H1N1 strain took place during the 2010-11 flu season. Though the report included a small number of cases, the authors found a higher prevalence in people who weren't treated with the drug, a change that bears watching.
Dec 29 N Engl J Med letter
Aug 26 CIDRAP News story on earlier Australian cases
Dec 19 CIDRAP News story on US cases

Workflow, equipment, and personnel efficiencies upped pandemic lab capacity
Using "Lean"-based workflow-efficiency methods, British Columbia's public health reference laboratory was able to increase the number of tests performed on flu viruses during the 2009 H1N1 pandemic 10-fold, according to a study in Emerging Infectious Diseases. The lab established a new rapidly scalable and standardized work process that involved breaking steps in the testing workflow into separate "cells," each assigned to a dedicated staff member. The Lean-based process also involved additional, higher-capacity equipment, an increased number of laboratory assistants, and cross-training to further bolster the testing staff. (The manufacturing industry uses Lean principles extensively.) These efficiencies and an extended workday (to 13.5 hours) enabled the lab to run a maximum 573 tests in 1 day during the pandemic, compared with a 53-test daily maximum in the 2008 flu season. The authors conclude, "The 2009 pandemic underscores the contributions of laboratories and the need for continuous improvements by using methods such as Lean."
January Emerg Infect Dis study

Crimean-Congo hemorrhagic fever virus in Spain, Egypt
Two letters to the editor in Emerging Infectious Diseases highlight the dangers of tickborne Crimean-Congo hemorrhagic fever virus (CCHFV), the first identifying it in wild ticks in Spain and the second in ticks found on imported livestock in Egypt. In the first letter, Spanish scientists report on collecting 117 semi-engorged Hyalomma lusitanicum ticks from red deer in Caceres, Spain, in November 2010. They then distributed the RNA of the ticks into 12 pools and retrotranscribed it. On polymerase chain reaction, 2 of the 12 pools showed amplicons of the expected size (211 bp). Only 1 of those could be sequenced, and it showed 98% genetic similarity with sequences recorded for CCHFV in Mauritania and Senegal in western Africa. CCHFV had not previously been confirmed west of the Balkans in Europe, according to the team. They say migratory birds could explain the virus's presence in southwestern Europe, but they could not rule out an ancient lineage.
January Emerg Infect Dis letter on CCHFV in Spain
In the second letter, US and Egyptian investigators report on 342 ectoparasites from slaughtered animals in Egypt collected in July 2009: 70 (20.5%) from 14 cattle, 52 (15.2%) from 17 buffalo, 6 (1.8%) from 2 sheep, and 214 (62.6%) from 10 camels. Only the camels were imported (from Sudan and Somalia). Of the parasites, 97% were ticks from the family Ixodidae, 76% of which were Hyalomma ticks. The remaining Ixodidae ticks were of the genus Boophilus. Of 138 pools tested (258 Ixodidae ticks), 6, all from Hyalomma ticks and all from camels, were positive for CCHFV. The authors conclude, "Although none of the domestic animals harbored infected ticks, it is not possible to conclude if these data reflect importation of CCHFV or infection acquired within Egypt."
January Emerg Infect Dis letter on CCHFV in Egypt

Dengue cases, deaths drop in Sri Lanka
Aggressive disease-control efforts have helped Sri Lanka decrease dengue fever cases 21% and deaths 30%, according to a story today from IRIN, the news service of the United Nations Office for the Coordination of Humanitarian Affairs. "Over the last 2 years we have gone all out to stop the spread of dengue. Now we are seeing some of the results," said Pabha Palihawadana, head of the Health Ministry's epidemiology unit. Dengue case declined from 34,105 in 2010 to 26,722 in 2011, according to the story, and deaths dropped from 246 to 172. In May 2010 the country began a huge anti-dengue campaign to increase awareness and clean up potential mosquito breeding areas. Troops tackled breeding areas, public health inspectors visited homes searching for breeding sites, and people faced criminal charges and fines for dumping trash in unauthorized locations. "It was with the fines and the environmental police that we saw the tide beginning to shift," Palihawadana said. The Sri Lankan government is drafting a National Dengue Prevention Act for 2012.
Dec 29 IRIN story

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