NEWS SCAN: NY Times critiques H5N1 studies, H5N1 in India, totally drug-resistant TB, flu and cancer

Jan 9, 2012

New York Times criticizes controversial H5N1 transmission studies
The editors of the New York Times asserted that a controversial study that produced a readily transmissible H5N1 virus should never have been conducted and that—as recommended last month by a federal biosecurity committee—the details should not be published. "In this case it looks like the research should never have been undertaken because the potential harm is so catastrophic and the potential benefits from studying the virus so speculative," says the Jan 7 editorial. It refers to the study led by Ron Fouchier of the Netherlands, in which an H5N1 virus was passed serially through ferrets, leading to mutations that allowed it to spread through the air. (A study by Yoshihiro Kawaoka of the University of Wisconsin reportedly yielded similar results.) The National Science Advisory Board on Biosecurity (NSABB) has recommended that methodologic details of the studies be withheld from publication but provided to scientists who need them. The Times editors wrote, "We doubt that anything at all should be published," adding that if the studies are published, the details should be shared with only a few laboratories. The editorial questions the cited justifications for conducting and publishing the studies, such as the surveillance benefits of knowing which mutations led to increased transmissibility. It is "improbable" that the virus would mutate in nature the same way it did in the lab, the editors said, "so the benefit of looking for these five mutations seems marginal." They also asserted that the virus in Fouchier's lab should be destroyed. The Times' stance contrasts with that of the US Department of Health and Human Services, which said in December that it agreed with the NSABB's assessment that the general findings were important to the public health and research communities.
Jan 7 Times editorial

H5N1 detected in poultry in India
Officials in the eastern Indian state of Odisha alerted authorities statewide after a poultry sample from the Khordha district tested positive for H5N1 avian flu, a story from the Indo-Asian News Service (IANS) said today. After hundreds of crows died in parts of the state, officials tested about 300 birds, mostly crows and poultry, according to the story. The High Security Animal Disease Laboratory in Bhopal reported yesterday that a poultry sample tested positive for H5N1. Officials asked all 30 districts to remain alert and take samples from birds that have flu-like symptoms. Less than 2 weeks ago, India declared itself free of avian flu, according to earlier media reports.
India reports cluster of totally resistant TB cases
Researchers in India have reported 12 cases of totally drug-resistant tuberculosis (TDR-TB), which involves a type of bacteria that resists first- and second-line antibiotic treatment, the Times of India reported. India is the second country to report TDR-TB; Iran first reported cases in 2009. Researchers from the Hinduja National Hospital and Medical Research Center in Mumbai described India's first four cases in a Dec 21 letter in Clinical Infectious Diseases (CID), but the Times article offers more details. All but 2 of the 12 TDR-TB cases are from Mumbai, and all cases were resistant to 12 drugs, the story said. Dr Zarir Udwadia, who coauthored the CID letter, told the Times that the emergence of the new form of TB has grave implications for human health. In the CID report, the doctors who conducted the drug susceptibility tests on the four patients described their methods and assessed the prescriptions that three of them had received. They found that the patients had received erratic, unsupervised, and often incorrectly prescribed treatment with second-line drugs from multiple private physicians. They suggested that only 1% of India's multidrug-resistant TB patients have access to targeted treatment initiatives.
Jan 7 Times of India story
Dec 21 CID letter extract

Study tracks clinical outcomes with H1N1, seasonal flu in kids with cancer
Kids with cancer who contracted 2009 H1N1 pandemic flu (pH1N1) had less severe illness by some measures but higher death rates compared with their counterparts who had seasonal flu, according to University of Texas researchers. The team analyzed data from 76 lab-confirmed flu cases at a pediatric cancer center, 20 of pH1N1 and 56 of seasonal flu. They found that, compared with seasonal flu patients, pH1N1 patients had significantly lower APACHE II scores, an indicator of disease severity (median 9 vs 14), fewer comorbidities (15% vs 46%), more solid tumors (45% vs 16%), more lower respiratory tract infections (20% vs 4%), higher rates of antiviral therapy (90% vs 48%), and higher mortality (10% vs 0%). They conclude, "Early diagnosis and prompt initiation of antiviral therapy may prevent serious complications of influenza in children with cancer."
Jan 5 Pediatr Infect Dis J abstract

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