NEWS SCAN: H1N1 and lung bleeding, more Pakistan polio workers killed, avian flu in pigs, TB drug shortage

Dec 20, 2012

Lower respiratory tract bleeding reported in 2009 pandemic flu patients
Influenza should be considered in the differential diagnosis of patients who have hemoptysis (coughing of blood) or other signs or symptoms of lower respiratory tract hemorrhage (LRTH), say the authors of a study published today in Influenza and Other Respiratory Viruses. LRTH has been reported in connection with past flu pandemics and occurs rarely with seasonal influenza. Using state and local surveillance records and reports from the Emerging Infections Program and the Centers for Disease Control and Prevention's Infectious Diseases Pathology Branch for the period from April 2009 to April 2010, the authors identified 44 patients who had 2009 H1N1 pandemic flu and evidence of pneumonia and LRTH. The median time from illness onset to clinical signs or LRTH was 1 day. Hemoptysis or respiratory tract bleeding was documented in 40% of cases; 21 (48%) of patients with LRTH had no other hemorrhagic diatheses. Antiviral treatment was administered within 2 days of illness onset in seven patients (23%). The authors state that because of the rapid progression of LRTH, empiric antiviral therapy may be justified in affected patients.
Dec 20 Influenza Other Respi Viruses abstract

Some polio vaccination continues as 9th polio worker is killed in Pakistan
Polio immunization efforts in Lahore in eastern Pakistan are proceeding under armed guard while vaccination efforts in other parts of the country have been shut down because of the murders of nine immunization workers in a coordinated anti-vaccine effort, the Associated Press (AP) reported today. The number of workers killed has increased in the past two days by three, after six deaths were reported Dec 18. Six of the workers killed have been women, three of them teens, and two others are critically injured, the AP said. The Taliban has denied responsibility for the deaths in spite of past vocal opposition to polio vaccine efforts. About 6,000 workers were being escorted by 3,000 police officers in a province-led effort in Lahore, even though the United Nations officially suspended its entire Pakistan vaccination campaign yesterday. Sarah Crowe, a spokeswoman for the UN Children's Fund (UNICEF), said the UN vaccination program will not resume until a government investigation is completed, according to an AP story yesterday. "This is undoubtedly a tragic setback, but the campaign to eradicate polio will and must continue," she said. The Taliban has accused vaccination workers of being US spies and has claimed that the polio vaccine renders kids sterile. The group also objects to US drone strikes in Pakistan. Opposition grew last year when the CIA faked a hepatitis vaccination campaign to try to obtain DNA from residents of Osama bin Laden's compound in Abbottabad.
Dec 19 AP story

Three avian flu strains found in Chinese pigs
Three strains of avian-origin influenza that have not been reported previously in pigs have been identified in swine in southern China, according to a study in the Journal of Clinical Microbiology. Although pigs have been infected experimentally with all avian flu subtypes, natural transmission is rare. Samples were collected in 2010 through 2012 from 1,080 pigs aged 21 to 25 weeks and tested for H3, H4, H5, and H6 subtypes of avian flu virus as well as for H1 and H3 subtypes of swine influenza. Results were positive for H1N1 and H3N2 swine flu in 35% and 19.7% of serum samples and for H3, H4, and H6 avian flu in 0.93%, 1.6%, and 1.8% of samples, respectively. The researchers also retrospectively analyzed 550 samples taken from apparently healthy pigs in 2001 in the same geographic area and found no samples positive for any of these viruses, so transmission was considered recent. The findings are important in terms of potential pandemic flu virus generation because of pigs' role as intermediate hosts ("mixing vessels") in genetic reassortment of avian and human flu viruses.
J Clin Microbiol study
Dec 19 American Society for Microbiology news release

States report TB drug shortage
Seven states have reported a shortage of a key tuberculosis (TB) drug, the US Centers for Disease Control and Prevention (CDC) said today. According to an update in Morbidity and Mortality Weekly Report (MMWR), Illinois TB officials first reported a shortage of 300-milligram (mg) tablets of isoniazid (INH). Since then, California, Indiana, Maryland, New York, Virginia, and Wisconsin, among other programs, also have reported shortages, including difficulties obtaining IsonaRif (made by VersaPharm), one of the commercially available anti-TB combinations of rifampin and INH. INH and rifampin are the two most important drugs used to treat TB disease and latent TB infection (LTBI), the CDC said. The shortage of 300-mg INH tablets requires an increase in daily dosage for TB disease from 11 to 13 tablets and for LTBI from 1 to 3 tablets. Of the three US suppliers of INH, Teva reported low inventory and a possible backorder of INH 300 mg because of a shipping delay, Sandoz reported a shortage of the active ingredient from its supplier and estimates it will be able to fill orders for INH 100 mg and 300 mg in late January, and VersaPharm estimated it will be able to fill orders yet this month. At least one alternative INH-rifampin combination, Rifamate (Sanofi-Aventis), is available.
Dec 21 MMWR report

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