NEWS SCAN: H7N9 serology study, Ebola suspected in DRC, steroid recall, EV71 vaccine trial, measles in Europe

May 29, 2013

Blood study finds no earlier H7N9 infections in Chinese poultry workers
Chinese researchers who looked at blood samples from poultry workers collected in 2012 for other studies found no evidence to suggest mild or asymptomatic human infections were occurring that time, according to a brief report today in the New England Journal of Medicine. The group from the Chinese Center for Disease Control and Prevention conducted serology tests on blood samples from poultry workers in the same part of eastern China where many of the human H7N9 cases were reported: the city of Shanghai, plus Zhejiang, Jiangsu, and Anhui provinces. The blood samples were collected from January 2012 to November 2012 as part of China's routine surveillance for subclinical avian flu. The 1,544 samples were from workers in live-poultry markets, farms, poultry yards, slaughterhouses, and wild bird habitats. For initial antibody screening scientists used a hemagglutination-inhibition (HAI) assay using turkey red cells. When HAI testing of 20 or more was found, the team used a microneutralization assay for confirmation, with a titer of 20 or more considered seropositive. Only 5 of the samples had HAI titers of 20 or more, and none of those were H7N9-positive by microneutralization assay. The researchers wrote that although no evidence of human H7N9 infection was found in the poultry workers before November 2012, it's possible that transmission from poultry to humans was occurring in other populations.
May 29 N Engl J Med correspondence

Ebola outbreak suspected in DRC
United Nations (UN) officials today said six suspected Ebola cases have been reported in an area of the Democratic Republic of Congo that had an outbreak in 2012, the South African Press Association (SAPA) reported today. Sylvestre Ntumba, with the UN's Office for the Coordination of Humanitarian Affairs told reporters at a briefing today that the cases were reported between May 1 and May 12 in Bas-Uele district in Orientale province, located in the northeastern part of the country. He said provincial health officials, with support from the World Health Organization (WHO), are in the area conducting an investigation and taking samples. Last year an outbreak in the same area was responsible for 62 infections, 34 of them fatal, according to the SAPA report.
May 29 SAPA story

Skin abscess reports prompt steroid injection recall
A Tennessee compounding pharmacy linked to reports of seven adverse events associated with its methylprednisolone acetate injections has recalled all of its sterile products, which were distributed nationwide, according to a recall notice yesterday by Main Street Family Pharmacy, LLC. The US Food and Drug Administration (FDA) warned health providers about the adverse events linked to the company's products on May 24. The company said the adverse events are in form of skin abscesses, one of which appears to be caused by a fungus. An investigation into the source of the adverse events is ongoing. The company said it has received reports of adverse events related to three lots of preservative-free methylprednisolone acetate, but it is recalling all of its sterile products as a precaution. The products have a use-by date on or before Nov 20, 2013. The company said the products were supplied to medical professionals and patients. A fungal illness outbreak linked to a Massachusetts compounding pharmacy that began in 2012 has so far sickened at least 741 people and killed 55.
May 28 FDA recall notice
May 24 CIDRAP News scan "FDA warns of injected steroids from Tennessee compounding center"

Good efficacy, safety found for EV71 vaccine
A phase 3 study of an enterovirus 71 (EV71) vaccine developed in China for preventing hand, foot, and mouth disease suggests that it is highly effective, with an acceptable safety profile, researchers reported today in The Lancet. The study took place from January 2012 through March 2013 and included 10,245 Chinese children ages 6 to 35 months. About half received an alum-adjuvant placebo and half received two doses of the vaccine administered 28 days apart. Developed by Beijing Vigoo Biological, the vaccine is a Vero cell alum-adjuvanted product targeted to the C4 genotype, the most common in mainland China. The study limited the number of vaccinated kids in each location to avoid any possible herd immunity effect. Vaccine efficacy against lab-confirmed EV71 infection was 90% (95% confidence interval [CI], 67.1% to 96.9%) and against EV71-associated disease was 80.4% (95% CI, 58.2% to 90.8%). The percentage of serious adverse events was consistent with previous findings: 1.2% in the vaccine group and 1.5% in the placebo group. Though the disease can be severe, few participants were hospitalized, a factor that played a role in the wide 95% confidence interval for efficacy, the group noted.
May 29 Lancet abstract

Europe sees little spring measles spike, but some countries miss targets
Over the past 12 months 14 of 30 reporting European countries have met their measles elimination target of less than 1 case per million population, the European Centre for Disease Prevention and Control (ECDC) said today in its monthly update. The new report covers the past 12 months to March 2013, during which 8,127 cases were reported through the surveillance system. The highest infection rates were reported in babies younger than 1 year old, followed by children ages 1 through 4 years old. The ECDC said the number of cases reported in March was half that for the same month in 2012 and that an expected spring increase so far has not been seen. Vaccination status was known for 95% of the reported cases, of which 82% involved unvaccinated kids. Though levels of unvaccinated cases were high among all age-groups, it was 78% in the group targeted by routine childhood immunizations: children ages 1 to 4 years old. The ECDC said France, Germany, Italy, Romania, Spain, and the United Kingdom reported 95% of all measles cases in the last 12 months. Disease transmission continues in England and Wales, where health officials launched a catch-up vaccine campaign to immunize 330,000 unvaccinated kids aged 10 to 16 years.
May ECDC measles and rubella monitoring report

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