Flu Scan for Jun 06, 2013

H5N1 challenges in Cambodia
;
H7N9 developments

Study tallies obstacles to treating H5N1 patients in Cambodia

A study that profiled H5N1 avian infections and their costs in Cambodia found that care of the typically young patients is hampered by hospitalization delays, inadequate antiviral treatment, and poor access to mechanical ventilation, researchers reported today.

Scientists from Cambodia and the London School of Hygiene and Tropical Medicine reported their findings in BMC Public Health. Their goal was to gauge the burden of the disease in one of Southeast Asia's poorest countries, which has many gaps in its healthcare system and one of the world's highest mortality rates for H5N1 infection.

The study focused on 18 patients who had lab-confirmed infections between January 2005 and August 2011, two of whom were treated in Vietnam. Sixteen of them died within 24 hours of hospital admission.

Although the delay between symptom onset and hospitalization wasn't much different from that in other developing nations, fewer Cambodians received antiviral treatment, and when they did receive it, it was delayed.

No parenteral or oral ostelamivir (Tamiflu) was reported to be available in Cambodia, which the group said may have affected the care of children with H5N1. They also found excessive use of antibiotics and corticosteroids. None of the patients treated in Cambodia received mechanical ventilation.

The average per-patient cost for H5N1 care in Cambodia was $300, most of which went toward diagnostic testing and medications.

The researchers concluded that a highly pathogenic flu outbreak in Cambodia could be catastrophic, but that prompt antiviral treatment could lower costs and improve care.
Jun 6 BMC Public Health abstract

 

Chickens shed H7N9 virus in quantity; Medicago tests H7 vaccine

Scientists at a US Department of Agriculture (USDA) lab in Athens, Ga., who are conducting tests with the new H7N9 influenza in poultry have found that chickens and quail shed high volumes of the virus, which could shed light on risks to humans in Chinese live poultry markets, the Canadian Press reported yesterday.

David Swayne, PhD, who directs the USDA's Southeast Poultry Research Laboratory, told the Canadian Press that pigeons, ducks, and geese also can be infected by H7N9 but that they don't shed the virus in significant amounts. Swayne said avian flu viruses typically infect birds in the gut and shed the virus through droppings, but researchers found H7N9 in the nasal passages of chickens and quail.

The findings suggest that chickens and quail played a key role in the spread of the virus, given the amount of virus they shed, Swayne said.
Jun 5 Canadian Press story
In other H7N9 developments, Medicago, a pharmaceutical company based in Quebec City, today announced the first results of preclinical tests of its candidate H7N9 vaccine.

Nathalie Landry, Medicago's vice president of product development, said in a statement that the H7 vaccine elicited a solid antibody response in mice after a single dose. The company said 3 micrograms of the plant-based virus-like particle (VLP) vaccine, administered with and without an adjuvant (glucopyranosyl lipid A), induced high antibody titers.

The findings appear to be the first preclinical results for an H7N9 vaccine. Landry said results from challenge studies should be available in the coming month.

Prospective studies haven't yet identified hemagglutination inhibition titers linked to protection against lab-confirmed flu. A lack of recognized correlates of protection for live-attenuated influenza vaccines (LAIV) is expected to pose challenges for interpreting the immunogencity of candidate H7N9 vaccines.
Jun 6 Medicago press release

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