Flu Scan for Oct 02, 2013

News brief

Modeling tool finds H7N9 transmission low, slowed by market closures

Researchers who used a sophisticated modeling approach incorporating H7N9 case data from China found hints that the virus has low transmission potential and that the pace of infection slowed in April after officials closed live-bird markets. The study, published in BMC Medicine today, was conducted by a team from the National Institutes of Health, Arizona State University, and George Washington University.

The investigators used a Bayesian modeling technique to assess if the outbreak had a reproduction (R) number consistent with unsustained human transmission and if interventions reduced transmission. They compared their estimates with other zoonotic pathogens, including H5N1 avian influenza, variant H3N2 (H3N2v) flu, and Nipah virus.

Based on 130 lab-confirmed cases reported in China from March through May 20, their analysis found that transmission was low in Shanghai and Zhejiang province, and at 0.6 the R was well below the 1.0 level needed to sustain transmission. Researchers also found that the growth rate slowed in mid April, which coincided with the closure of live-bird markets in large Chinese cities in early April. Compared with other zoonotic threats, the transmission threat from H7N9 was lower.

The authors said that, alhough the findings were based on a small number of cases and need to be confirmed, the modeling technique could be useful for measuring outbreak progression and the impact of control measures in the months ahead and provides a tool for monitoring pandemic potential in near real-time.
Oct 2 BMC Medicine abstract

CDC issues H7N9 prophylaxis guidance, treatment update

The US Centers for Disease Control (CDC) recently posted its first interim guidance on antiviral chemoprophylaxis for close contacts of people with H7N9 avian flu infections and updated its interim recommendations for antiviral treatment of confirmed or probable cases. The CDC posted the new guidance on Sep 30, the eve of the federal government shutdown.

The CDC posted its initial antiviral treatment guidance in the middle of April, soon after human H7N9 started emerging in China. At the time, the agency said it was working on close contact prophylaxis guidance but could advise health practitioners who needed help with that measure.

The CDC said the goal of the antiviral prophylaxis guidance is to limit the spread of the virus if H7N9 infections are detected in the United States, based on current patterns in China, where sporadic H7N9 cases are linked to poultry and possible limited human-to-human transmission is occurring. The CDC said it would update the guidance if the situation changes.

The recommendations define close contacts and say clinicians should base antiviral prophylaxis decisions based on the patient's risk status. Close contact is defined as being within about 6 feet or within the room or care area of a confirmed or probable case-patient for a prolonged period or in direct contact with infectious secretions, such as being in the path of a sneeze, while a patient was likely infectious.

Close contacts should be monitored for 10 days after the last known exposure to a confirmed or probable H7N9 case-patient, the CDC said. Prophylaxis is indicated for those in high-risk groups, which include household or close family members.

Health workers should consider prophylaxis for people in moderate-risk groups, which include medical staff who had higher risk contact with confirmed or probable case-patients. However, the CDC doesn't recommend prophylaxis for people in low-risk groups, such as those who had brief social contact with a confirmed or probable case-patient.

Treatment guidance updates are in line with the most current epidemiology regarding H7N9 infections and is consistent with other CDC and World Health Organization recommendations, the CDC said.

The main change in the treatment update applies to outpatient cases under investigation. Patients who had recent close contact with a confirmed H7N9 case-patients should still receive antiviral treatment, but treatment isn't recommended for outpatients under investigation who meet only travel exposure criteria.
Sep 30 CDC updated guidance on antivirals for H7N9 treatment
Sep 30 CDC guidance on antivirals for H7N9 prophylaxis

News Scan for Oct 02, 2013

News brief

Global health groups release plan to fight TB in children

The World Health Organization (WHO) and other health groups yesterday launched what they billed as the first global action plan to stop tuberculosis (TB) in children, saying it could save as many as 74,000 lives each year.

The "Roadmap for Childhood TB: Towards Zero Deaths" estimates that $120 million per year, pledged by governments and other donors, could have a major impact on TB in children, including those infected with both TB and HIV, the WHO said in a press release.

The agency said TB, which is treatable and preventable, kills more than 200 children under age 15 each day and that 6% to 10% of TB cases globally are in this age-group.

The $120 million in promised funds includes $40 million for HIV antiretroviral therapy and TB-preventive treatment in children who have both infections, the WHO said. The funds will also be used to improve TB detection, develop better medicines for children, and integrate TB treatment into existing maternal and child health programs.

"Getting more pediatric health professionals to actively screen for TB with better tools, ie, drugs, diagnostics, and vaccines, will help capture the full scope of the epidemic and reach more children with life-saving treatment sooner," the WHO said.

The action plan recommends 10 actions at national and global levels. Examples include considering children's needs in research, policy development, and clinical practices; collecting and reporting better data, including preventive measures; and developing training and reference materials on childhood TB for health workers.
Oct 1 WHO press release

Mexican cholera outbreak grows to 46 cases

Cases of cholera in Mexico rose from 10 less than a week ago to 46 in central Mexico, the Pan American Health Organization (PAHO) reported yesterday.

Two of the cases are in the Federal District and 44 are in Hidalgo state, PAHO said. The fatality count remains at one. On Sep 26 PAHO listed the two cholera cases in the Federal District but only eight in Hidalgo.

Patients' ages range from 2 to 82 years. Mexican officials have taken mitigation steps such as ensuring basic sanitation in communities, the report said.

PAHO also said that cholera cases in an outbreak in Haiti that began in October 2010 have now reached 678,840, with 8,289 deaths. The rate of new cases during the spring and summer this year, however, was lower than during the same period last year.

The Dominican Republic has confirmed 31,021 cases and 456 deaths since November 2010, PAHO reported.
Oct 1 PAHO report
Sep 27 CIDRAP News scan "Mexico reports cholera outbreak"

IOM publishes standards of care toolkit for crises

The Institute of Medicine (IOM) published a new toolkit for hospitals and long-term-care providers to develop crisis standards of care for pinpointing indicators and triggers when dealing with public health emergencies.

The publication, "Crisis Standards of Care: A Toolkit for Indicators and Triggers," covers indicators and triggers for both a "slow-onset scenario," such as an influenza pandemic, and a no-notice scenario, like an earthquake. The IOM defines "indicators" as pertinent data, and says about triggers, "When specific indicators cross a threshold that is recognized by the community to require action, this represents a trigger point, with actions determined by community plans."

"Crisis Standards of Care" features customized discussion toolkits to help organizations tailor indicators and triggers to their own situation. The publication contains scenarios, key questions, and examples of indicators, triggers, and tactics to promote discussion.

The toolkit also contains chapters directed toward emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.
Sep 27 IOM publication