Flu Scan for Nov 11, 2013

H5N1 death in Cambodia
Low global flu levels
Gelatin allergy and flu shots
H5N1 drug susceptibility

Cambodian 10-year-old with H5N1 has died

A 10-year-old boy from Kampot province in Cambodia who was reported to have H5N1 avian flu last week has died, The Cambodian Daily reported today. The boy is the second child to die from the disease in the country in 2 weeks.

In addition, Cambodia's Ministry of Health (MoH), and the World Health Organization (WHO), in a joint statement on Nov 8, confirmed the case. The boy, from Sdok Thlok village, developed a fever on Oct 28, according to the statement. His parents sought local treatment for the boy, but his condition deteriorated.

He was admitted to Kantha Bopha Hospital in Phnom Penh, on Nov 7 with fever, cough, sore throat, a distended abdomen, and difficulty breathing, the statement said. Lab samples were taken that day and tested positive for H5N1, and he began to receive oseltamivir (Tamiflu) on Nov 7 as well.

He died on Nov 9, The Cambodian Daily said. A 2-year-old girl from Pursat province who had H5N1 flu died on Oct 26, the WHO earlier confirmed

The boy's infection marks the 24th case this year, of which 13 have been fatal. Since 2005, the country has confirmed 45 H5N1 cases and 32 deaths. Of the 45 cases, all but 9 have been in children younger than 14 years, the MoH and WHO said.
Nov 11 Cambodian Daily story
Nov 8 Cambodia MoH/WHO statement


Northern Hemisphere flu activity remains low, WHO says

Influenza-like illness activity in many European countries is starting to rise, but overall influenza detections in the Northern Hemisphere remain low, the WHO said in an update today.

North America and Europe overall are reporting low flu activity, the WHO said, but "a few countries" in Europe are reported sporadic influenza detections in samples. Other temperate regions in the Northern Hemisphere are also reporting interseasonal flu levels.

The Southern Hemisphere is likewise reporting low influenza activity, but Australia and New Zealand both experienced a recent uptick, the WHO said.

In its weekly virus activity report, the agency said so far 992 clinical samples worldwide have tested positive for influenza. Of those, 746 (75.2%) were influenza A and 246 (24.8%) influenza B. Of the subtyped influenza A viruses, 293 (64.1%) were H3N2 and 164 (35.9%) were 2009 H1N1.
Nov 11 WHO flu activity report
Nov 11 WHO flu virus report


Flu shot could cause mild to severe reaction in those allergic to gelatin

People with a suspected or known gelatin allergy should take precautions when getting a flu shot, says a news release from the American College of Allergy, Asthma and Immunology (ACAAI).

How would one recognize such an allergy? According to the article, marshmallows, which contain gelatin, might make the tongue swell, or gummy bears, which also do, might bring about an itch.

Gelatin, which can contain proteins derived from animals or fish, is used in flu (and other) vaccines as a stabilizer, according to the release. Gelatin allergies, which are "very rare," according to allergist Stephanie Albin, MD, can cause hives, swelling, itching, sneezing, difficulty breathing, and even anaphylaxis in certain people.

A case report presented in a poster session at the ACAAI Annual Scientific Meeting in Baltimore discusses a case of anaphylaxis after a flu shot in a gelatin-allergic patient.

People who think they may have a gelatin allergy should not automatically avoid flu shots, however. According to ACAAI President Richard Weber, MD, "Those who believe they might have an allergy should be tested and diagnosed by an allergist before taking extreme avoidance measures or skipping vaccination." Precautions in a gelatin-allergic patient might include having the flu shot given by an allergist in case a reaction should occur, says the release.
Nov 8 ACAAI news release


Study finds some H5N1 viruses in birds less susceptible to antivirals

Many H5N1 avian flu viruses circulating in Vietnamese poultry show lowered susceptibility to common antiviral drugs, according to findings of a Nov 8 study in Emerging Infectious Diseases.

Researchers, many from the US Centers for Disease Control and Prevention, assessed drug susceptibility of 125 H5N1 viruses from poultry specimens collected from 2009 to 2011. The antiviral agents tested were the M2 blockers amantadine and ramantadine; the neuraminidase inhibitors oseltamivir (Tamiflu), zanamivir (Relenza), peramivir, and laninamivir; and the investigational agents DAS181 and favipiravir (T705). Viruses were assigned to three clades: 1.1,, and 2.3.4, with clade 2.3.4 further divided into three subclades.

Of 25 clade 1.1 viruses, all had S31N in the M2 protein, the most common marker of resistance to the M2 blockers; the remaining viruses had no known markers for M2 blocker resistance. Twenty-four of the clade 1.1 viruses were inhibited by the neuraminidase inhibitors.

Of 70 clade viruses, 1 had the H275Y marker of oseltamivir resistance and showed much-reduced inhibition by oseltamivir and peramivir. Clade viruses are being seen with increasing frequency in northern Vietnamese poultry, note the authors, and the H275Y marker has been reported in oseltamivir-treated patients.

Of 30 clade 2.3.4 viruses, 3 had an I223T mutation and a sevenfold reduced inhibition to oseltamivir.

According to the authors, their findings "emphasize the need to enhance the armamentarium of available anti-influenza drugs worldwide."
Nov 8 Emerg Infect Dis study

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