News Scan for Nov 15, 2013

Slow rise for US flu
USDA food safety chief to leave
US hantavirus cases
Smallpox vaccine delivered
Japanese encephalitis vaccine
CDC's emergency management affirmed

US flu activity slowly gains ground

Flu activity gained a bit more momentum last week but is still low overall, the US Centers for Disease Control and Prevention (CDC) said today in its weekly update. The percentage of respiratory specimens testing positive for flu rose again, to 5.4%, and for the first time one of CDC's regions—the one including south-central states such as Louisiana and Arkansas—saw clinic visits for flu-like illness rise above its specific baseline.

Most of the positive flu specimens were influenza A, and of the subtyped ones, 78% were the 2009 H1N1 virus. Antiviral-resistance testing found one additional 2009 H1N1 sample that was resistant to oseltamivir, raising the total so far to three.

The first two pediatric flu deaths of the new season were reported, one from an undetermined influenza A subtype and the other from an influenza A and B co-infection. Overall deaths from pneumonia remained below the epidemic threshold.

The CDC said it expects more flu increases in the coming weeks, and it urged people who have not been vaccinated to get their shots. In a separate update, it said 123.6 million doses of flu vaccine have been distributed from the 138 million to 145 million doses that manufacturers expect to make for the US market.

North of the border, the Public Health Agency of Canada (PHAC) said today that flu activity increased last week, and as in the United States, a larger percentage of influenza A detections have been of the 2009 H1N1 subtype.

Elsewhere, Europe's flu surveillance system picked up little sign of flu last week, with no evidence of sustained flu activity and all 27 reporting countries indicating low-intensity activity. Sentinel specimen testing found that only 2% of samples tested positive for influenza.
Nov 15 CDC FluView report
Nov 15 CDC flu vaccine update
Nov 15 PHAC FluWatch report
Nov 15 ECDC flu surveillance report


Hagen to leave position as head of USDA's FSIS

Elizabeth Hagen, MD, announced today that she will resign in December after serving close to 4 years as the US Department of Agriculture's (USDA's) under secretary for food safety and director of the agency's Food Safety and Inspection Service (FSIS).

In a USDA press release, Hagen said she will join the private sector when she departs in mid-December.

"It has been an ambitious three years," she said. "USDA and FSIS have successfully made preventing foodborne illness a real priority. The steps we have taken, from modernizing the agency, strengthening oversight of industry and increasing outreach to consumers has led to safer food and fewer foodborne illnesses."

USDA Secretary Tom Vilsack praised Hagen and said that under her leadership, the USDA adopted a new zero-tolerance policy for non-O157 strains of Escherichia coli in beef and adopted new standards to protect Americans from Salmonella and Campylobacter in poultry. She also spearheaded the development of a new Public Health Information System to better inform consumers about proper food handling and food safety, Vilsack said

In a news story on the meat industry Web site Meatingplace, several industry officials praised Hagen. Barry Carpenter, CEO of the North American Meat Association and a USDA veteran, told Meatingplace that Hagen "has been a strong advocate for the continuous improvement of food safety while understanding the realities of meat and poultry production. Her leadership and openness to all stakeholders has been key to her effectiveness [and] her efforts to modernize poultry inspection are a testament to her commitment to food safety."

Consumer groups commended Hagen as well, saying she brought a new level of respect to her post. "The very presence of a person with her training in and commitment to public health helped USDA move ahead in dealing with food," said a statement from the Consumer Federation of America.
Nov 15 USDA announcement
Nov 15 Meatingplace story
Nov 15 Consumer Federation of America statement


CDC notes 624 hantavirus cases in recent decades

In the 20 years since hantavirus pulmonary syndrome (HPS) was first identified, surveillance has confirmed 624 US cases, 96% of which have occurred west of the Mississippi River, according to a study published yesterday in Emerging Infectious Diseases.

Scientists from the Centers for Disease Control and Prevention (CDC) noted that the 624 cases of the rodent-borne disease occurred in 34 states, and the total includes 31 cases that occurred before 1993 but were retrospectively diagnosed from archived tissue or blood samples. Of 593 cases with known exposure locations, 570 (96%) happened west of the Mississippi. Four states logged more than 50 cases: New Mexico, 91; Colorado, 80; Arizona, 67; and California, 58.

Only 12 of the cases were caused by hantavirus species other than Sin Nombre virus: 5 by Bayou virus, 1 by Black Creek Canal virus, 2 by New York virus, and 4 by Monongahela virus.

The investigators also said 10 cases did not fit the CDC's clinical case definition of HPS and recommended that the case definition be broadened to include patients who don't have pulmonary symptoms.
Nov 14 Emerg Infect Dis report


Danish firm delivers last of 20 million smallpox vaccine doses to US

The Danish company Bavarian Nordic A/S announced today it has finished delivering 20 million doses of Imvamune smallpox vaccine to the US government, fulfilling a $549 million contract awarded in 2007.

Imvamune contains a weakened form of vaccinia virus and is intended for emergency use in people who have compromised immune systems, such as HIV patients and pregnant women, who face an increased risk of severe side effects if they receive the standard smallpox vaccine.

Bavarian Nordic began delivering doses to the US Strategic National Stockpile under the contract in 2010.

In April, the US government awarded Bavarian Nordic a new contract worth up to $228 million to supply 8 million more doses of Imvamune to maintain the 20 million-dose stockpile, the company said.
Nov 15 Bavarian Nordic press release


Japanese encephalitis vaccine recommended for at-risk kids

The CDC today recommended extending the indications for the inactivated, Vero-cell culture-derived Japanese encephalitis vaccine Ixiaro to children 2 months through 16 years of age who are traveling to areas in Asia where the disease poses a risk.

The vaccine had previously been recommended for travelers 17 and older en route to at-risk regions. The CDC's Advisory Committee on Immunization Practices (ACIP) voted on Jun 19 to broaden the indications for Ixiaro to children, and the CDC's notice today in Morbidity and Mortality Weekly Report (MMWR) makes it official.

In May the Food and Drug Administration (FDA) approved the use of Ixiaro in children. The vaccine, made by Intercell Biomedical, is the only FDA-approved vaccine for the disease.

Japanese encephalitis is a flavivirus-caused infection that can cause inflammation of the brain. It is endemic in parts of China, southeastern Russia, and South and Southeast Asia. Its case fatality rate is 20% to 30%, and up to half of survivors suffer neurologic or psychiatric effects, the CDC said in today's notice.

The agency said that providers, before administering the vaccine, should consider (1) the overall low risk for travel-associated Japanese encephalitis, which varies by destination and activities, (2) the lack of available treatment and seriousness of the disease, and (3) the high rates of seroprotection and low rates of serious adverse events associated with the vaccine.
Nov 15 MMWR notice


CDC's emergency management program earns accreditation

The CDC announced yesterday it has become the first federal agency to be fully accredited by the Emergency Management Accreditation Program (EMAP).

Accreditation means a program has completed the six-step EMAP process, including a self-assessment, an on-site appraisal, and a committee review, the CDC said in a press release. The on-site assessment and follow-up report include a summary of compliance with 64 EMAP standards, including program management; administration and finance; laws and authorities; operational planning; exercises, evaluations, and corrective action; and crisis communication, public education, and information.

"CDC's emergency management program has seen the nation through flu emergencies, multistate foodborne outbreaks, hurricanes and more," said CDC Director Tom Frieden, MD, MPH.

Since 1997, EMAP's independent assessors and program review committee have evaluated local, state, and national emergency management programs to ensure they meet nationally set standards and promote consistent quality, according to the CDC. Accreditation costs $50,000 and is valid for 5 years. Thirty-one states, the District of Columbia, and 14 cities and counties in the United States are accredited.
Nov 14 CDC press release
EMAP homepage

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