News Scan for Nov 26, 2013

WHO confirms 3 MERS cases
Pertussis protection gap
More polio cases in Syria
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WHO confirms 3 Saudi MERS cases, 2 deaths

The World Health Organization (WHO) today confirmed three cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia that the country's Ministry of Health (MOH) first reported last week. Two of the cases proved fatal.

As has been the pattern with Saudi MERS-CoV cases, the WHO report contained little information on the cases.

Two patients, both of whom died on Nov 18, are from Riyadh. One was a 73-year-old woman with underlying medical conditions who became ill Nov 12 and was hospitalized Nov 14. The second is a 37-year-old man who developed symptoms Nov 9 and was hospitalized Nov 13. The Saudi MOH reported the first case Nov 19 and the second on Nov 21.

The third WHO-confirmed MERS case-patient is a 65-year-old man from Al Jawf region who has an underlying medical condition. He became ill on Nov 4 and was hospitalized on Nov 14, but the agency did not specify his current condition. On Nov 19 the Saudi MOH said he had been taken to an intensive care unit.

The WHO said none of the patients were exposed to animals or had contact with any confirmed cases.

Since September 2012 the WHO has reported 160 lab-confirmed MERS-CoV cases, including 68 deaths. Of those, 130 cases and 55 deaths have been from Saudi Arabia.
Nov 26 WHO statement
Nov 19 CIDRAP News story "Saudi Arabia reports 2 more MERS cases"
Nov 21 CIDRAP News scan on 37-year-old patient


Primate study hints at source of pertussis vaccine problem

As a clue that might help science unravel the reasons behind a steep rise in pertussis cases, researchers who conducted primate experiments found that the acellular vaccine wasn't able to prevent infection or prevent transmission. The study, conducted by researchers from the US Food and Drug Administration (FDA), appeared yesterday in Proceedings of the National Academies of Sciences (PNAS).

The scientists vaccinated baby baboons at ages 2, 4, and 6 months with either the acellular or whole-cell vaccine, then infected them with Bordetella pertussis at 7 months. Investigators monitored the animals' symptoms and took nasopharyngeal washes to assess colonization. To test transmission, they placed the animals in cages with unvaccinated ones.

Baboons immunized with the acellular vaccine were protected from severe symptoms but not colonization, and they didn't clear the infection any faster than naive animals. Also, they easily transmitted the pathogen to unvaccinated cage mates. The researchers also found that previously infected animals were not colonized when exposed to infection again.

Animals vaccinated with the whole-cell vaccine cleared the infection faster than the naive and acellular groups. Though all groups had robust immune responses, researchers found a key difference in the T-cell profile: The previous-infection and whole-cell groups showed a similar pattern.

The suboptimal response to the acellular vaccine may help explain some of the disease resurgence and suggests the need to develop better pertussis vaccines, the team concluded. They noted that the findings suggest the cocoon strategy many not help protect babies from pertussis, but that the vaccine seems to reduce serious disease and that efforts to boost vaccination should continue.
Nov 25 PNAS abstract

In another pertussis development, the Indian Academy of Pediatrics recently revised its pertussis vaccine recommendations, proposing whole-cell vaccination for the infant series.

The group based its recommendation on evidence of waning protection in acellular vaccines. It also recommended the tetanus, diphtheria, and pertussis (Tdap) vaccine for pregnant women to protect young infants. The position paper appears in Indian Pediatrics.
November Indian Pediatrics abstract


More polio cases in Syria, kidnapped Pakistani health workers released

Two new cases of polio caused by wild poliovirus type 1 (WPV-1) have been reported from Syria, bringing the total in the current outbreak there to 17, says a news report today from the WHO.

The first 15 case-patients were from Deir Al Zour province in the eastern part of the country; the two new ones are from rural Damascus in the southwest and Aleppo in the northwest, signaling widespread circulation of WPV-1. The risk of spread is considered high because of frequent population movements due to the political situation there, the report says.

Mass polio vaccination campaigns targeting 22 million children under age 5 are part of a regional outbreak response including seven countries and territories. Containment efforts are likely to continue for 6 to 8 months or more, and the WHO and the UN Children's Fund (UNICEF) are committed to vaccinating all children "no matter where they live," says the report.
Nov 26 WHO release

In other polio developments, Pakistani polio workers who were kidnapped from a school in the northwestern part of that country several days ago have been released, according to a BBC News report today. Apparently the militants responsible for the kidnapping, thought to be part of the Lashkar-e-Islam group, agreed to the release after the government said no more vaccination teams would be sent into the Bara area of the country's Khyber tribal region, says the story.

The number of people in the kidnapped group, said to include teachers, is not clear, but they are expected to reach Peshawar tomorrow. Pakistan is one of only three countries where polio remains endemic. Militants reportedly think vaccination workers are spies or are attempting to sterilize Muslims, according to the story.
Nov 26 BBC News item
Nov 25 CIDRAP News scan on the kidnapping

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