News Scan for Feb 28, 2014

FDA flu strain selection
H5N1 cases in Cambodia
Flu hospitalization in babies
Measles after vaccination

FDA picks flu vaccine strains for 2014-15 flu season

A US Food and Drug Administration (FDA) advisory panel today made its recommendation on strains to include for the next flu season vaccine. The move is part of a process that the Vaccine and Related Biological Products Advisory Committee (VRBPAC) conducts to review the most current flu strains, surveillance, and updates on vaccine performance, uptake, and manufacturing.

After hearing several detailed expert presentations, VRBPAC voted to include the strains recently recommended by the World Health Organization (WHO) for next season's Northern Hemisphere flu vaccine. The WHO announced its strain selections on Feb 20, which kept in place the same ones included in this season's seasonal flu vaccines.

VRBPAC members voted separately on each of the strains for the trivalent (three-strain) vaccine, as well as an additional influenza B strain for quadrivalent (four-strain) versions. The votes for all four strains were unanimous.

Adivsers recommended strains similar to A/California/7/2009 (H1N1), A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012. The group also included the WHO's recommendation for a second influenza B strain from the Victoria lineage, B/Brisbane/60/2008.

The vote today allows vaccine manufacturers to start the steps for formulating next season's flu vaccine, which takes about 6 months.

Sam Lee, PhD, Sanofi Pasteur's senior director for pandemic influenza strategy, told the group that the quadrivalent vaccine accounted for about 20% of the total doses distributed this season and is expected to make up about 50% of next year's vaccine doses.

Though vaccine production hasn't started yet, Lee said that, based on the information the company has, he doesn't anticipate any major issues.
Feb 28 VRBPAC meeting agenda
Feb 20 CIDRAP News story "WHO keeps same strains for next season's flu vaccine"


Two Cambodian girls test positive for H5N1 avian flu

Two girls, 10 and 11 years old, from the same Cambodian province have tested positive for H5N1 avian flu, according to a news release yesterday from the country's Ministry of Health (MOH) and the WHO.

The girls, from Tboung Khmum province (formerly part of Kampong Cham province), have both recovered from their illness after being hospitalized, the release said. Their cases bring the total H5N1 count in Cambodia this year to five.

The 10-year-old is from a village in Cheung Prey district. She developed a fever on Jan 26 and then developed a cough, runny nose, and abdominal pain the next day. Staff at the Naval Medical Research Unit 2 (NAMRU-2) in Phnom Penh took samples on Jan 29, which were confirmed to be H5N1-positive by the Institut Pasteur du Cambodge on Feb 20.

Upon H5N1 confirmation, the girl was transferred to Kampong Cham Provincial Hospital, where she was administered oseltamivir (Tamiflu). She has since recovered, the two agencies said.

The girl's mother had bought sick and dead village ducks on Jan 25, and the girl had helped prepare them to eat.

The 11-year-old girl, from Ponhea Krek district, first had a fever and cough on Feb 9. The next day she also experienced a runny nose, sore throat, and vomiting. Staff at NAMRU-2 took samples on Feb 10, which were confirmed to be H5N1-positive also on Feb 20. The older girl likewise was then prescribed oseltamivir and has recovered.

From Feb 7 to Feb 10, all 30 chickens owned by the girl's family died near her house. Relatives said the girl had no direct contact with the birds, but they had died "in close proximity" to the girl, according to the MOH/WHO press release.

Of 52 H5N1 cases in Cambodia since 2005, 40 have been in children younger than 14, the release said, and 34 have been fatal.
Feb 27 Cambodia MOH/WHO news release


About 6,500 babies each year are hospitalized for flu

About 6,500 US babies are hospitalized each year due to influenza, many with serious disease, according to new data from the Centers for Disease Control and Prevention (CDC) published in The Pediatric Infectious Disease Journal.

The researchers used population-based, lab-confirmed flu hospitalization surveillance data from 2003 through 2012. They found that an average 6,514 infants younger than 1 year were hospitalized each year, with a range of 1,842 to 12,502.

They also noted that 75% of the hospitalizations were in otherwise healthy babies, among whom up to 10% were admitted to intensive care units (ICUs) and up to 4% had respiratory failure. ICU and respiratory-failure rates, however, were two to three times higher in infants with high-risk conditions. And those younger than 6 months were 40% more likely to be admitted to the ICU than were older babies.

The team said that lung disease, heart disease, and neuromuscular disorders were risk factors for ICU admission.

They conclude, "The impact of influenza on infants, particularly those very young or with high risk conditions, underscore the importance of influenza vaccination, especially among pregnant women and those in contact with young infants not eligible for vaccination."
Feb 26 Ped Infect Dis J abstract


Measles outbreak involved patient who had 2 vaccine doses

A five-case measles outbreak in New York City in 2011 involved the first known reported case in a person who had received two doses of measles vaccine, according to a report yesterday in Clinical Infectious Diseases. The index patient then spread the disease to others who had either been vaccinated or had antibodies against measles.

New York and CDC researchers studied medical histories and immunization records of the patients involved. Among 88 of the index patient's contacts, 4 secondary cases were lab-confirmed and had either received two doses of measles vaccine or had a positive measles immunoglobulin G antibody test in the past.

Neutralizing antibody titers of secondary cases reached more than 80,000 milli-international units per milliliter (mIU/mL) 3 to 4 days after rash onset, while titers for the index patient were less than 500 mIU/mL 9 days after rash onset. There were no tertiary cases identified despite numerous contacts, the investigators reported.

The authors conclude, "This is the first report of measles transmission from a twice vaccinated individual. The clinical presentation and laboratory data of the index were typical of measles in a naive individual."
Feb 27 Clin Infect Dis abstract

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