Flu Scan for Sep 30, 2014

News brief

Egypt reports H5N1 case in baby girl

Egypt's Minister of Health and Population, Dr. Adel Adawy, today announced a new case of H5N1 avian flu in a 3-month-old girl from Giza governorate, according to Outbreak News Today.

The girl became sick on Sep 22 with a fever, sore throat, cough, and vomiting. Her parents took her to a hospital, where she stayed for 3 days before being released. The child had been exposed to dead birds.

A throat sample was positive for H5N1 avian flu, the report said. The girl received oseltamivir (Tamiflu) and is in stable condition.

The new illness is the country's fifth H5N1 case this year, according to Egyptian health officials, though the World Health Organization has not confirmed any of them.
Sep 30 Outbreak News Today post
Jun 26 CIDRAP News scan on previous Egyptian case

Russia confirms 2 H5N1 outbreaks in backyard flocks

Highly pathogenic H5N1 avian flu has struck backyard flocks in two neighboring villages in southern Russia, the first time the country has reported the disease in birds in 2 years, according to a report today posted by the World Organization for Animal Health (OIE).

The outbreaks—both of which began on Sep 1—likely originated from contact with wild birds, an official from the country's Ministry of Agriculture said in the report.

In the first outbreak, the virus sickened 40 poultry in a village flock of 1,952 chickens, ducks, and geese, killing 4 of them. The remaining 4 sick birds were culled to prevent disease spread.

In the second outbreak, 286 chickens, ducks, and geese died in a flock of 793, and 18 additional birds were culled. All told, 326 birds were infected out of 2,745 susceptible birds, and 322 died. Twenty-two were culled. Officials did not destroy both flocks, however, which is often done with highly pathogenic H5N1.

The villages are in Altai Krai near the country's border with Kazakhstan, a region in Russia's Siberian federal district.

The report concludes, "Probably, hunted ducks and geese trophies had been placed in backyards where mortality occurred later in domestic birds."
Sep 30 OIE report

Study finds higher flu vaccine protection in previously unvaccinated

Results of a 5-year longitudinal study indicate that people not recently vaccinated against influenza have the most protective immune response to the seasonal flu vaccine, according to a study yesterday in Clinical Infectious Diseases that focused on two flu strains.

Researchers from Wisconsin and the CDC assessed data from the 2004-05 through 2012-13 flu seasons that included 7,315 enrollments, 1,056 of which (14%) were positive for H3N2 and 650 (9%) for influenza B. They calculated vaccine effectiveness (VE) for participants aged 9 years and older using logistic regression.

They found that vaccination during the current season only, previous season only, or both seasons yielded similar protection against H3N2 (adjusted VE range, 31%-36%) and B (52%-66%).

When they analyzed 5 seasons' data, however, they determined that current-season VE against H3N2 was significantly higher among those who had not received a vaccine in the previous 5 years (65%) compared with those who had frequently received the vaccine (24%, P = .01). VE against influenza B was 75% and 48%, respectively (P = .05). They had similar results when they restricted their analysis to adults aged 49 and younger.

The authors conclude, "Additional studies are needed to understand the long-term effects of annual vaccination."
Sep 29 Clin Infect Dis abstract

News Scan for Sep 30, 2014

News brief

Austria has first MERS case; Saudi Arabia reports another

Austria has reported its first MERS case, involving a visiting Saudi Arabian woman, while her home country has reported yet another case.

The Austrian health ministry said yesterday that the Saudi woman arrived in the country a few days ago and is now isolated in a Vienna hospital in critical condition, according to a Deutsche Presse Agentur (DPA) story today.

"The patient is responding to therapy and is on the path to stable condition," a hospital spokeswoman told DPA. The story did not list the woman's age, home city, or possible exposure sources.

Austria apparently is the 22nd country to have a MERS-CoV (Middle East respiratory syndrome coronavirus) case. An Aug 21 report from the European Centre for Disease Prevention and Control (ECDC) listed 21 countries that had reported cases by that date.

All the cases in countries outside the Middle East have had links to that region via travel, residence, or contact with another case-patient who visited there. In Europe, cases have also been reported in Germany, France, the United Kingdom, Italy, Greece, and the Netherlands, according to the ECDC.

Meanwhile, Saudi Arabia today reported that a 70-year-old Saudi man in Medina is hospitalized with MERS, marking the 12th case this month, after a summer lull. The country's Ministry of Health (MOH) said the man has preexisting disease and had contact with camels, which are suspected of spreading the virus to humans.

The case raises Saudi Arabia's MERS count to 754 cases, including 319 deaths; 426 case-patients have recovered and 9 are still being treated, according to the MOH.
Sep 30 DPA story
Sep 29 Austrian health ministry statement (in German)
Aug 21 ECDC report
Sep 30 Saudi MOH statement

Study: C diff rose 82% in US hospitals in 10 years

Clostridium difficile infections in US hospitals rose 82% from 2001 to 2010, according to a study today in the American Journal of Infection Control.

University of Texas researchers analyzed data on adult hospitalized patients from US National Hospital Discharge Surveys (NHDS) representing 2.2 million discharges for C difficile infection (CDI). From 2001 to 2010, CDI rates rose from 4.5 to 8.2 discharges per 1,000 total hospital discharges. The rate peaked in 2008, then tapered slightly, according to a press release from Elsevier, publisher of the journal.

Meanwhile, in-hospital mortality increased only slightly over the study period, from 6.6% in 2001 to 7.2% in 2010. The overall in-hospital mortality rate was 7.1%.

"Several factors may have contributed to the rise in CDI incidence in recent years," said Kelly Reveles, PharmD, PhD, lead author on the study. "Antibiotic exposure remains the most important risk factor for CDI."

According to the Centers for Disease Control and Prevention (CDC), C difficile is the most common bacterium responsible for healthcare-associated infections in US hospitals and is linked to 14,000 deaths each year, the release noted. Reducing the use of high-risk, broad-spectrum antibiotics by 30% could lower CDI by 26%, the CDC estimates.

Of the CDI discharges, 33% involved a principal diagnosis of CDI and the rest were classified as secondary CDI. And 7.1%, or 154,184 patients, died during the study period.

Reveles added, "The leveling off of CDI incidence toward the end of our study period may be the result of increased antibiotic stewardship programs and improved infection control measures."
October Am J Infect Control abstract
Sep 29 Elsevier press release

NIAID funds contracts for novel adjuvant candidates for vaccines

Seven institutions and companies are sharing in research contracts from the National Institute of Allergy and Infectious Diseases (NIAID) aimed at enhancing the protective ability of vaccines that could amount to $70 million over the contracts' 5-year span, the NIAID announced yesterday in a news release.

Adjuvants are components of vaccines that boost the body's immune response. Contracts awarded by NIAID in 2003 and 2009 "identified adjuvants that trigger a small set of receptors of the innate, or inborn, immune system," which confers long-term protection against various pathogens through helping shape adaptive (acquired) immunity, says the release.

The new contracts are meant to expand the scope of the earlier research to find any compounds involved in the direct or indirect activation of the adaptive immune system. Researchers will screen more than 1 million molecules to find ones potentially capable of doing this, determine how they work, make structural changes in them to optimize their immune-boosting abilities and safety, and test vaccines to which new adjuvant candidates have been added in animals.

The adjuvants currently approved for use in the United States are alum, included in many vaccines including those for hepatitis B and pneumococcal infections; AS04, which combines alum and a lipid and is used in Cervarix, a human papillomavirus (HPV) vaccine; and AS03, an oil-in-water compound added to the vaccine that would be used if an H5N1 avian flu epidemic were to occur.

Recipients of the new contracts are the University of California, San Diego; Boston Children's Hospital; Vaccine PTY LTD; Corixa Corporation; Duke University; Oregon Health & Science University; and the University of Kansas, Lawrence.
Sep 29 NIAID press release

FDA announces contract for medical countermeasures in emergencies

A 4-year, nearly $5 million contract to speed access to and evaluation of medical countermeasures used during public health emergencies has been awarded to the Critical Illness and Injury Trials Group (USCIITG), the US Food and Drug Administration (FDA) has announced.

The award, given through a collaboration of the FDA and the US Biomedical Advanced Research and Development Authority (BARDA), will fund the USCIITG Program for Emergency Preparedness (USCIITG-PREP) in developing processes and protocols to smooth the challenging process of collecting efficacy and safety data on medical products used in real-time, rapid-response situations.

Desired outcomes of the project include:

Developing and prepositioning a simple flu treatment protocol using intravenous zanamivir, an investigational flu treatment, in 10 US hospitals in the 2015-16 flu season and eventually in 20 hospitals
Creating an agreement between USCIITG-PREP hospitals to use a central institutional review board to speed approval of clinical protocols for emergency situations
Developing an electronic case report form for collecting data that converts it to a tabulation format
Creating a plan for dissemination of key findings from countermeasures in emergency settings to the FDA and other entities

It is hoped that the streamlined data collection and dissemination methods developed through the project will aid the FDA and federal partners in facilitating "timely decision-making about these important medical countermeasures to protect public health," states the FDA.
Sep 26 FDA press release