News Scan for Sep 24, 2014

More EV-D68 cases
;
MERS case definition
;
Early H7N9 vaccine trials

US enterovirus D68 cases top 200 in 31 states and DC

Enterovirus D68 (EV-D68) has been confirmed in 220 patients in 31 states and the District of Columbia, up 45 cases and 5 states in the past 2 days, according to an update today from the Centers for Disease Control and Prevention (CDC). In addition, Rhode Island confirmed the first reported US case this year in an adult.

The five newly affected states are Massachusetts, North Carolina, Rhode Island, South Carolina, and Utah. The CDC said that all but one illness have been in children. Today the Rhode Island Department of Health (RIDH) said in a news release that the adult with EV-D68 was recently hospitalized but has since improved and been discharged.

The virus, which was fairly rare in the United States until now, causes cold-like symptoms but can lead to serious breathing difficulty, especially in children who have asthma, the CDC said. Infants, children, and teenagers are most at risk for symptomatic infections.

The CDC first highlighted the outbreak on Sep 8 after investigating clusters of hospitalized kids in Chicago and Kansas City, Mo. The agency said the primary reason for increases in cases is that several states are investigating clusters of patients who have severe respiratory disease and that testing for EV-D68 is complex and slow and can only be done by the CDC and a "small number" of state public health labs.

"As the backlog of specimens is processed, the number of states and confirmed cases will likely increase," the CDC said. "These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse."

Some increases will be from new EV-D68 infections, though, because we are in the middle of the enterovirus season, the agency said.
CDC update on affected states
Sep 24 RIDH press release
CDC enterovirus page

 

Saudi health ministry publishes new MERS case definition

Saudi Arabia's Ministry of Health (MOH) has published a new MERS-CoV case definition that differs slightly from those published by the World Health Organization (WHO) and the CDC, according to a report today in The Lancet Infectious Diseases.

Tariq Madani, MBBS, special MOH consultant on MERS-CoV (Middle East respiratory syndrome coronavirus), writes, "As new clinical information became available, a revision of the MERS-CoV case definition seemed appropriate." He said the new case definition was approved after seeking expert CDC opinion.

The new guidance adds a fourth category for suspected cases for contacts of MERS patients who have upper or lower respiratory tract symptoms.

Suspected cases—those who should be tested for MERS-CoV—now include people who:

  1. Have a fever and community-acquired pneumonia or acute respiratory distress syndrome
  2. Are hospitalized with healthcare-associated pneumonia
  3. Have an acute fever; body aches, headache, diarrhea, or nausea/vomiting with or without respiratory symptoms; and unexplained leukopenia (reduced white blood cell count) and thrombocytopenia (platelet deficiency)
  4. Were exposed to a confirmed or probable MERS patient and develop upper or lower respiratory illness within 2 weeks after exposure

Neither WHO or CDC case definitions delineate upper and lower respiratory symptoms regarding suspected cases but they do discuss respiratory illness. The revised MOH case definition also includes specifics for probable and confirmed MERS cases.

Madani also presents an algorithm for case management that says confirmed case-patients with no evidence of pneumonia can be isolated at home after careful assessment of the home situation, among other steps.
October Lancet Infect Dis report
WHO MERS case definition
CDC MERS case definitions

 

Early clinical trials show H7N9 flu vaccine safe, immunogenic

An adjuvanted H7N9 avian flu vaccine produced by Novavax, of Gaithersburg, Md., was well tolerated and immunogenic in a phase 1/2 clinical trial, the company said in a news release yesterday.

The randomized, placebo-controlled study of Novavax's virus-like particle (VLP) H7N9 vaccine candidate involved 610 volunteers. The trial tested VLP H7N9 vaccine with and without the company's Matrix-M adjuvant to boost immune response. Subjects received two doses of either placebo, 15 milligrams (mcg) of H7N9 VLP alone, or 3.75, 7.5, or 15 mcg of H7N9 VLP with Matrix-M.

The safety profile of the vaccine with and without Matrix-M was similar to the company's previous experience with another saponin-based adjuvant, according to the release. Novavax reported similar antibody response after two doses comparable to levels reported in prior studies with another saponin adjuvant.

"The vaccine also elicited anti-neuraminidase (NAI) antibodies against N9, with 89 to 100% sero-response rates in the adjuvanted vaccine groups, and greater than 11-fold increases in geometric mean titers," the company said. The company did not specify how it measured serologic response rates.

Novavax also said that the trial demonstrated dose-sparing possibilities, as even the 3.75-mcg dose with adjuvant induced immune response greater than the 15-mcg dose without adjuvant.

The Biomedical Advanced Research and Development Authority (BARDA) of the Department of Health and Human Services in 2011 awarded Novavax a contract worth up to $179 million for the advanced development of recombinant flu vaccine products and manufacturing capabilities as part of pandemic preparedness. This has included tests of its VLP influenza vaccines.
Sep 23 Novavax news release

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