Avian Flu Scan for May 15, 2015

News brief

Global panel: H5N1 surge in Egypt likely due to more poultry contact

The recent dramatic increase in human cases of H5N1 avian flu in Egypt is likely not related to virus mutations or changing epidemiology but rather to more people becoming exposed to infected poultry, according to the joint findings of experts from six leading organizations, the World Health Organization (WHO) said in a press release today.

From November 2014 through April, 165 Egyptian H5N1 cases were reported, including 48 deaths, the WHO release said.

(That number, though, is a bit of an undercount, according to FluTrackers, an infectious disease news message board that has been tracking cases closely. FluTrackers, which bases its numbers on official reports, says at least 175 cases have occurred in that period. But either way, the surge is unprecedented in the history of the disease.)

"Based on all the evidence we have, we believe the upsurge is not explained by changes in the virus itself," said Keiji Fukuda, MD, MPH, WHO assistant director-general for health security and head of the H5N1 investigation team in Egypt, which included the WHO, the World Organization for Animal Health (OIE), the United Nations Food and Agriculture Organization (FAO), the UN Children's Fund (UNICEF), the US Centers for Disease Control and Prevention, and US Naval Medical Research Unit 3 (NAMRU-3) in Cairo.

"The most likely reason for the increase in cases is that more poultry in Egypt are infected by H5N1 and so more people are exposed to this virus," Fukuda added. "Coupled with insufficient awareness, behavioural patterns and inadequate precautions taken by humans when interacting with poultry, this explains what we are seeing."

The WHO noted, "There are indications that H5N1 is circulating in all sectors of poultry production and in all parts of Egypt."

The expert panel determined these factors about the surge of cases:

Although human-to-human transmission cannot be excluded, key epidemiologic and demographic features of cases did not change significantly
There was no evidence of transmission from patients to healthcare workers
About 70% of cases involved known exposure to infected backyard poultry
Genetic sequence data revealed no changes to indicate more efficient human-to-human transmission

May 15 WHO news release
May 15 expert panel executive summary
May 15 FluTrackers post on case numbers

Fujian province H7N9 case adds to China's total

A report of one more H7N9 avian influenza infection, involving a 5-year-old girl from Fujian province, has been detected in China, according to monthly and weekly surveillance reports translated, analyzed, and posted by FluTrackers, an infectious disease news message board.

Reports suggest the girl from Quanzhou got sick sometime at the end of March or early April and has recovered. An investigation found that she had been exposed to poultry or their environments.

The additional case lifts the H7N9 total to 663 cases, according to a running case list kept by FluTrackers.

The WHO said in an update yesterday that cases in China have declined recently, but it expects that sporadic cases will continue to be detected in the country's affected areas or possibly in neighboring countries.
May 14 FluTrackers thread
FluTrackers H7N9 case list
May 14 CIDRAP News scan "WHO confirms 6 recent H7N9 cases in China"

News Scan for May 15, 2015

News brief

UK group suggests $2 billion fund to develop antibiotics

To help address the growing problem of antibiotic resistance and the lack of new antibiotics in the pipeline, a new report commissioned by the UK government recommends establishing a $2 billion "global innovation fund" and separating drug companies' profits from drug sales, according to a news release from Review on Antimicrobial Resistance, which published the report, its third in a series.

The report recommends three types of targeted interventions: (1) paying successful pharmaceutical companies to support the highest-priority antibiotics, (2) committing more funding to early-stage research, and (3) fostering innovative partnerships between academia and industry during early development steps.

As a "pump-priming" measure, the report says the $2 billion innovation fund would be established by drug companies and would be used for basic research on bacterial resistance, improved diagnostics, and studies of the efficacy of old antibiotics.

The report proposes a system in which a global organization would have the authority to commit lump-sum payments to successful drug developers. "Such an approach would 'de-link' the profitability of a drug from its volume of sales, supporting conservation goals by eliminating the commercial imperative for a drug company to sell new antibiotics in large quantities—a key factor in contributing to the development and spread of resistance," the report says.

The Review on Antimicrobial Resistance, often called the O'Neill Commission, is chaired by former Goldman Sachs economist Jim O'Neill. The group said in a news release that an investment of $16 billion to $37 billion over 10 years could achieve a substantially revitalized antibiotic pipeline. The US Centers for Disease Control and Prevention (CDC) estimates that antibiotic resistance costs $20 billion a year in excess US healthcare costs.
May 14 full report
May 14 Review on Antimicrobial Resistance news release

Indiana HIV study shows same strain, recent introduction

A preliminary analysis of HIV samples from 72 people infected in Indiana's HIV outbreak shows that nearly all have the same strain, which was introduced to the region within the last 6 to 12 months, the Associated Press (AP) reported yesterday, citing state health officials and the CDC, where experts conducted the study.

Indiana State Department of Health (ISDH) spokesman Ken Severson told the AP that 69 of 72 people whose samples were tested had the same strain.

The findings are a stark reminder of how rapidly HIV can spread among intravenous drug users, Beth Meyerson, PhD, with Indiana University's Rural Center for AIDS/HIV Prevention, said.

A CDC official told the AP that the agency is working to determine if the strain in Indiana has been detected elsewhere and is related to other strains. In an update yesterday, the ISDH said 155 infections have been detected so far, 154 confirmed and 1 preliminary positive.

The outbreak, which surfaced in March, has affected a rural community centered in Scott County in southeastern Indiana. The outbreak prompted the state's governor to declare a health emergency and the CDC to issue a Health Alert Network warning, urging states to look for other similar clusters.

A profile in Morbidity and Mortality Weekly Report said the outbreak occurred in area that has a high unemployment rate and poor access to healthcare. It described multigenerational injection drug abuse of prescription opioid oxymorphone within households that has been going on for about the past decade.
May 14 AP report
May 14 ISDH update
Apr 24 CIDRAP News story "Indiana HIV outbreak grows, prompts national alert"