News Scan for Oct 02, 2015

Ebola in Guinean health workers
;
HPV vaccine against genital warts
;
Flu immunization in schoolkids
;
Influenza A vs influenza B

Health workers in Guinea had 42 times the risk of Ebola, report says

Healthcare workers (HCWs) in Guinea last year had an incidence of Ebola virus disease 42 times higher than non-HCWs, and lab technicians, physicians, and men were especially hit hard, according to a report today in Morbidity and Mortality Weekly Report (MMWR).

Researchers from the US Centers for Disease Control and Prevention and the World Health Organization pored through data on 2,210 lab-confirmed or probable Ebola cases in 2014 among patients 15 years and older, 162 of which (7.9%) involved HCWs. The rate among the country's HCWs was 140.5 per 10,000, compared with 3.3 per 10,000 in the general population—a rate 42.2 times higher.

HCW cases were reported in Conakry, the nation's capital, and 17 (52%) of Guinea's prefectures. Conakry saw the most cases by far, at 64, and N'Zerekore prefecture was second, with 17 cases. HCWs made up 20% of Ebola patients in Conakry.

Among Guinean HCWs, the incidence of Ebola infection was highest in laboratory technicians (34.7 per 1,000) and physicians (26.6 per 1,000), followed by midwives (8.7) and nurses (5.5). Of the 114 infected HCWs whose place of work was known, only 1 worked at an Ebola treatment unit.

Although no significant difference in HCW infection rates has been reported in Sierra Leone or Liberia, male HCWs appeared to be at increased risk in Guinea last year. They composed 75% of cases, in spite of accounting for just 46% of Guinean HCWs overall and 67% of physicians.

Fifty-seven percent of the HCWs in the study died, compared with 65% of non-HCWs.
Oct 2 MMWR report

 

HPV vaccine tied to 91% reduction in genital warts

Immunization with the quadrivalent (four-strain) human papillomavirus (HPV) vaccine was associated with a 91% reduction in the incidence of genital warts, according to a study of more than 19,000 girls and women in the Czech Republic published yesterday in Vaccine.

Researchers assessed population data on 19,199 girls and women 16 to 40 years old, of whom 1,086 had received the quadrivalent HPV vaccine. They found that the acquisition of genital warts was reduced by 90.6% in immunized women at least 1 year after completing the vaccination series. They determined that the prevalence of recurrent warts was 1.1% in vaccinated women and 10.9% in the unvaccinated cohort, for an overall vaccine effectiveness of 89.0%.

The investigators also found 97.6% protection of immunized girls or women who had a sexual partner with genital warts. They concluded that either the quadrivalent or nine-strain HPV vaccine should be recommended to reduce the incidence of genital warts.
Oct 1 Vaccine abstract

 

UK study notes benefits of expanded flu vaccination in schoolkids

Expanding the coverage of live attenuated influenza vaccine (LAIV) in Britain last season led to fewer flu-related disease outcomes among elementary-age schoolchildren but not older children in pilot areas in spite of drifted vaccine strains, according to a report from Public Health England in yesterday's issue of Eurosurveillance.

After rolling out an LAIV program in England in 2013, officials expanded the effort in the 2014-15 season to all children 2 to 4 years old, as well as an expansion of several pilot areas in which LAIV was offered to primary-age (4 through 11 years) and secondary-age (11 through 13 years) children. School- and pharmacy-based delivery was employed. The researchers sought to compare clinical and virologic respiratory endpoints between pilot and non-pilot areas.

An estimated 196,994 children of primary school age received at least one LAIV dose in the pilot areas, for an uptake of 56.8%, and 184,975 kids of secondary school age received at least one dose, for an uptake of 49.8%.

The researchers found that primary school children in the pilot areas saw the following reductions in lab-confirmed influenza: 94% among general practitioner (GP) consultations for flulike illness, 94% among hospital admissions, and 74% in respiratory-related emergency department visits. The reductions were even seen among children in this age-group who were not targeted for intervention. No such reductions were seen among the older children, whether targeted or not.

The authors conclude, "Vaccination of healthy primary school age children resulted in population-level impact despite circulation of drifted A and B influenza strains."
Oct 1 Eurosurveillance study

 

Study: Influenza A and B result in similar clinical course

The clinical presentation of influenza A and influenza B infection is very similar, according to a study yesterday in PLoS One of patients in France and Turkey.

In international team of researchers performed descriptive analyses and employed a multiple regression model to investigate disease characteristics of 774 influenza cases, including 419 influenza B cases (209 in France and 210 in Turkey) and 355 influenza A cases (205 in France and 150 in Turkey) during the 2010-11 and 2011-12 seasons. Data were collected at the swab test day, after about 9 days, and after about a month if the patient was still sick.

The investigators found no differences in clinical presentation or the number of consultations with a healthcare practitioner between flu A and B patients. The only difference was in use of antivirals, which was higher among flu B patients in both countries. The researchers noted that illness duration increased with age but did not differ by virus type.

They conclude, "Our findings show that influenza B infection appears not to be [a] milder disease than influenza A infection."
Oct 1 PLoS One study

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