News Scan for Apr 04, 2016

News brief

WHO details maternal-fetal Zika findings in Martinique microcephaly case

The World Health Organization (WHO) on Apr 1 shared more information about Martinique's first probable Zika-related microcephaly case, which documents Zika virus infection in the mother and the fetus.

Also, Brazilian researchers today reported on clinical patterns they saw in people who tested positive for the virus in an acute care clinic, and the US Centers for Disease Control and Prevention (CDC) added Fiji to its list of countries for which is has travel advisories.

A series of serology tests in December, January, and February confirmed flavivirus and other infections in the Martinique mother. In the second test in January she was positive for immunoglobulin G (IgG) against flavivirus and chikunguna and for IgM antibodies against Zika virus.

The microcephaly diagnosis was made at just over 22 weeks gestation on Mar 10. A week later, amniotic fluid and fetal blood samples were positive for Zika virus on polymerase chain reaction testing, and the results were confirmed on Mar 22. Doctors had recommended medical termination of the pregnancy.

Details of the case help shed light on maternal and fetal Zika virus infection, suggesting that the risk is high during early pregnancy, though more investigations are needed to fully describe the role of the virus in the development of congenital abnormalities, the WHO said. It added that the case shows that the fetus can test positive for the virus months after the mother's initial infection.
Apr 1 WHO statement

Rash was the most common Zika symptoms that sent patients to doctor's offices, according to a retrospective case series of 57 Brazilian patients described today in a letter in Emerging Infectious Diseases.

The convenience sample reflects people who were seen at an acute care clinic in Rio de Janiero from Apr 28 to Jun 8, 2015, and tested positive for the virus. Rash was reported by 98% of patients. Other common symptoms included headache (67%), low-grade fever (67%), joint pain (58%), and muscle pain (49%). Conjunctivitis and retro-orbital eye pain were also seen in more than a third of the cases.
Apr 4 Emerg Infect Dis letter

Finally, the CDC today posted a "level 2" Zika virus travel notice for Fiji, which means travelers should practice enhanced precautions such as avoid mosquito bites. It also recommends that pregnant women or those planning on becoming pregnant not travel to such countries or territories, which now number 42.
CDC travel notice page

Study: Women more likely than men to receive antibiotic prescriptions

Women are 27% more likely to be prescribed antibiotics in their lifetime when compared to men, according to a study yesterday in the Journal of Antimicrobial Chemotherapy.

A team of researchers from German and Swedish institutions reviewed 11 studies of antibiotic prescription practices in primary care practices. Studies were published between 1976 and 2013; obtained surveillance data from pharmacy, insurance, or national healthcare systems; and represented 44,333,839 people.

The number of antibiotics prescribed to women ages 35 to 54 was 40% higher than men in the same age group, and women ages 16-34 had a 36% higher rate of antibiotic prescriptions compared to their male peers, the authors said.

Researchers observed especially high gender differences in the cephalosporin and macrolide antibiotic classes, with 44% and 32% higher numbers of prescriptions, respectively, written for women.

The authors said that more research is needed into the reasons behind gender differences in antibiotic prescription practices, as well as into any potential gender inequality in antibiotic resistance rates.
Apr 3 J Antimicrob Chemother study

Philippines begins world's first dengue immunization program

The Philippines began the world's first public immunization program for dengue fever this Monday, according to an Associated Press (AP) story. The government subsidized the $76 million cost for the three-dose vaccine Dengvaxia, and children under the public health system and public school system have already begun to receive their free vaccinations.

Although the WHO has not finished its assessment of vaccine effectiveness in the Philippines, Dengvaxia has already been approved by the country's food and drug administration, according to CNN Philippines. The WHO should be finished with its review soon.

In support of the new program, the nation's health department cited a study done by a University of the Philippines-Manila professor that suggested the vaccine can reduce dengue cases by 24.2% in 9-year-olds within 5 years, the CNN story said.

Dengvaxia was developed by the French pharmaceutical company Sanofi Pasteur and is the first licensed vaccine to treat dengue, according to the AP report. The vaccine has been shown to be effective for all four strains of dengue.

In 2015, the Philippines had 200,415 suspected cases of the mosquito-spread disease, according to WHO data.
Apr 4 AP story
Mar 31 CNN Philippines article

Flu Scan for Apr 04, 2016

News brief

Influenza D transmits between cattle, causes mild disease

Cattle serve as a natural reservoir for influenza D, which causes mild upper respiratory disease and can be transmitted to other cattle through contact, according to a Mar 30 study in the Journal of Virology.

Researchers from Mississippi State University and St. Jude Children's Research Hospital intranasally inoculated three healthy calves with flu D, a virus in the family Orthomyxoviridae initially identified in swine in 2011. Inoculated calves were compared to three control cows and three calves placed in direct contact with inoculated cattle.

All inoculated and contact calves seroconverted to flu D, and virus was detected in tissues of the nasal passage, trachea, and bronchus. Inoculated calves experienced higher increases in inflammatory markers, such as neutrophil tracking and tracheal epithelial attenuation, which could make them more susceptible to co-infections, the authors said.

Though inoculated and contact calves had mild signs of disease consistent with upper respiratory infections, clinical signs appeared enhanced in contact animals, the authors said. Disease in the inoculated group involved dry coughing, nasal discharge, depression, and mild abnormal lung sounds, while the contact group experienced abnormal lung sounds and nasal and eye discharge.

Two ferrets exposed to flu D fomites (plastic toys soaked with nasal discharge) from the infected cows did not seroconvert or shed virus, suggesting that flu D cannot be transmitted through fomites to ferrets but can successfully be transmitted through contact between cattle, which serve as a natural reservoir for the virus, the authors said.
Mar 30 J Virol study

Low-path H5N3 detected on French goose farm

French agriculture officials recently reported another low-pathogenic H5N3 avian flu outbreak, detected during routine surveillance at a goose breeding farm in Landes department in the southwestern part of the country, according to an Apr 1 report to the World Organization for Animal Health (OIE).

The farm in Montaut had 700 birds, which are slated for culling. The event began on Mar 17 and was declared resolved on Mar 31. Other control measures include disinfection, screening, and poultry tracking.

France has battled several avian flu outbreaks since December, involving several different strains, including highly pathogenic H5N1, H5N2, and H5N9. The events have occurred in departments in the country's southwestern region. The most recent outbreak is the fifth to involve low-pathogenic H5N3.
Apr 1 OIE report