News Scan for Aug 24, 2016

Favipiravir benefits for Ebola
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Polio emergency continues
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Study suggests favipiravir benefits for Ebola patients

A trial of the antiviral drug favipiravir in Ebola patients during Sierra Leone's outbreak suggests that it can reduce viral load, improve clinical symptoms, increase the survival rate, and prolong survival time, Chinese and African researchers reported yesterday in Clinical Infectious Diseases (CID).

The retrospective case study took place in Ebola patients treated at the Sierra Leone-China Friendship Hospital near Freetown. The control group consisted of 85 patients with lab-confirmed infections who were treated from Oct 10 to Oct 30, 2014, with World Health Organization (WHO) recommended supportive care. The intervention group included 39 patients with confirmed infections between Nov 1 and Nov 14, 2014, who also received favipiravir.

Survival rate in the treatment group was 56.4%, compared with 35.3% in the control group. Of 35 patients who completed all study end point observations, survival rate was 64.8% in the treatment group and 27.8% in the control group. Survival time was longer in the treatment group: 46.9 days compared with 28.9 days, and patients in the treatment group showed significant symptom improvement.

Of patients treated with favipiravir, 52.9% experienced a 100-fold viral load reduction, compared with 16.7% of the control group. Researchers said the findings support future randomized control trials of the drug.

In a commentary on the findings in the same CID issue, Colleen Kraft, MD, with the division of infectious diseases at Emory University, wrote that the trial has limitations, but the findings on viral load reduction and tolerance of the drug are important. She noted that an earlier similar trial in Guinea suggested that favipiravir might be helpful for patients with moderate viremia, and that those in the Sierra Leone trial had similar viral loads.

Dosing was lower in the Sierra Leone trial, and Kraft wrote that since the drug showed tolerability in the current trial and in influenza studies, the dosing could be increased and should be an aspect of future randomized controlled trials. She concluded that although treatments are needed, supportive care is still the most important intervention, adding that the global community should press for adaptive study designs that can answer key questions about treatment.
Aug 23 Clin Infect Dis abstract
Aug 23 Clin Infect Dis
commentary

 

WHO committee keeps polio public health emergency in place

A World Health Organization (WHO) emergency committee tasked with evaluating polio developments met for the 10th time on Aug 11 by teleconference and unanimously recommended that the international spread of the virus still constitutes a public health emergency of international concern (PHEIC), as defined by the International Health Regulations (IHRs).

In an Aug 22 statement on the outcome of the deliberations, the WHO said after hearing from affected countries and other experts, the committee said it was gravely concerned about the two recent wild poliovirus type 1 cases in Nigeria's Borno state, especially since the genetic analysis suggested the virus had circulated undetected for several years, revealing surveillance lapses.

Also, it applauded progress made against polio in Afghanistan and Pakistan, especially the cooperation on the international border. However, committee members raised concerns about deteriorating security in parts of Afghanistan that would make children in some areas inaccessible to vaccine campaigns.

The group acknowledged that Equatorial Guinea and Cameroon have gone 2 years without new cases, but they said neither country has provided the requested final reports. They noted that no new circulating vaccine-derived polio cases have been reported since the committee's May meeting, though it is still concerned about several countries such as Nigeria and Ukraine that have reported it over the past several months.

WHO Director-General Margaret Chan, MD, MPH, accepted the group's recommendation. WHO IHR emergency committees typically meet every 3 months or sooner if needed.
Aug 22 WHO emergency committee statement

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