News Scan for Aug 24, 2016

News brief

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

Flu Scan for Aug 24, 2016

News brief

Findings build case for role of pikas in avian flu evolution in China

Evidence is growing that the pika, a small mammal thought to be the inspiration behind the Pokemon Pikachu character, may play a role in the evolution of avian influenza viruses in China's Qinghai Lake region, according to new findings today from a Chinese research team.

The lake is major stopover for migrating birds that have spread highly pathogenic H5N1 to major global flyways.

The report, based on sampling of wild birds and pikas from 2006 to 2009, focuses on H7N2 viruses that were isolated and analyzed. The group published its findings in Scientific Reports.

The investigators said the study was done to yield more information about pikas' role in avian flu ecology, given that H5N1 has been detected in the animals and that experiments have shown they are susceptible to both avian and human flu viruses. Scientists suspect that pikas, like pigs, could be a mixing vessel for flu viruses because they have receptors for both types of viruses in their respiratory tracts. The authors also said waterfowl and poultry have been the main targets in past Qinghai Lake surveillance activities, leaving questions about how common the viruses are in the region's wild birds.

The researchers sampled 941 healthy animals along Qinghai province migration routes, isolating 17 H7N2 viruses, 8 from pikas and 9 from wild birds. The viruses were closely related to each other and similar to ones isolated in Hong Kong in the 1970s, hinting that H7N2 there has been stable. Pathogenicity tests found that the H7N2 isolates were low pathogenic in chickens and mice.

The authors concluded that H7N2 has become enzootic in wild animals around Qinghai Lake and that the findings build the case that pikas could serve as a healthy reservoir, as part of a complex transmission pattern that could involve wild birds that live in close contact. They added that pikas should be considered for future surveillance programs. So far the H7N2 strain hasn't been detected in the region's poultry, perhaps due to limited surveillance, they note.
Aug 24 Sci Rep abstract

WHO: Flu rising in South Africa, Australia

Flu activity in the Southern Hemisphere still reflects a mixed picture, with a continued rise in temperate parts of southern Africa and slowly rising detections in Australia and New Caledonia, the World Health Organization (WHO) said in its latest global flu update. The pace of the disease, though, is still low for this time of year in New Zealand.

In South America, flu activity remained elevated in Chile and has plateaued in Paraguay, with co-circulating 2009 H1N1 and influenza B viruses. Colombia's flu activity continued to decline, as did the disease in Ecuador and Bolivia—all countries that had reported brisk 2009 H1N1 activity. Peru's flu activity increased over the past week, with activity in Brazil reported as low.

In Asian countries, flu remained at low levels except for Southeast Asia, where detections have increased over the past few weeks, with both influenza A and B strains circulating, the WHO said.

At the global level, 66.3% of flu-positive respiratory specimens were influenza A, and of subtyped viruses, 67.1% were H3N2 and 32.9% were 2009 H1N1. The numbers reflect an H3N2 surge since the previous WHO update, when the subtype made up less than half of subtyped influenza A viruses.
Aug 22 WHO global flu update