News Scan for Feb 07, 2017

H7N9 case in China
Bacteremia treatment
HPV vaccine endorsement
Zika blood screening

H7N9 hospitalizes man in China's Henan province

One more H7N9 avian flu infection was reported from China today, a sign of ongoing activity that is within striking distance of the record 319 cases reported during the second wave of activity during the winter of 2013-14.

The latest case-patient is a 38-year-old man from Henan province in central China, Hong Kong's Center for Health Protection (CHP) said in a statement today. The man is from Kaifeng but lives in Zengzhou, the provincial capital, and is hospitalized in critical condition.

China is in its fifth wave of H7N9 activity, and after reporting 6 cases in November, the country recorded a sudden surge of 106 illnesses in December, which was topped by 183 infections in January. With the case reported today, the country now has at least 296 cases.
Feb 7 CHP statement


Inappropriate antibiotic therapy tied to poor bacteremia outcomes

A new study out of Denmark shows that inappropriate empiric antibiotic therapy (EAT) in bacteremia patients is associated with an increased risk of recurrence and long-term mortality but has no impact on short-term mortality.

The retrospective population-based cohort study, published yesterday in BMC Infectious Diseases, analyzed the data of 6,483 Danish patients diagnosed with incident bacteremia—the presence of bacteria in the bloodstream—in 2007-08, with follow-up of recurrence and vital status conducted through 2009. The investigators considered three different study outcomes: recurrence, 2-to-30-day mortality, and 31-to-365-day mortality.

Because antibiotic treatment for bacteremia cannot await identification of the microorganisms causing the infection, clinicians have to initiate therapy on an empirical basis. EAT was defined as appropriate if given intravenously (except fluoroquinolones, metronidazole, and fluconazole) and if all blood isolates were susceptible to one or more of the antibiotics used. EAT was considered inappropriate if it did not fulfill these criteria, and it was considered unknown if the antibiotic treatment was unrecorded.

Of the 6,483 patients, 3,778 (58%) received appropriate EAT, 1,290 (20%) received inappropriate EAT, and 1,415 (22%) had unknown EAT. Within 1 year of the initial episode, 712 patients (11%) had recurrent bacteremia. When compared with appropriate EAT, inappropriate EAT was independently associated with recurrence (hazard ratio, 1.25). The 2-to-31 day mortality was 15.1% in patients who received appropriate EAT and 17.4% in those who received inappropriate EAT, for an adjusted odds ratio (OR) of 0.85. But 31-to-365 day mortality was 22.3% in patients given appropriate EAT compared with 30.7% in those given inappropriate EAT, for an adjusted OR of 1.35.

"These findings have clinical importance and highlight the importance of vigilance in the identification and antibiotic treatment of bacteraemia," the authors write. "Identification of patients and characteristics associated with inappropriate EAT may contribute to empirical prescribing guidelines and thereby improve EAT."
Feb 6 BMC Infect Dis study


American Cancer Society endorses 2-dose HPV vaccine recommendation

The American Cancer Society (ACS) today endorsed a recommendation in October by a federal vaccine advisory group that reduces the number of doses for human papillomavirus (HPV) vaccination.

After reviewing the latest scientific evidence about protection, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) in October voted to support a two-dose recommendation for boys and girls who receive their first dose from ages 9 tp 14 years. The move whittles the number of doses in the HPV regimen from three to two, a move that could improve vaccine uptake—which is much lower than health officials would like—by streamlining doses and decreasing cost.

Young people who receive their first HPV vaccine dose between ages 15 and 26 should still receive the three-dose series to be fully protected.

HPV has been linked to cervical cancer, as well as vaginal, vulvar, oropharyngeal, anal, and penile cancers. Despite strong evidence of safety and effectiveness, US vaccination uptake is low compared with other countries: 28% in boys and 42% in girls ages 13 to 17.

In making its recommendation, the ACS reviewed data from several clinical trials and published its finding today in CA: A Cancer Journal for Clinicians.

Debbie Saslow, PhD, senior director of HPV and women's cancers for the ACS, said in an ACS press release, "In the past several years, studies have shown the vaccine is even more effective than expected. This new two-dose regimen is easier to follow, and we now know is very effective in preventing HPV, which is linked to a half dozen types of cancer."
Feb 7 CA Cancer J Clin abstract
Feb 7 ACS press release
Oct 19, 2016, CIDRAP News story "Vaccine panel recommends 2 doses of HPV vaccine for preteens"


Study shows low rate of positive tests in US Zika blood donor screening

Researchers this week described the first positive results from a new test to screen blood donations for Zika virus RNA, based on results from 358,796 donations—mostly from the southern United States between May 23, 2016, and Oct 9, 2016. Twenty-three samples were positive on initial tests, with follow-up testing suggesting that 14 represented probable Zika infections.

In March the US Food and Drug Administration ruled that a polymerase chain reaction screening test made by Roche Molecular Systems could be used to screen blood for evidence of Zika virus under an investigational new drug application. A team from the company, along with health department and blood center officials in Florida and Texas, reported it findings Feb 5 in Transfusion.

The 23 samples with positive screening results were collected in August, September, and October. When the investigators looked at the 14 probable cases, they found that 10 people had traveled to active Zika transmission areas within 90 days of donating blood. Six (43%) reported at least one of four major symptoms of Zika illness. Three of the people with travel histories also had potential sexual exposure to the virus.

The authors said they couldn't rule out the chance that some of the nine who tested negative on follow-up testing were true positives. Only four of them completed follow-up, so it's not clear if the other five seroconverted. However, assuming that all nine were false-positives on initial screening, the specificity of the test is still high, at 99.997%, they noted. The findings suggest that the test helps flag infected donors and shine a light on donor risk factors, which include travel to an affected area more than 4 weeks before donation and sexual exposure to the virus.
Feb 5 Transfusion abstract

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