News Scan for May 11, 2017

CDC cholera vaccine advice
;
Hepatitis C in pregnancy
;
High-path H7N9 threats
;
H5N1, H5N8 outbreaks
;
Somalia, Yemen disease threats

CDC issues final cholera vaccine recommendations for adult travelers

The US Centers for Disease Control and Prevention (CDC) today finalized its cholera vaccine recommendation for adults traveling to disease outbreak areas, based on June 2016 advice from its Advisory Committee on Immunization Practices (ACIP).

ACIP's recommendation last summer came in the wake of the Food and Drug Administration's approval of Vaxchora, making it the first cholera vaccine available to US travelers. The live vaccine is given as a single dose for adults 18 through 64 and targets Vibrio cholerae serogroup O1.

The CDC recommends the vaccine only for adults going to areas of active cholera transmission, not for routine travel. Examples include people going to affected areas to visit family or for health providers or cholera outbreak responders. The full recommendation, which also covers administration with other medication or vaccines, as well as contraindications and precautions, appears today in Morbidity and Mortality Weekly Report (MMWR).
May 12 MMWR report
May 11 CDC press release

 

Number of pregnant US women with hepatitis C doubled in recent years

The number of pregnant women in states reporting hepatitis C (HCV) infections almost doubled from 2009 to 2014, according to a report today in Morbidity and Mortality Weekly Report (MMWR).

During the 6-year period studied, the prevalence of maternal HCV infection among reporting states increased 89%, from 1.8 to 3.4 per 1,000 live births. The increases are most drastically seen in white, rural, poor regions of the country, particularly in areas of Tennessee and West Virginia the researchers, from Tennessee, reported. Smoking and infection with hepatitis B increased the risk of maternal HCV infection, 4.5-fold and 17-fold, respectively.

"The increase in maternal HCV infection coincides with the rising heroin and prescription opioid epidemics occurring in the United States that have also disproportionately affected rural and white populations," the authors write. "There has also been a recent surge in opioid use among pregnant women."
May 12 MMWR study

 

Analysis highlights human threats from high-path H7N9 in China

Highly pathogenic H7N9 avian influenza, detected in people for the first time in China in 2013, have a slightly increased binding preference for human airway receptors compared with the low-pathogenic form, a research team from China reported today in Eurosurveillance.

The scientists also found that highly pathogenic H7N9 containing the R292K substitution was resistant to multiple antivirals, requiring urgent further assessment. In January, Taiwan reported a resistance mutation in an imported case involving a patient infected with highly pathogenic H7N9.

For their study, the researchers compared high-path H7N9 genetic sequences from patients infected earlier this year in Guangdong province with low-pathogenic H7N9 and highly pathogenic H5N6.

Compared with low-path H7N9, the highly pathogenic form showed slightly increased binding preference for the types of receptors found in human upper and lower airways. The researchers said high-path virus's persistent preference for both avian and human receptors may result in their circulation in poultry and possible transmission among people.

The team confirmed that the high-path viruses showed little or no response to antibodies against the low-path H7N9 vaccine strain. The World Health Organization has already recommended a new candidate vaccine strain for the new form of the virus.

In their analysis of antiviral resistance, the investigators found that high-path H7N9 that contained the R292K substitution in the neuraminidase protein showed resistance to oseltamivir (Tamiflu), zanamivir (Relenza), and peramivir. They said the virus had the ability to acquire the substitution as early as 2 days after the administration of the antiviral drugs.

They concluded that highly pathogenic H7N9 doesn't pose an enhanced risk solely to poultry; it also has implications for human health surveillance and control strategies. The authors also said their findings are a reminder of the crucial role of antiviral surveillance monitoring as a key component of pandemic preparedness.
May 11 Eurosurveill report

 

Bangladesh reports pair of H5N1 outbreaks; more H5N8 in Germany

Bangladesh reported two recent highly pathogenic H5N1 avian flu outbreaks, and Germany reported one more H5N8 outbreak in poultry, according to the latest notifications from the World Organization for Animal Health (OIE).

The Bangldeshi events both occurred in Dhaka, the country's capital. One of the outbreaks began on Apr 13 in backyard birds, and the other event began on Apr 20 at a farm. Between the two locations, the virus killed 66 of 160 birds, and the survivors were culled to control the spread of the virus. Bangladesh's last H5N1 occurred in January at a commercial farm, also in Dhaka. H5N1 is endemic in the country's poultry.

Germany's H5N8 outbreak began on May 8 in backyard chickens in North Rhine-Westphalia state. The virus killed 10 of 13 susceptible birds, and the rest were destroyed as part of the control measures.
May 11 OIE report on H5N1 in Bangladesh
May 10 OIE report on H5N8 in Germany

 

WHO warns of cholera, other health threats to Somalia, Yemen

In a pair of announcements today, the World Health Organization (WHO) warned of drought and disease threats to Somalia and a resurgence of cholera in Yemen.

In Somalia, an ongoing funding shortage is threatening the response to drought that is pushing the country into a famine and increasing the risk of infectious diseases, the WHO said in a statement today. It said drought has led to a lack of clean water, which is fueling the country's biggest cholera outbreak in 5 years. So far this year more than 36,000 cases and 690 deaths have been reported. Floods expected with the upcoming rainy season could push the illness total past 50,000 by the end of June, the group warned.

Somalia is also in the midst of a measles outbreak, with 6,500 cases reported so far in 2017, 71% of them in children younger than 5.

The WHO says it has only 23% of the $103 million it needs for the overall response in Somalia and that it has only 10% of the $25 million it needs for an organizational response. It commended the United Kingdom for hosting an international conference to tackle Somalia's challenges, and it called for more support from the international community.

Meanwhile, the WHO said in a separate statement that it and its partners are responding to a surge in cholera in several parts of Yemen that since Apr 27 has resulted in 2,752 suspected cases, 51 of them fatal. The agency said it has already distributed supplies and treatments and is building 10 new treatment centers in affected areas.

Yemen has been battling cholera since October 2016 amid a health system that has been weakened by 2 years of conflict. Warmer weather and rains have also played roles in the spread of the disease.
May 11 WHO statement on Somalia
May 11 WHO statement on Yemen

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