News Scan for Nov 28, 2017

Scarlet fever resurgence
;
Plague outbreak contained
;
MERS cases
;
Yemen diphtheria supplies
;
Shoddy medical products
;
Malaria drug application

Study probes scarlet fever recurrence in England

England has experienced an unprecedented resurgence in scarlet fever infections that began in 2014, but so far the reasons for the escalation aren't clear, researchers from Public Health England reported yesterday in The Lancet Infectious Diseases.

The team analyzed surveillance data between 1911 and 2016 for England and Wales, examining the timing of scarlet fever spikes, outbreak characteristics, as well as complication and hospitalization patterns. They also looked at isolates from throat swabs to assess activity from different Streptococcus pyogenes (group A streptococcus) clones.

The rate of scarlet fever per 100,000 population tripled in 2014 compared to 2013, resulting in increased hospitalizations. The median age of case-patients was 4, and outbreaks were common in daycares and schools.

Different molecular emm types were identified from recent isolates, including emm3 (43%) emm12 (15%) emm1 (11%), and emm4 (9%).

The researchers concluded that England is experiencing its highest scarlet fever incidence in 50 years, and determining what's fueling the increase is a high public health priority.

In a related editorial in the same issue, two infectious disease experts from the University of Queensland in Brisbane, Australia, said England's scarlet fever rise is similar to a 2011 epidemic in Hong Kong, which is still continuing and has also involved a variety of S pyogenes clones. They said more research is needed to see if there are any shared links between the two outbreaks.

Also, the uptick in cases raise questions about why the latest outbreaks are associated with less death and severe disease than those that occurred in the 19th and early 20th centuries, and what factors might trigger epidemics, such as changes in the S pyogenes population, human immune status changes, environmental changes, or coinfections that could predispose patients to scarlet fever infection.
Nov 27 Lancet Infect Dis study
Nov 27 Lancet Infect Dis commentary

 

WHO declares Madagascar plague outbreak contained

In an update yesterday, the World Health Organization (WHO) said the 2,000-plus-case outbreak of plague in Madagascar has now been contained, though it reported 58 new cases.

"Due to concerted national and international response the current and unprecedented outbreak of plague in Madagascar, which started on 1 August 2017, has been contained," The agency said in its latest situation update.

As of Nov 24, officials have reported 2,384 confirmed, probable, and suspected cases, including 207 deaths, for a case-fatality rate of 8.7%. Of the total, 1,828 (77%) have been classified as pneumonic plague and 347 (15%) as bubonic plague, with 208 (9%) remaining unclassified. Of the 1,828 clinical pneumonic cases, which is the more serious form, 347 (21%) have been confirmed, 614 (34%) are listed as probable, and 824 (45%) remain suspected. All 33 isolates of Yersinia pestis—the bacterium that causes plague—have been cultured and are sensitive to all recommended antibiotics.

Of the 58 new cases reported last week, 1 is confirmed, 8 are probable, and 49 are suspected. Cases have been reported in exactly half of the country's 114 district, with Analamanga Region in central Madagascar the hardest hit. As of Nov 24, only 11 patients remain hospitalized for plague.

The disease is endemic in Madagascar, with a season that typically runs during the rainy season from September to April, but the size of this outbreak and the number of pneumonic plague cases are unprecedented in recent decades.
Nov 27 WHO update

 

MERS reported in 2 Riyadh teens

The Saudi Arabian Ministry of Health (MOH) today reported two new cases of MERS-CoV in teenage boys from Riyadh.

Both boys are Saudis and presented with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus) infection. One boy is 15 and in critical condition. His source of infection is listed as "primary," meaning it's unlikely he contracted the virus from another person. A 13-year-old boy is in stable condition and is listed as a household contact of another MERS patient, possibly the 15-year-old.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,750, including 708 deaths. Five patients are still being treated, according to the MOH.
Nov 28 MOH report 

 

Tons of diphtheria-fighting supplies arrive in Yemen after blockade

After 3 weeks of closed ports and military blockades, the WHO reported yesterday its personnel had successfully delivered 17 tons of medical supplies to Yemen in an effort to staunch the current diphtheria outbreak. The shipments included antibiotics and vaccines.

"It is shocking that in 2017, there are children dying of an ancient disease that is vaccine-preventable and can be easily treated," said Dr Nevio Zagaria, WHO country representative in Yemen. "In recent days, children and adults have died while the medicines needed to save their lives were available only a few hours away. We need unconditional and sustained access to all areas of Yemen to stop these unconscionable deaths from malnutrition, cholera, and now diphtheria."

In the past 3 months, diphtheria has returned to war-torn Yemen with 189 cases and 20 deaths. According to the WHO, a vaccination campaign targeting 300,000 children younger than 12 months began on Nov 25.

This is the latest public health crisis to hit Yemen, which is already experiencing the world's worst cholera outbreak.
Nov 27 WHO update

 

WHO says 1 in 10 medical products in developing nations substandard

About 10% of medical products used in low- and middle-income countries is either substandard or fake, according to a WHO news release today.

Since 2013, the WHO has received 1,500 reports of substandard or falsified products, with antimalarials and antibiotics as the most commonly reported. The highest percentage of the reports (42%) come from Africa, 21% from the Americas, and 21% from the WHO European Region.

"Substandard and falsified medicines particularly affect the most vulnerable communities,” says Tedros Adhanom Ghebreyesus, PhD, WHO director-general. "Imagine a mother who gives up food or other basic needs to pay for her child’s treatment, unaware that the medicines are substandard or falsified, and then that treatment causes her child to die. This is unacceptable. Countries have agreed on measures at the global level—it is time to translate them into tangible action."

The WHO added that the 1,500 instances is likely just a small portion of the total problem, with many cases likely not reported. The agency noted that only 8% of reports of substandard or falsified products to WHO came from the Western Pacific, 6% from the Eastern Mediterranean region, and just 2% from Southeast Asia.
Nov 28 WHO news release

 

GSK applies for FDA approval of drug to treat relapse of P vivax malaria

GSK and Medicines for Malaria Venture (MMV) today announced the submission of a new drug application (NDA) to the US Food and Drug Administration (FDA), seeking approval of single-dose tafenoquine for the prevention of relapse of Plasmodium vivax malaria in patients 16 years of age and older, GSK said in a news release.

If approved, tafenoquine would be the first new medicine for the prevention of relapse of P vivax malaria in more than 60 years, potentially addressing the need for a single-dose and effective medicine for the disease.

The submission follows the FDA's ruling in December 2013 to grant tafenoquine Breakthrough Therapy Designation to expedite drug development and review. The NDA submission includes phase 3 data from two previously reported studies conducted by GSK and MMV.

Pauline Williams, MD, head of global health research and development for GSK, said, "Treating Plasmodium vivax malaria is particularly challenging because the parasite can lie dormant in the liver resulting in relapses. Poor compliance to primaquine in real-world settings can lead to higher relapse rates than those seen in the controlled setting of clinical trials, so a single dose treatment is an attractive proposition. GSK and MMV have been working together since 2008 to develop single-dose tafenoquine as an alternative to primaquine. If approved, tafenoquine will potentially become an important tool to help eliminate P vivax malaria for good."
Nov 28 GSK press release

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