Immune globulin shows promise for severe Zika thrombocytopenia
An analysis of Puerto Rican Zika patients who had thrombocytopenia, a rare complication, found that, in those with the severest cases, immune treatments may be more effective than platelet transfusion. A team from the US Centers for Disease Control and Prevention (CDC) and Puerto Rico reported its findings today in Open Forum Infectious Diseases.
The researchers scoured the medical records of 37,878 patients infected with Zika virus in 2016 and found that 47 (0.1%) had thrombocytopenia, including 12 people who had a severe form of the complication, which is marked by low blood platelets. Most patients were adults, and 53% were male. For patients with severe disease, platelet levels were at their lowest at a median 6 days after symptom onset, and for those with the milder form, platelet levels were lowest a median of 5 days post onset.
Of those with severe thrombocytopenia, all had bleeding, 4 (33%) were admitted to the intensive care unit, and 1 (8%) died. Of the 12 patients, 11 received intravenous immune globulin (IVIG) or corticosteroids, and 9 responded to clinical treatment.
Of five patients with severe thrombocytopenia who received intravenous immunoglobulin, median platelet increase was 112 X 109/L (range, 65 to 202 X 109/L), which was higher than four patients who received receive platelet transfusion, for whom the median platelet count increase was 8.5 X 109 (range, -6 to 52 X 109/L), which the researchers said resulted in minimal response.
The investigators said the cases from the Puerto Rico series nearly doubles the number of documented cases of severe thrombocytopenia in Zika patients that could be due to immune thrombocytopenia (ITP). They also noted the investigation is the first to determine the population incidence of Zika virus (ZIKV)-linked thrombocytopenia, which was 1.4 cases per 100,000 population.
"Regardless of the mechanism, the findings from this investigation demonstrate that timely diagnosis of ITP among patients with ZIKV associated severe thrombocytopenia is crucial to initiating life-saving interventions," they wrote.
Dec 3 Open Forum Infect Dis abstract
WHO reports successful end to polio outbreak in Syria
The World Health Organization (WHO) announced that a polio outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) detected in Syria 18 months ago has been successfully stopped.
The outbreak began in June of 2017 in the Deir ez-Zor governorate in eastern Syria. A total of 74 polio cases were linked to the outbreak, and the most recent patient suffered onset of paralysis on Sep 21, 2017. No international spread was noted, the WHO said.
"Surveillance is stronger today than it was 18 months ago, when the initial cases were detected," said Chris Maher, the manager for polio eradication for the WHO's Eastern Mediterranean Region. "Access for both surveillance and immunization is dramatically better, and immunity levels have been increased as a result of the comprehensive outbreak response conducted across Syria."
In 2013, the same region of Syria was affected by an outbreak of wild poliovirus type 1 (WPV1).
The WHO warned that Syria is at risk for re-infection because of a deteriorated health infrastructure, ongoing fighting, and internal population movements.
Dec 2 WHO news release
UK announces vaccine innovation center; Canada boosts CEPI coffers
In hopes of speeding the development of vaccines against emerging infectious disease threats, UK officials announced a dedicated Vaccines Manufacturing Innovation Center (VMIC), which will be led by the University of Oxford's Jenner Institute, and at the G20 meeting over the weekend in Buenos Aires, Canadian Minister Justin Trudeau announced $1 million ($765,750 in US dollars) more for the Coalition for Epidemic Preparedness Innovations (CEPI).
A news release today from the University of Oxford said the VMIC signals a major commercial opportunity and way to protect the nation against pandemic threats. It is designed to address a gap in late-stage vaccine manufacturing and will allow the development and production of vaccines for clinical trials and at moderate scale for epidemic threats to the UK population.
The center is slated to begin operations by 2022 and will be located on a new site at The Oxford Science Park. It is funded through £66 million ($84 million) from the UK Government's Industrial Strategy Challenge Funds Medicines Manufacturing Challenge. Additional funding of £10 million ($12.7 million) will come from commercial and other partners. Three academic centers will run the VMIC: the University of Oxford, Imperial College, and the London School of Hygiene and Tropical Medicine.
Meanwhile, CEPI's CEO Richard Hatchett, MD, said in a statement yesterday that the group is grateful that Canada has increased its contribution and that the current Ebola outbreak in the Democratic Republic of the Congo is a timely reminder of the devastation diseases can cause. "It's only through collective action that we can hope to protect the world from the threat of epidemics and we warmly welcome Canada's contribution to that effort," he said.
Canada was one of the groups that provided an initial investment after CEPI was formed in 2017 with a goal of streamlining and funding vaccine candidates targeting three diseases: Middle East respiratory syndrome coronavirus (MERS-CoV), Lassa virus, and Nipah virus. So far, CEPI has received $630 milllion from Australia, Belgium, Canada, the European Commission, Germany, Japan, Norway, the Bill & Melinda Gates Foundation, and Wellcome Trust.
Dec 3 Oxford press release
Dec 2 CEPI statement
Report: TB research funding climbed to new heights in 2017 but still lags
Research and development funding for tuberculosis (TB) rose to $772 million in 2017, the highest ever and the second year in a row that funding topped $700 million but still well short of what is needed, according to a new report released today by Treatment Action Group (TAG) and the United Nations–hosted Stop TB Partnership.
During the first-ever United Nations High-Level Meeting on TB, held during the UN General Assembly in September 2018, TAG reported a $1.3 billion gap annually, which represents the difference between what the Stop TB Partnership says the world needs to invest in TB R&D from 2016 to 2020 (a total of $9 billion, or about $2 billion per year) and current funding.
"In order to hit $9 billion in funding for the 2016-2020 period, the world will now have to invest almost as much ($7.5 billion) in the three years from 2018 to 2020, since investments in 2016 and 2017 only amounted to $1.5 billion combined," TAG said in a press release.
That money will likely come in the form of government commitments, as more than 60% of current TB funding comes from the public sector.
Dec 3 TAG press release