News Scan for Jun 26, 2019

Ineffective MERS treatment
;
Sequential H3N2 flu in child
;
US hepatitis A outbreaks
;
Avian flu in Nepal, Taiwan

Study: Ribavirin plus interferon ineffective for critically ill MERS patients

A new multicenter study today in Clinical Infectious Diseases found little effect of ribavirin and interferon therapy on critically ill MERS patients.

The study took place from 2012 to 2018 at 14 Saudi Arabian hospitals, and involved 349 Middle East respiratory syndrome coronavirus (MERS-CoV) patients seeking treatment in intensive care units (ICUs).

Of the 349 patients, 144 (41.3%) received a combined treatment of ribavirin and recombinant interferon (RBV/rIFN) therapy within 2 days of admission to the ICU. Outcomes were compared with critically ill MERS patients who did not receive the treatment.

At the end of 90 days, RBV/rIFN was not associated with changes in mortality (adjusted odds ratio, 1.03) or with more rapid virus RNA clearance (adjusted hazard ratio, 0.65), despite positive results in preclinical trials on monkeys.

"While benefit of RBV/rIFN was suggested by pre-clinical studies, our observational study that accounted for baseline and time-varying differences among 349 critically ill patients with MERS treated with RBV/rIFN or not, demonstrates that RBV/rIFN was not associated with decreased mortality or with faster in [sic] MERS-CoV RNA clearance," the authors concluded.

MERS-CoV causes a serious respiratory illness with a case-fatality rate of 34.5%, according to the World Health Organization (WHO). There are no known treatments.
Jun 26 Clin Infect Dis study
WHO MERS factsheet

 

Healthy, vaccinated child has consecutive H3N2 flu illnesses in 1 season

A healthy, vaccinated 9-year-old girl from Wisconsin became the first person with a documented unique case of two sequential, within‐season infections with highly similar influenza A (H3N2) viruses, an event described today in Influenza and Other Respiratory Viruses.

Though within‐season influenza A (H1N1) infections have been reported in two high‐risk patients, this is the first description of the event in a healthy child, he authors write.

The girl became sick in both January and March of 2018. She tested negative for the virus via polymerase chain reaction (PCR) during the 37-day interim between the two episodes of illness. She had received the quadrivalent inactivated influenza vaccine in October 2017.

"The period between ILI episodes (37 days), the absence of influenza by PCR at 7‐day follow‐up of the first episode, the resolution of symptoms, and the development of a new ILI [influenza-like illness] support two distinct episodes of influenza infection," the authors said.

The case was detected as part of a longitudinal school‐based influenza surveillance in the Oregon School District in south-central Wisconsin.

"This case demonstrates the intrinsic value of longitudinal studies of influenza within communities coupled with laboratory support that can provide antigenic characterization and genomic sequencing," the authors concluded.
Jun 26 Influenza Other Respir Viruses study

 

CDC: 24 hepatitis A outbreaks in US since 2016 total 20,500 cases

In the past 3 years, US health officials have recorded 20,512 cases of hepatitis A virus (HAV) infection, with 54% of those cases hospitalized for their illnesses. The numbers come from a new update from the Centers for Disease Control and Prevention (CDC).

Since March 2017, the CDC's Division of Viral Hepatitis has assisted 24 states in controlling ongoing outbreaks of the virus, which occur most frequently among people who use drugs, the homeless, people who are or were recently incarcerated, men who have sex with men, and people with chronic liver disease.

Kentucky, Ohio, and West Virginia have the largest ongoing outbreaks, with Kentucky recording 4,715 cases since August 2017. Of those patients, 48% have been hospitalized. Ohio has confirmed 3,070 cases since January 2018 and West Virginia 2,533 since March 2018. Other states with outbreaks of more than 1,000 cases are Florida (1,876 cases), Tennessee (1,791), and Indiana (1,581).

Only two states, California and Utah, have declared an end to large outbreaks. Overall hospitalization rate among all outbreaks has been 57%.

HAV outbreaks can be controlled through the use of a single dose of inactivated hepatitis A vaccine, which is up to 95% effective and offers protection for up to 11years, the CDC said.
Jun 24 CDC update

 

H5N1 avian flu strikes more poultry in Nepal; Taiwan reports more H5N2

Part of sporadic detections since March and the identification of a human case in early May, Nepal reported two more highly pathogenic H5N1 avian flu outbreaks in poultry, according to two new notifications from the World Organization for Animal Health (OIE).

One of the events began on Jun 11 at a facility raising commercial broiler chickens in the city of Suryabinayk in Bagmati zone, killing 1,535 of 5,496 susceptible birds. The second outbreak started on Jun 18 in backyard poultry in the rural city of Naukunda, also in Bagmati zone, killing 219 of 900 susceptible birds.

In both instances, the source of the virus hasn't been determined.
Jun 25 OIE report on H5N1 in Nepal commercial poultry
Jun 26 OIE report on H5N1 in Nepal backyard poultry

Elsewhere, animal health officials in Taiwan reported another highly pathogenic H5N2 outbreak in poultry, according to a separate report today from the OIE. Taiwan first reported the virus in poultry in 2015, and though activity has slowed, a small but steady stream of detections continues.

The latest outbreak began on Jun 18 at a farm in Changhua County housing native chickens. The virus killed 1,070 of 29,030 susceptible poultry.
Jun 26 OIE report on H5N2 in Taiwan

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