News Scan for Jan 22, 2014

News brief

CDC updates guidelines on preventing, treating anthrax in adults

The US Centers for Disease Control and Prevention (CDC) recently released updated guidelines for treating and preventing anthrax in adults and pregnant women, recommending, among other things, the simultaneous use of antimicrobial drugs and antitoxin in patients who have systemic disease.

The two sets of guidelines were published Jan 17 in Emerging Infectious Diseases. They were prepared by multidisciplinary expert panels that met in 2011 and 2012.

The adult report says that before 2001—the year of the anthrax letter attacks—mortality rates for patients with inhalation anthrax approached 90%. Since then, 8 (53%) of 15 known patients with inhalation anthrax have survived, thanks to early diagnosis, combination antimicrobial treatment to kill the bacteria and inhibit toxin production, and aggressive pleural effusion management.

The adult CDC guidelines cover postexposure prophylaxis (PEP) and antimicrobial and antitoxin treatment options and describe critical care measures. The report includes an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including antimicrobial treatment for possible anthrax meningitis.

For PEP for those exposed to airborne Bacillus anthracis spores, the revised guidelines, like the previous version, recommend 60 days of antimicrobial drugs, regardless of whether the patients have been vaccinated.

The report discusses two antitoxins, anthrax immune globulin and raxibacumab, and says there are no considerations that clearly favor one over the other. An antitoxin should be added to antimicrobial treatment for any patient in whom systemic anthrax is highly suspected, the report recommends, because the potential benefit outweighs potential risks.

The revised guidelines for pregnant women also discuss considerations for postpartum and lactating women, with the aim of guiding health professionals caring for women in the event of a bioterrorist attack involving anthrax. The report discusses general principles of prevention and treatment, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication.
Jan 17 Emerging Infect Dis reports: adults; pregnant women
Aug 30, 2011, CIDRAP News story on treatment of anthrax patient


Seven more polio vaccination workers killed in Pakistan

The latest violence against Pakistani polio immunization workers has killed seven people in Charsadda in Khyber Pakhtunkhwa province, The Hindu, a newspaper based in India, reported today.

Six policemen on security detail and a 13-year-old boy were killed when an explosion ripped through a police vehicle. The officers were heading out to provide security for polio vaccination teams when the improvised explosive device, reportedly placed on a bicycle, detonated, according to the story. Nine additional people were injured.

A separate attack in Bhakkar district in Punjab wounded two people when assailants fired on a polio team there. Also, 3 polios workers were killed on Jan 20 in yet another attack, in Kirachi. Officials said 33 polio workers, including 11 security personnel, have been killed and 9 injured in such attacks in Pakistan since July 2012.
Jan 22 Hindu story
Jan 21 CIDRAP News scan on Kirachi attack

Militant groups in Pakistan, including the Taliban, have considered polio vaccine campaigns as covers for espionage and as a plot to sterilize young Muslims. Today, however, the Pakistani newspaper Dawn reported that the Tehreek-i-Taliban Pakistan (TTP) has officially distanced itself from recent attacks on polio workers in Khyber Pakhtunkhwa and Karachi, saying it was not involved.

A senior TTP member, Ehsanullah Ehsan, said that the group was "in principle" not targeting polio workers. But some senior TTP members said that some hard-liners within the organization might possibly be involved in attacks on immunization teams.

Ehsan said the TTP has been working toward nonviolence toward polio workers. "We have been holding detailed deliberations on the polio issue for some time and have been consulting trustworthy Muslim medical experts," he said. "Some of our doubts have been removed."
Jan 22 Dawn article


UNICEF begins measles vaccination in Guinea

An outbreak of measles in the West African country of Guinea has prompted a nationwide vaccination effort led by the United Nations Children's Fund (UNICEF) and its partners, the agency said in a news release yesterday.

Since November 2013, 37 measles cases have been confirmed in the capital city of Conakry, all in children 9 years or younger, and the number has increased sharply over the past few weeks, UNICEF said. One child has died from the disease, which has also been reported in other parts of Guinea.

In the coming weeks health workers will begin immunizing more than 1.6 million children to stop the outbreak.

"Measles is highly contagious and extremely dangerous—especially for young, malnourished children," said UNICEF's representative in Guinea, Mohamed Ayoya, MD, PhD. "In a densely populated city like Conakry, disease spreads quickly."
Jan 21 UNICEF news release


Sanofi's QIV found safe, immunogenic in young kids

A quadrivalent (four-strain) influenza vaccine (QIV) produced by Sanofi was shown to be safe and immunogenic in children 6 months to 8 years old, according to the results of a phase 3 trial published in The Pediatric Infectious Disease Journal.

Sanofi researchers randomly assigned 4,363 US kids to receive either the QIV or one of two trivalent inactivated vaccines (TIVs), which differed by which influenza B strain they contained. (The QIV contains two A strains, H3N2 and 2009 H1N1, as well as the two B strains that commonly circulate.)

The investigators collected patients' blood before and 28 days after vaccination, and safety was assessed for 6 months. The antibody response to the QIV was rated as "non-inferior" to that of the TIVs and superior to that of the non-corresponding B strain in each TIV. Safety profiles were similar in all three groups.

Last March a similar trial produced similar results for GlaxoSmithKline's (GSK's) QIV. And in December the GSK vaccine was found in a large, randomized clinical trial to be 55% effective in preventing lab-confirmed flu in children 3 to 8 years old.

Sanofi's QIV has been found safe and immunogenic in adult trials, as well.
Jan 17 Pediatr Infect Dis J abstract
Mar 8, 2013, CIDRAP News scan on GSK vaccine trials
Dec 13, 2013, CIDRAP News story on GSK vaccine efficacy

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