Public Health England notes 28 cases of acute flaccid paralysis

Public Health England (PHE) announced today its investigation into 28 cases of acute flaccid paralysis (AFP, known in the United States as acute flaccid myelitis) reported in England this year, most of them since September.

"AFP is very rare. However, if you or your child develops weakness in any limb you should seek medical care immediately so that appropriate testing and care can be given," said Mary Ramsay, MD, head of immunizations at PHE. "We are investigating potential causes and working hard to build better awareness amongst health care professionals about how to test and manage patients with AFP."

The case count is high for England, which usually sees only a handful of cases of the polio-like illness each year.

According to PHE, 12 cases of AFP this season have been associated with an enterovirus; EV-D68 has been detected in 8, EV-C104 in 1, and coxsackie B1 in 1; in 2 cases the enterovirus was not typeable. Enteroviruses have also been linked to previous AFP cases in the US.

PHE also released "Acute flaccid paralysis: clinical management guidance," a document to guide clinicians, and an information guide for patients and their families.
Dec 19 PHE press release
Dec 19 PHE clinician guide
Dec 19 PHE patient guide

IDSA updates flu clinical practice guidelines

The Infectious Diseases Society of America (IDSA) today released updated guidelines on diagnosing, treating, and preventing flu, marking first overhaul of its clinical practice guidance since before the 2009 H1N1 pandemic. The guidelines committee published the document in Clinical Infectious Diseases.

According to the update, pregnant women and people who are extremely obese (those with a body mass index of 40 or more) are among those at high risk for complications and should be tested and started on antiviral treatment promptly if they are sick enough to be hospitalized for flu symptoms.

People diagnosed in outpatient settings and are at high risk for complications should also be treated with antivirals as soon as possible, IDSA says. High-risk groups also include young children, women who have recently given birth, those with weakened immune systems because of medical conditions or treatment, those with neurologic or neurodevelopmental conditions, those with chronic medical conditions, American Indians, and native Alaskans.

Though antiviral treatment should begin within 2 day of symptoms onset, the guidance says these drugs should be prescribed for those at high risk, even if they have been sick for more than 2 days.

Regarding testing, the IDSA recommends newer, highly accurate molecular tests that give a result in 15 to 60 minutes rather than rapid influenza diagnostic tests, which give a quick result but are falsely negative at least 30% of the time in outpatient groups.

Physicians should prescribe antivirals for hospitalized high-risk patients without waiting for the results of molecular testing, according the guidelines. However, testing is important, the guidelines say, because doctors are most likely to treat patients with appropriate medications if they have a definite diagnosis, which reduces inappropriate antibiotic prescribing, especially in outpatients.

Timothy Uyeki, MD, MPH, IDSA guidelines committee cochair and chief medical officer of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, said in an IDSA press release, "Annual influenza vaccination is the best way to prevent influenza, but it is not 100 percent effective. Those at high risk need to be encouraged to seek medical care right away if they develop influenza symptoms during influenza season."

Health providers should consult infectious disease (ID) physicians when high-risk patients are diagnosed with flu, according to new guidance. Andrew Pavia, MD, guidelines cochair and chief of the University of Utah's division of pediatric infectious diseases, said, "ID doctors also can provide guidance when a patient who has the flu is not responding to antiviral treatment or is getting worse."
Dec 19 Clin Infect Dis report
Dec 19 IDSA press release

EU flu vaccination coverage rates still below target

A European Centre for Disease Prevention and Control (ECDC) report on flu vaccine coverage over the past three seasons found most nations have clear recommendations on which groups should receive it, such as those in high-risk groups, but only a few came close to meeting the European Union target of 75%. The coverage rates were provided by 19 member states.

Coverage rates for older age-groups, for example, a group at high risk for flu complications, ranged from 2% to 72.8%, with the highest levels reported by the United Kingdom.

In an ECDC press release yesterday, Pasi Penttinen, MD, PhD, MPH, head of the ECDC Influenza Disease Program, said achieving high coverage in those at risk remains a serious public health challenge. "The best way to prevent or minimize severe disease from influenza among vulnerable groups is timely vaccination, even though the effectiveness of the vaccine varies depending on the virus in circulation. Sufficient vaccination coverage also saves healthcare systems money in decreased consultation rates and hospitalisations," he said.

Meanwhile, in a positive sign, about half of reporting countries said they saw increases in the use of newer flu vaccines designed to provide broader protection—quadrivalent formulations or ones that contain an adjuvant—during the 2017-18 season.

The study also tracked antiviral recommendations, finding that most countries have issued guidance for treatment. Recommendations for prophylaxis, however, weren't common.

Based on the findings, ECDC officials recommend improving vaccination coverage rates by targeting vulnerable groups with communication campaigns and ensuring adequate and sustained funding for national vaccination programs.
Dec 18 ECDC press release
Dec 18 ECDC report