Flu Scan for Dec 09, 2015

News brief

Study shows nasal spray vaccine safe for youth with egg allergies

A UK study of 779 young people 2 to 18 years old who had egg allergies showed that live attenuated influenza vaccine (LAIV, a nasal spray) can be administered safely, even among those with a history of asthma or recurrent wheezing, a study yesterday in BMJ found.

The results may open the way for lifting contraindications for those with egg allergies that are currently in place for LAIV in the United States, the United Kingdom, and elsewhere. Most flu vaccines are manufactured using eggs, but LAIV contains low levels of ovalbumin, the protein found in egg whites.

Participants were recruited from 30 allergy centers and immunized with LAIV. Of the 779 vaccine recipients, 270 (34.7%) had previous anaphylaxis—or severe allergic reaction—to egg, of whom 157 had experienced respiratory or cardiovascular symptoms or both, and 445 (57.1%) had physician-diagnosed asthma or recurrent wheezing.

Vaccine recipients were observed for at least 30 minutes, then telephoned 72 hours later to assess adverse events. Those with a history of asthma or recurring wheeze were also followed up 4 weeks post-vaccination.

The young people had no systemic allergic reactions, and only nine (1.2%) had mild symptoms.

In a related editorial, pediatrician Matthew Greenhawt, MD, of the University of Colorado Denver School of Medicine, said the results show that policies should change to allow LAIV in children.

"The arguments for withholding influenza vaccination from egg allergic children have always been weak, given the lack of data indicating real risk," he wrote. "This situation has been enabled by a policy that guards against an unsubstantiated theoretical risk, while failing to protect children against a bigger risk [influenza] that is all too real."

Greenhawt said 955 egg-allergic children have now been reported in the literature as having safely received LAIV.
Dec 8 BMJ study
Dec 8 BMJ editorial
Dec 8 BMJ press release


France's avian flu outbreaks grow to 10, with H5N9 now involved

France's avian flu outbreaks expanded in number, affected regions, and strains involved, as officials confirmed 4 new outbreaks—or 10 total—the Haute-Vienne region reported an event, and H5N9 has been noted in at least 2 of the outbreaks, Reuters and French officials reported today.

The H5N1 strain was detected at a poultry farm in Haute-Vienne, Reuters reported, but officials did not specify how many birds were involved. In addition France's agriculture department confirmed avian flu on a farm of 1,000 ducks, in a flock of 630 ducks, and in 30 ducks, geese, and chickens in Dordogne region, which has now had seven outbreaks. The larger duck farm was infected with an H5 virus of unknown strain, the mixed-poultry flock had H5N1 avian flu, and the smaller duck flock was affected by an unspecific avian flu strain.

A translated version of the agriculture department's update was posted today by Avian Flu Diary, an infectious disease blog. The other two previously reported outbreaks were in the Landes region.

Eight countries have restricted imports of French poultry and poultry products because of the outbreaks, Reuters reported, including Japan, which is France's leading importer of foie gras, which is the liver of fattened duck or goose. The country's foie gras industry has been hit hard by the outbreaks.

A reassortant H5N9 virus detected in live-bird market poultry was reported by Chinese scientists in June, but no recent outbreak has been previously attributed to the strain.|
Dec 9 Reuters story
Dec 9 France agriculture department update (in French)
Dec 9 Avian Flu Diary blog post
Jun 22 CIDRAP avian flu scan on H5N9 in China


Avian flu confirmed in Taiwan and German poultry, and in Russian duck

Officials in Taiwan have reported four new outbreaks of highly pathogenic H5N2 avian flu and two of H5N8, according to separate reports filed with the World Organization of Animal Health (OIE), while a third OIE report yesterday confirmed the low-pathogenic H5N2 outbreak reported earlier this week by German authorities. As well, Russian officials have detected H5 in a wild duck.

Taiwan's H5N2 outbreaks affected a chicken farm, chickens at an abattoir, and a duck farm in Pingtung County in the south, as well as a chicken abattoir in Hualien County in the east-central part of the country. All told, 26,878 birds were involved, and the virus killed 12,779 of them. The remaining 14,099 poultry were culled to prevent disease spread. All the outbreaks occurred in November.

The H5N8 virus, meanwhile, was confirmed on geese farms in Tainan City and Chiayi County on the southwestern part of the island after farm workers noted high mortality in the flocks. Of 3,000 susceptible geese, 1,329 were felled by the virus and the rest euthanized.

The outbreaks happened in September but weren't reported promptly, for unknown reasons. Taiwan has had numerous avian flu outbreaks this year.

In Germany, the low-path H5N2 virus was detected on Dec 4 in 1 bird among 13,100 poultry on a farm in Bavaria in the southeast. The flock comprised 9,500 laying hens, 2,000 ducks, 1,500 free-range geese, and 100 turkeys. All surviving birds were euthanized to contain the virus, according to the third OIE report.

In related news, Russian officials detected an H5 avian flu strain in a wild duck in Zagorsk, in the Moscow Oblast region, according to a report translated and posted today by Avian Flu Diary. Pathogenicity and subtype are not known at this time.
Dec 8 OIE report on H5N2 in Taiwan
Dec 8 OIE report on H5N8 in Taiwan
Dec 8 OIE report on H5N2 in Germany
Dec 8 Avian Flu Diary post

CDC replaces top lab regulator in wake of biosafety missteps

The US Centers for Disease Control and Prevention (CDC) has replaced its longtime head of national lab regulation after a series of key lab safety breaches involving bioterror pathogens like Bacillus anthracis—which causes anthrax—and H5N1 avian flu viruses, USA Today reported yesterday.

In a statement yesterday, the CDC declined to specify why it replaced Robbin Weyant, PhD, as director of the agency's Division of Select Agents and Toxins on Nov 9. The move happened 18 days after the CDC completed an internal review of the national lab regulation program that was launched after an extensive USA Today probe revealed multiple problems nationwide with lab safety and security and a program cloaked in secrecy, even after inspectors identified safety lapses.

Weyant headed lab regulation at the CDC since 2006 and now lists his position on LinkedIn as a senior advisor in the CDC's lab safety office, yesterday's story said. He declined to comment on the reason for his job change but told USA Today, "I'm extremely excited about the opportunity to contribute to CDC's new office dedicated to supporting laboratory safety."

In a statement, Rep. Fred Upton, R-Mich., chairman of the House Committee on Energy and Commerce, and Oversight & Investigations Subcommittee Chairman Tim Murphy, R-Pa., said, "We’ll be taking a close look at CDC's actions and are disappointed the agency did not consult with the Committee prior to its announcement. Strong and effective management of the select agent program is our top priority, and we want to know whether this signals deeper problems that CDC has not yet disclosed."
Dec 8 USA Today story


UK group lists steps to limit antimicrobial misuse in ag, environment

A UK expert group recommends several steps to reduce unnecessary use and waste of antimicrobials in agriculture and the environment, including setting a global target for use in food animals and minimum standards to reduce manufacturing waste released into the environment.

The group, called the Review on Antimicrobial Resistance (AMR-Review), was commissioned by UK Prime Minister David Cameron and outlined the problem and its recommended response in a 44-page report released yesterday. It published an initial paper detailing the crisis of drug-resistant pathogens and their impact on human health and the economy a year ago. AMR-Review followed that with a report in February on initial steps to take and one in May on how governments around the globe need to act to stimulate the development of new antibiotics.

In its new report, AMR-Review said antibiotic use in food production needs to be restricted to a global target per kilogram of livestock and fish. "We need to reduce global levels of antibiotic use in agriculture, to an agreed limit for each country, but it should be for individual countries to decide how best to achieve this goal." Antibiotics important for human use should be restricted or even banned for animal use, the report adds.

The group also advocates for the rapid development of minimal standards to reduce waste from antimicrobial manufacturing released into the environment. "The risk of drug resistance must urgently become a key environmental consideration for all pharmaceutical companies, healthcare buyers and regulatory agencies everywhere," the report authors write.

A third major recommendation is to improve surveillance to monitor antimicrobial-resistance and drug-overuse problems in agriculture and the environment. AMR-Review also lays out ways policies could be implemented, and it says countries could lower antimicrobial use in agriculture by focusing more on vaccines, rapid diagnostics, and public awareness.
Dec 8 AMR-Review report
AMR-Review home page


WHO: Globally, more than 1 million new STIs occur each day

Each day almost 1 million teens and adults through age 49 contract one of four common sexually transmitted infections (STIs), according to estimates from the World Health Organization (WHO) published yesterday in PLoS One, and the number tops 1 million when more STIs are included.

WHO experts based their estimates on prevalence data published in the literature from 2005 through 2012. They found that among girls and women 15 to 49 years old in 2012, the estimated prevalence of chlamydia was 4.2%, gonorrhea 0.8%, trichomoniasis 5.0%, and syphilis 0.5%. Among men, the percentages were 2.7%, 0.6%, 0.6%, and 0.48%, respectively.

These figures correspond to about 131 million new cases of chlamydia, 78 million of gonorrhea, 143 million of trichomoniasis, and 6 million of syphilis that year, or 358 million cases of those four diseases.

If the data were combined with previous estimates of herpes and human papillomavirus infections, the STI incidence tops 1 million cases a day in this age-group, the WHO said yesterday in a news release. A large proportion of the new STI cases occur in adolescents and young adults who may not know they are infected, which can harm their future sexual and reproductive health, the agency added.
Dec 8 PLoS One study
Dec 8 WHO news release

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