Flu Scan for Feb 18, 2015

News brief

Guangdong man with H7N9 brings global case total to nearly 600

An additional case of H7N9 avian flu in China's Guangdong province has been reported to Hong Kong's Centre for Health Protection (CHP), according to a machine-translated statement posted today by FluTrackers, an infectious disease news message board.

The case-patient is a 65-year-old man from Dongguan City in Guangdong, site of numerous recent cases. He apparently had preexisting coronary heart disease and hypertension and is hospitalized in critical condition.

A CHP statement says the man is being closely monitored and that the public is again urged "to maintain strict personal, food, and environmental hygiene both locally and during travel."

The total number of H7N9 cases globally now stands 598, according to a case list maintained by FluTrackers. The CHP statement puts the total cases from mainland China at 575, with the largest number in Guangdong (164) and Zhejiang (156) provinces.
Feb 18 FluTrackers posting
Feb 18 CHP press release
FluTrackers H7N9 case list

More avian flu outbreaks reported in Taiwan, Nigeria

Agriculture officials in Taiwan yesterday said 29 poultry sites have been hit by H5N2 avian influenza, with H5N8 striking five more farms and H5N2 and H5N3 detected in wild birds, according to three reports to the World Organization for Animal Health (OIE).

In addition, Nigeria, in an OIE report today, confirmed an H5N1 outbreak in poultry.

The H5N2 outbreaks affected 29 farms in the Taiwanese counties of Taitung, Yunlin, Pingtung, Chiayi, and Changhua, as well as in the city of Tainan. A dead black-crowned night-heron in Taitung County also tested positive. Of 269,894 susceptible poultry (geese, chicken and ducks), 95,908 deaths were reported, and 168,686 birds were culled to prevent disease spread.

In the second report, Taiwanese authorities detailed five H5N8 outbreaks on poultry farms in Yunlin and Chiayi counties, as well as in Tainan. Of 24,790 susceptible turkeys and geese, 4,676 birds died and 20,114 were culled. Farms within the outbreak regions are under surveillance for 3 months.

Taiwanese officials also reported H5N3 avian flu findings in three wild birds. The dead light-vented bulbuls were found in Miaoli County, and surrounding poultry farms are under surveillance, according to the third OIE report.

In related news, Nigerian veterinary officials reported an outbreak of H5N1 avian flu on a farm in the state of Ogun's Ewekoro region. Of 9,000 susceptible birds, 110 birds died, and 8,890 were culled.
Feb 17 OIE H5N2 report
Feb 17 OIE H5N8 report
Feb 17 OIE H5N3 report
Feb 18 OIE H5N1 report

Study: Antibodies in flu-vaccinated people may protect against H7N9

Researchers found that antibodies in samples taken from people who had received seasonal flu vaccine protected against H7N9 avian flu in cell culture and mice, according to a study yesterday in the Journal of Clinical Investigation.

US researchers selected 83 antibodies that were isolated from 28 vaccinated people and that reacted with H3N2, a common seasonal flu strain. When tested, at least 7% of the antibodies reacted against rare H7 strains, even though H7 strains are not included in seasonal flu vaccines.

Of these, three antibodies appeared to completely neutralize H7N9 in cell culture. The investigators then treated mice with each antibody before exposing them to a normally lethal H7N9 dose. All three antibodies prevented the mice from dying, whereas mice without the antibodies died from their infections. Mice were also protected when they received the antibodies 24 hours after they were infected.

The team found that the three antibodies could also neutralize H3 and other H7 strains in cell culture. This broad reactivity is probably due to the location on the influenza virus to which the antibodies bound: highly conserved regions that differ little among strains, according to a press release on the study from the University of Chicago.

"We have clear evidence that a normal immune response to flu vaccination offers protection against dangerous and highly unique strains of influenza such as H7N9," said coauthor Patrick Wilson, PhD, associate professor of medicine at the University of Chicago, in the release. "We now need to develop ways of amplifying this response."

The authors called for studies to evaluate the protective efficacy and safety of these antibodies in people.
Feb 17 J Clin Invest study
Feb 17 University of Chicago press release

News Scan for Feb 18, 2015

News brief

New MERS case, 3 deaths reported in Saudi Arabia

A new case of MERS-CoV and three deaths in previously reported cases bring totals since June 2012 to 897 and 377, respectively in Saudi Arabia, according to a report today from the country's Ministry of Health (MOH).

The new case is in a 58-year-old man from Khobar in the east central part of Saudi Arabia, who has preexisting disease and is in critical condition. He is not a healthcare worker but reportedly had contact with confirmed or suspected MERS-CoV (Middle East respiratory syndrome coronavirus) patients in a hospital or clinic setting. He had no apparent exposure to animals or to MERS patients in the community setting.

The deaths occurred in three men, 54, 65, and 60 years old. The first two were Saudis from Buraydah in the central part of the country and Tabuk in the northwest. The third was an expatriate living in Riyadh. None of the case-patients was a healthcare worker, and all three had preexisting disease.

The MOH report also notes that two men, 53 and 52, both in Dhahran, near Khobar, have recovered from the disease. Neither is a healthcare worker and both had preexisting disease. Their recoveries leave 32 active cases plus 2 case-patients on home isolation, according to the MOH.
Feb 18 MOH report

Study reports success with wide azithromycin use for yaws

Mass treatment with azithromycin—a central component of the World Health Organization's (WHO's) strategy to eradicate yaws—was followed by a drop in disease prevalence to one-eighth the previous level on an island where the disease is endemic, according to a study in the New England Journal of Medicine today.

Yaws is an infectious disease caused by Treponema pallidum subspecies pertenue, a gram-negative bacterium closely related to T pallidum subsp pallidum, which causes syphilis. It is 1 of 17 neglected tropical diseases that the WHO has classified as disproportionately affecting economically disadvantaged areas.

Researchers administered one dose of azithromycin to 83% of 16,092 residents of Lihir Island in Papua New Guinea in 2013 and 2014. The prevalence of yaws dropped from 2.4% before treatment began to 0.2% 12 months later, which was statistically significant. The prevalence of high-titer latent yaws among children declined from 18.3% to 6.5%, "with a near-absence of high-titer seroreactivity in children 1 to 5 years of age."

Side effects were mild, and no drug resistance was detected, the authors noted.

An accompanying commentary in the same issue said that, although challenges to yaws eradication lie ahead, today's study shows that the WHO strategy of mass treatment with azithromycin "should result in the eradication of yaws, if it is implemented and sustained long enough."
Feb 18 N Engl J Med study
Feb 18 N Engl J Med commentary