Flu Scan for Mar 19, 2018

News brief

NIAID announces launch of phase 2 trials for updated H7N9 avian flu vaccine

The National Institute of Allergy and Infectious Diseases (NIAID) last week announced the launch of two phase 2 clinical trials of a candidate H7N9 influenza vaccine, one to assess different dosages with or without an adjuvant and the second to look at the adjuvanted vaccine's performance alongside a quadrivalent seasonal flu vaccine.

The inactivated H7N9 vaccine was developed by Sanofi Pasteur with support from the Biomedical Advanced Research and Development Authority, part of the US Department of Health and Human Services. In a Mar 15 press release, NIAID, sponsor of the vaccine trials, said the vaccine has been updated to include an inactivated form of the H7N9 virus collected in 2017 to ensure that it protects against a new H7N9 strain circulating in China.

Anthony Fauci, MD, NIAID director, said in the statement, "As we experience one of the worst seasonal influenza epidemics in recent years here in the United States, we also must maintain a scientific focus on novel influenza viruses, such as H7N9, that have the potential to cause a pandemic." He added that the new studies will provide a more detailed picture of the vaccine's safety and ability to generate an immune response against current H7N9 strains.

One of the trials, led by a researcher from Kaiser Permanente Washington Health Research Institute in Seattle, will enroll up to 420 male and nonpregnant female participants ages 19 to 64 from sites in Georgia, Iowa, Maryland, North Carolina, and Washington. Volunteers will be divided into five groups, of which three will receive the adjuvanted vaccine at three different dosages and two will receive the unadjuvanted version at two different dosages. Both groups will be vaccinated at the first visit and again 21 days later.

The second trial, led by a researcher at the University of Maryland, will randomly sort up to 150 healthy adult volunteers into three groups, all of whom will receive the adjuvanted vaccine. Study sites are in Alabama, Maryland, Ohio, and Tennessee.

The first group will get the initial H7N9 dose within 15 minutes of the quadrivalent seasonal flu vaccine, the second will receive the H7N9 vaccine about 3 weeks after the seasonal vaccine, and the third group will receive only the seasonal vaccine. Both of the H7N9 groups will receive a second dose 21 days later.
Mar 15 NIAID press release 


Three H9N2 infections reported in China

China has reported three more H9N2 avian flu infections in humans, all of them mild and two of them in children, according to the latest update on zoonotic influenza from the World Health Organization (WHO).

The first illness occurred in a 9-year-old girl from Anhui province who got sick on Dec 29 and whose exposure source is unknown. The second child infected with the virus is a 3-year-old girl from Guangdong province whose symptoms began on Jan 21 after she had contact with live market poultry.

The third case involves a 51-year-old woman from Beijing who started having symptoms on Feb 13. The WHO said she had slaughtered domestic poultry before she became ill.

H9N2 is endemic in China's poultry, and sporadic infections in humans are typically mild, with the illness more common in children.
Mar 2 WHO flu at the human-animal interface report


USDA-Korea deal narrows restrictions for US high-path avian flu outbreaks

The US Department of Agriculture (USDA) recently announced an agreement with South Korea's government that would limit trade restrictions to the state level rather than the country level in the wake of future highly pathogenic avian flu detections.

In a Mar 15 statement, the USDA said the step will prevent a repeat of trade actions taken in 2015 when South Korea banned all US poultry, poultry products, and eggs because of an avian flu detection. In 2015, highly pathogenic H5N2 struck poultry in several US states, especially in the Midwest.

Greg Ibach, USDA undersecretary for marketing and regulatory programs, said in the statement, "The new science-based agreement will allow unaffected U.S. producers to keep poultry, poultry products and eggs going to South Korea."

In 2014—the last full year when no highly pathogenic avian flu restrictions were in place—South Korea imported $122 million worth of US poultry and poultry products, making it the 10th largest market for US poultry producers, the USDA said. South Korea lifted its most recent avian flu–related ban in August 2017, which followed a highly pathogenic outbreak in March 2017.
Mar 15 USDA press release

News Scan for Mar 19, 2018

News brief

Saudi Arabia and Oman report new MERS infections

The Saudi Arabian Ministry of Health (MOH) announced a new case of MERS-CoV late last week, in a household contact of a previously reported case.

A 36-year-old Saudi woman from Jeddah was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). She presented with symptoms and is in stable condition. Last week the MOH said a 56-year-old Saudi man from Jeddah had MERS-CoV after coming into contact with camels.

Saudi Arabia's MERS-CoV total cases since 2012 have now reached 1,816, including 736 deaths. Nine people are still being treated for their infections.

Meanwhile, the World Health Organization (WHO) on Mar 15 announced a new MERS-CoV case from Oman, that country's first of the year. The patient was 74-year-old Omani man, living in Batinah whose symptoms began on Feb 23. An investigation found that prior to his illness he had taken care of camels that were reportedly sick. Oman reported its last MERS-CoV case in November 2017.

The WHO said the development lifts global total from the disease to 2,144 cases, at least 750 of the fatal.
Mar 14 Saudi MOH update
Mar 15 WHO update


US and Europe warn of yellow fever threat in Brazil, urge vaccination

Both the US Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) issued warnings late last week for travelers heading to Brazil.

Brazil is currently experiencing its largest yellow fever outbreak in decades, with an upsurge of cases recorded since January.

The CDC said Friday during media briefing that all travelers to Brazil should receive a yellow fever vaccination at least 10 days prior to their trip. If they are unable get the vaccine, the CDC said they should avoid traveling to areas of Brazil where vaccination is recommended.

The CDC said travelers who were vaccinated more than 10 years ago for yellow fever may consider getting a booster dose before their trip, and it warned that the vaccine is available at a limited number of clinics that that travelers should plan ahead to get the vaccine.

The ECDC released a similar warning, highlighting recent cases of yellow fever among unvaccinated Europeans.

"Five travel-associated cases of yellow fever have been reported among unvaccinated EU/EEA travellers returning from Brazil, since the beginning of January 2018," the ECDC said. "In Switzerland an unvaccinated traveler infected with yellow fever died. For comparison, there were six travel-related cases in EU/EEA travelers between 1999 and 2016."
Mar 16 CDC statement
Mar 16 ECDC statement


Kratom-related Salmonella outbreak sickens 47 more, spreads to 35 states

A multistate Salmonella outbreak linked to kratom supplements has sickened 47 more people and expanded to 8 more states, raising the total to 87 cases from 35 states, the US Centers for Disease Control and Prevention (CDC) said in a Mar 15 update. States reporting their first cases are Alaska, Illinois, Indiana, Maryland, Mississippi, Nevada, Texas, and West Virginia.

Also, three other Salmonella subtypes have been linked to the outbreak: Salmonella Javiana, Okatie, and Thompson. Patients included in earlier reports were infected with S I 4,[5],12:b:-. The latest illness onset is Feb 24, and patient ages range from 6 to 67 years. So far 27 people have been hospitalized, but no deaths have been reported.

State and local health officials continue to interview sick people about foods they ate and other exposures. Of 55 people interviewed so far, 40 (73%) reported consuming kratom in pills, powder, or tea. Kratom is used as a stimulant and herbal alternative to opioids and is also known as Thang, Kakuam, Thom, Ketom, and Biak.

Investigators in three more states have found outbreak strains in leftover and unopened kratom products. California officials found the S I 4,[5],12:b:- outbreak strain in leftover Phytoexactum brand kratom power from a patient in that state, which on Mar 10 prompted a recall of PXD Aromatics kratom powder sold online between Jan 18 and Feb 18 of this year.

Also, authorities in Oregon and Utah who tested kratom powder from retail outlets and online sellers where sick people bought kratom identified Salmonella Okatie and Salmonella Thompson in the samples. No brand was available for the kratom sample from Oregon, but the Utah sample was sourced from the website kratoma.com.

In an earlier update, the CDC said health departments in North Dakota and Utah had identified the outbreak strain in kratom samples. Despite the spate of positive samples, the CDC said no single common brand or supplier has been connected to the outbreak. For now, it recommends that the public avoid any brand of kratom in any form.
Mar 15 CDC outbreak update


Afghanistan notes more WPV1 cases; DRC has 2 vaccine-derived polio cases

Afghanistan has reported two more wild poliovirus 1 (WPV1) cases, and the Democratic Republic of the Congo (DRC) has reported two more cases of vaccine-derived poliovirus type 2 (cVDPV2) in its ongoing outbreak, the Global Polio Eradication Initiative (GPEI) said in a Mar 16 update.

The cases in Afghanistan are advance notifications, and more details will be available in later updates, the GPEI said. However, it noted the new WPV1 cases are from Kunar and Kandahar provinces. So far this year, Afghanistan has reported five WPV1 cases.

Three positive WPV1 environmental samples have been detected in Afghanistan, all from Nangarhar province, and another has been reported in Pakistan's Balochistan province, according to the GPEI.

In the DRC, the two new cVDPV2 cases are from two provinces, Haut Lomami and Tanganyika. Paralysis onsets were Jan 16 and Jan 19, respectively. They reflect the first cases of 2018, after 22 cases reported so far for 2017. The DRC's government recently declared a public health emergency due to the ongoing cVDPV2 outbreak.
Mar 16 GPEI report

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