Flu Scan for Nov 11, 2013

News brief

Cambodian 10-year-old with H5N1 has died

A 10-year-old boy from Kampot province in Cambodia who was reported to have H5N1 avian flu last week has died, The Cambodian Daily reported today. The boy is the second child to die from the disease in the country in 2 weeks.

In addition, Cambodia's Ministry of Health (MoH), and the World Health Organization (WHO), in a joint statement on Nov 8, confirmed the case. The boy, from Sdok Thlok village, developed a fever on Oct 28, according to the statement. His parents sought local treatment for the boy, but his condition deteriorated.

He was admitted to Kantha Bopha Hospital in Phnom Penh, on Nov 7 with fever, cough, sore throat, a distended abdomen, and difficulty breathing, the statement said. Lab samples were taken that day and tested positive for H5N1, and he began to receive oseltamivir (Tamiflu) on Nov 7 as well.

He died on Nov 9, The Cambodian Daily said. A 2-year-old girl from Pursat province who had H5N1 flu died on Oct 26, the WHO earlier confirmed

The boy's infection marks the 24th case this year, of which 13 have been fatal. Since 2005, the country has confirmed 45 H5N1 cases and 32 deaths. Of the 45 cases, all but 9 have been in children younger than 14 years, the MoH and WHO said.
Nov 11 Cambodian Daily story
Nov 8 Cambodia MoH/WHO statement

Northern Hemisphere flu activity remains low, WHO says

Influenza-like illness activity in many European countries is starting to rise, but overall influenza detections in the Northern Hemisphere remain low, the WHO said in an update today.

North America and Europe overall are reporting low flu activity, the WHO said, but "a few countries" in Europe are reported sporadic influenza detections in samples. Other temperate regions in the Northern Hemisphere are also reporting interseasonal flu levels.

The Southern Hemisphere is likewise reporting low influenza activity, but Australia and New Zealand both experienced a recent uptick, the WHO said.

In its weekly virus activity report, the agency said so far 992 clinical samples worldwide have tested positive for influenza. Of those, 746 (75.2%) were influenza A and 246 (24.8%) influenza B. Of the subtyped influenza A viruses, 293 (64.1%) were H3N2 and 164 (35.9%) were 2009 H1N1.
Nov 11 WHO flu activity report
Nov 11 WHO flu virus report

Flu shot could cause mild to severe reaction in those allergic to gelatin

People with a suspected or known gelatin allergy should take precautions when getting a flu shot, says a news release from the American College of Allergy, Asthma and Immunology (ACAAI).

How would one recognize such an allergy? According to the article, marshmallows, which contain gelatin, might make the tongue swell, or gummy bears, which also do, might bring about an itch.

Gelatin, which can contain proteins derived from animals or fish, is used in flu (and other) vaccines as a stabilizer, according to the release. Gelatin allergies, which are "very rare," according to allergist Stephanie Albin, MD, can cause hives, swelling, itching, sneezing, difficulty breathing, and even anaphylaxis in certain people.

A case report presented in a poster session at the ACAAI Annual Scientific Meeting in Baltimore discusses a case of anaphylaxis after a flu shot in a gelatin-allergic patient.

People who think they may have a gelatin allergy should not automatically avoid flu shots, however. According to ACAAI President Richard Weber, MD, "Those who believe they might have an allergy should be tested and diagnosed by an allergist before taking extreme avoidance measures or skipping vaccination." Precautions in a gelatin-allergic patient might include having the flu shot given by an allergist in case a reaction should occur, says the release.
Nov 8 ACAAI news release

Study finds some H5N1 viruses in birds less susceptible to antivirals

Many H5N1 avian flu viruses circulating in Vietnamese poultry show lowered susceptibility to common antiviral drugs, according to findings of a Nov 8 study in Emerging Infectious Diseases.

Researchers, many from the US Centers for Disease Control and Prevention, assessed drug susceptibility of 125 H5N1 viruses from poultry specimens collected from 2009 to 2011. The antiviral agents tested were the M2 blockers amantadine and ramantadine; the neuraminidase inhibitors oseltamivir (Tamiflu), zanamivir (Relenza), peramivir, and laninamivir; and the investigational agents DAS181 and favipiravir (T705). Viruses were assigned to three clades: 1.1, 2.3.2.1, and 2.3.4, with clade 2.3.4 further divided into three subclades.

Of 25 clade 1.1 viruses, all had S31N in the M2 protein, the most common marker of resistance to the M2 blockers; the remaining viruses had no known markers for M2 blocker resistance. Twenty-four of the clade 1.1 viruses were inhibited by the neuraminidase inhibitors.

Of 70 clade 2.3.2.1 viruses, 1 had the H275Y marker of oseltamivir resistance and showed much-reduced inhibition by oseltamivir and peramivir. Clade 2.3.2.1 viruses are being seen with increasing frequency in northern Vietnamese poultry, note the authors, and the H275Y marker has been reported in oseltamivir-treated patients.

Of 30 clade 2.3.4 viruses, 3 had an I223T mutation and a sevenfold reduced inhibition to oseltamivir.

According to the authors, their findings "emphasize the need to enhance the armamentarium of available anti-influenza drugs worldwide."
Nov 8 Emerg Infect Dis study

News Scan for Nov 11, 2013

News brief

Syrian polio cases rise to 13

Three more wild poliovirus type 1 (WPV-1) infections have been confirmed in Syria, pushing the number of cases to 13, the World Health Organization (WHO) said today.

Further genetic sequencing testing of the WPV-1 strain isolated in the Syrian outbreak suggests that its closest relative is a virus found in an environmental sample in Egypt in December 2012, which itself had been linked to a WPV circulating in Pakistan, according to the WHO. The agency said that the virus detected in Syria is also closely related to environmental samples found in Israel, West Bank, and Gaza Strip since February.

The WHO said risk of further international WPV-1 spread is high, given frequent population movements in the region and the challenge in maintaining vaccination levels that keep the spread of the disease in check.

The report on the new cases comes amid an emergency campaign to vaccinate about 1.6 million kids in the war-torn country against polio and other childhood diseases, as well as a broader effort to reach 20 million kids in Syria and six other Middle East countries over the next 6 months.
Nov 11 WHO outbreak update
Nov 8 CIDRAP News story "Syria's polio outbreak prompts huge Mideast immunization drive"

One of two remaining poliovirus types not seen in a year

It has been a full year since any wild poliovirus type 3 (WPV-3)—one of two remaining polio types—has been detected, suggesting that vaccination efforts may have exterminated the strain, though experts are not ready to say that, according to a Canadian Press report yesterday.

The disappearance of type 3 viruses would mean that only WPV-1 remains to be conquered to achieve the long-sought goal of polio eradication, the story said.

The last WPV-3 detection occurred in Nigeria in November 2012. Pakistan, one of the other two countries in which polio remains endemic, last reported a WPV-3 infection in April 2012, according to the story. Before that, the US Centers for Disease Control and Prevention (CDC) had been reporting a decline in the number of type 3 lineages.

"I think the available information is cause for some cautious optimism," Olen Kew, PhD, a senior CDC virologist and polio expert, told the Canadian Press. "But in particular in Nigeria I think we would look for more evidence before we would . . . uncork the champagne."

Polio surveillance in Nigeria is less than ideal, the story noted. But in Pakistan, testing of sewage in Peshawar has not revealed WPV-3, which is encouraging, said Kew.

The global polio eradication effort started in 1988, the story notes. WPV-2 has not been detected since 1999.

WPV-1, the type that recently turned up in Syria and in Israel's sewage, is the most aggressive polio strain and can easily travel great distances. WPV-3 is less likely to travel, but it is harder to detect, because only 1 in 1,200 infections leads to paralysis, the story said. That fact prompts experts to be very wary of saying the strain has disappeared from Nigeria.
Nov 10 Canadian Press story