Phase 1 trial shows good safety, immune response for H7N9 flu vaccine

A live attenuated influenza vaccine (LAIV) candidate for H7N9 avian flu produced a good immune response and was shown safe in a phase 1 human trial, researchers from Russia and the World Health Organization (WHO) reported yesterday in The Lancet Infectious Diseases.

The investigators gave two doses of the vaccine to 29 healthy adults aged 18 to 49 years and placebo doses to 10 volunteers of the same age. The vaccine was made from an H7N9 strain in China, where almost all of the world's human cases of H7N9 flu have been confirmed, and was administered in October 2014.

Seroconversion as measured by microneutralization assay was noted in 14 LAIV recipients (48%) after one dose and in 21 (72%) after two doses. Cellular immune responses were induced in 27 of 29 recipients (93%).

The vaccine was well tolerated, with mainly local, mild adverse events in 19 recipients (63%) after the first dose and in 9 recipients (31%) after the second dose. The frequency of adverse events did not differ between the vaccine and placebo groups.

The LAIV vaccine offers distinct advantages over the injected inactivated versions, which haven't tested well in people without the use of immune-boosting adjuvants, the authors noted.

A commentary in the journal by US experts called the results promising and noted that the same researchers saw a much lower immune response for an H7N3 LAIV vaccine that they previously tested: seroconversion rates of only 17% and 41% after one and two doses, respectively.
Dec 7 Lancet Infect Dis study
Dec 7 Lancet Infect Dis commentary


Brazil microcephaly cases rise by more than 500

Brazil's health ministry today reported another steep increase in the number of microcephaly cases, with the detection of 513 more instances, lifting the total to 1,761 cases this year. The increase was noted in a ministry statement translated and posted by Avian Flu Diary (AFD). The ministry said the increase came despite a recent change in diagnostic criteria from a head circumference of 33 cm to 32 cm.

Health officials in Brazil sounded the alarm about an association between a Zika virus outbreak in the northeastern part of the country with an usual increase in microcephaly cases. Lab findings in some pregnant women and in one baby who died have also hinted at a Zika virus link, and similar neurologic anomalies have also been reported in a recent Zika virus outbreak in French Polynesia.

Zika virus is spread by Aedes mosquitoes and causes an illness with symptoms that are similar to dengue fever, but generally milder.
Dec 8 AFD post


Study finds better pediatric HUS outcomes with early fluid expansion

Early and more aggressive volume expansion can improve outcomes in children with hemolytic uremic syndrome (HUS) related to Shiga toxin-producing Escherichia coli infections, Italian researchers reported yesterday in Pediatrics.

The investigators based their findings on children referred to their center for treatment of HUS from 2012 through 2014 who received early volume expansion to 10% above body weight. Currently, there is no specific treatment for the potentially fatal condition, and management is typically centered on preventing fluid overload by fluid restriction or dialysis.

They compared the experimental treatment in 38 children with the outcomes in 38 children who had been hospitalized in the years before at the facility when HUS treatment routinely involved fluid intake restriction.

The team found that the volume expansion protocol improved both short- and long-term treatment parameters. For example, they found a lower rate of central nervous system problems (7.9% vs 23.7%, P = .06) and fewer intensive care unit days (2 vs 8.5 days, P = .03). Youngsters who received volume expansion also had fewer longer-term renal and other health problems (13.2% vs 39.5%, P = 01.)

Researchers concluded that the patients greatly benefited from early volume expansion, perhaps because it may reduce thrombus formation and organ damage from ischemia.

In a related commentary, David Cornfield, MD, from Stanford University's Center for Excellence in Pulmonary Biology, wrote that the study's findings are the first in several decades that could drive a clinically useful change in standard practice. He also praised the study design and approach, noting that generating new and robust findings in pediatric populations can be difficult.

"That the authors were able to demonstrate efficacy after enrolling only 38 children is remarkable," Cornfield wrote, noting that the only two outcomes that weren't statistically significant were death and central nervous system involvement, which likely resulted from justifiable type 2 errors.
Jan 2016 Pediatrics abstract
Jan 2016 Pediatrics commentary extract


Korean officials tie animal feed bacteria to fall illness cluster

South Korean health officials who have been investigating a cluster of respiratory infections that began in October in animal lab workers at Seoul's Konkuk University said today that a type of bacterium in animal feed is the source of the outbreak.

The outbreak sickened 55 people since Oct 19, some hospitalized with pneumonia, the Korea Times reported today, citing the Korea Centers for Disease Control (KCDC) and Prevention. All were student workers in the university's animal sciences lab.

The mysterious outbreak came on the heels of the country's Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak earlier this year and was the topic of a Nov 16 notification from the WHO, which said South Korea had alerted it of the cluster on Oct 29, when 55 patients were reported in seven different hospitals, along with 29 other patients with mild symptoms. No deaths were reported.

The KCDC probe found the bacterium Saccharopolyspora rectivirgula in samples from patients and the labs, according to the Times report. Inhalation of the bacteria can cause "farmer's lung," a type of hypersensitivity pneumonitis in those who handle hay bales.

Health officials said the bacteria are often found in plants or soil, adding that improperly stored animal feed in the labs probably contributed to the infections and contaminated the environment through the ventilation system. Health officials are still investigating if other factors are involved and will sanitize the now-shuttered building before the school's spring semester begins in March.
Dec 8 Korea Times story
Nov 16 WHO report


WHO develops tool to track attacks on health workers

The WHO today announced a new tool to track violence against healthcare workers across the globe, from attacks on Ebola response workers in West Africa to assaults on polio immunization teams in Pakistan to recent bombings of Doctors without Borders hospitals.

The new system is being tested in Central African Republic, Syria, the West Bank, and the Gaza Strip and will be available for use early next year, the WHO said in a news release.

"But the project doesn't only aim to collect data," the agency said. "It also plans to use the information to identify patterns and find ways to avoid attacks or mitigate their consequences."

In 2014 alone, 603 healthcare workers were killed and 958 injured in attacks in 32 countries, the WHO said. "Protecting health care workers is one of the most pressing responsibilities of the international community," said Jim Campbell, director of WHO's Health Workforce department.
Dec 8 WHO news release

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