Flu Scan for Aug 27, 2014

News brief

Study: 4 reassortant H7N9 strains circulating in Chinese province

Sequence analysis of human and environmental samples demonstrated that four strains of reassorted H7N9 avian flu viruses have been circulating in Guangdong province—one of the country's hardest hit—and that an increase of human cases last year coincided with an increase in H7 isolates in environmental samples, according to a study today in Emerging Infectious Diseases.

Researchers from the Guangdong Provincial Center for Disease Control and Prevention, as well as Ron Fouchier, PhD, and Marion Koopmans, DVM, PhD, of Erasmus Medical Center in the Netherlands, analyzed data from 8,942 environmental samples taken from poultry markets in 21 cities from Apr 15, 2013, through Feb 28, 2014. Of those, 425 samples (4.8%) from 13 cities tested positive for H7 viruses, and 1,050 (11.8%) from 19 cities were positive for H9 viruses.

The team also analyzed data from 34,342 samples from patients with pneumonia or flu-like illness from 21 cities from April 2013 through February 2014. Of those, samples from 81 patients in 10 cities tested positive for H7N9. All but 6 of the cases were confirmed in early 2014.

Sequence analysis showed co-circulation of four distinct H7N9 strains that evolved by reassortment with H9N2 avian flu viruses circulating in the province, the authors wrote. They also found that an increase in human cases starting in late 2013 coincided with an increase in H7 virus isolates detected by environmental surveillance.

The authors conclude, "Co-circulation of multiple avian influenza viruses that can infect humans highlights the need for increased surveillance of poultry and potential environmental sources."
Aug 27 Emerg Infect Dis study

Study: Flu vaccine against unfamiliar strain may induce broad protection

US researchers say they have found that giving people a flu vaccine targeting an unfamiliar flu strain—H5N1 avian flu, in this case—may be a good way to generate antibodies targeting the stem of the flu virus's hemagglutinin (HA) protein, a structure that is a major focus of efforts to develop a "universal" or broadly protective flu vaccine.

The HA head, the part most visible to the immune system, mutates frequently, requiring yearly reformulation of flu vaccines to keep up with circulating flu strains. In contrast, the stem is relatively stable, and it is believed that a vaccine that generates antibodies to the stem might provide protection against a number of different strains.

In the study, published in the Proceedings of the National Academy of Sciences, researchers with the Emory Vaccine Center found that people vaccinated against H5N1, to which the US population has not been exposed, developed antibodies against the HA stem. Those who received a regular trivalent seasonal flu vaccine, however, developed antibodies mainly against the HA head.

In an Emory press release, lead author Ali Ellebedy, PhD, said the key to having volunteers' bodies produce antibodies against the stem region seemed to be their immune systems' unfamiliarity with the H5N1 virus.

In 2009, Emory researchers found that several patients infected with the 2009 H1N1 pandemic flu strain developed broadly cross-reactive antibodies, according to the release. At the time, most young adults had never been exposed to that strain.

In the current study, the team analyzed levels of antibody against different parts of the HA in 17 volunteers before and after H5N1 vaccination, the release explains. Anti-stem antibody levels rose an average of fourfold after the first H5N1 vaccination. But after an H5N1 booster shot, anti-head responses dominated while anti-stem responses were feeble.

The authors say their data also show that antibodies and memory B cells directed against the HA stem region are prevalent in humans, but at levels much lower than B-cell responses directed to the HA head.

"Our findings delineate a potential vaccination strategy where H5N1 or H7N9 immunization could be used not only for immunologically priming the population to quickly respond to serious pandemic influenza threats, but also for generating broadly neutralizing antibodies against influenza in humans," the report concludes.
Aug 25 Proc Natl Acad Sci abstract
Aug 25 Emory press release

News Scan for Aug 27, 2014

News brief

Feds plan to ask labs to pause for 'high-consequence' inventories

The US government plans to request that federally funded laboratories suspend all work on potentially dangerous pathogens for about 24 hours to inventory stocks of microbes, ScienceInsider reported today.

"Essentially, what the government will request is a short term on the order of 24 hours suspension of research involving high-consequence pathogens in order to allow institutional lab personnel to take stock of what pathogens they have stored in freezers, cold rooms, etc.," Carol Blum of the Council on Governmental Relations (COGR) in Washington, D.C., wrote in a memo sent to universities today and quoted in the story.

The White House Office of Science and Technology Policy is expected to deliver the request via funding agencies, the memo says. Several federal agencies appear to have already begun inventories, the story said. In addition, the American Society for Microbiology (ASM), which represents many of the affected researchers, asked its members to conduct such inventories.

ASM President Timothy Donohue, PhD, said in an Aug 25 statement, "I ask all microbiologists to make sure that you and your colleagues know what they have in the lab (freezer, refrigerator, store room, etc). Simply put, I think it is good 'laboratory housekeeping' to review what microbes we each have in the lab, inventory them, and use appropriate methods to deposit in an approved collection or destroy any cultures that are no longer needed by our labs."

The moves come after several high-profile US lab breaches involving variola virus, which causes smallpox; Bacillus anthracis, which causes anthrax; and highly pathogenic H5N1 avian flu virus.
Aug 27 ScienceInsider story
Aug 25 ASM statement

CDC releases Ebola guidance for EMS and 911 providers

As part of its growing resource base for public health workers and clinicians, the US Centers for Disease Control and Prevention (CDC) yesterday released interim guidance for emergency medical services (EMS) systems and 9-1-1 service providers that might be managing US patients with suspected or confirmed Ebola virus disease (EVD).

The guidance addresses issues related to the uncontrolled environment that EMS personnel might face, such as the need to intubate, suction, or perform cardiopulmonary resuscitation (CPR) on a patient in a moving vehicle, which could increase the risk of exposure for workers. The guidance urges EMS workers who come into direct contact with a suspected Ebola patient's body fluids to immediately stop working, wash skin surfaces with soap and water, and immediately report the exposure to a supervisor for follow-up.

It also walks responders through personal protective equipment (PPE) requirements and procedures and covers facility transport, environmental infection control, cleaning vehicles after transport, and patient care follow-up steps.

For 9-1-1 providers, the guidance covers what screening criteria to use for Ebola and when to consider the risk of Ebola to be elevated in the community.

The CDC also updated its interim guidance for specimen collection, transport, testing, and submission for patients with suspected EVD infections and posted an infographic on contact tracing.
Aug 26 CDC Ebola guidance for EMS and 9-1-1 providers
Aug 26 CDC updated guidance on specimen collection and testing
Aug 26 CDC infographic on Ebola contact tracing

USAID funding boosts West Africa Ebola commitment to $19.6 million

The US Agency for International Development (USAID) announced today that it is providing an additional $5 million to help West Africa battle its EVD outbreak. The amount lifts USAID's commitment to the effort to nearly $19.6 million, the agency said in a press release.

USAID's director of foreign disaster assistance announced the extra funding in Liberia during a 3-day visit with CDC Director Tom Frieden, MD, MPH, who is touring the three countries that have been hardest hit by the outbreak.

The boost in funding is targeted to health equipment and emergency supplies, training and support for healthcare workers, public outreach, and strengthening local health and emergency response systems.

USAID recently airlifted more than 16 tons of medical supplies and emergency equipment into Liberia, including 10,000 sets of PPE, water treatment systems, water tanks, and 100 rolls of plastic sheeting that can be used to build Ebola treatment units. The group deployed a multiagency Disaster Assistance Response Team on Aug 5 to coordinate the US government's response, with more than 25 members in Liberia, Guinea, and Sierra Leone.
Aug 27 USAID press release

US chikungunya cases near 700

Although the chikungunya epidemic in the Caribbean region has slowed somewhat, reports of US cases continue, most of them in returning travelers, with the total reaching 696 as of Aug 26, which is 60 more than a week ago, says a CDC update today.

The large majority of cases (680, 52 more than last week) have occurred in people who traveled to the Caribbean or South America. Another 6 have been in travelers to the Pacific Islands, which is 1 more than last week, and 4 in travelers to Asia, also 1 more than last week.

In addition, six cases of locally transmitted infection have been reported in Florida, an increase of two that was previously reported by state and local health officials. Florida and New York are the states with the most travel-associated cases (139 and 108, respectively); Florida is the only state with local transmission.

US territories have reported chikungunya as well. Puerto Rico's cases number 16 linked to travel and 201 locally acquired, both the same as last week. The US Virgin Islands have had 4 travel-related cases, 2 more than last week, and 21 locally transmitted cases, 19 more than last week.

Total confirmed and suspected cases in the current epidemic in the Caribbean and South America number nearly 590,000 as of Aug 22. In the period before the epidemic (2006 to 2013), the average number of US cases reported per year was 28.
Aug 26 CDC update
Aug 25 CIDRAP News scan on the epidemic

Japan records first local dengue case in 60 years

Japan's health ministry has confirmed the country's first locally acquired dengue infection in more than 60 years, the Associated Press (AP) reported today. It said the case occurred in Saitama, a prefecture northwest of Tokyo. The patient is a teenage girl who has recovered from her infection.

The disease was common in Japan during World War II, but the mosquito that spread the disease has been eradicated for decades, according to the AP.

A machine translation of background information on the case on Japan's health ministry Web site said the country records about 200 travel-linked dengue cases each year, and the closest area to Japan where the disease is endemic is Taiwan. It said that although the principal vector of the disease is Aedes aegypti, another type of mosquito that can spread the disease—Aedes albopictus—is present in some regions of Japan.
Aug 27 AP story
Aug 28 Japan health ministry background