Flu Scan for Dec 04, 2014

News brief

Meta-analysis hints that premies may risk flu complications

A systematic review published today of data on 15,698 children found that premature birth may need to be added to the risk factors that place children at risk for serious complications from influenza, but an accompanying commentary advised not reading too much into the findings.

Writing in The Lancet Respiratory Medicine, UK researchers conducted a meta-analysis involving 27 published and 4 unpublished studies and found neurologic disorders (univariable odds ratio [OR], 4.62), sickle cell disease (3.46), immunosuppression (2.39), diabetes (2.34), and age younger than 2 years (2.51) to be associated strongly with hospital admission. These risk factors are consistent with UK, US Centers for Disease Control and Prevention (CDC), and World Health Organization guidelines.

The team also noted, though, that premature birth was associated with an OR of 4.33, which would be a new risk factor. And they did not find asthma or other respiratory conditions, obesity, cardiac conditions, or cancer to be statistically significant risk factors.

In a commentary in the same issue, however, Harish Nair, MD, PhD, of the University of Edinburgh and the CDC's Marc-Alain Widdowson, VetMB, MSc, said both the negative results and the finding of premature birth as a risk factor should be interpreted with caution.

They note that the authors measured the risk of hospital admission in children already seeking care, including in emergency departments, which would already place them at high risk and underreport risk factors. And they said that five of the seven studies analyzed for prematurity did not define it in terms of gestational age, which is a study weakness.

Yet Nair and Widdowson agreed with the study authors that identifying children vulnerable to flu complications is crucial. They emphasized the importance of increasing flu and pneumococcal vaccine uptake in children, especially in countries with low coverage.
Dec 4 Lancet Respir Med abstract
Dec 4 Lancet Respir Med commentary

China's Fujian province reports H7N9 case

Another human case of H7N9 avian influenza has been reported this week, this one in a 27-year-old man from the city of Fuqing in the Fujian province of southeast China, according to a story from China's state news agency Xinhau today.

He is in critical condition at a hospital in Fuzhou, capital of the Fujian province. His is the 23rd case reported from the province, says a story in Outbreak News Today.

Reports of human H7N9 in China first began in the spring of 2013. Since then, 463 cases have been reported, according to a case list kept by FluTrackers, an infectious disease news message board. At least 175 deaths have been reported
Dec 4 Xinhua report
Dec 4 Outbreak News Today story
FluTrackers H7N9 case list

News Scan for Dec 04, 2014

News brief

Reports reveal over 100 safety breaches at high-security UK labs

UK labs that handle the most dangerous pathogens have reported at least 116 accidents or other biosecurity breaches in the past 5 years—about one every 2 weeks—The Guardian reported today.

Reports from the UK regulatory agency Health and Safety Executive revealed that, in one instance, live Bacillus anthracis samples—the causative agent of anthrax—were mistakenly sent from a high-security government facility to lower-security labs across the country. In another breach, an air-handling system that helped contain foot-and-mouth disease virus failed at a large animal lab.

More than 70 of the incidents were serious enough to investigate, The Guardian reported. Many led to enforcement letters or orders to shut labs down until improvements were made.

Some of the most worrisome breaches, including the B anthracis incident, happened at the Surrey-based Animal Health and Veterinary Laboratories Agency (AHVLA), renamed the Animal and Plant Health Agency in October.

Biosecurity expert Richard Ebright, PhD, of Rutgers University, said the reports, taken together, revealed failures in procedures, infrastructure, training and safety culture in some labs. Regarding the AHVLA incidents, he said, "Does British agriculture have a death wish?"
Dec 4 Guardian story

Infants, adolescents most affected in California pertussis epidemic

Nearly 10,000 cases of pertussis have occurred this year in California, with preponderance in infants, so expectant mothers are being encouraged to receive the Tdap (tetanus, diphtheria, and acellular pertussis) vaccine in their third trimester to provide transplacental immunity to their children, researchers reported today in Morbidity and Mortality Weekly Report (MMWR).

The authors, from the California Department of Public Health (CDPH), analyzed the 9,935 cases occurring through Nov 26 to prioritize public health activities and work toward prevention, particularly of severe cases, which most often occur in infants.

Pertussis incidence during the study period was 26 cases per 100,000 population overall. Disease burden was highest in infants up to 12 months of age, with an incidence of 174.6 cases per 100,000. Hispanic infants had the highest incidence (rate ratio = 1.7; 95% confidence interval [CI], 1.5-2.1) and Asian/Pacific Islander infants the lowest (rate ratio = 0.4; CI, 0.3-0.6) , compared to white, non-Hispanic infants.

Hospitalization was necessary in 347 of the 6,790 patients for whom information was available; 275 (79%) of these were infants were younger than 12 months, with 214 (62%) younger than 4 months; Tdap vaccine is not given until 2 months of age. Very few of the mothers had been vaccinated during pregnancy.

Disease burden was also high in 14- to 16-year olds, with the incidence peaking at 137.8 cases per 100,000 in 15-year-olds. In 1997 acellular vaccine rather than all or some whole-cell pertussis vaccine was introduced, so adolescents at the upper end of this current high-incidence group would have received only the acellular type. The authors point out that the immunity conferred by this type wanes more quickly than does that of whole-cell vaccine.

CDPH declared that pertussis had reached epidemic stage on June 13 when the number of cases reached five times the baseline level. The authors point out that pertussis incidence is cyclical, peaking every 3 to 5 years; the last epidemic was in 2010.
Dec 5 MMWR article

Pew study reveals gaps in FDA food-animal antibiotic rule

Research by the Pew Charitable Trusts found that, a year after the US Food and Drug Administration (FDA) released guidance on overprescribing antibiotics in animals, gaps exist that could allow many drugs to be used to augment weight gain instead of treat disease, Food Safety News reported today.

Pew researchers reviewed the labels of 287 antibiotic products governed by the FDA recommendations, called "Guidance for Industry #213." They found that 66 of them (23%) can be used in chickens, turkeys, pigs, or cattle for disease prevention at the same levels as weight-promotion doses and without a limit on duration.

The FDA classifies 29 of those 66 products as critical and 37 as highly important for human treatment. Thirteen labels had overlapping dosages but with duration limits, and four overlapped but only partially.

The guidance is set to be fully implemented by December 2016.

"Even if Guidance #213 is fully implemented, we are concerned that dozens of products could still be added to animal feed or water throughout the animals' lives in the absence of any threat from a specific bacterial disease," said Gail Hansen, DVM, in a Pew news release.
Dec 4 Food Safety News story
Nov 30 Pew press release