Flu Scan for Feb 19, 2016

News brief

US flu levels show steady rise

Flu activity indicators in the United States showed a solid rise last week, with notable increases in the percentage of respiratory specimens positive for flu and the proportion of doctor visits for influenzalike illness (ILI), the US Centers for Disease Control and Prevention (CDC) said today.

The percentage of flu-positive respiratory tests rose from 9.1% to 12% last week, its highest point so far this season, while the percentage of clinic visits for flu increased from 2.4% to 3.1%. Last week's activity was still dominated by the 2009 H1N1 virus, which is known to cause serious disease even in previously healthy younger and middle-aged adults.

Nine of the CDC's 10 regions are above their specific baselines for flu-related clinic visits. Puerto Rico, Arizona, and Oklahoma reported high ILI activity. Widespread flu activity was reported from Puerto Rico and 12 states, . most in the southwest and northeast regions. This represents a rise from the week before, when such activity was present in the territory and seven states.

Surveillance showed a rise in the cumulative number of hospitalizations, which is now at 4.1 per 100,000 population, up from 3.2 per 100,000 last week.

Two more pediatric flu deaths were reported, lifting the season's total to 13. Overall deaths from pneumonia and flu, a marker that usually lags others, were at and below seasonal baselines in the two systems the CDC uses to monitor those patterns.
Feb 19 CDC FluView report

China reports 2 H7N9 cases

Chinese provincial and Hong Kong health officials yesterday reported two more H7N9 avian flu infections in adults from China's mainland, according to translated updates posted on FluTrackers, an infectious disease news message board.

Both case-patients are 57-year-old men who had contact with poultry before illness onset. The first patient is from China's eastern Shandong province and is hospitalized in critical condition in Yantai.

The second patient is from the town of Shaoxing in Zhejiang province; he is hospitalized in serious condition. Hong Kong health officials said his infection is the first H7N9 case in Zhejiang's Xinchang county.

The new cases are part of a fourth wave of H7N9 activity in China, in which 55 cases have been reported so far. They lift the overall global total from the disease to 740, according to a case list maintained by FluTrackers.
Feb 18 FluTrackers post on Shandong case
Feb 18 FluTrackers post on Zhejiang case

France and Hong Kong detect HPAI; Indiana will lift H5N8 control area

France and Hong Kong have reported recent detections of the highly pathogenic avian influenza (HPAI) strains H5N1 and H5N6, respectively, while Indiana officials prepare to lift the control and surveillance areas around farms that reported H5N8 detections in January.

French agricultural officials reported an outbreak of H5N1 to the World Organization for Animal Health (OIE) yesterday. H5N1 was detected as part of routine surveillance on a farm in the town of Creysse, located in France's south central Lot region. All 7,650 birds on the farm were destroyed to prevent spread of the infection.

Hong Kong health officials reported today that H5N6 was detected in a chicken carcass found at a beach in the Lung Kwu Tan region of Hong Kong's western Tuen Mun district. Officials said that no poultry farms are located in the region and are conducting surveillance for backyard flocks, which are banned in Hong Kong.

In related news, the Indiana State Board of Animal Health (BOAH) announced yesterday that it will lift its 10-kilometer control area and 10-kilometer surveillance area around farms affected by January outbreaks of HPAI and low-pathogenic H5N8, provided no new positive detections occur in the meantime.

The January detections resulted in the destruction of 258,045 turkeys and 156,178 chickens on 10 farms in Indiana's Dubois county, the BOAH said.

Ongoing testing at Purdue University's Indiana Animal Disease Diagnostic Laboratory has revealed no new positive H5N8 results since Jan 16. The lab has tested about 2,100 samples since the outbreak began.

Affected counties in the control and surveillance areas include Dubois, Crawford, Daviess, Martin, and Orange. Permits from the BOAH must be obtained for all poultry movements within these regions until the control and surveillance areas are lifted.
Feb 18 OIE report
Feb 19 Hong Kong Government Information Center press release
Feb 18 Indiana BOAH press release
Jan 15 CIDRAP News story on Indiana H5N8 outbreak

News Scan for Feb 19, 2016

News brief

Salmonella outbreak tied to nutritional powder grows to 18 cases, 15 states

An outbreak involving Salmonella Virchow linked to Garden of Life RAW Meal Organic Shake and Meal Replacement products has grown by 7 cases, to 18, and the number of affected states has increased from 9 to 15 since the outbreak was first reported more than 2 weeks ago, the Centers for Disease Control and Prevention (CDC) said today.

Patients range in age from 1 to 76 years, with a median of 34. Of 12 patients with available information, 4 were hospitalized, with is an increase of 3 since the initial CDC report on Feb 2. No deaths have been reported. Illness-onset dates range from Dec 5, 2015, to Feb 3.

Of 14 patients interviewed, all reported consuming Garden of Life RAW Meal products in the week before they fell ill.

The Utah Public Health Laboratory and Oklahoma Public Health Laboratory isolated the outbreak strain of Salmonella Virchow from open containers of Garden of Life RAW Meal collected from sick people's homes. And Food and Drug Administration sampling confirmed the outbreak strain in organic moringa leaf powder used in the products.

Garden of Life, of West Palm Beach, Fla., recalled some products on Jan 29, then expanded its recall on Feb 12. The company also said it will remove moringa leaf powder from its products.
Feb 19 CDC update
Feb 16 CIDRAP News scan on the outbreak

Study: Ebola antibody-binding at protein stalk most effective in mice

The effectiveness of Ebola neutralizing antibodies depends significantly on where they target the virus's glycoprotein, according to findings published yesterday in Science.

A team of researchers from numerous US institutes and Adimab LLC isolated 349 monoclonal antibodies (mAbs) that bond to Ebola virus (EBOV) glycoprotein (GP). The mAbs were obtained from the B cells of an EBOV survivor who exhibited a strong immune response to the virus 3 months following infection. Of the 349 antibodies, 77% were able to neutralize live EBOV.

Investigators studied the effect of isolated mAbs that target three areas of the EBOV GP: the glycan cap, the GP1/GP2 interface, and the stalk. Antibodies that targeted the GP stalk, which is located next to the viral membrane, were highly effective in neutralizing EBOV, leading to 60% to 100% survival rates in mice.

Five of the six antibodies in the mAb KZ52 group, which targets the GP1/GP2 interface and is a component of the ZMapp Ebola vaccine, also were effective in neutralizing the virus, leading to a 60% to 100% survival rate in mice.

Antibodies that targeted the glycan cap showed low efficacy in mice, with survival rates at or below 50%, with the exception of an antibody known as ADI-16037, which led to survival rates of about 80%.

Investigators also analyzed mAb-binding responses at the virus's mucin-like domain, which is hypothesized to shield EBOV glycoprotein from neutralizing antibodies. Only two mAbs failed to bind to the mucin-like domain, the study said, and about 30% of mAbs showed increased binding responses to the domain.

The researchers said their findings have implications for future EBOV therapies that should be tailored to where the virus is most vulnerable to neutralizing antibodies.
Feb 18 Science study