Flu Scan for Sep 08, 2014

News brief

Fed inspector finds DHS poorly prepared for flu pandemic

The US Department of Homeland Security (DHS) has done a poor job of managing supplies of personal protective equipment (PPE) and antiviral medications to protect its workforce during an influenza pandemic, the department's Office of Inspector General (OIG) has found.

"The department has no assurance that it has sufficient PPE and MCM [medical countermeasures] for DHS employees to continue operations," says the report, released today. "DHS also has no assurance that the supplies on hand remain effective."

Among other problems, "DHS and its components do not know where its personal protective equipment is located, how much it has, and the usability of the stockpiles that exist," the OIG said in a statement today.

Congress appropriated $47 million in supplemental funds in 2006 to enable DHS to plan, train, and prepare for a pandemic, the statement said.

But the report says the department did not adequately assess its needs before buying PPE and MCMs, and it didn't effectively manage what it bought.

DHS did not have clear methods for deciding the kinds and amounts of supplies to buy, and it failed to develop and implement replenishment plans, sufficient controls to monitor stockpiles, and contract oversight processes, according to the report.

As examples of the resulting problems, the OIG statement said:

84% of nearly 5,000 bottles of hand sanitizer in the DHS stockpile were expired
81% of antiviral drugs acquired by DHS will expire by the end of 2015
DHS has a reported inventory of 16 million surgical masks but has not demonstrated a need for that quantity

The OIG said it made 11 recommendations to correct the problems, and DHS agreed with the intent of all 11.

In the statement, Inspector General John Roth said he was pleased with DHS's response and pledged to would work with DHS officials to make sure that the preparedness program is strengthened.
Sep 8 DHS OIG statement
DHS OIG report (38 pages)

Study data show flu symptom reduction after peramivir shot

A phase 2 and a phase 3 clinical trial indicate that a single injection of the antiviral drug peramivir might reduce influenza symptoms and shedding of flu virus, according to data presented today at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), an infectious diseases meeting of the American Society for Microbiology.

In the two placebo-controlled studies involving a total of 427 adults, a single 300-milligram shot of peramivir was given within 48 hours after the onset of flu-like symptoms. For 14 days study participants recorded their temperature and the severity of seven flu symptoms using a four-point scale.

Compared with patients who received a placebo, peramivir reduced the median time to alleviation of symptoms by 22 hours, time to resolution of fever by 24 hours, and the amount of nasal viral shedding in the first 2 days after treatment.

The studies also demonstrated the injected drug to be safe and well tolerated.

In August a trial of intravenous (IV) peramivir was discontinued after it did not speed up relief from flu symptoms.
Sep 8 ICAAC abstract
Aug 13 CIDRAP News scan on IV peramivir trial

News Scan for Sep 08, 2014

News brief

Saudi Arabia reports MERS in another health worker

Saudi Arabia today confirmed one new MERS-CoV case, in a 60-year-old foreign health worker whose illness was detected in the city of Jubail, in the northeastern part of the country, according to a statement from the Ministry of Health (MOH).

The man is hospitalized in an intensive care unit, according to the report. He had no pre-existing disease, the MOH said.

The case is the first to be reported in 9 days. The last case, reported Aug 29, was also in a non-Saudi health worker in Jubail. The latest case raises Saudi Arabia's number of MERS-CoV (Middle East respiratory syndrome coronavirus) infections to 727, of which 302 have been fatal.
Sep 8 MOH statement
Sep 2 CIDRAP News scan "New MERS case raises Saudi count to 726"

Chikungunya case numbers increase by another thousand

Suspected and confirmed cases of chikungunya in the Caribbean increased over the past week by 1,088, with no new fatalities, according to numbers from the Pan American Health Organization (PAHO).

Given the far larger jump last week (more than 69,000) and the fact that none of this week's new cases are in the countries with large increases last time, it seems likely that some countries did not report current numbers.

The new cases as of Sep 5 occurred mainly in Puerto Rico, with 906 reported. The US Virgin Islands reported 109 more cases, and Barbados had 12. Total reported cases in the outbreak stand at 659,554.
Sep 5 PAHO report
Sep 2 CIDRAP News scan on last week's numbers

Cameroon, Pakistan report more polio cases

Two new wild poliovirus type 1 (WPV1) cases have been detected in Cameroon's East Region, signaling continued circulation, surveillance gaps, expansion to new areas, and a heightened threat to other African populations, especially the influx of refugees from the Central African Republic (CAR) into the country, the World Health Organization (WHO) said in a Sep 6 statement.

Cameroon's polio outbreak has been under way since at least October 2013 and has been linked to spread to Equatorial Guinea, one of the factors that led the WHO in May to declare a public health emergency of international concern to address the ongoing spread of the disease. The country's two new cases involved paralysis onsets of Jun 26 and Jul 9. Cameroon was one of the countries that met the criteria for states currently exporting WPV.

The country's East Region was the target of two recent subnational immunization campaigns, and Cameroon has conducted seven nationwide supplemental vaccination drives so far this year, the WHO said. Neighboring CAR launched a series of five activities in August covering the western half of the nation.
Sep 6 WHO statement

In related developments, Pakistan's National Institute of Health has confirmed 20 polio cases over the past 5 days, raising the country's total so far this year to 138, the Associated Press of Pakistan (APP) reported yesterday.

Among 11 of the newest cases, 8 were from the Federally Administered Tribal Areas and 3 were from Khyber Pakhtunkhwa province. The other recent infections were reported from Sindh and Punjab provinces.

Pakistani health officials yesterday launched a 3-day polio immunization campaign in the tribal regions, consisting of 2,000 vaccination teams that will administer drops to 600,000 children, Independent News Pakistan (INP) reported yesterday. Special arrangements have been made to protect the teams from attacks, according to the report.
Sep 7 APP story
Sep 7 INP story

Study: Viral contamination spreads quickly, cleans up easily on fomites

Viral contamination of a single fomite in a facility, such as a doorknob, can spread to 40% to 60% of fomites and people in the facility within 2 to 4 hours but can be largely removed just as quickly with disinfectant cleaning, according to a study presented today at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, DC.

The researchers applied bacteriophage MS-2, a surrogate of norovirus, to 1 or 2 surfaces early in the morning in office buildings and healthcare facilities. After 2 to 8 hours they sampled 60 to 100 fomites such as knobs, light switches, sink handles, and phones and found that 40% to 60% of them were contaminated with the virus.

To test a method of intervention, they provided cleaning personnel and employees with disinfectant wipes containing quaternary ammonium compound (QUAT) and instructions to use them at least once a day on surfaces. The number of fomites on which the virus could be detected was reduced by at least 80% with cleaning, and the concentration of the virus was reduced by at least 99%.

Noroviruses are highly infectious agents that spread quickly in facilities and often necessitate their closure for decontamination, according to an ICAAC press release. The QUAT used by the researchers is known to be effective against non-lipid containing viruses, such as norovirus.

ICAAC is an annual meeting convened by the American Society of Microbiology.

"The results show that viral contamination of fomites in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses," said Charles Gerba, PhD, of the University of Arizona, who presented the study, according to the press release. Proper selection of QUATs is key to control of contaminants, said the study abstract.
Sep 8 presentation abstract