CDC: 2016-17 flu season was long, vaccine protection fairly low

The US Centers for Disease Control and Prevention (CDC) said today in Morbidity and Mortality Weekly Report (MMWR) that the 2016-17 flu season was dominated by influenza A (H3N2), and the flu vaccine was only 34% effective in protecting recipients against that strain and 42% effective against all strains.

The vaccine was 56% effective in protecting against the influenza B strain that also circulated last season.

The CDC said that modest vaccine effectiveness is typical in years when influenza A dominates. In February, the CDC estimated that overall vaccine effectiveness was 48%. In general, the CDC said, influenza vaccines are more protective against H1N1 strains and influenza B.

Most regions in America reported increasing influenza-like illness (ILI) activity by the first week of December, with flu season peaking in February for influenza A infections. Influenza B activity peaked by April 1. 

The weekly percentage of hospital visits for ILI was above the national average for 17 consecutive weeks, beginning in mid-December. People over the age of 65 had the most (31.8%) cases of laboratory confirmed influenza, with young children and adults ages 5 to 24 years old following at 30.4%.
Jun 30 MMWR report
Feb 16 CIDRAP News story "Current flu vaccine protects about half of recipients"


Investigation identifies hot peppers as source of 2016 Salmonella outbreak

In a separate MMWR report, CDC investigators and their state health partners today described a 2016 Salmonella Anatum outbreak linked to hot peppers that sickened 32 people in nine states.

The outbreak came to light in June 2016 when PulseNet identified a cluster of 16 infections from four states that had the same genetic fingerprint, which matched a pattern from an isolate from an Anaheim pepper sample that had been uploaded to the system the month before. The Food and Drug Administration (FDA) had collected the sample during routine surveillance cultures of produce, and the positive findings prompted the agency to place the consolidator/grower from Mexico that sourced the peppers on an import alert.

An investigation after the illnesses surfaced turned up 32 illnesses with onset dates between May 6 and July 9.

Combined evidence from PulseNet and foodborne illness interviews with patients found that 7 of 14 had eaten at Mexican-style restaurants the week before they got sick. Open-ended interviews with 18 patients from Texas, Colorado, Illinois, and Minnesota revealed that 14 had eaten hot peppers or food containing hot peppers, 9 of them in restaurant settings. Eleven remembered possibly eating jalapenos, but none reported eating Anaheim peppers.

There was one, 2-person restaurant cluster among the sick patients, both of whom ate at the same Texas restaurant on the same day and had several common food items. The only fresh hot peppers in the meals were jalapenos, which were in the pico de gallo and the mild salsa.

Of three restaurants included in the trace-back investigation, two had received peppers from the consolidator/grower that was the source of the contaminated Anaheim pepper. The authors said genetic sequencing findings, plus the epidemiological and trace-back results, point to fresh hot peppers as the source of the outbreak, but it wasn't possible to pinpoint one pepper or one farm. Though whole-genome sequencing is helpful, they said careful review of all data is critical to determining the outbreak source.
Jun 30 MMWR report


World Bank launches pandemic bonds to support emergency funding

The World Bank yesterday announced the launch of specialty bonds geared toward funding the Pandemic Emergency Financing Facility (PEF), designed to streamline surge funding to developing countries facing a pandemic threat.

In a press release, the World Bank said the launch marks the first time it has used bonds to finance the battle against infectious diseases and the first time pandemic risk in low-income countries is being transferred to the financial markets.

The PEF will provide more than $500 million to cover developing countries against pandemic outbreaks over the next 5 years through bonds and derivatives, a cash window, and future commitments from donor countries.

The transaction was oversubscribed by 200%, which the World Bank said reflects a strongly positive reaction from investors and high confidence in the World Bank's new instrument. Strong demand allowed the World Bank to price the transaction well below initial guidance, with the total amount of risk transferred to the market through the bonds and derivatives at $425 million.

World Bank President Jim Young Kim said the new tool has the potential to save millions of lives and entire economies from one of the biggest global threats. "We are moving away from the cycle of panic and neglect that has characterized so much of our approach to pandemics."

Kim said the PEF launch creates a new market for pandemic risk insurance and draws on lessons learned from West Africa's Ebola outbreak.

The World Bank announced the PEF in May 2016 at the G7 meeting in Japan. It has two windows: an "insurance" window with premiums funded by Japan and Germany, consisting of bonds and swaps, and a second "cash" window that Germany provided with initial $57.1 million in funding. The case window will be available starting in 2018 to contain diseases that may not be eligible for funding under the insurance window.
Jun 28 World Bank press release


Yemen’s cholera outbreak grows by nearly 40,000 cases

The World Health Organization (WHO) today reported 39,688 more suspected cases of cholera this week, including 183 associated deaths. Since the outbreak began last October, there have been 224,989 suspected cases of cholera, 1,416 of them fatal.

The current outbreak began to surge in late April, and since then Yemen has an estimated 5,000 new cases per day. The overall case-fatality rate is 0.6%, but the WHO said that percentage is much higher in some areas and among certain age groups. Last week, UNICEF and the WHO said the current outbreak is the world's worst.

Ongoing conflict and civil war have created a powder keg situation in Yemen, with many of the country's hospitals closed and healthcare professionals forgoing paychecks for 10 months. Public health infrastructure, including water sanitation stations, has also collapsed in the last 2 years.
Jun 29 WHO update


Early data promising for antiviral against MERS, SARS, related viruses

An antiviral drug candidate effectively inhibited a broad range of coronaviruses in early studies, including MERS-CoV (Middle East respiratory syndrome coronavirus) and SARS (severe acute respiratory syndrome)-CoV, according to a paper yesterday in Science Translational Medicine.

The drug, called GS-5734, is in clinical development for treating Ebola virus disease. A US team of researchers showed that it effectively inhibited MERS-CoV, SARS-CoV, more broadly circulating human CoVs, bat CoVs, and prepandemic bat CoVs in human lung cells, "thus demonstrating broad-spectrum anti-CoV activity," the authors wrote. The finding was a surprise, because compounds in the same class—nucleoside analogs—have typically failed to inhibit coronavirus replication, according to a press release from Vanderbilt University.

In mice, GS-5734 significantly reduced the viral load of SARS-CoV in lung tissue and improved clinical signs of disease as well as respiratory function.

The authors concluded, "These data provide substantive evidence that GS-5734 may prove effective against endemic MERS-CoV in the Middle East, circulating human CoV, and, possibly most importantly, emerging CoV of the future."
Jun 28 Sci Transl Med study
Jun 28 Vanderbilt press release

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