Flu Scan for Aug 22, 2017

News brief

Meta-analysis finds no negative impact of repeated flu vaccination

In a study designed to help clinicians and health policy makers decide whether to recommend and offer annual flu vaccination, a new meta-analysis published today found no evidence that prior season immunization blunts the protection of the current seasonal vaccine.

Researchers from Ontario and Hong Kong published their meta-analysis of observational studies today in BMC Medicine.

Some recent studies have raised the possibility that repeated flu vaccination might negatively impact protection.

From a literature search, 27 studies met the inclusion criteria for analysis, and they included 20 in their meta-analysis. The team compared vaccine effectiveness in four groups: those vaccinated in the current season only, those immunized in the prior season only, those in both seasons, and those in neither season.

Authors of the new meta-analysis found that regardless of previous season vaccination status, current season vaccination was associated with greater protection against lab-confirmed H1N1 and influenza B infection. When compared to those who weren't immunized the season before, people who were vaccinated in the current season had greater protection against all three flu subtypes. "Therefore, vaccination in the current season is generally the best option for the patient," they wrote.

The only exception they found was for the 2014-2015 season, in which pooled vaccine effectiveness across three of the studies was lower for those vaccinated in both the current and previous season compared to those who were only vaccinated during the current season. (The H3N2 component that year was a poor match with the circulating strain.)

Researchers said their findings were similar to a review in 1999, but that their review includes the latest lab-testing methods with study designs and offers more consistency across vaccination groups.
Aug 21 BMC Med abstract


H5N8 avian flu strikes again in 2 South African provinces

South Africa today reported two more highly pathogenic H5N8 outbreaks, including one in newly affected Kwazulu-Natal province in the southeast of the country, according to a report from the World Organization for Animal Health (OIE).

The virus was first detected in South African poultry in June, and H5N8 has now been detected in four provinces.

The latest outbreaks occurred in backyard birds in earlier-affected Mpumalanga province and a commercial farm in Kwazulu-Natal. The events began on Aug 11 and Aug 17, respectively, and between the two locations, the virus killed 93 of 248,266 susceptible birds. The remaining ones were culled as part of the outbreak response.
Aug 21 OIE report on H5N8 in South Africa


Australia, Southeast Asia among current global flu hot spots

High flu activity continues in parts of the Southern Hemisphere and in Southeast Asia, the World Health Organization (WHO) said today in its latest global flu update.

In Australia, flu is still rising, with differences among regions. New South Wales is reporting steep increases in flu-like illness and pneumonia hospitalization. In a separate Australian government flu surveillance report, officials said that, as of Aug 4, that there has been a nearly two-and-a-half-fold increase in the number of lab-confirmed flu infections compared with this time last year, fueled in part by an earlier onset of the season and the introduction of rapid testing.

H3N2 has been the dominant strain, and influenza B continues to circulate. Adults age 85 and older and young children ages 5 to 9 have been the hardest hit groups. So far seasonal flu vaccines seem to be a moderate-to-good match for the circulating viruses, the Australian health department report said.

In New Zealand, where H3N2 and influenza B are the predominant strains, flu activity is declining. Elsewhere in the Southern Hemisphere, flu is decreasing in South America and appears to have peaked in South Africa.

In Southeast Asia, flu activity continued to increase, with all subtypes reported for the region. Sharp increases were reported from Myanmar and the Philippines, especially involving 2009 H1N1, and in Thailand, where H3N2 is the dominant strain.

Other flu hot spots include South Asia, where increased 2009 H1N1 detections were reported from India and Nepal, and Southern China and Hong Kong, where activity seems to have peaked but is still elevated.

Globally, flu virus testing through Aug 6 found that 91% were influenza A and 9% were influenza B. Of the subtyped influenza A strains, 88% were H3N2.
Aug 21 WHO global flu update
Aug 4 Australia Department of Health flu surveillance report

Saudi Arabia reports new MERS case linked to camels

The Saudi Arabian Ministry of Health (MOH) announced a new case of MERS-CoV yesterday, in a patient who had contact with camels, a known risk factor for contracting the virus.

A 48-year-old Saudi man from Al Aflaj in the central part of the country was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) and is in stable condition after presenting with symptoms of the virus. According to the MOH, his possible source of infection was direct contact with camels.

Saudi Arabia now has now recorded 1,702 MERS-CoV cases, 690 of them fatal, since the first detection in humans in 2012. Eleven people are still receiving treatment for their infections.
Aug 21 MOH report


CDC reports that Candida auris cases now top 100

The number of Candida auris cases in the United States has risen to 112, according to a case count update yesterday from the Centers for Disease Control and Prevention (CDC).

The multidrug-resistant fungus has now been identified in healthcare facilities in nine states, with the vast majority of cases in New York (77) and New Jersey (23). The count reflects the number clinical cases of C auris infection, which rose from 98 in July. The pathogen has been isolated from an additional 120 patients from healthcare facilities in four of the affected states, meaning those patients were colonized with the fungus but did not show clinical signs of infection.

The CDC warned healthcare facilities about C auris in June 2016 based on reports from other countries about severe invasive infections caused by the fungus, which has shown increasing resistance to all three major classes of antifungal drugs. This type of resistance has not been seen in other Candida species. C auris can also persist on hospital surfaces and appears capable of spreading between patients.

In patients with compromised immune systems, C auris can cause serious invasive infections that affect the bloodstream, heart, brain, ear,            and bones. The CDC estimates that more than 1 in 3 patients with an invasive C auris infection die, and reports from other countries estimate mortality rates as high as 50%.

The CDC encourages all laboratory staff who identify C auris to notify state or local public health authorities and CDC officials.
Aug 21 CDC case count update

Report: FDA finds sprout contamination from a number of sources

Citing 2014-2016 data, the US Food and Drug Administration (FDA) today published a report on sprout contamination, noting that 14 (1.7%) of 825 samples from across the country tested positive for Salmonella or Listeria, with most of the positive samples coming from four sprouting operations.

The agency tested bean, alfalfa, and other sprouts for pathogens because, from 1996 to July of last year. sprouts were implicated in 46 foodborne disease outbreaks in the United States, which caused at least 2,474 illnesses, 187 hospitalizations, and 3 deaths. Officials tested for Salmonella, Listeria, and Escherichia coli O157:H7, three common food outbreak bacteria.

Of the 825 samples collected, 74% were from growers, 12% from distributors, and 14% from retailers. Scientists collected samples in 37 states plus the District of Columbia and Puerto Rico.

All positive samples were from production sites, with 6 samples testing positive for Salmonella and 8 for Listeria. Of the Salmonella samples, 4 were from pre-sprout seeds, 1 from the finished product, and 1 from spent irrigation water. For Listeria, 1 sample was from seeds, 6 from finished product, and 1 from spent irrigation water. No samples tested positive for E coli O157:H7, but the FDA did not test seeds for E coli because of test limitations.

Ten of the 14 positive samples were collected from 4 growers, 2 in the Southwest, 1 in the Midwest, and 1 in the West. The other samples were collected from 4 other sprouting operations.

The  executive summary of the report concludes, "The fact that the agency found multiple positive samples at some of these operations underscores the need for sprouting operations to comply with the agency’s Produce Safety Regulation (published November 2015), which seeks to prevent outbreaks of foodborne illness and improve sprout safety."

In addition, "The FDA will continue to consider microbial contamination of sprouts and how best to reduce it. . . . Going forward, the FDA intends to inspect sprouting operations to ensure they are complying, as applicable, with the Produce Safety Rule, which includes new requirements for sprouts growers."
Aug 22 FDA sprout sampling report

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