Flu Scan for Feb 23, 2016

News brief

Study: High-dose flu vaccine benefits seniors, regardless of prior-year dose

A new analysis of data from a large randomized trial suggests that the high-dose (HD) flu vaccine is more protective in seniors than the standard-dose (SD) vaccine, and this benefit is not affected by which formulation seniors received in the previous flu season.

The study, reported Feb 21 in Clinical Infectious Diseases, was conducted by researchers from Sanofi Pasteur, Vanderbilt University, and the University of Pittsburgh. It was sponsored by Sanofi, which produces the high-dose vaccine, introduced in 2010.

The original study was a double-blind, randomized controlled trial that compared the efficacy of HD and SD vaccines in 14,500 seniors (65 years and older) over two flu seasons. More than half (7,643) of the year 1 participants re-enrolled in year 2; vaccines were randomly assigned both years. The authors note that recent observational studies suggest that previous flu vaccination may influence the effectiveness of current-season vaccination.

The researchers examined the incidence of lab-confirmed flu in year 2 among the various vaccine assignment groups. Compared with those who received SD in both years, those who received HD in year 2 had better protection. The relative vaccine efficacy (VE) for the year 2 HD recipients was 28.3% overall; it was 25.1% for those who received HD both years and 31.6% in those who had received SD in year 1. (The study did not include an unvaccinated group, so there was no measure of absolute VE.)

In addition, the researchers used multivariate regression models to determine that year 1 vaccination had no significant effect on year 2 VE (P = 0.43). The models affirmed that year 2 HD vaccination was significantly linked to lower flu risk (P = 0.043). Further, year 2 HD recipients had significantly higher flu antibodies (measured by hemagglutination inhibition) than those in the other vaccine groups.

The authors also report that they found no safety concerns associated with the HD vaccine.
Feb 21 Clin Infect Dis study

Hong Kong reports imported H7N9 case from China

Hong Kong's Centre for Health Protection (CHP) today announced an imported H7N9 avian influenza case from the mainland, its first in the fourth wave of illnesses in the region. The patient is a 60-year-old man from Jiangsu province who started having symptoms on Feb 8, 3 days after he arrived in Hong Kong.

He was initially admitted to a hospital on Feb 11, where he tested negative for influenza A and was diagnosed with pneumonia. The man was discharged on Feb 15 but sought care from a private clinic on Feb 18 and 22. Further tests on samples taken during his hospitalization were positive for H7N9, and he was admitted to a different hospital today and is listed in stable condition.

The man's son, who has a sore throat but no fever, has been admitted to the same hospital for observation, and his wife currently has no symptoms. The CHP said tracing is underway for the man's other Hong Kong contacts.

An investigation suggests the man may have been exposed to the virus during a visit to the wet market in his hometown of Suzhou.

The CHP said the man's illness is Hong Kong's 14th imported H7N9 case since the virus first emerged in 2013. The latest illness, plus a retrospective report of a healthcare worker from Guangdong province infected in 2015, lifts the global total to 742, according to a case list maintained by FluTrackers, an infectious disease news message board.
Feb 23 CHP statement
FluTrackers H7N9 case list

Indiana lifts H7N8 outbreak restrictions

Indiana's state veterinarian yesterday lifted the control zone in a Dubois County area hit by recent H7N8 avian influenza outbreaks, clearing the way for poultry producers to resume normal operations and movements of birds and poultry products.

The 6.2-mile control zone was established Jan 15 after highly pathogenic H7N8 was detected on a Dubois County turkey farm, according to a statement yesterday from the Indiana Board of Animal Health (IBAH). Testing in the wake of the finding turned up the low-pathogenic form of H7N8 virus at nine of the county's other turkey farms. Birds at all of the farms, plus those at a nearby egg farm thought to be at risk, were culled.

Yesterday's release of the control zone follows a 38-day testing period at farms in the control zone. Officials had also placed an additional 6.2-mile surveillance zone around the control zone, and yesterday’s action lifted that measure as well.

Bret Marsh, DVM, Indiana's state veterinarian, said in the statement, "We are pleased to be where we are today, just 38 days after HPAI was identified in Dubois County. This is an unprecedented event for the state of Indiana, and the level of cooperation and response at all levels has been incredible."
Feb 22 IBAH statement

News Scan for Feb 23, 2016

News brief

Study links HPV vaccine to markedly lower infection levels in girls, women

Use of the quadrivalent (four-strain) human papillomavirus vaccine (4vHPV)—which was introduced in 2006—was associated with a 64% decrease in prevalence of the vaccine strains in girls and women 14 to 19 years old and a 34% drop in women 20 to 24 years old, according to a study yesterday in Pediatrics.

The researchers, with the Centers for Disease Control and Prevention (CDC), used National Health and Nutrition Examination Survey data from the "prevaccine era" (2003 to 2006) and the "vaccine era" (2009 to 2012). 4vHPV was made to protect against the HPV-6, -11, -16, and -18 strains. And between those two eras, the prevalence of those four strains decreased from 11.5% to 4.3% among females 14 to 19 years old and from 18.5% to 12.1% in those 20 to 24 years old, according to the study.

The authors were surprised by the magnitude of the decrease and suggest that further research should focus on the effectiveness of an incomplete three-dose vaccine series and on the "herd effect" of 4vHPV administration.
Feb 22 Pediatrics study

Saudi Arabia confirms another new MERS case

Saudi Arabia's Ministry of Health (MOH) today confirmed another new MERS case, the country's seventh one in 8 days.

The latest MERS-CoV (Middle East respiratory syndrome coronavirus) infection involves a 53-year-old Sudanese man in the southwestern city of Abha. He is hospitalized in critical condition and is not a healthcare worker, the MOH said.

His case is listed as primary, meaning he did not contract the disease from another person. The MOH, however, did not specify any potential risk factors.

Saudi Arabia has now had 1,300 MERS cases since the outbreak began in 2012, the MOH said. Of those cases, 554 have proved fatal.
Feb 23 Saudi MOH update

UK nurse hospitalized a third time for Ebola complications

A Scottish nurse infected with Ebola in December 2014 after working in Sierra Leone has been hospitalized in an isolation unit in London for the third time, according to official statements.

Paula Cafferkey's latest hospitalization was prompted by findings from routine monitoring by the Infectious Diseases Unit at National Health Services Greater Glasgow and Clyde, according to statements from the agency. She was initially admitted to Queen Elizabeth University Hospital for further investigation and was in stable condition.

Royal Free London Hospital said in a statement today that Cafferkey would be transferred to its facility because of a late complication, which was not described, related to her earlier Ebola infection. "She will now be treated by the hospital's infectious diseases team under nationally agreed guidelines," the facility said today in a statement.

Cafferkey had been hospitalized at Royal Free London's isolation unit twice before—once for her initial infection and again in October 2015 for Ebola-related meningitis, a rare late complication of the disease.

Her case brought attention to lingering health problems in Ebola survivors and the unanswered clinical and scientific questions about the disease. The virus can hide out in immune-protected areas such as the brain, eyes, and testes.
Feb 23 NHS Greater Glasgow and Clyde statement
Feb 23 NHS Greater Glasgow and Clyde updated statement
Feb 23 Royal Free London statement
Nov 12, 2015, CIDRAP News story "UK nurse with Ebola meningitis released from isolation"

CDC: Salmonella outbreak tied to sprouts reaches 13 cases in 4 states

A Salmonella outbreak linked to Sweetwater Farm sprouts that was first noted in the media late last week has now grown to 13 cases in four states, the CDC said in a notice today.

Of the 13 patients, 5 have required hospitalization, the CDC said. They range in age from 18 to 73 years, with a median age of 51. All but 1 are women. They reported that they first had symptoms from Dec 1, 2015, to Jan 21.

Cases in each state are: Kansas (5), Missouri (3), Oklahoma (3), and Pennsylvania (2). The cases in Kansas and Oklahoma had been reported in the media on Feb 19. The outbreak strain is Salmonella Muenchen.

Ten of 12 case-patients reported eating or possibly eating sprouts in the week before they became ill, and 9 of them reported eating alfalfa sprouts. One patient reported buying Sweetwater Farms brand alfalfa sprouts from a grocery store.

"State and local health and regulatory officials performed traceback investigations from five different restaurant locations where ill people ate sprouts," the CDC said. "These investigations indicated that Sweetwater Farms supplied alfalfa sprouts to all five locations.

"We recommend that consumers do not eat and restaurants and other retailers do not sell or serve alfalfa sprouts produced by Sweetwater Farms at this time."

Sweetwater Farms, of Inman, Kan., recalled one lot of its sprouts because of the outbreak, the Kansas Department of Health and Environment (KDHE) reported on Feb 19.
Feb 23 CDC outbreak notice
Feb 22 CIDRAP News scan on initial cases
Feb 19 KDHE news release

Obama administration seeks boost in funds to combat malaria

The Obama administration yesterday announced that its fiscal year 2017 budget request calls for $874 million for the President’s Malaria Initiative (PMI), a $200 million increase, as well as $1.35 billion for the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The announcement came at the United Nations Foundation's Nothing But Nets Champion Summit in Washington, D.C., according to a Nothing But Nets press release.

The $200 million increase for PMI, if passed by Congress, will mean the program can expand to three new countries—Sierra Leone, Cote d'Ivoire, and Cameroon—and expand its existing program in Burkina Faso. It would also mean launching an effort to eliminate malaria in Zambia and Cambodia.

The funding boost would help provide nearly 14 million additional bed nets, which would protect more than 27 million people in sub-Saharan Africa from malaria, according to the release. PMI funds also promote research and development of new tools to combat the disease.

The requested funds would more than double the PMI budget from what it was 8 years ago, said Shaun Donovan, director of the Office of Management and Budget, in a White House blog post yesterday.
Feb 22 Nothing But Nets news release
Feb 22 White House blog post