European study finds 33% vaccine effectiveness against hospital flu

The flu vaccine in three European nations in 2012-13 provided 33% protection against hospitalization for influenza in adults, according to a study yesterday in PLoS One.

European investigators analyzed data collected from the Global Influenza Hospital Surveillance Network for 14 hospitals—5 in Spain, 5 in France, and 4 in Russia—during the 2012-13 influenza season. Influenza was confirmed by reverse-transcription polymerase chain reaction.

They found vaccine effectiveness (VE) against hospitalization for lab-confirmed flu in adult patients targeted for vaccination to be 33% against all strains, with a 95% confidence interval (CI) of 11% to 49%.

VE by strain was 23% (95% CI, −26% to 53%) against 2009 H1N1, 30% (95% CI, −37% to 64%) against H3N2, and 43% (95% CI, 17% to 60%) against the influenza B lineage (Yamagata) included in the vaccine, even though the Victoria B strain circulated more widely that year.
Jun 19 PLoS One study


Unexpected 2009 H1N1 findings raised thorny public health issues

Unexpected findings that first appeared in the media about a higher risk of 2009 H1N1 infections in people who had been vaccinated for seasonal flu complicated decision making for governments that were setting policies about the use of a 2009 H1N1 vaccine, according to Canadian experts in a perspective piece yesterday in Eurosurveillance.

The authors, from Public Health Toronto and the University of Toronto, said studies on the association between the seasonal flu vaccine and 2009 H1N1 illnesses were reviewing the scientific evidence at the time, and the news accounts put the review outside of the traditional peer-review process. They said that complication raises compelling issue about how to handle new evidence that emerges in the middle of a public health emergency.

The experts noted that unexpected findings can be a rigorous test of a health system's capacity to evaluate scientific findings, handle uncertainty, and rapidly translate them into practical public health steps.

When the situation arose during the pandemic months, public health policymakers seemed to dismiss the unexpected findings, researchers were reluctant to release their findings, and almost all journals were reluctant to publish the findings, which the authors said resulted in a confusing media message.

The experts wrote that although similar issues haven't cropped up during the H7N9 or Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks, a critical review needs to take place about public health officials and how the scientific community handles unexpected research findings during a public health event and how information can be communicated transparently to the public.
Jun 19 Eurosurveill perspective


H5N8 confirmed on South Korea farm

H5N8 avian flu—which led to millions of poultry being culled in the spring—has returned to South Korea, killing 100 chickens and 94 geese at a poultry farm near Daegu, a city in the southeastern part of the country, the Korea Times reported this week.

Officials from the Daegu Metropolitan Government confirmed the presence of the highly pathogenic strain in three of the dead chickens, the story said. The surviving 388 chickens and 13 geese were culled to prevent disease spread, and authorities are increasing efforts to contain the disease through checkpoints, disinfection, and other measures.

The city had not had an avian flu outbreak since 2008, according to the report.

The story also mentions two outbreaks in Hoengseong in Gangwon province and in Muan in South Jeolla province in the past week but did not provide details. The Daegu outreak farm had bought 107 goslings from a farm in Hoengseong on Jun 14, the article said.
Jun 18 Korea Times story

News Scan for Jun 20, 2014

News brief

Saudi Arabia reports another MERS-CoV case

Saudi Arabia reported one new MERS-CoV (Middle East respiratory syndrome coronavirus) case today, raising the country's official total to 706 cases.

The latest patient is a 45-year-old expatriate who is hospitalized in Riyadh, the Ministry of Health (MOH) said in today's update. He has no preexisting conditions and is not a healthcare worker. The ministry gave no information about how he was exposed to the virus.

Today's case is only the fourth in the past week, as the rate of reported new infections continues to be far below what it was in April and part of May, when hospital-related outbreaks sparked hundreds of cases. The previous week, Jun 6 to 13, brought nine cases.

With no deaths reported today, the fatality toll in Saudi Arabia remained at 290. Forty patients are still being treated, the MOH says.
Jun 20 Saudi MOH statement
MOH coronavirus page with case count


Multistate Salmonella outbreak tied to feeder rodents declared over

A Salmonella Typhimurium outbreak linked to feeder rodents has grown to 41 cases in 21 states but is now likely over, the Centers for Disease Control and Prevention (CDC) said today in a final outbreak notice.

The total reflects four new cases and three new affected states since the CDC's previous update on May 20. Colorado, Missouri, South Carolina, and Virginia all reported new cases, and the cases were the first for all those states but Missouri, which now has three. California confirmed the most cases: seven.

Illness-onset dates range from Jan 11 to May 17, with patients ranging in age from younger than 1 year to 19 years. Of 37 patients with available information, 6 (16%) were hospitalized. No deaths were reported.

"Epidemiologic, laboratory, and traceback findings linked this outbreak of Salmonella infections to contact with frozen feeder rodents packaged by Reptile Industries, Inc.," the CDC said in its notice.

"Feeder rodents" are those fed to pets such as snakes and birds of prey.

The Food and Drug Administration said to dispose of any Reptile Industries' Arctic Mice brand frozen rodents bought from PetSmart stores from Jan 11 through May 21 by placing the product in a sealed container in the trash, the CDC said. Reptile Industries is based in Naples, Fla.

Earlier this month Canadian officials announced 20 Salmonella Typhimurium cases linked to snakes and feeder rodents. It's not clear whether the two outbreaks are related.
Jun 20 CDC notice
Jun 3 CIDRAP News scan on Canadian outbreak


Study: 7% of deer ticks harbor both Lyme, babesiosis pathogens

Deer ticks (Ixodes scapularis, also called blacklegged ticks) sampled in upstate New York simultaneously harbored the pathogens that cause Lyme disease and babesiosis at almost twice the expected levels, according to a study in PLoS One.

Researchers from the Cary Institute of Ecosystem Studies (CIES) in Millbrook, N.Y., and elsewhere in the United States measured the infection prevalence in 4,368 "questing" nymph ticks (young ticks seeking to feed) that were gathered in the field in Dutchess County, N.Y. They tested for Borrelia burgdorferi, Babesia microti, and Anaplasma phagocytophilum, the pathogens that cause Lyme disease, babesiosis, and human granulocytic anaplasmosis, respectively.

The investigators found that almost 30% of the questing nymphs were infected with B burgdorferi, and a third of those were also infected with at least one other pathogen.

Specifically, 6.7% of the questing nymphs (292) were infected by both B burgdorferi and B microti, a rate 83% higher than would be predicted by chance alone. Infections with all three pathogens occurred in only 0.52% of ticks, and co-infection of A phagocytophilum with either of the other two pathogens was also low (0.53% and 2.4%).

"People in tick-infested parts of the United States, such as the Northeast, Mid-Atlantic, and Upper Midwest, are vulnerable to being exposed to two or three diseases from a single tick bite," said senior author Felicia Keesing, PhD, in a CIES press release. "And, of course, that risk increases when they're bitten by more than one tick."
Jun 18 PLoS One study
Jun 19 CIES press release


Meta-analysis shows benefits of antibiotics for cholera

Antimicrobial drugs substantially improve clinical and microbiologic outcomes in patients with cholera, according to a meta-analysis published yesterday in the Cochrane Library.

The research team, based at Liverpool School of Tropical Medicine (LSTM), reviewed 39 randomized and quasi-randomized controlled clinical trials that encompassed 4,623 patients, both adults and children.

From a clinical perspective, the drugs shortened diarrhea episodes by a day and a half compared with placebo or no treatment. Antimicrobial treatment also halved stool volume, cut the amount of rehydration fluid by 40%, and shortened the duration of fecal bacteria extraction by nearly 3 days.

Researchers found variation in the size of the antibiotic benefits, which they said probably related to differences in antibiotics, trial methods, and outcome assessments. They noted, though, that benefits were seen across a range of disease severity.

No obvious differences stood out in drug head-to-head comparisons, but indirect comparisons seemed to show tetracycline had greater benefits than doxycycline, norfloxacin, and trimethoprim-sulfamethoxazole, and single-dose azithromycin shortened diarrhea by a day when compared with ciprofloxacin and by a half day when compared with erythromycin.

Lead author Ya'ara Leibovici-Weissman from Tel Aviv University said in an LSTM press release that, for Vibrio cholerae infections, quick and accurate diagnosis is key, but the results of the study show antibiotics yield substantial improvements. "Our results also point to the likelihood that azithromycin and tetracycline may have some advantages over other antibiotics."
Jun 19 Cochrane Library abstract
Jun 19 LSTM press release

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