Flu Scan for Sep 13, 2013

News brief

Few flu hotspots at global and national levels

Over the 2 weeks that closed out August, flu activity in the world remained at low levels, with H3N2 as the predominant strain and 2009 pandemic H1N1 (pH1N1) and influenza B circulating in many countries as well, the World Health Organization (WHO) said today.

The two main hot spots were Australia, where pH1N1 activity increased, and New Zealand, which reported that H3N2 and influenza B activity is still high. The Southern Hemisphere's flu season typically runs from May through October.

The WHO said flu activity remained low in Europe, North America, and Asia.

In the United States, flu levels remained well below seasonal baselines, according to an update today from the Centers for Disease Control and Prevention (CDC). Reports of sporadic outbreaks are starting to appear in the media, however, and earlier this week Los Angeles County reported an uptick in activity, mainly from pH1N1.

No new variant H3N2 (H3N2v) cases were reported, keeping the total at 18. The most recent case was reported last week by Michigan, which has now detected two of the novel infections.

The CDC reported three more pediatric flu deaths, which raised the total for the 2012-13 season to 164. The newly reported fatalities all occurred in March; one was linked to H3N2, and the other two involved influenza B viruses.
Sep 13 WHO global flu virologic update
Sep 13 CDC weekly influenza update
Sep 11 CIDRAP News scan "Los Angeles reports uptick in flu cases"

ECDC confirms three H7N7 cases in Italian poultry workers

Three poultry workers in the Italian region beset with outbreaks of highly pathogenic H7N7 avian flu in poultry have contracted H7N7 conjunctivitis, the European Centre for Disease Prevention and Control (ECDC) confirmed today.

The Emilia Romagna region in northern Italy has now had six outbreaks in birds, Bloomberg News reported this week.

One of the H7N7 cases was in a 51-year-old who developed conjunctivitis in one eye on Aug 30. He had recovered by Sep 3. He was isolated at home, and four family members are under 10-day active surveillance for disease.

In addition, a 46-year-old man developed bilateral conjunctivitis and was placed in isolation to prevent disease spread. Details on the third man's case are sketchy, but he was also placed in isolation. The three men all worked on the same poultry farm.

One of these cases was reported by the media on Sep 2, but the reports did not specify his age. The ECDC said in today's report, "Active surveillance has been implemented to all workers exposed to sick animals and their close contacts. The same applies to workers involved in culling operations."

Bloomberg News reported on Sep 11 that, since Aug 28, the Emilia Romagna had seen three more H7N7 poultry outbreaks, bringing the region's outbreak total to six. One of the new outbreaks had previously been reported by the World Organization for Animal Health (OIE) on Aug 28.

Two of the new outbreaks, including the one already confirmed by the OIE, were on commercial farms owned by a poultry company affected by a previous outbreak, while the third involved a rural backyard flock, according to the report. Almost 220,000 birds were culled in the three outbreaks to prevent disease spread, Bloomberg reported. More than 730,000 were killed in the prior three outbreaks, according to the story.
Sep 13 ECDC report
Sep 11 Bloomberg story

Study affirms test-negative design for gauging flu vaccine effectiveness

The test-negative design (TND) for assessing influenza vaccine effectiveness, an increasingly common method, stacks up well against randomized controlled trials (RCTs), the "gold standard" approach, according to an analysis published yesterday in Eurosurveillance.

The TND involves comparing the vaccination status of patients who test positive or negative for flu after seeking medical care for a flu-like illness. It is a convenient and relatively low-cost approach, says the report, because it does not require recruitment of healthy controls, the procedure typically used in case-control studies.

In the study, researchers from two Canadian institutions and MedImmune Inc., the manufacturer of live attenuated influenza vaccine (LAIV), aimed to test the "core assumption" of TND: that the vaccine has no effect on other, non-targeted pathogens that cause flu-like illnesses.

They used data from four large RCTs of LAIV to compare RCT estimates of flu vaccine effectiveness with estimates from the TND. For a further test, they applied the TND to data from two RCTs of the efficacy of humanized monoclonal antibody for preventing hospitalization in respiratory syncytial virus (RSV) cases.

The results: "Efficacy estimates and their confidence intervals were virtually identical for per-protocol RCT versus TND analyses of LAIV and also for RSV monoclonal antibody," the report says. The results also showed that LAIV and the RSV antibody did not affect the risk of diseases caused by non-targeted pathogens.

"This study validates the core assumption of the TND approach for influenza vaccine efficacy estimation and confirms the accuracy and precision of its estimates compared to the gold standard of classic per-protocol RCT analysis of the same data sets," the authors conclude.
Sep 12 Eurosurveillance report

Kids with neurologic conditions had low seasonal flu vaccination rates

Although they are at greater risk for poor influenza outcomes, flu vaccination coverage of children with neurologic or neurodevelopmental (NND) conditions was similar to that in the general pediatric population, according to a report today in Morbidity and Mortality Weekly Report (MMWR).

Working with Family Voices and the American Academy of Pediatrics, researchers from the Centers for Disease Control and Prevention (CDC) surveyed parents and physicians during the 2011-12 influenza season. Overall, parents of children with high-risk conditions completed 1,940 surveys, and flu vaccination rates ranged from 41% for children with metabolic conditions to 78% for those with chronic lung disease.

Of the 1,005 children with NND conditions, parents reported that 50% of children were vaccinated or had a vaccine appointment scheduled. Vaccination rates were low both for children with intellectual disability (52%) and for those with epilepsy (59%).

In addition, physician recognition of high-risk conditions was low for intellectual disability (46%) and epilepsy (52%). But physicians who care for children with NND conditions were statistically more likely than other physicians to identify most NND conditions as risk factors for influenza complications, the report said.
Sep 13 MMWR report

News Scan for Sep 13, 2013

News brief

Study shows 94% post-vaccine meningitis drop in Chad

The incidence of meningitis in areas covered by a 2011 vaccination campaign was 94% lower a year later compared with nonvaccinated regions of Chad in sub-Saharan Africa, a new study found.

An international team of scientists measured the incidence of meningitis during the 2012 meningitis season after a mass vaccination campaign the year before with a new meningococcal serogroup A vaccine, PsA-TT (MenAfriVac). About 1.8 million people aged 1 to 29 years in three regions of Chad received PsA-TT in December 2011.

The team, led by researchers from the London School of Hygiene & Tropical Medicine (LSHTM), published its findings yesterday in The Lancet.

The incidence of meningitis of any kind in these regions during the 2012 meningitis season was 2.5 per 100,000 people, compared with 43.8 per 100,000 in regions where mass vaccination was not done, a 94% difference, the authors wrote. In addition, investigators detected no cases of serogroup A meningococcal meningitis in the three vaccinated regions, despite enhanced surveillance.

Meningococcus nasal carriage was also markedly reduced. Two to 4 months before the campaign, 32 serogroup A carriers were confirmed in 4,278 people tested via throat swabs. Four to 6 months after vaccination, that number dropped to 1 in 5,001.

Senior author Brian Greenwood, MD, from the LSHTM, said in a school news release, "This is one of the most dramatic outcomes from a public health intervention that I have seen during a long career of research in Africa [since the early 1970s]. There are now real prospects that the devastating effects of this infection in Africa can be prevented.''
Sep 12 Lancet abstract
Sep 11 LSHTM news release
Sep 12 Lancet commentary on the study

Global preschooler deaths cut almost in half since '90, UN says

Global deaths among preschoolers dropped from 12 million in 1990 to 6.6 million in 2012, four United Nations (UN) groups announced today, but that still adds up to 18,000 deaths each day in children under 5 years old.

Worldwide, 45% of those deaths are linked to undernutrition, according to a press release from the agencies, including the World Health Organization and the UN Children's Fund (UNICEF). Other leading causes of death in this age-group include pneumonia, prematurity, birth asphyxia, diarrhea, and malaria. Newborns are especially at risk.

"Care for mother and baby in the first 24 hours of any child’s life is critical for the health and wellbeing of both," said WHO Director-General Margaret Chan, MD, MPH. "Up to half of all newborn deaths occur within the first day."

Basic healthcare for newborns is the key to preventing future deaths in young children, the UN agencies said, as are vaccines, access to basic drugs like antibiotics, and safe living environments. Vaccines against preventable diseases save about 2 million to 3 million lives in all age-groups each year, the UN release said.
Sep 13 UN news release

Risk of MERS persists in Europe, ECDC says

Europe faces a continuing risk of Middle East respiratory syndrome coronavirus (MERS-CoV) cases, given the ongoing detection of cases in the Middle East, the European Centre for Disease Prevention and Control (ECDC) said in a short update on the topic today.

"Surveillance for cases is essential, particularly with expected increased travel to Saudi Arabia for the Hajj in October," the ECDC said in this week's Communicable Disease Threats Report for Sep 8 through 14.

The ECDC put the total number of MERS-CoV cases at 132, with 57 deaths. The agency reported 108 cases (both symptomatic and asymptomatic) with 47 deaths in Saudi Arabia, which differs from Saudi Arabia's own posted count of 104 cases and 47 deaths.

"The reason for the discrepancy between the number of cases reported for Saudi Arabia here and in the official Saudi Ministry of Health [MOH] website area is unclear and is being investigated," the ECDC said.

The ECDC global case count of 132 also exceeds the 130 cases listed here 2 days ago in the wake of the latest Saudi Arabian reports of a total of eight new cases. The World Health Organization has not issued an update on MERS-CoV cases since Sep 7.

The ECDC report notes that 14 MERS cases have been reported outside the Middle East, including 4 in the United Kingdom, 3 in Italy, 2 in France, 2 in Germany, and 3 in Tunisia.

It also says that 17 asymptomatic cases have been reported by Saudi Arabia and 2 by the United Arab Emirates.
Sep 14 ECDC report
Sep 11 CIDRAP News story on latest Saudi cases
Saudi MOH MER-CoV page with case count

Deadly ameba species found in Louisiana water system

The ameba Naegleria fowleri has been found in the water system of St. Bernard Parish, La., near New Orleans, after a child who had visited the parish died of an infection with the rare organism, the Louisiana Department of Health and Hospitals (DHH) announced yesterday.

N fowleri was found in water at the home where the child had visited, and tests also showed low chlorine in some water samples in the communities of Violet and Arabi, the DHH said. The agency sent samples to the US Centers for Disease Control and Prevention for further testing, which confirmed the organism's presence.

The parish began flushing its water lines with additional chlorine last week as a precaution, officials said.

"The parish will continue this action until it raises chlorine residuals to recommended levels, and this process will continue for several weeks," Assistant Secretary for Public Health J.T. Lane said in the statement. "DHH is working with parish officials to provide assistance and support to the parish's staff to ensure that chlorine levels are being monitored daily."

People can't become infected with N fowleri by drinking water, but there is a risk if it enters a person's nose, the statement said. It advised people to take precautions against that, such as not allowing children to play unsupervised with hoses and sprinklers. Also, officials advised people to run bath and shower taps for 5 minutes to flush out the pipes before using them.

Louisiana had two deaths due to N fowleri infections in 2011, as well as the one reported last week, the DHH said. The infection causes primary amebic meningoencephalitis, which destroys brain tissue.
Sep 13 DHH statement