FLU NEWS SCAN: Avian flu in Cambodia, Egypt; flu corticosteroid warning; half-dose H1N1 vaccine

Aug 2, 2011

UN confirms avian flu death in Cambodian girl, case in Egypt
The World Health Organization (WHO) today confirmed previous media reports of a fatal case of H5N1 avian influenza in a 4-year-old girl in Cambodia. The girl was from Chork Reaksmey village in Banteay Meanchey province, the WHO said, citing the Cambodian health ministry. She got sick on Jul 11, was initially treated by local private practitioners, was hospitalized on Jul 18, and died 2 days later, the agency said. Poultry deaths have been reported in the girl's village, and she was said to have been exposed to dead poultry, the statement said. Thirteen contacts of the girl were tested for H5N1, all with negative results, and enhanced surveillance at local medical facilities has yielded no evidence of increases in flu-like illness or severe respiratory infections, the WHO said.
Aug 2 WHO statement
In addition, the United Nations Food and Agriculture Organization (FAO) today confirmed a case of highly pathogenic avian flu in Egypt. The FAO report said the case was in Al Beheira governorate in the northern part of the country but supplied few details, such as the age and sex of the person and how transmission likely occurred. A positive test was confirmed on Jul 27.
Aug 2 FAO report
Meanwhile, H5N1 recently killed 100 backyard chickens and ducks at two villages elsewhere in Banteay Meanchey province, according to a report that Cambodia filed yesterday with the World Organization for Animal Health (OIE). Officials culled another 480 birds to stop the outbreak, the report said. The source of the outbreak was listed as unknown.
Aug 1 OIE report

Study links early corticosteroid treatment to severe 2009 H1N1 illness
Chinese health practitioners often use parenteral glucocorticoids to reduce fever early in influenza infections, but a Clinical Infectious Diseases study of the treatment in patients who were hospitalized with 2009 H1N1 infections found that the practice put them at greater risk for severe infections and deaths. Their retrospective cohort study included 83 hospitalized patients with confirmed 2009 H1N1 infections who are admitted to four Shenyang City facilities. Of 17 patients treated early during the mild stage of illness with glucocorticoids, 71% became severely ill compared with 39% of 66 patients who received later (greater than 3 days) or no treatment with the drugs. the researchers calculated that early glucocorticoid treatment tripled the risk of severe illness. They concluded that the findings, plus indications in the medical literature, suggest that glucocorticoids shouldn't be used to treat fever or prevent pneumonia complications, and they recommended that China establish limiting their use to instances in which the drugs have an established benefit.
Aug 15 Clin Infect Dis abstract

Study finds half dose of adjuvanted H1N1 vaccine immunogenic
A half dose of adjuvanted 2009 pandemic H1N1 influenza vaccine proved immunogenic in adults 20 to 45 years old but not in older people, according to a study by Canadian researchers. They immunized 97 volunteers with a half dose (1.875 micrograms [mcg] of hemagglutinin [HA]) and 50 with a full dose (3.75 mcg HA) of monovalent H1N1 vaccine that contained AS03, GlaxoSmithKline's squalene-based adjuvant, which has been used in much of Canada's H1N1 flu vaccine supply. In those receiving the half dose, US Food and Drug Administration criteria for seroprotection and seroconversion were met by day 21 for those aged 20 to 45 but not for those aged 46 to 60. Furthermore, the scientists found no statistically significant difference in immune response between the half-dose and full-dose cohorts, as those 46 to 60 years old in the full-dose cohort also showed significantly less seroprotection. The authors conclude, "Dose reduction is a possible strategy for expanding the availability in the event of vaccine shortage" for those 20 to 45 years old.
Jul 28 Eur J Clin Microbiol Infect Dis abstract

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