NEWS SCAN: Uganda Ebola update, Ebola research hiatus, resistant mosquitoes, novel NDM strain

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Aug 15, 2012

WHO reports another Ebola case in Uganda
The number of probable and confirmed Ebola fever cases in Uganda has increased by one, to 24, since Aug 10, while the death toll was unchanged at 16, the World Health Organization (WHO) said in an update yesterday. The count of lab-confirmed cases also stayed the same, at 10, the WHO said. Forty-three people, including one confirmed case-patient, have been discharged from the Kagadi isolation facility after treatment and recovery, the agency said. The patients received counseling before their discharge and have been reintegrated into their communities. The WHO said counseling of people in the patients' communities has been very important in that it "has allayed fears and reduced stigma, enabling them to be accepted back in the community." All reports of suspected cases outside Kibaale district have been investigated and ruled out, officials said. Meanwhile, social mobilization teams composed of Red Cross volunteers and village health teams have reached most of the households in the affected subcounties of Kibaale district.
Aug 14 WHO statement

DoD tells two companies to suspend work on Ebola drugs
The US Department of Defense (DoD) recently told two companies that are testing treatments for Ebola virus infections to suspend the research because of funding constraints, the companies said. The treatments are being developed by Sarepta Therapeutics (formerly AVI BioPharma), based in Cambridge, Mass., and Tekmira Pharmaceuticals Corp., based in Vancouver, B.C. In an Aug 7 statement, Sarepta officials said they received the stop-work order on Aug 2, while Tekmira reported the DoD order in a statement yesterday. Tekmira said it expects further word from DoD officials on the future of the program by Sep 1. Sarepta officials said the suspension does not apply to their DoD-funded work on a Marburg virus treatment. Meanwhile, experts quoted in a BBC News report today said availability of an Ebola vaccine is years away at best, even though vaccines have been tested successfully in animals. Gene Olinger, a virologist at the US Army Research Institute of Infectious Diseases in Maryland, told the BBC, "With the current funding, if it doesn't change, I would say there should be a vaccine in five to seven years. It could double or triple it if the funding goes away." Also, Heinz Feldmann, MD, PhD, of Rocky Mountain Laboratories in Montana, a leading authority on Ebola, commented, "It is hard to say when a vaccine might be available, if ever." Uncertainty over funding and lack of interest from large pharmaceutical companies were cited as obstacles to vaccine development.
Aug 7 Sarepta Therapeutics statement
Aug 14 Tekmira statement
Aug 15 BBC News story

Study: Cote d'Ivoire malaria mosquitoes resistant to multiple insecticides
Mosquitoes that harbor the malaria parasite in Cote d'Ivoire were found resistant to all approved classes of insecticides, according to a study today in Emerging Infectious Diseases. Researchers from the UK's Liverpool School of Tropical Medicine tested hundreds of Anopheles gambiae mosquitoes for sensitivity to approved insecticides using World Health Organization susceptibility criteria, which define resistance as producing less than 80% of mosquito deaths 24 hours after a 1-hour exposure to the insecticide. Death rates by insecticide were: fenitrothion, 74.0%; deltamethrin, 31.9%; permethrin, 24.0%; bendiocarb, 12.4%; and DDT, 8.2%. Thus, the mosquitoes were resistant to all five repellents. The team also found an "unexpectedly strong" resistance phenotype to deltamethrin and bendiocarb in the mosquitoes. The authors said that determining the selective pressure responsible for the resistance is difficult, given that the use of insecticide-treated bed nets in the region where the insects were collected is similar to their use in other parts of Africa. They concluded, "The implications of this resistance scenario for malaria control are severe. With no new classes of insecticides for malaria control anticipated until 2020 at the earliest, program managers have few options available when confronted with multiple-insecticide resistance."
Aug 15 Emerg Infect Dis study

Novel NDM variant identified in Cameroon man
A man from Cameroon may represent the first reported African case of infection with bacteria carrying New Delhi metallo-beta-lactamase-4, an enzyme that blocks many antimicrobials, according to a letter yesterday in Emerging Infectious Diseases. Infections with New Delhi metallo-beta-lactamase-1–producing (NDM-1) bacteria were first described in 2010 in India. Since then, NDM-2, NDM-4, and NDM-5 variants have been identified, with NDM-4 having a higher carbapenemase activity than NDM-1. Yesterday's letter details the case of a man with Hodgkin lymphoma who was treated with chemotherapy 1 year before his current 1-month hospitalization for an inflammatory disorder with kidney failure. After transfer to a hospital in France, a rectal swab revealed NDM-4 Escherichia coli. The strain was resistant to all beta-lactam antimicrobial drugs, including imipenem, meropenem, ertapenem, and doripenem, and to fluoroquinolones. It was also resistant to all aminoglycosides except amikacin. A literature search turned up only one previously reported NDM-4 case, in a patient from India.
Aug 14 Emerg Infect Dis letter

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