NEWS SCAN: Coronavirus patient visited farm, smallpox drug debate, azithromycin heart effect, Nipah in Bangladesh, polio in Afghanistan

Mar 13, 2013

Latest coronavirus patient had visited farm, Saudi official says
Investigators in Saudi Arabia learned that the latest person to die of a novel coronavirus (NCoV) infection had visited a farm before he got sick, according to a Saudi Arabian health official. Similar findings have been reported in at least 2 of the 14 other NCoV cases reported since the virus emerged last year. The latest case, involving a 39-year-old man in Saudi Arabia, was announced by the World Health Organization yesterday. Ziad A. Memish, MD, deputy minister for public health in Saudi Arabia, told CIDRAP News by e-mail, "What we know is that the patient has not traveled recently outside KSA [the Kingdom of Saudi Arabia] and he has been to a farm outside Riyadh owned by his brother." Previous reports revealed that a Qatari man who was treated for NCoV infection in Germany last fall owned a farm where some goats had been sick before he fell ill himself. Also, a Saudi Arabian gym teacher whose NCoV illness was reported in November had visited a farm 3 days before he got sick. The source of the novel virus has not been identified, though it is related to coronaviruses found in bats. Memish commented that all patients hospitalized with pneumonia in Saudi Arabia are being screened for NCoV infection, "a strategy not implemented to my knowledge by any country in the world and that's why we continue to sporadically detect new cases. It will be good if other countries apply the same strategy to give the world an indication how wide spread this disease." Eight of the 15 confirmed cases have occurred in Saudi Arabia.
Related CIDRAP News stories: Mar 12; Feb 21; Nov 29, 2012

New smallpox drug for US stockpile stirs controversy
The US government last week received its first shipment of a drug to treat smallpox infection in the event of a bioterror event, stirring debate about the size and cost of the program, the New York Times reported yesterday. The antiviral drug called tecovirimat (Arestvyr) is made by SIGA Technologies, which received a $463 million order for 2 million doses of the drug to be added to the Strategic National Stockpile, alongside about 300 million smallpox vaccine doses. The government is paying about $200 per 14-day treatment course, an amount Biomedical Advanced Research and Development Authority (BARDA) director Robin Robinson, PhD, said is reasonable, based on federal purchasing guidelines and the price of other commercial antiviral drugs. However, D.A. Henderson, MD, MPH, a biodefense expert who is now with the Center for Biosecurity at the University of Pittsburgh Medical Center, told the Times that after the Sep 11 terror attacks the drug was expected to cost only $5 to $10 per treatment course. Dr Richard Ebright, a bioweapons expert at Rutgers University, said the drug is appropriate for the stockpile, but he questioned the need to order so much of it. An official from SIGA countered that the price is reasonable compared with other patented drugs. In a press release yesterday, SIGA announced delivery of the first 190,000 drug courses under its contract with BARDA and said it may begin collecting payment under the BARDA contract once it has delivered 500,000 of the 2 million courses.
Mar 12 New York Times story
Mar 12 SIGA press release

FDA warns about heart condition associated with azithromycin
The US Food and Drug Administration (FDA) announced yesterday that the antibiotic azithromycin (Zithromax or Zmax) can cause fatal irregular heart rhythm. The condition, known as prolonged QT interval, stems from drug-related abnormal changes in the heart's electrical activity. Patients at particular risk "include those with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or use of certain drugs used to treat abnormal heart rhythms, or arrhythmias," the agency said. The announcement follows an FDA review of studies by medical researchers and a manufacturer of the drug. The drug's labels have been updated to strengthen the "Warnings and Precautions" section. "The potential risk of QT prolongation should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide or fluoroquinolone drug classes also have the potential for QT prolongation or other significant side effects," the FDA advised healthcare professionals. Last May a New England Journal of Medicine study found an increased risk of cardiovascular death associated with azithromycin.
Mar 12 FDA notice
May 17, 2012, N Engl J Med study
May 17, 2012 FDA statement on the N Engl J Med study

Bangladesh confirms 19 cases of Nipah infection
Bangladesh has confirmed 19 cases of Nipah virus infection in 2013, with 3 new cases reported since the country's last update on Feb 23, its Institute of Epidemiology, Disease Control and Research (IEDCR) announced yesterday. Of the 19 cases, 17 (89%) have been fatal, including all 3 new cases. The patients, 13 of whom have been male, ranged in age from 8 months to 55 years, with 9 being children. The two survivors are 8 months and 3 years old—two of the three youngest case-patients. Cases have been confirmed in 13 districts across the country, the IEDCR said. From 2001 through 2011 Bangladesh confirmed 196 cases, 150 (77%) of them fatal, according to a 2012 IEDCR report. That averages to 18 cases per year.
Mar 12 IEDCR update
2012 IEDCR report

Taliban halts polio vaccination campaign in remote Afghan district
The Taliban has halted a polio vaccination campaign in Waygal district in the remote and mountainous Nuristan province of Afghanistan, the UK's The Guardian reported yesterday. "For the past 3 years Waygal district has been under the Taliban, they are very strong there," said provincial governor Tamim Nuristani. "For the last 2 years the vaccine process went on in the district, but this year they stopped it." Afghanistan is one of only three nations in which polio is endemic, along with Nigeria and Pakistan. Neighboring Pakistan has also struggled with forces intent on preventing polio vaccination on religious or anti-Western grounds. Several people involved in vaccination campaigns have been killed in Pakistan in recent months.
Mar 12 Guardian story

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