News Scan for Sep 09, 2013

Possible MERS drug treatment
DTaP vaccination and pertussis risk
H5N1 hurts Nepal economy
Polio efforts in Nigeria

Study in macaques shows promise for 2-drug MERS therapy

Researchers from the National Institutes of Health (NIH) report that a small study in macaques has shown promise of using a two-drug combination against infection with Middle East respiratory syndrome coronavirus (MERS-CoV), according to study findings published yesterday in Nature Medicine.

The investigators infected six rhesus macaques with MERS-CoV, then treated half of them 8 hours later with a combination of ribavirin and interferon (IFN)-alpha-2b. Compared with the untreated animals, the treated monkeys showed no breathing difficulties and only minimal x-ray evidence of pneumonia. On necropsy, the scientists found that the treated animals also had lower amounts of virus and less severe tissue damage in the lungs.

NIH researchers this spring noted that rhesus macaques were good but not perfect animal models for how MERS-CoV behaves in humans.

The authors conclude, "As these two drugs are already used in combination in the clinic for other infections, IFN-alpha-2b and ribavirin should be considered for the management of MERS-CoV cases."

In a Canadian Press story yesterday, however, lead author Heinz Feldmann, MD, PhD, said, "There are doctors who don't have much problem using ribavirin and interferon [alpha-2b], and there are physicians that have all kinds of problems to use ribavirin and interferon," citing side effects.

Saudi Arabia's deputy health minister, Ziad Memish, MD, told the Canadian Press that physicians in his country have used the drug combination on some MERS patients with little success, but the patients were severely ill and far along in the disease process.
Sep 8 Nat Med abstract
Sep 8 NIH
press release
Sep 8 Canadian Press


Study: Late, missing TDaP vaccine doses may raise kids' risk of pertussis

Undervaccination with the diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine is strongly associated with the risk of pertussis (whooping cough) in 3- to 36-month-old children, found a case-control study today in JAMA Pediatrics. The Advisory Committee on Immunization Practices recommends a five-dose regimen of DTaP vaccine for children at 2, 4, 6, 15 to 18, and 48 to 83 months of age.

Children with lab-confirmed pertussis from eight managed-care organizations (MGOs) were studied from 2004 to 2010. Each of the 72 cases was matched for MGO, sex, and age at the index date (date of pertussis diagnosis) with four randomly selected disease-free controls, for a total of 288 controls. Undervaccination was defined as missing or delayed doses in the first four doses of the DTaP regimen by the index date.

Of the 72 pertussis case-patients, 34 (47.2%) were undervaccinated with DTaP, compared with 64 (22.2%) of the matched controls, and a dose-response relationship was apparent, meaning the risk of pertussis increased as the magnitude of undervaccination increased

The attributable risk percent in the population as a whole was 36.4% (95% CI, 19.65% to 49.7%, suggesting that this percentage of cases could have been prevented had the children received four on-time DTaP doses.

"Undervaccination is an increasing trend that potentially places children and their communities at an increased risk for serious infectious disease," the authors said.
Sep 9 JAMA Pediatr abstract


Nepal's bird flu outbreaks may rattle entire economy

The poultry industry in Nepal has lost more than 7 billion rupees (more than $100 million) because of a rash of H5N1 avian flu outbreaks in the Kathmandu Valley and other areas recently, which could have reverberations through the country's economy, according to a Himalayan Times article Sep 7.

Insecurity in the poultry sector has resulted in thousands of large and small poultry farmers to abandon the business, which accounts for about 4% of Nepal's gross domestic product, says the story. The chairman of the country's Egg Producers' Association, Shiva Ram, said the outbreaks have set the industry back 40 years.

Consumption of poultry has fallen in the country, not because of bird deaths but because of rumors in the market, the story reported.

Nepal's government has been criticized by some observers for a lack of effective steps to control the outbreaks. Farmers are calling for relief packages, including subsidized loans.
Sep 7 Himalayan Times article
Most recent (Aug 15) CIDRAP News scan on Nepal outbreaks


Polio eradication nears in Nigeria

Nigeria, one of only three countries in the world where wild poliovirus still circulates and causes polio, is nearing a state of eradication, according to an AllAfrica report Sep 6. Jean Gough, the United Nation's Children's Fund's (UNICEF's) Nigeria representative, made the announcement in Sokoto.

Efforts to reach the eradication goal continue. An AllAfrica notice today said that Jigawa state plans a polio immunization drive this month that will reach 1.2 million. In addition, 86 vaccination teams have been set up in motor parks in the state to ensure that children coming from elsewhere are immunized.

A third report says Sokoto state is targeting nearly 88,000 children for polio immunization over a 4-day campaign. To alert families to the vaccination program and attract their participation, 16 groups of drummers have been enlisted and refreshments are being offered at vaccination stations.

Afghanistan and Pakistan are the other countries in which polio has not yet been eradicated.
Sep 6 AllAfrica report on eradication
Sep 9 AllAfrica notice on Jigawa
Sep 9 AllAfrica notice on Sokoto


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