News Scan for Sep 20, 2013

Anthrax antitoxin orders
H7N7 risk assessment
Poliovirus in Palestine
Malaria drug ban

HHS orders more anthrax antitoxin

The US government will maintain its supply of anthrax antitoxin through 2018 under Project BioShield contracts issued by the Department of Health and Human Services' (HHS's) Office of the Assistant Secretary for Preparedness and Response (ASPR), the HHS said in a news release yesterday.

The contracts will ensure that fresh batches of antitoxin replace those in the Strategic National Stockpile that are set to expire, and they establish for the first time surge capacity to produce the antitoxin should an attack occur involving Bacillus anthracis, the bacterium that causes anthrax.

HHS awarded the contracts of $100,000 or more to Cangene Corporation of Winnipeg; Elusys Therapeutics Inc. of Pine Brook, N.J.; Emergent Product Development of Gaithersburg, Md.; GlaxoSmithKline (GSK) of Research Triangle Park, N.C.; and PharmAthene of Annapolis, Md.

Under the contracts, HHS will order about $196 million worth of antitoxin from GSK. The agency will also buy materials to manufacture antitoxin, including blood plasma from Cangene for about $63 million and a total of $1.6 million in cells from GSK, PharmAthene, and Emergent. PharmAthene and Emergent have antitoxin at earlier stages of development than the GSK and Cangene products.

Cangene and Human Genome Sciences (since acquired by GSK) began delivering antitoxin to the national stockpile in 2007 and 2009, respectively.
Sep 19 HHS press release


ECDC details Italian H7N7 infections, response actions

The European Centre for Disease Prevention and Control (ECDC) issued an epidemiologic report yesterday on highly pathogenic H7N7 outbreaks in Italian poultry and three related infections in poultry workers, noting that the risk of spread to the community is low.

So far the H7N7 virus has turned up on six farms in the Emilia-Romagna region, with the most recent two detected during the first week of September. As many as 1 million birds will be culled to curb the outbreak, according to the ECDC.

Because H7N7 has caused both mild and fatal infections in humans before, active surveillance activities are under way to look for related illnesses in people living at the farms, workers and their close contacts, and responders involved in culling operations.

Of about 370 people who are being monitored, three conjunctivitis cases linked to the H7N7 virus have been found. All are in men 46 to 51 years old who worked at the farms or were involved in culling, the ECDC said.

The men were isolated in their homes after tests revealed H7N7, and the conjunctivitis resolved after 5 or 6 days without complications. One of the patients had chills and muscle aches along with the eye symptoms.

The ECDC said a serologic study is planned in potentially exposed people to asses the level of asymptomatic infections. "These results will provide valuable information about the frequency of avian-to-human transmission of H7N7 and the potential risk factors," the group said in its report.

For now, at-risk people appear to be mainly be those who have direct contact with poultry or handle diseased or dead chickens, the ECDC said, adding a reminder that pre- and postexposure antiviral prophylaxis should be considered, because it has been shown to decrease the risk of H7N7 transmission.
Sep 19 ECDC risk assessment


Poliovirus detected in Palestinian sewage

Wild poliovirus type 1 (WPV1), which has been detected in 10 sites in Israel, has now been detected in sewage samples collected by the Palestinian Authority in both the West Bank and the Gaza Strip, the World Health Organization (WHO) said today in an alert.

No cases of paralytic polio have been detected in Israel or Palestine, but "WHO considers the risk of further international spread of WPV1 from Israel to be high," the agency said.

"Health authorities of Israel and the Palestinian Authority have taken steps to respond to the threat posed by WPV1 circulation by strengthening surveillance for acute flaccid paralysis and increasing the frequency of environmental sample collection," the WHO added.

A campaign in Israel to immunize children 9 years old and younger with oral polio vaccine that began in early August has reached 60% of the 1.38 million children targeted. Palestinian officials are preparing to conduct similar campaigns in the Gaza Strip and West Bank, the WHO said.
Sep 20 WHO update


Problematic malaria drug barred for elite Army forces

Medical officials who oversee the care of the Army's special operations forces have ordered doctors to stop prescribing mefloquine, an antimalarial drug that has been increasingly linked to psychiatric and neurologic side effects, the Military Times reported yesterday.

A letter to providers from the Surgeon General's Office of the Army Special Operations Command on Sep 13 cited a July ruling by the Food and Drug Administration (FDA) that the drug needs a black box warning label detailing the risks, according to the report.

The letter also asked commanders and healthcare workers to assess if soldiers who took the drug and may be suffering side effects are mistakenly thought to have post-traumatic stress disorder or other problems.

In the wake of the FDA's order in July, the Pentagon launched a review of potential side effects in military personnel, which is expected to wrap up in January, the report said. The order from the special forces branch is stricter than the current stance from the Department of Defense, which says the drug can be given to soldiers who can't use alternatives. In 2011 the Army said it was discontinuing use of the nearly 40-year-old drug, according to earlier reports.

Mefloquine hydrochloride is a generic medication in the United States and is still sometimes prescribed for travelers.
Sep 19 Military Times story
Jul 29 CIDRAP News scan "FDA toughens malaria drug safety warning"

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