Flu Scan for Dec 19, 2013

WHO on H10N8 death
Pandemic vaccine narcolepsy clues

WHO confirms H10N8 avian flu in Chinese woman

The World Health Organization (WHO) today confirmed that the H10N8 avian flu death in a woman from Jiangxi province, China, reported 2 days ago by Chinese officials is indeed the first human case involving that strain, and it provided some new details.

In a statement, the WHO said the 73-year-old woman visited a live-bird market 4 days before onset of symptoms. As previously reported, she was immunocompromised because of underlying medical conditions, was hospitalized Nov 30, and died Dec 6.

"The fact that the virus was isolated from a patient and reported through active surveillance by the Chinese health authorities is a sign that the surveillance system is working well," the WHO said.

"The specific source of the infection is unknown. As wild birds/poultry have been known to carry this virus, further sporadic cases may be detected."

The agency said contact tracing is ongoing, and so far there is no evidence of human-to-human transmission. The statement called for vigilance and close monitoring.

As reported previously, H10N8 has been detected in birds in China before. But the WHO added that, since 1965, it has also been detected in birds in the United States, Canada, Italy, Sweden, South Korea, and Japan.

The WHO said it is closely monitoring the situation and facilitating information sharing with member states. It added that it is collaborating with animal health professionals to identify a possible animal source and assess health risks.
Dec 19 WHO statement
Dec 17 CIDRAP News story on the case


Immune study yields clues in H1N1 vaccine-related narcolepsy

In an ongoing effort to unravel why some European children experienced narcolepsy after receiving the Pandemrix 2009 H1N1 vaccine, an international research team led by scientists at Stanford University found that an immune response to a protein on the virus may provide a clue. The team published its report yesterday in Science Translational Medicine.

They examined CD4+ T-cell activity in 39 narcoleptic children, plus their siblings who were also vaccinated but did not develop narcolepsy. The study included identical twins for four of the cases.

In youngsters with narcolepsy, CD4+ cells reacted to both hypocretin, a neurotransmitter that carries a "waking" signal, and the hemagglutinin surface protein on the 2009 H1N1 virus. The researchers said the findings suggest that immunity to the 2009 H1N1 virus protein, from the vaccine or from the virus itself, affected hypocretin production, and that the adjuvant in the vaccine doesn't appear to have contributed to the problem, aside from boosting the immune response.
Dec 18 Sci Transl Med abstract

In a related development, researchers from Oxford University who reviewed the vaccine safety response in the cases of narcolepsy in kids who received the 2009 H1N1 vaccine wrote that the experience yielded valuable lessons. The report appears today in Lancet Infectious Diseases.

According to the report, as of June more than 900 cases of narcolepsy had been reported in those who received Pandemrix, a GlaxoSmithKline vaccine that included the AS03 adjuvant. Countries reporting cases include Finland, Sweden, England, Ireland, France, and Norway.

Their review concluded that the rare occurrence was flagged by existing surveillance strategies, triggered by clinicians' spontaneous reports, and that the events were followed by appropriate investigations and timely interventions. However, they noted that the delayed onset of narcolepsy meant that some pandemic-related pharmacovigilance strategies could not have detected the signal, because their work had already been completed.
Dec 19 Lancet Infect Dis abstract

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