News Scan for Dec 13, 2013

TB skin test shortages
California meningitis vaccine request
Shenzhen market closures
Pakistan polio attacks
Schistosomiasis in Yemen

CDC expects TB skin test shortages to ease

Supplies of tuberculin skin test antigen solutions are expected to return to normal in January, following shortages that health providers have been experiencing since 2012, the US Centers for Disease Control and Prevention (CDC) said today in the latest issue of Morbidity and Morality Weekly Report (MMWR).

Two tests are approved by the Food and Drug Administration (FDA) to detect latent Mycobacterium tuberculosis infection and diagnose active illness: Tubersol made by Sanofi Pasteur Limited and Aplisol produced by JHP Pharmaceuticals, LLC. Shortages were first reported for Tubersol, which was out of production from late 2012 through April 2013, which boosted demand for Aplisol.

The companies have addressed the shortages by basing allocations on historical purchasing practices. In August, a CDC survey found 29 of 52 US jurisdictions were reporting a shortage of at least one purified-protein derivative (PPD) tuberculin skin test (TST) antigen solution.

Surges in testing following shortage periods might further stretch the supplies, the CDC warned. To address shortages, it recommended that health officials substitute interferon-y release assay (IGRA) blood tests, prioritize TST supplies, or substitute Aplisol for Tubersol for skin testing, depending on Aplisol supplies. The agency urged health officials to be cautious about switching products and methods for surveillance purposes, because changes in test results could be difficult to interpret.
Dec 13 MMWR report


California seeks to use vaccine for UCSB meningitis outbreak

The California Department of Public Health (CDPH) has asked the US CDC for federal clearance to use an unapproved vaccine against meningitis serogroup B as part of the response to an outbreak at the University of California at Santa Barbara, Reuters reported today.

The vaccine against Neisseria meningitidis serogroup B, called Bexsero, is made by Novartis. The FDA approved importation of the vaccine under an Investigational New Drug application for use in a vaccine campaign currently under way at Princeton University, where eight students have been sickened by serogroup B, which is not included in US meningococcal vaccines.

Bexsero has been approved in Europe, Australia, and Canada. Clinical trials of the vaccine are under way in the United States, and Novartis has said it is working on a vaccine that would protect against serogroup B and four other strains.

Four infections have been confirmed at UCSB, and earlier reports suggested that health officials there were talking with the CDC about using the vaccine. Health officials have said the Princeton and UCSB outbreaks are unrelated and that the organisms have different genetic fingerprints. Since then, worried parents have been requesting the vaccine, according to media reports, and a suspected case has been reported in a staff member at the University of California, Riverside.

G. Richard Olds, MD, dean of the UC Riverside medical school, told Reuters that the vaccine should be considered for use on all 10 University of California campuses.

Meanwhile, Princeton University said yesterday that it reached 91% of the students targeted in a vaccine campaign that was held Dec 9 through 12. It reported that 5,268 eligible students received the vaccine, which is given in two doses.
Dec 13 Reuters story
Dec 12 Princeton press release


H7N9 findings prompt Shenzhen market closures

Authorities in Shenzhen, a mainland China city that has links to two H7N9 influenza cases in Hong Kong, temporarily closed poultry wet markets in one district in an effort to curb the spread of the novel virus, the South China Morning Post reported today.

The closures follow the detection of the virus in three environmental samples out of 50 that were collected as part of the response to the illnesses in a 36-year-old woman and an 80-year-old man, both of whom were hospitalized after arriving in Hong Kong from Shenzhen.

The two markets subject to the closure are in the city's Longgang district, where the stalls that yielded the positive samples are located, according to the Post.

Earlier reports said the woman had visited a residence in Longgang district and had handled live poultry. The older man lives with his family in Shenzhen, and reports said he had not visited live poultry markets and did not have contact with live poultry, though his family reportedly bought and cooked slaughtered chicken from a Shenzhen market.
Dec 13 Post story
Dec 9 CIDRAP News story "Hong Kong, China offer more details on H7N9 cases"


Attacks on Pakistani polio vaccination teams kill 3 more

Two separate attacks in Pakistan today killed a polio worker and two police offers who were protecting a polio vaccination team, Agence France-Presse (AFP) reported.

In one incident, two policemen riding on a motorbike leaving the town of Swabi were intercepted and attacked by at least four militants. In the other attack, men on a motorcycle opened fire on a polio team working in the village of Jamrud.

So far at least 26 deaths have been reported among polio vaccinators since June 2012, AFP reported. The latest attacks came despite a recent fatwa from one of Pakistan's top religious scholars supporting vaccinating children against life-threatening diseases. Taliban groups harbor suspicions that polio vaccination is a front for foreign spies and is designed to make children sterile.

Elsewhere, India has issued a polio vaccination requirement for Pakistani travelers entering the country, according to a Dec 12 AFP report. India's embassy in Islamabad announced the new policy on Dec 11; it will require all adults and children traveling to India from Pakistan after Jan 30 to obtain polio vaccination at least 6 weeks before their departure.

In other developments, efforts to battle the disease in Nigeria are showing progress, though wild poliovirus 1 (WPV1) is still a threat to wider eradication efforts, according to a report today in MMWR.

The analysis of polio cases reported in Nigeria from January 2012 to September 2013 shows that no WPV 3 cases have been reported for more than a year and that WPV transmission doesn't appear to be occurring in the country's western-most states. Also, the report said the number of WPV cases through September of this year was half that of the same period in 2012.
Dec 13 AFP story
Dec 12 AFP story
Dec 13 MMWR


WHO reports progress in battling schistosomiasis in Yemen

A stepped-up campaign against the parasitic disease schistosomiasis is producing results in Yemen, the World Health Organization (WHO) reported yesterday.

The agency estimates that more than 3 million people in the country are infected with the parasite and that at least 750,000 have severe chronic illness. The urogenital and intestinal forms of schistosomiasis are both prevalent.

Health authorities in Yemen have distributed 18 million doses of praziquantel to treat the disease, also known as bilharzia, in the past 3 years, the WHO said in a press release. In March of this year, more than 9.5 million Yemenis were treated for both schistosomiasis and intestinal soil-transmitted helminthiases in two separate 4-day campaigns, compared with a total of 1.9 million people treated during 2012.

A recent impact analysis showed that infection levels assessed in 2,000 people in sentinel districts have dropped by more than half, from 20% to 8%, since the beginning of the Yemen Schistosomiasis Control Project, with fewer than 4% having severe infections, the WHO reported.

The findings were presented at a recent technical review meeting organized by the Yemen Ministry of Public Health, the WHO, and other groups and held in Geneva. The WHO said the findings were certified by an external auditing firm.
Dec 12 WHO statement

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