News Scan for Jan 16, 2014

H5N1 strain in Canada
Meningitis and stroke
Drug combo for hepatitis C
Dengue in South Pacific

Sequencing indicates H5N1 virus in Canada akin to Chinese strain

Early findings from sequencing of the H5N1 virus that recently caused the death of a Canadian woman suggest that it is similar to strains previously seen in China, according to a CBC News story yesterday.

A spokesman for Canada's National Microbiology Laboratory in Winnipeg told CBC that the sequence data collected so far suggest that the virus is "consistent with a previously circulating H5N1 strain from China."

The lab plans to sequence the virus's full genome and analyze the data to learn more about the strain's characteristics, the spokesperson said. When the sequencing is complete, the data will be shared with researchers around the world via the Global Initiative on Sharing All Influenza Data (GISAID) database, the story said.

The lab also plans to share the isolate with the US Centers for Disease Control and Prevention (CDC), according to the report.

The Canadian victim, a young nurse from Red Deer, Alta., died on Jan 3, 8 days after returning from a 3-week trip to Beijing. Her case was the first human H5N1 infection reported in the Americas. It's not clear how she was exposed to the virus, since she had no contact with poultry in Beijing.
Jan 15 CBC News story

In related news, the CDC yesterday issued a Health Alert Network (HAN) advisory that said clinicians should consider the possibility of H5N1 infection in patients who have a severe respiratory illness and a history of travel within 10 days before illness onset to areas with H5N1 circulation.

The notice also encourages state health departments to investigate such cases and to report them to the CDC within 24 hours. Potential human cases of H7N9 avian influenza also should be investigated and reported, the agency said. Human H7N9 cases emerged in China last spring, and many cases, some fatal, have been reported in the past few weeks.
Jan 15 CDC HAN advisory


Study: 1 in 7 meningitis patients has stroke

About 1 in 7 patients with bacterial meningitis experience a stroke, and the outcome doesn't appear to be tied to atherosclerotic risk factors, according to a study yesterday in the International Journal of Infectious Diseases.

The researchers analyzed data from 152 patients in North Denmark Region who had community-acquired bacterial meningitis from 1998 through 2010. Of the patients, 22 (14%) had a stroke; 15 of the strokes were ischemic, 3 hemorrhagic, and 4 a combination.

The authors found that age and atherosclerotic risk factors were not significantly associated with stroke. They did find, though, that patients who had a stroke had higher rates of in-hospital mortality (27% vs 16%), unfavorable outcome (86% vs 37%), and long-term sequelae (88% vs 40%) than those who did not have a stroke.
Jan 15 Int J Infect Dis abstract


Combination therapy shows promise against hepatitis C

Two experimental oral antiviral drugs are safe and highly effective in treating hepatitis C, according to a study today in the New England Journal of Medicine.

US researchers conducted a phase 2b, open-label study that included 14 treatment subgroups and various agents. One group involved daclatasvir and sofosbuvir therapy in 211 men and women who had any of the three major types of hepatitis C, according to a Johns Hopkins press release on the study. The volunteers took a daily combination of 60 milligrams (mg) of daclatasvir and 400 mg of sofosbuvir, with or without ribavirin.

Among participants with genotype 1—the most common US strain—98% of both 126 previously untreated patients and 41 patients whose infections remained after triple therapy were considered cured and had no detectable virus in their blood 3 months after treatment. Results were similar in those with genotypes 2 or 3.

"This research paves the way for safe, tolerable and effective treatment options for the vast majority of those infected with hepatitis C," said study leader Mark Sulkowski, MD, medical director of the Johns Hopkins Center for Viral Hepatitis.

The US Food and Drug Administration (FDA) on Dec 6, 2013, approved sofosbuvir in combination with peginterferon and ribavirin for treating genotype 1 infection and in combination with only ribavirin for genotype 2 and 3 disease. The FDA has not yet approved daclatasvir.

Sulkowski said in the release that if declatasavir and other new drugs for hepatitis C win FDA approval, weekly injections of peginterferon will no longer be needed.

Last November, The Lancet reported that a daily pill containing sofosbuvir and ledipasvir cleared the virus from 97 of 100 hepatitis C patients in a phase 2 trial.
Jan 16 N Engl J Med abstract
Jan 15 Johns Hopkins news release
Nov 6, 2013 CIDRAP News story on Lancet study


Dengue reappears in the South Pacific 20 years later

After a nearly 20-year absence, dengue virus serotype 3 has reemerged in the South Pacific, according to a notice today from the World Health Organization's Western Pacific Region (WPRO). Affected areas are Fiji, French Polynesia, Kiribati, and the Solomon Islands.

The health ministries in these areas are instituting prevention measures, educating healthcare providers and the public, and enhancing surveillance efforts in health facilities. Individuals and communities are being mobilized to clean up sites with standing water where mosquitoes may breed, and clinicians are being re-educated on the warning signs of dengue and on managing severe cases.

Dengue is transmitted by mosquitoes. Four strains of the virus exist, and infection with one does not confer immunity to the others. Symptoms of infection, lasting up to a week, can be flu-like and include high fever, headaches, pain behind the eyes, nausea and vomiting, swollen glands, rash, and pain in joints, bones, or muscles. No vaccine exists, and treatment is supportive.

The WPRO notes that it is not uncommon for dengue serotypes to re-emerge after being absent, probably because of an increase in the susceptible population above a certain threshold as babies are born who have not been infected with a given strain.
Jan 16 WPRO notice

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