News Scan for Aug 25, 2014

H3N2v case in Ohio
MERS case in Saudi Arabia
Chikungunya outbreak slows
Aerosol TB vaccine trial

CDC: Variant H3N2 case reported in Ohio

Ohio last week reported a case of variant H3N2 (H3N2v) influenza in a person who had had close contact with pigs, the US Centers for Disease Control and Prevention (CDC) reported on Aug 22, marking what appears to be the first such US case this summer.

The infected person was hospitalized but has recovered completely, the CDC said in its weekly FluView surveillance report.

Public health and agriculture officials are investigating the extent of disease among humans and swine and have found no ongoing transmission of the virus or increases in flu-like illness, the CDC said.

H3N2v surfaced in 2011, with 12 cases, and took off in the summer of 2012, with 309 cases, followed by 19 cases last year, according to the CDC. Nearly all of them involved people who had contact with swine at county and state fairs.

Most illnesses have been mild, but 17 people were hospitalized in 2012 and 2013, and there was one death in 2012, according to the CDC. H3N2v viruses have spread from person to person in a few instances, but there has been no sustained transmission.

The CDC said it sequenced the Ohio patient's virus and found it has a slightly different combination of internal genes than H3N2v viruses reported in previous years. The Ohio isolate contained both the nucleoprotein (NP) and matrix (M) genes from the 2009 H1N1virus, whereas the earlier isolates contained only the M gene from 2009 H1N1.

"However, this H3N2v virus has the same genetic composition as influenza viruses previously isolated from swine in the U.S. this summer," the agency said.
Aug 22 CDC FluView report
CDC H3N2v case-count table


Saudi Arabia reports first MERS case since Aug 12

Saudi Arabia today announced a new MERS-CoV (Middle East respiratory syndrome coronavirus) infection, its first one since Aug 12.

The case involves a 60-year-old Saudi man in Dammam who is in an intensive care unit, the Saudi Ministry of Health (MOH) said. He has a pre-existing disease and is not a healthcare worker.

With his case, the MOH's MERS count reached 724 cases, including 301 deaths, the MOH said. Twenty-four patients remain in treatment, and 399 have recovered.

After a spring and early summer that brought hundreds of cases in healthcare-related outbreaks, Saudi Arabia has reported only three since Jul 10, including today's case and single cases announced Aug 11 and 12.

On Aug 22 the MOH reported a death in a previously reported MERS-CoV case. The victim was a 66-year-old male expatriate in Riyadh who was not a healthcare worker.
Aug 25 MOH statement


Caribbean chikungunya outbreak continues to slow

The pace of new chikungunya cases in the Caribbean region slowed for the second consecutive week, according to an Aug 22 update from the Pan American Health Organization (PAHO).

The region reported only 3,325 new cases, compared with 9,798 the week before, after seeing jumps of almost 38,000 and 63,000 in the previous 2 weeks. The outbreak has now reached 589,123 suspected and confirmed cases, up from 585,798 the week before.

Some countries, however, have not reported cases in weeks. Haiti, for example, which had been an outbreak hot spot, hasn't reported new numbers in 6 weeks.

And the Dominican Republic, which had almost single-handedly led the recent surge in cases, did not report numbers last week. The previous week it reported no new cases, remaining at 370,141 outbreak cases, making it by far the hardest-hit nation.

Most of the new cases were in El Salvador, which had 1,531 new cases, and Puerto Rico, which saw a 1,174-case increase. Those two areas now have 5,106 and 3,723 cases, respectively.

No new chikungunya-related deaths were reported, leaving that number at 37.
Aug 22 PAHO update
Aug 18 CIDRAP News scan "Chikungunya cases appear to slow, outbreak total passes 585,000"


Phase 1 trial raises possibility of aerosol TB vaccine

A small, preliminary trial of a candidate tuberculosis (TB) vaccine showed that it could prove immunogenic when delivered in aerosol form, according to a report in The Lancet Infectious Diseases.

In the double-blind phase 1 trial, UK scientists assigned 12 volunteers to receive the experimental MVA85A TB vaccine (made by DT Biologika GmbH of Dessau-Rosslau, Germany) intradermally and 12 via aerosol.

The researchers found both administration routes to be well tolerated and immunogenic, with only mild respiratory adverse events. Ag85A-specific systemic responses were similar in both groups of patients, they reported, but Ag85A-specific CD4 T-cell response in the lungs was higher in the aerosol group.

The authors conclude that further clinical trials should address the aerosol route of TB vaccine delivery, which might offer immunologic and logistical advantages.

An accompanying commentary in the same issue said, "Although the trial had only 12 volunteers in each group, this was sufficient to show that the vaccine delivered by aerosol was safe and elicited an immune response in the lungs that was superior to that induced by the intradermally administered MVA85A." But it added, "Whether or not the increased local immunity in the lungs from the aerosol delivery of MVA85A is going to be able to increase the level of protection from tuberculosis is still an outstanding question."
Aug 21 Lancet Infect Dis abstract
Aug 21 Lancet Infect Dis

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