News Scan for Sep 11, 2014

More Ebola in DRC
EV-D68 cases in 6 states
US HPV vaccine coverage
Anthrax vaccine contract
Marburg in Ugandan mine

DRC has 62 Ebola cases, 35 deaths

The toll in the Democratic Republic of the Congo's (DRC's) Ebola outbreak reached 62 cases and 35 deaths as of Sep 9, including 7 fatal cases in healthcare workers, the World Health Organization (WHO) announced yesterday.

The new numbers compare with 53 cases and 31 deaths reported on Sep 2. The outbreak involves a different Ebola virus species from the one circulating in West Africa and is a separate event.

The 62 cases include 14 confirmed, 26 probable, and 22 suspected, the WHO said. Of the 35 deaths, 9 were in confirmed cases and 26 in probable ones. The earlier update didn't specify how many cases were confirmed.

The WHO said 31 new cases were reported between Sep 2 and 9, implying that some of the earlier suspected cases were ruled out by testing.

Nine healthcare workers have had the disease, and seven have died, the agency said.

All the cases have occurred in four villages in Jeera county in northwestern DRC. Nine patients have been hospitalized. Investigators have identified 386 contacts of case-patients and have followed up on 239 of them, the WHO said.

All the cases are linked to the original case reported to the WHO on Aug 26, which involved a woman who caught the virus from a game animal that she butchered.

A team of DRC and foreign specialists is working with the local response teams, and patients are being treated in temporary isolation units in the four villages, the WHO reported. A mobile DRC laboratory is operating in one village, Lokolia, while two laboratory epidemiologists from the US Centers for Disease Control and Prevention (CDC) have arrived in DRC to help.
Sep 10 WHO statement


CDC: 84 EV-D68 cases confirmed in six states

Six states now have a total of 84 confirmed infections with enterovirus D68 (EV-D68), a respiratory virus that has been fairly rare until recently, the CDC said today, as reports of suspected cases in a dozen or more states continued to accumulate.

The CDC announced 3 days ago that 30 EV-D68 cases had been confirmed in children in Kansas City and Chicago, with most of them hospitalized and a few requiring mechanical ventilation. Most of the patients have asthma.

The additional states with confirmed cases are Colorado, Kansas, Iowa, and Kentucky, according to a CDC map posted with an update today. It did not specify the number of cases in each state, nor did it list the patients' age range.

The virus causes fever, cold-like symptoms, and, in severe cases, wheezing and difficulty breathing. There is no vaccine or specific treatment for the infection.

Reporting of EV-D68 cases is not required, but the CDC has asked clinicians to watch for them. Most clinical and hospital labs cannot test for EV-D68 specifically, but testing can be done by the CDC and possibly by some state health department laboratories, according to the CDC.

Earlier this week, the Colorado Department of Public Health and Environment announced that 19 of 25 samples submitted by Children's Hospital Colorado had tested positive for EV-D68. Meanwhile, Denver media reports spoke of hundreds of additional suspected cases in the city's hospitals.

On Sep 9 the Michigan Department of Community Health reported an increase in severe respiratory illnesses in children and said samples were being sent to the CDC to be tested for EV-D68.

Media reports this week have also mentioned possible cases in Alabama, Georgia, Ohio, Oklahoma, Utah, and Texas.
Sep 11 CDC update
Sep 8 Colorado statement
Sep 9 Michigan statement
Related Sep 9 CIDRAP News story


CDC reports low HPV vaccine coverage in teens

Just over half of US girls 13 to 17 years old have received at least one dose of human papillomavirus (HPV) vaccine, while only a third have received the recommended full three-dose regimen, according to a CDC report today.

As outlined in Morbidity and Mortality Weekly Report (MMWR), CDC scientists analyzed national data from 2011, 5 years after the first HPV vaccine was approved for use in the United States.

They found that 53.0% of girls and 8.3% of boys in this age-group had received at least one dose of vaccine, while 34.8% of girls and 1.3% of boys had received the full three-dose complement. Coverage among girls increased an average of 5 to 6 percentage points per year of age for both dose-groups.

The researchers also noted that, for both sexes, receipt of at least one dose was significantly higher among Hispanics and African-Americans compared with whites. And among girls, receipt of three or more doses was significantly higher in Hispanics than in whites. They also noted that, for those who received at least one vaccine dose, completion of the vaccine series was higher in African-American girls than in white girls.

Three-dose coverage in girls 13 to 15 was 30.0%, far short of the Healthy People 2020 goal of 80%, the report said.
Sep 12 MMWR report


PharmAthene wins contract to develop heat-stable anthrax vaccine

PharmAthene Inc. announced yesterday it has received a federal contract worth up to $28.1 million to develop a lyophilized (freeze-dried), heat-stable version of its next-generation anthrax vaccine.

The contract, awarded by the National Institute of Allergy and Infectious Diseases (NIAID), pertains to PharmAthene's recombinant protective antigen (rPA) vaccine.

On the basis of in vitro and animal data, the company said it believes that the new lyophilized formulation "should result in a vaccine which is thermostable and shows improved long-term stability, cold-chain-free storage stability, and enhanced immunopotency compared to existing liquid anthrax vaccines."

The company said its previous research has shown that a lyophilized rPA vaccine candidate is structurally stable and that it protected mice from a normally lethal dose of anthrax spores after storage at various temperatures up to 70°C (158°F).

The PharmAthene announcement came just 2 days after Emergent BioSolutions announced receipt of a $29 million NIAID contract to develop a dry, heat-stable version of its adjuvanted anthrax vaccine, NuThrax. Emergent makes the only anthrax vaccine licensed in the United States and contained in the Strategic National Stockpile.
Sep 10 PharmAthene statement
Related Sep 9 CIDRAP News item


Report: Bats bring Marburg virus back to Ugandan mine

Bats that have repopulated a Ugandan mine after eradication efforts in 2008 over concerns about Marburg hemorrhagic fever (MHF) also harbor Marburg virus and were likely the source of a nearby human outbreak, investigators reported in a letter yesterday in Emerging Infectious Diseases.

Marburg virus is a relative of Ebola virus; both are filoviruses.

US and Ugandan researchers, including those from the CDC, found that 53 (13%) of 400 Egyptian fruit bats collected from the mine in 2012 harbored Marburg virus. In 2007, four miners contracted MHF, and one died. In response, local officials eradicated the mine's bat population by trapping and killing the animals after it was found they harbored the virus.

In 2012, a village about 12 miles away experienced the country's largest-ever MHF outbreak, involving 15 lab-confirmed cases. The current study was conducted in response to that outbreak after it was determined that bats that repopulated the mine constituted the largest colony in the vicinity.

Results of phylogenetic sequencing of isolates from three of the bats were nearly identical to sequences of isolates obtained from patients in the 2012 outbreak, indicating that bats from the mine were likely the source of the outbreak, the authors said.
Sep 10 Emerg Infect Dis letter

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