News Scan for Nov 11, 2014

800th Saudi MERS case
Uganda Marburg outbreak over
H5N6 in poultry
Malaria control in Africa
Post-exposure BioThrax

Saudi Arabia reports its 800th MERS case, plus death

Saudi Arabia's Ministry of Health (MOH) today reported a new MERS-CoV case and the death of a previously reported patient. The new case brings the country's count of MERS-CoV (Middle East respiratory syndrome coronavirus) cases to 800.

The new case is in a 70-year-old Saudi woman in Al-Kharj, a city not far from Riyadh in central Saudi Arabia. She is hospitalized in critical condition, is not a healthcare worker, and had no contact with MERS case-patients in the community.

The possibility of exposure to MERS-CoV patients in a healthcare setting and potential contact with animals are being investigated, the MOH said. The patient has preexisting disease.

The death reported today is in a 56-year-old Saudi man in Taif in the southwestern part of the country near Mecca, the agency reported. He was not a health worker and had preexisting disease.

The MOH also noted that four patients in Riyadh and one in Taif have recovered from the disease. The Riyadh patients included three Saudis—two men, ages 33 and 41, and a woman, 31—and a 44-year-old male expatriate healthcare worker with preexisting disease. The patient in Taif is a 75-year-old Saudi man who likewise had an underlying condition. He is not a healthcare worker.

Of the 800 Saudi cases, 14 are still active and 340 have been fatal.
Nov 11 Saudi MOH update


Uganda reports no new cases of Marburg since September

Ugandan junior health minister Sarah Opendi declared the country free of Marburg virus cases, more than a month after a healthcare worker (HCW) died of the disease in Kampala, Reuters reported today.

The infected HCW died on Sep 28, and Ugandan health authorities implemented a 42-day minimum monitoring period for 197 of his contacts. None of the contacts became ill, and the outbreak has been declared contained, the story said.

Both Marburg and Ebola are in the Filoviridae virus family, although Ugandan authorities say the case in Kampala had no connection to the ongoing Ebola outbreak in West Africa.

Both viruses can be transmitted through contact with bodily fluids or infected wild animals and cause similar symptoms. Marburg is fatal in 80% of cases within a week, and no vaccine or effective treatment is available.
Nov 11 Reuters
Oct 10
CIDRAP News scan on Ugandan Marburg confirmation


FAO: H5N6 poses emerging threat to poultry in eastern Asia

Outbreaks of H5N6 avian flu in Asian poultry may be an emerging public health threat, according to a November EMPRES Watch report from the United Nations Food and Agriculture Organization (FAO) published last week.

A highly pathogenic avian influenza (HPAI) strain of H5N6 emerged in China in May. In the following months, the FAO identified 3,434 poultry outbreaks of HPAI H5N6 in China, Laos, and Vietnam. Although H5N6 is not readily transmissible from birds to humans, one man in China's Sichuan province died of the virus on May 6.

Outbreaks of HPAI H5N6 in Asian poultry are expected to rise as winter approaches. Given H5N6's prevalence in poultry and the diversity of circulating avian flu strains such as H5N1, H9N2, and H7N9 in Asia, the FAO recommends ongoing surveillance for mutations and reassortments in H5N6.

The FAO is currently conducting evaluation of poultry vaccines and diagnostic tests and working with the US Agency for International Development (USAID) to assist affected countries in implementing surveillance for H5N6 in bird markets and among domestic poultry.
November FAO EMPRES Watch


Chinese group says new drug has rid African nation of malaria

In a controversial experiment involving a drug combination not approved for human use, Chinese scientists claim to have wiped out malaria on a tiny island nation off the African coast, CBS News reported today.

The entire population of Comoros—more than 700,000 people—received three doses of Artequick, a combination of antimalarial drugs not approved by any global health body, the story said. Comoros is an archipelago off the coast of east Africa.

The researchers say the doses of Artequick have eliminated the malaria-causing Plasmodium parasite from the entire Comoran population's bloodstreams. The theory is that, if Plasmodium is eliminated in people for 3 months—the life-cycle of the mosquitoes that transmit malaria—the disease will disappear. For that to work, all the people had to take the drug at roughly the same time.

The team now hopes to expand trials into continental Africa, where the drug's maker is marketing Artequick, and beyond. "The vision is to contribute to the elimination of malaria in the world," san Pan Longhua, general manager of Artepharm Co. Ltd., which produces Artequick.

A World Health Organization (WHO) official, however, warned that the drug is very new and is still relatively untested. Andrea Bosman, MD, PhD, of the WHO's Global Malaria Program also questioned whether the research team, in concert with national officials, adequately monitored  the population for adverse effects.

And Dr. Yao Kassankogno, the WHO representative in Comoros, expressed concern that the mass drug administration will deplete built-up malaria immunity in the population, rendering them susceptible to an epidemic if the disease is re-introduced. Kassankogno also questioned whether the Comoran government is able to monitor malaria adequately.

Critics also feared that administering the drug to such a large population could spawn resistance to the widely used antimalarial drug artemisinin, one of the key ingredients in Artequick, the story said.
Nov 11 CBS News story


Post-exposure indication sought for BioThrax

Emergent BioSolutions Inc. has filed a supplemental Biologics License Application (sBLA) with the US Food and Drug Administration (FDA) for expansion of Anthrax Vaccine Adsorbed's (BioThrax's) label to include a post-exposure prophylaxis (PEP) indication, according to a news release yesterday from the company.

BioThrax, the only FDA-licensed vaccine for prevention of anthrax, is at present given in a three-dose series to adults at high risk for exposure to Bacillus anthracis, the bacterium that causes anthrax, primarily military personnel. The new indication would be for administration at 0, 2, and 4 weeks after suspected or confirmed exposure to B anthracis. The recommended course of antibiotics for anthrax would be given as well.

Twelve nonclinical studies and three phase 2/3 clinical trials have been carried out to support the PEP indication, and a pre–phase 3 Vaccines and Related Biological Products Advisory Committee meeting was held in 2010.

A number of improvements to BioThrax have been made over the years, according to the release, including "an enhanced route of administration, a streamlined vaccination schedule, and an extended shelf life." Emergent, of Rockville, Md., plans on a manufacturing capacity of 20 million to 25 million doses per year. The company has delivered more than 66 million doses of BioThrax to the US government to date; more than 12 million doses have been given to members of the military since 1998, says the release.

"This sBLA submission reflects years of collaboration between Emergent and the U.S. government to enhance the country's preparedness to meet immediate public health needs in the event of an anthrax attack," said company official Adam Havey in the release.
Nov 10 Emergent BioSolutions press release

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