News Scan for Nov 23, 2015

BioWatch capabilities
Flu vaccine protection
More chikungunya cases
Malaria funding
Cholera in Iraq

GAO says DHS needs to prove BioWatch pathogen-detection capabilities

The US Government Accountability Office (GAO) today recommended in a report that the Department of Homeland Security's (DHS's) BioWatch program not pursue any upgrades to its second-generation (Gen-2) technology for monitoring the country for potential bioterror attacks until it can provide better efficacy data.

The DHS had earlier begun moving toward next-generation (Gen-3) technology for obtaining faster lab results from its detection filters autonomously—without need for an external lab—until questions about cost and effectiveness forced it to scrap those plans in April 2014.

The DHS "lacks reliable information about BioWatch Gen-2's technical capabilities to detect a biological attack and therefore lacks the basis for informed cost-benefit decisions about upgrades to the system," the GAO said in today's report. "DHS commissioned several tests of the technical performance characteristics of the current BioWatch Gen-2 system, but has not developed performance requirements that would enable it to interpret the test results and draw conclusions about the system's ability to detect attacks."

The report also said that although DHS officials have said the system can detect attacks large enough to cause 10,000 casualties, they have not specified the performance results that would reliably meet this objective. GAO experts also took issue with the computer modeling and other simulation studies the DHS has used to generate effectiveness data in lieu of performance requirements.

The GAO also found limitations in the four key tests of Gen-2 performance. "Because it is not possible to test the BioWatch system directly by releasing live biothreat agents into the air in operational environments, DHS relied on chamber testing and the use of simulated biothreat agents, which limit the applicability of the results. These limitations underscore the need for a full accounting of statistical and other uncertainties."

The GAO, which is the accountability arm of Congress, added that the DHS could apply lessons learned from assessing the scuttled Gen-3 program to assess Gen-2 capabilities, especially as it explores options for autonomous detection. Gen-2 technology cost almost $87 million to operate in fiscal year 2015, the report said.

The report concludes, "GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system's current capabilities." It said the DHS "generally concurred" with the recommendations.
Nov 23 GAO report


Three years of surveillance data show moderate flu vaccine effectiveness

Flu vaccine effectiveness (VE) estimates drawn from US surveillance data show moderate protection that varied by age-group, similar to what previous studies using different methods have found, researchers reported Nov 21 in Vaccine.

Investigators from Hong Kong and the US Centers for Disease Control and Prevention (CDC) used surveillance data from patients who had acute respiratory illnesses in 101 US clinics across in three consecutive flu seasons from 2010-11 to 2012-13. They also analyzed lab test results for influenza virus, self-reported vaccine history, and patient characteristics to establish cases and matched controls. Their analysis included 10,650 patients.

Estimated flu VE over the three seasons was 58% in kids 6 months to 5 years old, 45% in kids 6 to 17 years, 36% in adults 18 to 49 years, and 34% in adults 50 and older.

The authors concluded, "Comparability of these estimates with other studies supports the feasibility of this approach for routine monitoring of influenza VE."
Nov 21 Vaccine study


Chikungunya outbreak grows by 2,500 cases as CDC issues alerts

Regions in the Americas and Caribbean reported 2,556 recent cases of chikungunya, bringing the outbreak total to 1,770,662, according to a Pan American Health Organization (PAHO) update late last week, and the CDC issued level-1 travel alerts for the disease for Mexico and Central America.

The agency's previous two updates included 2,938 and 4,370 new cases, respectively. The new infections reported in the Nov 20 update bring the total this year to 623,893 suspected and confirmed cases. Also, after reporting 13 deaths in the previous three weekly updates, PAHO reported no new chikungunya deaths, leaving this year's fatality count at 76.

Colombia accounted for almost all the new cases. The nation, which for a number of months has often had the most cases, reported 2,142 new cases last week, and its 2015 total now stands at 350,848. Mexico was second, with 330 cases, and now has 9,972 total cases. Many countries, however, have not reported on chikungunya for weeks.

The epidemic began in December 2013 with the first locally acquired chikungunya case ever reported in the Americas, on St. Martin in the Caribbean.

The CDC, meanwhile issued level-1 travel alerts on chikungunya in both Mexico and Central America late last week. The level-1 alert is labeled "watch," meaning that the agency recommends that travelers practice usual precautions, such as avoiding mosquito bites.
Nov 20 PAHO update
Nov 19 CDC alert on Mexico
Nov 19 CDC alert on Central America


UK, Gates Foundation announce $1.5 billion to combat malaria, other threats

UK Chancellor of the Exchequer George Osborne and the Seattle-based Bill & Melinda Gates Foundation are collaborating on establishing a $1.5 billion (£1 billion) fund as part of a global effort to end malaria and combat other infectious disease threats, the UK government said yesterday in a news release.

The announcement comes with a restructuring of Britain's aid budget as part of the chancellor's spending review. UK and Gates leaders have created the Ross Fund, named after Sir Ronald Ross, the first ever British Nobel Laureate who discovered that mosquitoes transmit malaria.

The $1.5 billion will include a $450 million package focused on malaria and other infectious diseases, including about $360 million for an eradication of malaria implementation fund, $150 million for research and development of products to combat infectious diseases, and $174 million to develop countermeasures, diagnostics, and insecticides for drug-resistant malaria, tuberculosis, and other infectious diseases.

The fund will also target diseases with epidemic potential, neglected tropical diseases, and diseases with emerging resistance.

Chancellor Osborne said in the release, "Eradicating malaria would save 11 million lives, so today’s announcement of the £1 billion Ross Fund is an important step to help tackle this global disease."
Nov 22 UK government news release


Iraq's cholera outbreak nears 5,000 cases but slows

The outbreak of cholera in Iraq has reached 4,858 lab-confirmed cases but has slowed in recent weeks, the World Health Organization's Eastern Mediterranean Regional Office (WHO EMRO) office said in a press release yesterday.

The total reflects a more than doubling of cases since the previous WHO EMRO update, on Nov 1, when the agency noted 2,173 cases. The latest increase, therefore, presumably reflects that many of the newly reported cases involve recently confirmed infections that occurred earlier in the outbreak.

The agency said that, since the WHO was first notified of the outbreak on Sep 15, Iraq's Ministry of Health has collected 119,983 stool samples for suspected cholera. After retesting, 2,745 of those samples were found to be positive for the outbreak strain of Vibrio cholerae 01 Inaba.

WHO EMRO said that 16 of the country's 19 governorates have reported lab-confirmed cases, but that 10 districts within Baghdad, Babylon, Diwaniya, and Muthana governorates have reported over 89% of those cases.
Nov 22 WHO press release

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