News Scan for Mar 14, 2016

American Lassa fever patient
Chikungunya outbreak expands
H7N9 cases in China
Adjuvanted anthrax vaccine

American clinician treated for imported case of Lassa fever

An American physician's assistant has been flown from West Africa to the United States for treatment of Lassa fever, according to recent reports from CNN and Emory University Hospital.

The patient, who was working with a missionary organization in Togo, tested positive for Lassa fever upon arrival to Emory University Hospital in Atlanta, Ga. The individual is currently isolated in Emory's Serious Communicable Diseases Unit, which successfully treated four patients with Ebola virus disease in 2014, CNN said.

The US State Department requested that the patient be flown from West Africa to Emory's treatment facilities, where health workers are working with the Centers for Disease Control and Prevention (CDC) and the Georgia Department of Public Health to manage the case, Emory said in a Mar 11 statement.

Lassa virus, which can cause hemorrhagic fever and bleeding, infects 100,000-300,000 people in West Africa each year, causing approximately 5,000 deathsaccording to the hospital. Symptoms are similar to, but less severe than, those caused by Ebola virus. Lassa virus spreads to humans through contact with rodent urine and droppings and through direct contact with a sick patient's bodily fluids.

Six cases of Lassa fever have been reported in the United States, all in people with a history of travel to areas where the disease is endemic. The most recent US case was reported in New Jersey in May 2015, Emory said. Recent outbreaks have been reported in Nigeria and Benin.
Mar 13 CNN story
Mar 11 Emory University Hospital statement


Argentina reports its first local chikungunya cases as outbreak grows

Argentina has reported its first locally acquired chikungunya cases ever, as the outbreak in the Americas expands by more than 10,000 cases, the World Health Organization (WHO) and its regional office, the Pan American Health Organization (PAHO) reported.

The WHO said today that Argentinian officials on Mar 7 reported 1,281 suspected chikungunya cases in 2015, including 21 that were lab-confirmed and 22 classified as probable, the agency said in a news release today. The country also noted 1,030 suspected cases through February of this year, including 55 lab-confirmed and 4 probable. Of the lab-confirmed cases, 30 were acquired within the country.

Previously, PAHO had noted only 42 imported chikungunya cases in Argentina in 2015, and none so far for 2016. Local health officials are ramping up surveillance efforts, mosquito control, and communications with health professionals and the public, the WHO said.

In its weekly update on Mar 11, meanwhile, PAHO reported 9,079 new cases for the year, not including the new WHO-noted infections in Argentina. When Argentina's 2016 cases are added in, the 2016 total rises to 10,109.

The 2016 outbreak total has now reached 30,842 confirmed and suspected cases, according to PAHO. The agency did not report any new 2015 cases since its previous update, leaving that number at 731,920 cases. Therefore, the outbreak total since 2012 has now reached 1,910,388 cases, according to PAHO's total. But when the new 2015 and 2016 Argentina cases are added, the outbreak total rises to 1,912,699.

A high percentage of PAHO's new 2016 cases were from Bolivia and Nicaragua. Bolivia, reporting data for the first 8 weeks of the season after reporting none previously this year, tallied 5,175 new cases. And Nicaragua, reporting 4 weeks of data, had 2,147 new cases, raising its 2016 total to 3,925 infections.

No chikungunya-related deaths have been reported so far in 2016. The outbreak began in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas.
Mar 14 WHO news release
Mar 11 PAHO update  
Latest PAHO 2015 cumulative case numbers


China reports 12 new H7N9 cases

Chinese health officials recently reported two more H7N9 avian flu infections in adults from China's mainland, while China's most recent monthly infectious disease report lists 29 H7N9 cases and 15 deaths that occurred during February.

China's official news agency, Xinhua, today reported a severe case of H7N9 in a patient from Hubei province in central China. The individual, who was diagnosed yesterday and placed in isolation, is a poultry trader being treated for severe pneumonia, sepsis, and multiple organ failure.

On Mar 11, the Shanghai Health and Family Planning Commission reported an imported H7N9 case in a 79-year-old woman from Anhui, who is currently being treated for the disease, according to FluTrackers, an infectious disease news message board.

China's National Health and Family Planning Commission released its infectious disease report for the month of February on Mar 11, revealing 29 H7N9 cases, 10 of which had not been previously reported. The report also indicated that 15 people died from the disease during February, yielding a mortality rate of 51.7% for the month, FluTrackers said.

The new cases lift the overall global total from the disease to 764, according to a case list maintained by FluTrackers.
Mar 14 Xinhua
Mar 11 FluTrackers post on Shanghai case
Mar 11 FluTrackers post on China's February report
FluTrackers H7N9 case list


Adjuvanted anthrax vaccine produces high immune response in 2 doses

A study of the adjuvanted anthrax vaccine AV7909 (also known as NuThrax) found that all dose schedules evaluated resulted in higher immune responses compared to the currently recommended vaccine regimen, according to findings published Mar 12 in Vaccine.

The phase 2, randomized, double-blind, controlled trial followed 168 healthy adults who were assigned to one of five immunization groups: group 1 (44 people receiving AV7909 on days 0 and 14), group 2 (34 people receiving AV7909 on days 0 and 28), group 3 (23 people receiving AV7909 on days 0, 14, and 28), group 4 (44 people receiving a half-dose of AV7909 on days 0, 14, and 28), and the control group 5 (23 people receiving the currently recommended BioThrax vaccine on days 0, 14, and 28).

AV7909 is produced by Emergent BioSolutions, Inc., which sponsored the study. The vaccine is a combination of CPG 7909 adjuvant and the currently used prophylactic anthrax vaccine BioThrax.

The highest peak immune response occurred in group 2 (two doses of AV7909 given 28 days apart. Peak immune response was also high in group 3 (three doses of AV7909 given 14 days apart. Peak titers in all four AV7909 groups were higher than in the BioThrax control group.

The immune response necessary to neutralize anthrax toxin was above the required threshold at day 28 for groups 1, 3, and 4. All groups were above the threshold at day 42. Though the highest titer levels were observed in group 2, group 3 reached the immunity threshold seven days earlier than group 2.

Most subjects reported mild or moderate reactions (eg, swelling at the injection site) to the vaccine, with many reporting mild or moderate systemic reactions. Adverse events, though not serious, led six vaccine-group subjects to remove themselves from the study.Adverse events were more common in the groups receiving AV7909 (79% of subjects) compared to the control group (65

US agencies currently recommend three doses of BioThrax administered 2 weeks apart, followed by a 60-day antimicrobial regimen, for post-exposure anthrax prophylaxis. The findings suggest that use of two or three doses of AV7909 may require fewer vaccinations to achieve sufficient immune response to anthrax toxin and may increase compliance with vaccination.
Mar 12 Vaccine study

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