News Scan for May 10, 2016

Gain-of-function research policy
New chikungunya cases
MDR-TB treatment

Policy draft, risk-benefit analysis posted ahead of NSABB meeting

Ahead of its upcoming meeting, the National Science Advisory Board for Biosecurity (NSABB) has posted a draft of a working group's recommendations to guide federal officials in evaluating proposed gain-of-function (GOF) studies on H5N1 flu and other dangerous pathogens, and an outside company tasked with crafting a risk-benefit analysis of GOF research has posted its final report.

The two items are key parts of efforts to reach common ground on controversial GOF studies and are part of the Obama Administration's October 2014 charge to the NSABB to come up with ways to guide the federal funding policies for that type of research.

The research evaluation recommendations, posted May 6, were first discussed at the NSABB's January meeting, and again in March at a symposium hosted by the National Academies. The group said the draft is intended as a deliberative document, which could be finalized during the NSABB's upcoming full meeting on May 24, which will be live-streamed on the Web. The group will also discuss its next steps for guiding US government policies on GOF studies.

In a related development, Gryphon Scientific, a life sciences group hired to conduct the GOF risk-benefit analysis, posted its final report on its Web site. It released its first draft in December 2015. The company finalized the document in April after the March National Academies symposium.

"GOF" refers to experiments that enhance the pathogenicity, transmissibility, or host range of a pathogen with the aim of advancing scientific understanding.
May 6 NSABB GOF research evaluation recommendations draft report
April Gryphon GOF risk-benefit final report


PAHO reports almost 1,000 new chikungunya cases in the Americas

The Pan American Health Organization (PAHO) late last week reported 996 new suspected and confirmed cases of chikungunya, bringing the 2016 total to 83,599 cases.

Colombia had the largest increase. The country's 571 new cases brought its 2016 total to 13,029, according to the May 6 update. Venezuela was next with 316 new cases and 2,396 total. Many countries did not report cases last week and have not for many weeks.

In the previous week, PAHO reported 28,317 new cases, mostly in Brazil. No new deaths were reported last week, keeping that number at 12 for the year, all in Brazil.

The outbreak was first reported in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas. Since then PAHO has reported 1,963,145 suspected or confirmed cases, including 279 fatalities.
May 6 PAHO update


Study: Aggressive treatment greatly lowers risk of recurrent MDR-TB

In patients with multidrug-resistant tuberculosis (MDR-TB), aggressive treatment regimens with long continuation after conversion can greatly lower the risk of recurrence, say the results of a study published May 8 in Clinical Infectious Diseases.

The authors, from several institutions in Russia and in Boston, retrospectively analyzed the cases of 399 MDR-TB patients in Tomsk, Russia, whose illnesses were successfully treated (ie, cured or treatment completed) from Sept10, 2000, through Nov 1, 2004.

Outcomes in patients receiving long, aggressive regimens were compared with outcomes in patients receiving other treatment regimens. Long, aggressive treatment means five or more drugs judged likely to be effective, including a second-line injectable agent and a fluoroquinolone, in the intensive phase (ie, for at least 6 months after sputum culture conversion) and four or more drugs in a continuation phase of at least 18 months post-conversion.

Over a 42.4-month median duration of follow-up, there were 27 recurrences. After adjusting for risk factors for recurrence such as age, sex, presence of diabetes, extensive pulmonary involvement, and other confounding factors, patients receiving the long, aggressive regimens had a 78% reduction in disease recurrence (hazard ratio, 0.22 [95% confidence interval, 0.05-0.92] for those receiving regimens other than the long aggressive one).

Further research by means of controlled trials is needed to determine such factors as the importance of duration of continuation of treatment and the potential contribution of all drugs available for TB treatment, the authors say.

They conclude, "Our study adds to a growing body of evidence that individualized aggressive regimens improve treatment outcomes for MDR-TB, particularly among populations where previous exposure to second-line drugs is common.
May 8 Clin Infect Dis study abstract

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