News Scan for Aug 16, 2016

Malaria may boost Ebola survival
Scallop hepatitis A source
Inhaled vs injectable flu vaccine
Camels and human cold virus
Venezuela malaria spike

Study reveals better Ebola survival in patients with malaria co-infections

Patients infected with the Ebola virus were 20% more likely to survive if they were co-infected with malaria, according to a study of Liberians who received care at a treatment center in Monrovia in 2014 and 2015 during West Africa's outbreak. A research team led by the National Institute of Allergy and Infectious Diseases (NIAID) published the findings yesterday in Clinical Infectious Diseases.

Of 1,868 blood samples tested at the treatment center, 1,182 were positive for Ebola. Lab workers also tested 956 of the samples for malaria, of which 185 were positive. The researchers found that 58% of those with co-infections survived, compared with 46% of those infected only with Ebola.

The investigators also found a positive correlation between greater numbers of Plasmodium parasites and increased Ebola survival.

Antimalarial drugs, routinely administered to all patients seen at the treatment centers, didn't seem to play a role in increased survival. Experiments in the United States on mice didn't show any survival benefit from antimalarial drugs in those infected with Ebola.

The NIAID said in a press release that the team is working to determine what mechanism might explain the findings, which could shed more light on understanding Ebola and raise possibilities for new treatments.
Aug 15 Clin Infect Dis abstract
Aug 15 NIAID
press release


Imported scallops linked to hepatitis A in Hawaii

A 2-month investigation into a hepatitis A outbreak in Hawaii that has sickened 168 people strongly suggests that frozen imported scallops served raw at sushi restaurants is the source, the Hawaii State Department of Health (DOH) said in a statement today.

The DOH said the scallops were served at at Genki Sushi restaurants. The chain of sushi restaurants will be closed until further notice.

Virginia Pressler, MD, the DOH's director, said officials have ordered an embargo on the frozen scallops and ordered the restaurants to temporarily close. "The business has complied with all orders, contacted all of their Hawaii restaurants, and is working with the department to ensure the safety of its customers. Our staff is in the field today working with distributors to embargo the product."

The scallops were distributed by Koha Oriental Foods and True World Foods in Hawaii.

Health officials said they are in contact with the US Food and Drug Administration (FDA) to investigate the product origin.

Of the 168 people sickened in the outbreak, 46 were hospitalized. Illness onsets range from Jun 12 to Aug 1.
Aug 16 DOH statement
Aug 10 DOH outbreak update


Trial finds no protection difference between inhaled and injectable flu vaccines

A randomized controlled trial comparing the inhaled flu vaccine with the injectable version in Hutterite children in two Canadian provinces found no difference in protection, according to a report by Canadian researchers today in Annals of Internal Medicine.

The study comes in the wake of a US advisory committee's recommendation against using the nasal vaccine for the upcoming US flu season because of Centers for Disease Control and Prevention (CDC) data that showed no benefits over the last few seasons for children ages 2 to 17 from the quadrivalent version of the live attenuated influenza vaccine (LAIV), called FluMist. The pattern hasn't been seen in other countries that have assessed the vaccine.

Over three flu seasons between October 2012 and May 2015, children in 52 Hutterite communities in Alberta and Saskatchewan were randomly assigned by community to receive either LAIV or the flu shot. A total of 1,186 children were vaccinated, and 3,425 community members were used as controls. Both vaccines were trivalent.

Average vaccine coverage was 76.9% in the LAIV group and 72.3% in the flu-shot group. During the study period, flu infections occurred in 5.3% of the LAIV group and 5.2% of the injectable vaccine group. There was no significant difference in lab-confirmed flu incidence between the two groups (pooled hazard ratio, 1.03 [95% confidence interval, 0.85 to 1.24]).

The researchers said the study may not be generalizable, because flu transmission patterns may be different in non-Hutterite communities.

Mark Loeb, MD, lead author of the study and professor in the department of pathology and molecular medicine at McMaster University, said in a press release from the school, "Our study is the first blinded randomized controlled trial to compare the direct and indirect effect of the live vaccine versus the inactivated vaccine."

He added that the findings challenge previous studies, including ones used by the CDC's Advisory Community on Immunization Practices in its recent recommendation against LAIV. "Our study challenges previous studies because our results show conclusively that the vaccines show similar protection when both direct and indirect effects are taken into account," he said.
Aug 16 Ann Intern Med abstract
Aug 15 McMaster University
press release
Jun 22 CIDRAP News story "
ACIP recommends against inhaled flu vaccine for next season"


Study finds camel link to a human cold coronavirus

Tests on dromedary camels in Saudi Arabia and Kenya found a close relative of one of the common human coronaviruses frequently linked to common colds, shedding light on a possible camel source for the human virus and offering a reminder of the pandemic potential of Middle East respiratory syndrome coronavirus (MERS-CoV). The study, led by a team at the University of Bonn, is based on viruses found on nasal swabs collected from 1,033 camels during 2014 and 2015. The group published their findings yesterday in the Proceedings of the National Academy of Sciences (PNAS).

The coronavirus related to a human cold virus (HCoV-229E) was found in 5.6% of camels tested. Genetic analysis suggested that the human version probably became established in humans after it jumped from camels.

A battery of lab tests on HCoV-229E to assess its ability to cause human disease found that it could enter cells, but it didn't replicate efficiently and wasn't well adapted to human airway cells. Also, the camel version of the virus was sensitive to the interferon response in human cells.

The researchers drew parallels to the emergence of MERS-CoV, also linked to camels and able to infect humans, though it hasn't shown the capacity for sustained human-to-human transmission. "Livestock species, including species that are of regional importance such as camels, should be systematically tested for viruses capable of infecting humans," they wrote.
Aug 15 PNAS abstract


Economic crisis in Venezuela leads to malaria spike

In 1961, Venezuela was the first country to be certified by the World Health Organization for eradicating malaria, but the New York Times reported yesterday that the dire economic collapse in Venezuela is fueling a return of the mosquito-borne disease.

The Times explained that as thousands flock to rural mines to find work, they become infected with malaria, then bring the disease back with them to their families in Venezuela’s cities.

"… [B]ecause of the economic collapse, there is often no medicine and little fumigation to prevent mosquitoes there from biting them and passing malaria to others, sickening tens of thousands more people and leaving entire towns desperate for help," the Times reported.

According to the Times, the return of malaria has been treated like a state secret by the Venezuelan government, which has not published any epidemiological reports on the disease in the past year. But secret documents prepared by Venezuelan doctors show, "In the first six months of the year, malaria cases rose 72 percent, to a total of 125,000."
Aug 15 New York Times story 

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