News Scan for Aug 31, 2016

Ebola persistence in semen
Saudi MERS case
More chikungunya
H5N6 in China
FDA OKs 4-strain flu vaccine

In Liberian study, Ebola virus persisted in semen of 9% of male survivors

A study in Liberia has produced more evidence of persistence of the Ebola virus in semen after patients' recovery from the disease, with some of them still testing positive more than a year after recovery and greater age indicated as a possible risk factor.

The findings come from Liberia's Men's Health Screening Program, in which male Ebola survivor are offered semen testing and counseled about safe sex, according to a report yesterday in The Lancet Global Health.

In the study, men and boys ages 15 and older were tested for Ebola RNA by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). They graduated from the program after receiving two consecutive negative semen test results. Data obtained between Jul 7, 2015, and May 6, 2016, were included in the study.

Of 429 participants, 38 (9%) had at least one positive semen test for Ebola RNA, and 24 (63%) of these tested positive a year or longer after their recovery. The longest interval between discharge from treatment and collection of a positive sample was 565 days.

Among participants who provided samples more than 90 days after recovery, those older than 40 were significantly more likely to have a positive test than were younger men (P = 0.0004), the report says.

The study also suggests that the counseling part of the program has been effective, as 84 of 113 men who reported not using condoms at enrollment reported using them at their first follow-up visit. Also, 176 of 385 participants who initially said they were sexually active reported abstinence at the first follow-up.

In an accompanying commentary, two experts said the findings must be interpreted cautiously, since the authors could not do cell culture isolation to confirm the presence of viable Ebola virus, as opposed to just residual viral RNA.

But the commentators, Daniel Bausch, MD, MPH&TM, of the Tulane School of Public Health and Tropical Medicine in New Orleans, and Ebola survivor Ian Crozier, MD, of the Infectious Diseases Institute in Kampala, Uganda, added that sexual transmission more than 6 months after recovery has been documented in Liberia. Therefore, they advise that male Ebola survivors should continue to follow advice to abstain from sex or use condoms until RT-PCR semen testing is repeatedly negative.
Aug 30 Lancet Glob Health report
Aug 30 Lancet Glob Health commentary


First case of MERS confirmed in Saudi Arabia in 6 days

The Saudi Arabia Ministry of Health (MOH) reported a case of MERS-CoV infection today after 5 days of no new cases. In the last 6 weeks, there's been a slowdown of MERS diagnoses in the country, which has been battling an outbreak of the respiratory disease since 2012.

According to the MOH, a 40-year-old man from Al Hofuf is in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). The MOH described the expatriate as having contact with camels.

Direct and indirect contact with camels is a known risk factor for contracting MERS, but researchers do not yet know how the animals pass the disease to humans.

Saudi Arabia's MERS case count has now reached 1,449, including 610 deaths and 3 patients still being treated, according to the MOH.
Aug 31 MOH update


PAHO reports 1,428 more chikungunya cases in Central, South America

In its most recent weekly update late last week, the Pan American Health Organization (PAHO) reported 1,428 new suspected or confirmed chikungunya cases, lifting the total in the Americas this year to 252,154.

Weekly increases have varied, and some countries report several weeks worth of cases at a time, while some go several weeks with reporting any. For comparison, in the previous 2 weeks PAHO reported increases of 32,492 and 3,100 cases, respectively.

Most of the newly reported cases were from Costa Rica, El Salvador, Honduras, Colombia, and Venezuela. One more death was reported, putting that total for the year at 55.
Aug 26 PAHO update

In other chikungunya developments, researchers from the Philippines, where the disease is endemic, yesterday reported that in an outbreak, rising antibodies approaching 50% seem to signal the end of the event. Their observation came from active febrile illness surveillance in the city of Cebu during 2012 to 2014.

They made weekly telephone calls, made home visits, and collected blood samples. They reported their findings in Emerging Infectious Diseases.

Overall chickungunya incidence during the second year was significantly lower than the first year: 2.84 cases per 100 person years, compared with 12.32 cases per 100 person years. The authors said the change was driven by a drop in subclinical infections across all age-groups. Prevalence of neutralizing antibodies rose significantly, from 28% at the beginning of the first surveillance year to 42% at the start of the second year.

The investigators said the seroprevalence level was higher than the 10% to 30% reported at the end of a major outbreak on St. Martin in the Caribbean, but they said the neutralizing test they used in the Philippines was more sensitive and might account for the difference.
Aug 30 Emerg Infect Dis report


Commercial farm in China reports H5N6 avian flu

A commercial farm in TaijiangCounty, China, today reported an outbreak of H5N6 avian flu, according to the World Organization for Animal Health (OIE). TaijiangCounty is located in Guizhou province, in the southwestern part of the country.

More than 16,000 birds were destroyed after 7,167 poultry on the farm died from the disease and 10,113 were infected, for a total loss of 23,884 birds. The outbreak is continuing, and officials will provide updates after an investigation is completed. The outbreak appears to have a 30% mortality rate and a 71% case-fatality rate.

H5N6 is a highly pathogenic avian flu virus that has caused 15 human infections in China, including 8 deaths, the most recent in January.
Aug 31 OIE report
Jan 11 CIDRAP news story on most recent case


Seqirus reports FDA approval of its second quadrivalent flu vaccine

The vaccine manufacturer Seqirus announced this week that it has gained US Food and Drug Administration (FDA) approval of its second quadrivalent (four-strain) influenza vaccine, Afluria Quadrivalent, for use in adults.

Seqirus is offering both Afluria Quadrivalent and Flucelvax Quadrivalent, a cell-based vaccine that won FDA approval in May, for use in the 2016-17 flu season in the United States, according to a press release. Seqirus was formed to combine the flu vaccine operations of CSL and Novartis when CSL bought Novartis's US flu vaccine business in 2015.

Afluria Quadrivalent is an inactivated vaccine that contains two influenza A and two influenza B strains, the company noted. It comes in single-dose, preservative-free pre-filled syringes. In a randomized controlled trial with 3,449 participants, the vaccine was shown to be non-inferior to two trivalent inactivated flu vaccines for all flu strains targeted, the company said.

Trivalent flu vaccines contain two type A strains and one type B. Several flu vaccine makers have added quadrivalent products to their lines in recent years because of the difficulty of predicting which of the two influenza B lineages will be more common in any given season.

Seqirus offers a trivalent formulation of Afluria that is available in a needle-free injector. The company announcement does not mention a needle-free version of Afluria Quadrivalent.
Aug 29 Seqirus press release

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