News Scan for Oct 07, 2016

Salmonella from live poultry
High-dose colistin
Vaccines in young kids
Ebola vaccine contract
Polio in Nigeria

CDC: 2016 was record year for Salmonella cases linked to live poultry

In issuing its final report yesterday on eight Salmonella outbreaks linked to contact with backyard poultry, the US Centers for Disease Control and Prevention (CDC) said the 895 illnesses reported is the largest number ever reported in outbreaks linked to chicks and ducklings.

The final number reflects 284 more cases than the CDC's last update in July and includes illnesses from 3 more states, putting that total at 48. States reported 71 more hospitalized patients, lifting the number to 209. Patient ages ranged from younger than 1 year to 106, with a median age of 27.

Two more deaths were reported, bringing the fatality count to three. However, Salmonella is considered the cause of death in only one of the patients, a person from Mississippi. Kentucky and New Jersey reported the other two deaths.

Illnesses onset dates ranged from Jan 4 though Sep 10. The eight outbreaks involved baby poultry from a variety of sources, from feed stores to internet sites. Seven different Salmonella strains were involved: Enteritidis, Muenster, Hadar, Indiana, Mdbandaka, Infantis (2), and Braenderup.

The CDC said though the outbreak investigations are over, people can still contract Salmonella infections from live poultry. It urges consumers to wash their hands after handling live poultry or anything in the birds' environments and to not keep poultry in houses or near where food is prepared, served, or stored. Children younger than 5, adults over age 65, and those with weakened immune systems should avoid handling live poultry.
Oct 6 CDC final outbreak update
Jul 19 CIDRAP News scan "
Infections nearly double in 8 poultry-linked Salmonella outbreaks"


Study finds high-dose colistin treatment has no mortality benefit

Treatment with high doses of colistin was found to have no mortality benefit for patients with carbapenem-resistant gram-negative infections, according to a study published yesterday in Clinical Infectious Diseases. But it was associated with greater nephrotoxicity.

The study used data from two prospective cohort studies performed from 2006 to 2009 and from 2012 to 2015 at two hospitals in Israel, involving 529 adult patients with invasive infections caused by carbapenem-resistant gram-negative bacteria susceptible to colistin. Of the 529 patients, 144 were treated with high doses of colistin (a median of 9 million international units [MIU] per day) and 385 were treated with lower-dose regimens (a median of 4 MIU/day).

The primary outcome was 28-day all-cause mortality. The hypothesis was that higher doses might translate to improved patient outcomes.

In an unadjusted analysis, 28-day mortality was 34.7% for the high-dose patients (50 deaths out of 144 patients) and 42.9% for the low-dose patients (165/385). In a propensity-matched analysis, which yields a more accurate comparison, high-dose mortality was 36.0% and low-dose mortality was 33.7%. When the researchers disregarded the loading dose, the numbers were even closer: 35.0% versus 33.9%, respectively. None of these differences was statistically significant.

There was no observed difference in earlier mortality or in other clinical outcomes, which included fever duration, length of hospital stay, and resistance development. The researchers did note, however, that renal failure was significantly more common in the patients receiving high doses of colistin. In addition, high-dose patients suffered seizures more frequently.
Oct 6 Clin Infect Dis abstract


CDC says vaccine uptake stays steady in young children

Little has changed in vaccine uptake among young US children in recent years, although the percentage of parents refusing vaccines appears to have dropped a bit, according to three studies published yesterday by CDC researchers, two in Morbidity and Mortality Weekly Report (MMWR) and one in Clinical Infectious Diseases.

In the first MMWR study, based on national immunization data that the CDC reports each year, median vaccination coverage for two doses of measles, mumps, and rubella vaccine (MMR) vaccine in kindergartners in 2015 was 94.6%. For diphtheria, tetanus, and acellular pertussis (DTaP) vaccine it was 94.2%. That compares with 94.0% and 94.2%, respectively, in 2014. The US goal is 95%.

The study also found a median exemption rate of 1.9% among kindergartners, up from 1.7% in 2014. The exemption rate ranged from less than 0.1% in Mississippi to 6.3% in Oregon.

The other MMWR study, involving US kids 19 to 36 months old, found that vaccination coverage did not change at all from 2014 to 2015. "More than 90% of children were up to date on vaccination against polio; hepatitis B; measles, mumps, and rubella; and varicella," the CDC researchers said. "However, children living below the poverty level continued to have lower coverage with rotavirus vaccine; pneumococcal conjugate vaccine; Haemophilus influenzae type b vaccine; and diphtheria, tetanus, and acellular pertussis vaccine."

In the third study, CDC investigators reported on a national poll of children younger than 7 years conducted in 2012 and 2014. They found that the percentage of parents refusing one or more vaccines for their children fell from 5.4% in 2012 to 3.6% in 2014. They said the rate of refusal dropped slightly among parents of 2- to 6-year-olds but not in those with kids up to 2 years old.
Oct 7 MMWR report on kindergartners
Oct 7 MMWR report on preschoolers
Oct 6 Clin Infect Dis study


BARDA issues $24.8 contract for advanced VSV-EBOV development

NewLink Genetics announced that it has received a $24.8 million contract from the US Health and Human Services (HHS) Biomedical Advanced Research and Development Authority (BARDA) to support the advanced development of VSV-EBOV, one of the candidate Ebola vaccines that is furthest along in clinical trials and is already being used on an emergency basis in West Africa.

In an Oct 4 statement the company said the contract includes $51 million more in options that could be exercised by BARDA, which has already awarded $76.8 million to further the development of VSV-EBOV (vesicular stomatitis virus-Ebola virus), originally developed by scientists at the Public Health Agency of Canada and licensed by Merck.

The new funding is earmarked to cover manufacturing facility readiness, manufacturing process qualification, and more clinical trials to support regulatory approval.

Thomas Monath, MD, chief scientific officer and chief operating officer at NewLink Genetics, based in Ames, Iowa, said in the statement, "This new contract issued by BARDA will enable accelerated full-scale production of V920, once it is approved, and is a critical step in helping to make this vaccine available to the health care community as they work to control epidemics and protect medical workers and others at high risk."
Oct 4 NewLink Genetics press release


WHO details Nigeria polio detections, reports vaccine-derived case

In an update on recent wild poliovirus (WPV) cases in Nigeria, the World Health Organization (WHO) yesterday said the country has confirmed three WPV type 1 cases, one more than initially announced in August, and that the investigation into the infections turned up vaccine-derived poliovirus type 2 (cVDPV2) in a sample from a healthy household contact.

The three lab-confirmed WPV type 1 cases are Nigeria's first after going 2 years without a case, and the patients' illness onsets were between July and August. All three cases are in children ages 2 to 5 years old in Borno state. Two developed acute flaccid paralysis and the other was an asymptomatic close contact of one of the other two cases, the WHO said.

Genetic analysis reveals that the viruses are closely related to WPV1 last found in Borno state in 2011, suggesting that the strain has been circulating undetected since then.

The WHO said the cVDPV2 case was detected during enhanced surveillance and was found in a family member. Gene studies also suggest that the cVDPV2 has been circulating undetected in the area for at least 2 years.

Large-scale supplemental immunization activities are underway in the region alongside other humanitarian activities, with Nigeria declaring a public health emergency and four other nations—Cameroon, Central African Republic, Chad, and Niger—declaring public health emergencies for the Lake Chad region.

The WHO said the risk of international WPV1 and cVDPV2 spread is high, especially in the Lake Chad region, and insecurity and inaccessibility in some areas of Nigeria are obstacles to response activities. It added that the recent poliovirus detections underscore the importance of maintaining high levels of routine vaccination coverage.
Oct 6 WHO statement
Aug 11 CIDRAP News scan "
Nigeria confirms pair of polio cases after 2-year hiatus"

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