Flu Scan for Sep 25, 2017

Flu in Maryland fair pigs
H7N9 cluster analysis
Peramivir pediatric indication
H5N1 in Malaysia

Swine influenza found in more Maryland fair pigs; more human cases noted

State and county health officials in Maryland are investigating influenza in 11 pigs that were recently shown at a fair in Frederick County, the second time flu has been detected at the state's county fairs in as many weeks.

In the latest developments, preliminary tests show the pigs are infected with influenza A, but officials don't know if it's a strain that can spread to people. The Maryland Department of Agriculture (MDA) has issued a quarantine order for all pigs at the Frederick County fairgrounds until 7 days after the last pig shows signs of illness signs, the agency said in a news release.

The fair took place from Sep 15 to Sep 23. So far no human illnesses have been linked to contact with the pigs, but the local media said authorities were investigating a possible illness in a child who has a flulike illness.

On Sep 20, the state health department announced that tests had presumptively identified variant H3N2 (H3N2v) in seven Maryland resident who had close contact with pigs at the Charles County Fair. In a Sep 22 update, officials said the total of presumptive positives has risen to 10.
Sep 24 MDA press release
Sep 23 Frederick News-Post
Sep 21 CIDRAP News scan "
Seven fairgoers contract H3N2v in Maryland"


H7N9 cluster analysis finds multiple but limited human-to-human spread

A closer analysis of 21 clusters of H7N9 avian flu infections in the first three waves in China's ongoing outbreak suggests that human-to-human transmission is involved in a small fraction of cases.

Researchers from China and their collaborators at the US Centers for Disease Prevention and Control (CDC) used a simple framework to gauge the likelihood of human-to-human transmission and published their findings Sep 19 in the Journal of Infectious Diseases.

The 21 clusters with 22 infected contact cases were identified by the Chinese Center for Disease Control and Prevention from March 2013 to June 2015. The team looked at detailed epidemiologic information, including timing of contact exposures to people and poultry during the incubation period. Using a framework based on exposure timing to help distinguish person-to-person transmission from a common infectious source such as poultry, they graded the likelihood of exposure as probable, possible, or unlikely.

Probable person-to-person transmission occurred in 12 clusters, was possible in 4, and unlikely in 6. Two of the probable clusters involved nosocomial transmission. The investigators found no evidence of sustained transmission among people.

The researchers said the framework they employed could be used as a standardized tool to help quickly assess future H7N9 clusters as they occur.
Sep 19 J Infect Dis abstract


FDA approves pediatric indication for IV peramivir

The US Food and Drug Administration (FDA) has approved an expanded indication for peramivir injection (Rapivab) in children ages 2 years and older with flu, the first new influenza antiviral available for kids in more than 10 years.

A press release from BioCryst, a pharmaceutical company based in Research Triangle Park, N.C., said the new FDA indication for the intravenous neuraminidase inhibitor covers uncomplicated influenza in pediatric patients age 2 and older who have had symptoms for no longer than 2 days. The agency based its approval on the interim analysis of an ongoing clinical study, which will be presented at the ID Week meeting in San Diego in early October.

John Vanchiere, MD, PhD, chief of the section of Pediatric Infectious Diseases at LSU Health Sciences Center, said in the press release that Rapivab is a great addition to antiviral agents available for fighting flu. "It will be especially helpful for patients who cannot tolerate oral medications. In addition, the long half-life allows for one-time dosing, which will improve compliance."

The FDA in December 2014 approved the drug for adult flu patients who have difficulty taking oral or inhaled antivirals.
Sep 21 BioCryst press release


More H5N1 events linked to earlier Malaysian outbreaks

The World Organization for Animal Health (OIE), based on updates from Malaysian veterinary officials, reported 25 more highly pathogenic H5N1 avian flu outbreaks that occurred back in March, part of activity that marked the country's first resurgence of the disease in nearly a decade.

All of the events occurred in Kelantan state, with start dates from Mar 8 to Mar 26. All of the events were declared as resolved on Apr 1. Most of the newly reported outbreaks involved backyard or village poultry, including chickens, ducks, Guinea fowl, geese, turkeys, and pet birds. The virus sickened 132 of 14,924 susceptible birds, and authorities culled all of the remaining ones to help limit the spread of the virus.

In March, Malaysia reported 11 H5N1 outbreaks, all in Kelantan state, which is located in the northeastern part of the country's peninsular region.
Sep 25 OIE report
Mar 8 CIDRAP News story "
Malaysia reports first H5N1 outbreak in nearly 10 years"

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