News Scan for Sep 15, 2017

H7N9 case
Campy, Crypto worksite risk
Shingles vaccine
Measles in Italy

New H7N9 avian flu case reported in northeastern China

Hong Kong's Centre for Health Protection (CHP) today reported a new case of H7N9 avian flu in Liaoning province, further evidence that the virus has not disappeared during the summer.

A 54-year-old male poultry breeder fell ill Sep 3 and was admitted to a hospital with severe pneumonia. The man, from Tieling, a city of 3 million people, tested positive for H7N9 influenza last week. Liaoning province is in northeastern China and borders North Korea.

The CHP cautioned, "Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry."

The new illness raises the number of H7N9 cases in the fifth and by far largest outbreak wave to 758 cases. At least 281 of the infections were fatal. Though cases have slowed since a sudden rise last fall that lasted into spring, China continues to report sporadic cases.
Sep 15 CHP update


Worksite animal exposure noted in Campylobacter, Cryptosporidium cases

Occupational exposure to animals was linked to a substantial number of infections with Campylobacter and Cryptosporidium in Nebraska, researchers from that state and the US Centers for Disease Control and Prevention (CDC) reported today in Morbidity and Mortality Weekly Report (MMWR).

From 2005 through 2015, researchers identified occupational animal exposure in 557 (16.6%) of 3,352 campylobacteriosis patients 14 years old and older and 93 (8.7%) of 1,070 cryptosporidiosis cases. Among those Campylobacter and Cryptosporidium cases, 380 (68.2%) and 73 (78.5%) patients, respectively, were involved in animal production, and 91 (16.3%) and 5 (5.4%) patients, respectively, reported animal slaughtering and processing.

Among cattle production workers, feedlot exposure, fecal exposure, hauling cattle, and branding cattle were reported by 29.9%, 8.9%, 6.6%, and 3.0% of campylobacteriosis patients, respectively, and by 7.9%, 11.1%, 6.3%, and 6.3% of cryptosporidiosis patients, respectively.

Cattle were the most common animal type mentioned among workers for both diseases. Among workers with campylobacteriosis, poultry and swine were next.

The authors conclude, "It is important that workers with occupational animal exposure be educated about symptoms of diseases and preventive measures, which include using dedicated clothing at work and proper handwashing after touching animals."
Sep 15 MMWR report


FDA panel approves GSK shingles vaccine

The Vaccines and Related Biological Products Advisory Committee (VRBPAC) of the US Food and Drug Administration (FDA) said in an 11-0 vote that safety and efficacy data warrant FDA approval of GSK's Shingrix shingles vaccine for preventing herpes zoster (shingles) in adults 50 and over, GSK said in a Sep 13 news release.

VRBPAC provides non-binding recommendations for consideration by the FDA, but the agency often follows its recommendations.

VRBPAC members were "very impressed" by efficacy data from Shingrix clinical trials, and said the vaccine represents an improvement over Merck's Zostavax, the only FDA-approved shingles vaccine, Reuters reported.

Shingrix is considered one of the more important products in GSK's pipeline, with annual sales forecast to reach $1 billion by 2023, the story said. Zostavax, approved in 2006, is expected to generate sales of about $730 million this year.

GSK submitted a Biologics License Application to the FDA in October 2016, according to the release. Shingrix is not approved for use anywhere in the world, but regulatory filings are under way in the European Union, Canada, Australia, and Japan.
Sep 13 GSK news release
Sep 13 Reuter story


Italian measles outbreak fueled by low vaccine uptake, hospital spread

An ongoing measles outbreak in Italy that has topped 4,400 cases has been fueled by low vaccination rates and healthcare spread, according to a report yesterday in Eurosurveillance.

Investigators analyzed data on the 4,477 cases reported from Jan 1 through Aug 31 of this year, 3,417 of which have been lab confirmed. (The European Centre for Disease Prevention and Control [ECDC] today noted 4,487 cases, including 3 deaths, through Sep 13.) The highest number of cases—900—was reported in March.

Cases has been reported in 20 of the 21 Italian administrative regions, but 90% were reported by only 7 regions. The Lazio region, in central Italy, reported the most cases (1,588) and the highest incidence (269.7 cases per 1,000,000 population).

Vaccination status was known for 4,182 cases (93.4%), of whom 3,691 (88.3%) were unvaccinated, 271 (6.5%) had received only one dose of measles-containing vaccine, 69 (1.6%) were fully vaccinated, and 151 (3.6%) had received an unknown number of vaccine doses. A law passed in July is designed to address this deficit.

The probable transmission setting is known for 1,352 cases (30.2%). Among those patients, transmission occurred in families 64.1% of the time (867 cases), healthcare settings 22.3% of the time (301), schools 10.1% (137), and nomadic settlements 3.5% (47).

Of the outbreak total, 296 cases (6.6%) involved healthcare workers. Complications were reported by 35.1% of patients, 43.2% were hospitalized, and an additional 22.4% visited an emergency department.

The authors note, "The main reason for this outbreak is an accumulation of a large pool of measles-susceptible population due to sustained low uptake of measles vaccine in Italy over the years." Measles vaccine uptake peaked in Italy in 2003 at 90.6%, well below the 95% target rate, and has declines since, to 85.3% in 2015, they write.

The investigators conclude, "The size of the described outbreak highlights that there are wide measles immunity gaps in the Italian population, which together with nosocomial transmission are challenges to elimination."
Sep 14 Eurosurveill report
Sep 15 ECDC update

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