News Scan for Sep 29, 2017

Pandemic flu vaccine strains
Ebola vaccine support
More Cyclospora
Promising typhoid vaccine
Plague in Madagascar
Pakistan polio

WHO announces 3 candidate vaccine viruses for pandemic preparedness

The World Health Organization (WHO) advisory committee that reviewed the most recent influenza developments and recommended strains for the Southern Hemisphere's 2018 flu season also looked at the newest genetic findings with zoonotic influenza viruses and recommended three new candidate vaccine viruses (CVVs).

The action is part of ongoing work by the world's influenza labs to have updated CVVs on hand in case a vaccine needs to be made to curb a pandemic threat to humans.

The group proposed two new CVVs against variant H1 (H1v), given that tests suggests that current CVVs aren't a close match with two H1N2v viruses detected this year in the United States, both of which caused mild disease in kids who had direct contact with pigs. The WHO noted that one of the recent H1N2v viruses was related to a North American swine lineage, while the other had a seasonal humanlike hemagglutinin (HA) gene segment and is closely related to HA genes circulating in US swine.

Also, tests on recent H3N2v samples from the United States, which have a humanlike HA gene from 2010 seasonal H3 flu, weren't a close match against the nearest current CVV, with some of the tests hinting at even less protection in children. So vaccine advisors recommended a new CVV based on a 2017 H3N2v sample from Ohio.
Sep 28 WHO candidate pandemic vaccine virus recommendations


BARDA awards $45 million for prime-boost Ebola vaccine

Johnson & Johnson announced today that it will pursue further development of its investigational prime-boost Ebola vaccine with support from a new award from the Biomedical Advanced Research and Development Authority (BARDA), part of the office of the Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services.

In its press release, the company said the funding signals one of BARDA's first Project BioShield awards for candidate Ebola vaccines and drugs.

The 5-year $44.7 million agreement has options for additional funding to support development and possible licensure. The vaccine had received BARDA funding in 2015 and 2016 to optimize manufacturing, and the new agreement will strengthen support for the program. Johnson & Johnson has collaborated with the National Institutes of Health on the vaccine, and had also received support from the European Commission.

The novel regimen involves a priming dose of the adenovirus-vectored Ad26.ZEBOV vaccine developed by Johnson & Johnson and a booster dose of MVA-BN-Filo from Bavarian Nordic.

Eleven vaccine phase 1, 2, and 3 trials are under way in Europe, the United States, and Africa. In September 2016 the company filed for emergency use and assessment listing with the WHO, which is still reviewing the application.

Johan Van Hoof, MD, global head of infectious diseases at Janssen Vaccines & Prevention, said in the company press release, "Thankfully, the Ebola crisis in West Africa is over, but we and other vaccine manufacturers remain determined to ensure that Ebola vaccines are successfully developed and made available to the world."
Sep 29 Johnson & Johnson press release


More Cyclospora cases reported to the CDC

The US Centers for Disease Control and Prevention (CDC) today reported 23 more Cyclospora cases, raising the multistate total to 1,054, with many of the cases linked to infections in people who didn't travel and pointing to a suspected foodborne illness outbreak.

Of the new cases, 14 patients didn't have a history of recent travel outside the United States, raising the foodborne illness outbreak portion of the total to 592 from 36 states, with Texas the hardest hit. The latest illness onsets were on Sep 13.

So far no food vehicle has been identified, but the CDC noted in its update that previous outbreaks have involved imported fresh produce such as basil, cilantro, mesclun lettuce, raspberries, and snow peas.

Cyclospora infection is caused by the Cyclospora cayetanensis parasite. Symptoms can include watery diarrhea, appetite loss, cramping, bloating, and fatigue.
Sep 29 CDC update


New typhoid vaccine immunogenic, protective in human challenge trial

A new typhoid vaccine that is already being used in India and is so far the only vaccine of its kind that can be used in infants was safe, highly immunogenic, and moderately protective in a phase 2b human challenge study that took place in the United Kingdom.

A team based at the Oxford Biomedical Research Center reported their findings for the Vi-conjugate typhoid vaccine (Typbar-TCV) yesterday in an early online edition of The Lancet. The findings come just weeks before World Health Organization (WHO) vaccine advisors are slated to consider use of the vaccines, with possible financing by Gavi, the Vaccine Alliance.

Typhoid, caused by Salmonella enterica serovar Typhi, typically occurs in regions where water quality and sanitation are lacking, especially in South Asia and sub-Saharan Africa. Antibiotics are used to treat the condition, but resistance to the drugs is increasing. Children younger than 2 years are especially vulnerable, and although there is a vaccine, it's not licensed for worldwide use in that age-group.

The human challenge trial involved 112 adults who were randomly assigned to receive a single dose of the new vaccine, the current vaccine, or a control meningococcal vaccine. A month after vaccination, they were given an oral dose of the bacteria. Researchers monitored them for 2 weeks, and participants who had symptoms received antibiotic treatment. At the end of the 2 weeks all participants got antibiotics.

Of the control group, 77% were diagnosed as having typhoid, compared with 35% for the new vaccine, and 35% of the current vaccine. Efficacy of the new typhoid vaccine was estimated to be 54.6%, compared with 52.3% for the existing vaccine.

Researchers also found that the disease was less severe in the group that received the new vaccine compared with the other groups and that using different diagnostic criteria suggested an even bigger efficacy benefit for the new vaccine.

Even though the study population isn't representative of the vaccine's target populations, the findings suggest the vaccine could halve infection rates and be an important new tool for controlling typhoid, the authors wrote.

In a related commentary, Nicholas Feasey, MBBS, with the Liverpool School of Tropical Medicine and Myron Levine, MD, DTPH, with the University of Maryland, wrote that the public health community has eagerly awaited the results of the human challenge trial, and that in India, the new vaccine has been shown to elicit robust serum antibody responses in infants as young as 6 months.

Despite the findings in India, until now there has been no evidence of actual efficacy, they wrote. "Importantly, the authors provide the first data documenting that Typbar-TCV is protective."
Sep 28 Lancet abstract
Sep 28 Lancet commentary
Sep 28 Lancet press release


Madagascar reports 2nd plague outbreak of year

Madagascar has reported 105 plague cases in recent weeks—51 pneumonic, 53 bubonic, and 1 septicemic— and 12 deaths, the WHO confirmed today.

The first reported case of pneumonic plague involved a 31-year-old man from Tamatave, who developed malaria-like symptoms on Aug 23 while visiting Ankazobe District. Four days later he developed respiratory symptoms while sharing a long public taxi ride. He later died, and his body was prepared for funeral without safety steps. Thirty-one people who came in contact with him became ill, and four of them died.

As of yesterday, the outbreak involved at least 51 suspected, probable, and confirmed cases of pneumonic plague, which is caused by Yersinia pestis, including 12 deaths. In addition, 53 people have contracted bubonic plague throughout the country, which is typically less serious. And one case of septicemic plague has been reported but is not linked to the outbreak.

Madagascar's Ministry of Health has activated crisis units in the affected regions, and all patients have been provided access to treatment at no cost, the WHO said. Active case finding and contact tracing are ongoing, and all patients who have pneumonic plague are being isolated and treated, and all contacts are receiving preventive antibiotics.

In January the WHO reported 62 cases of pneumonic and bubonic plague in the country. Before that, the country had a small outbreak in 2015.
Sep 29 WHO statement
Jan 10
CIDRAP News scan on earlier outbreak


New polio case identified in Pakistan

Officials reported one new case of wild-type poliovirus reported in Pakistan this week, according to the weekly update from the Global Polio Eradication Initiative (GPEI). The case brings the total number of wild poliovirus cases in Pakistan this year to five.

The case occurred in the Lakki Marwat district of Khyber Pakhtoon province. The patient first experienced paralysis on Aug 21. No other details were available, including the patient's age and vaccination status.

Pakistan, along with Afghanistan and Nigeria, is one of three countries where wild poliovirus is still endemic. Last week, Syria and the Democratic Republic of the Congo reported new cases of vaccine-derived polio.
Sep 27 GPEI update

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