News Scan for Oct 10, 2017

Chikungunya in Europe
Ebola ring vaccination
Flu antivirals reduce ICU use

Local chikungunya cases rise in Italy, France

Italy's chikungunya outbreak has expanded to a second region, and the total number of suspected or confirmed cases has climbed to 298 as of Oct 4, a rise of 115 cases from World Health Organization's update at the end of September.

In an updated risk assessment yesterday from the European Centre for Disease Prevention and Control (ECDC), officials said a cluster of illnesses has been reported in the city of Guardavalle Marina, located in Calabria region, about 300 miles southeast of Lazio region, where earlier clusters were reported.

So far, 239 confirmed or probable local chikungunya cases have been reported in Lazio region, and 55 (including 6 confirmed illnesses) have been reported in Calabria region. Also, several probable and confirmed cases with links to three cities (Anzio, Rome, and Guardaville Marina) in two affected regions have been reported from other parts of Italy, as well as France and Germany, pushing the outbreak total to 298.

The virus circulating in Anzio is similar to 2016 chikungunya viruses from Pakistan and India; sequencing of the strain from Calabria region is under way.

Meanwhile, a local outbreak in France has sickened 17 people so far, part of activity involving two epidemiologically linked clusters, one in Cannet-des-Maures in the south and the other in nearby Taradeau. The chikungunya strain in France is related to a Central African sublineage.

The ECDC said local transmission in France and Italy in warmer months in areas where Aedes albopictus are established is not unexpected. The ECDC said the likelihood of further spread in Italy is moderate, and that more cases are expected. However, environmental conditions over the next several weeks will become less suitable for the mosquitoes that spread the virus.
Oct 9 ECDC risk assessment


Study: ring vaccination strategy successful in rural settings

Ring vaccination, a strategy that vaccinates a ring of close contacts in a disease outbreak, was successful in preventing wider spread of Ebola in Guinea after the country's final case was detected in March 2016. The research on the vaccination practice and the results were published yesterday in The Lancet Infectious Diseases.

In 2016, Guinea reported a flare up of the ongoing Ebola outbreak in two confirmed cases, and the unlicensed rVSV-ZEBOV vaccine was used for the first time in an outbreak setting to contain the spread of the virus. From Mar 17 to Apr 21, 2016, 1,510 people were vaccinated in four rings. The vaccine recipients included 303 children ages 6 to 17 years and 307 healthcare workers and first responders.

No secondary cases of Ebola were reported in those who received rVSV-ZEBOV. Participants were checked for adverse reactions 30 minutes after receiving the vaccine, and again each week basis for 3 weeks. No severe adverse events were reported.

"Our results show that a ring vaccination strategy can be rapidly and effectively implemented at scale in response to Ebola virus disease outbreaks in rural settings and across borders," the authors concluded.
Oct 9 Lancet Infect Dis study


IV flu antivirals reduce use of ICU, mechanical ventilation

New Canadian research presented at IDWeek 2017 last week showed that intravenous administration of influenza antivirals cut the risk of mechanical ventilation (MV) and reduced intensive care unit (ICU) admissions, according to an MPR story.

Each year, influenza causes approximately 12,200 hospitalizations and 3,500 deaths in Canada. Researchers used data from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN), to track the outcomes of hospitalized patients who tested positive for influenza from 2011 to 2014. A total of 4,861 patients were included in the study. Of those, 16% were admitted to the ICU, 11% required MV, and 9% died. 

According to the researchers, the odds ratio for ICU or MV among patients who received antiviral use was 0.10.

"Treatment with antivirals was associated with a significant reduction in admission to ICU and/or need for MV (odds ratio [OR] 1.10, 95% CI: 0.08–0.13; P < 0.001) but was not significantly associated with a reduction in death irrespective of the time between symptom onset and start of antivirals," said Zach Shaffelburg, BSc, from the Canadian Center for Vaccinology.
Oct 6 MPR report

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