News Scan for Oct 30, 2017

Kenya Marburg tracing
Madagascar plague
Yellow fever in South America
Oral flu vaccine trial
Antibiotics in nursing homes

Ugandan man who died from Marburg virus visited healer in Kenya

Uganda's recently announced second lab-confirmed Marburg virus patient—part of a family cluster— visited two traditional healers for his symptoms, one of them across the border in western Kenya, the World Health Organization Regional Office for Africa (WHO AFRO) said today in its weekly outbreak and health emergencies bulletin.

The man's sister was the first lab-confirmed case-patient, and the man had driven her to a hospital on Sep 10. Afterward he became symptomatic but refused treatment and returned to the community. He and his sister both died from their Marburg virus infections. Their brother also died a few weeks earlier after having similar symptoms, but no lab samples had been taken for testing.

One of the traditional healers is in Uganda's Bukwo district, and the other is in western Kenya's Kitake district. The WHO said health authorities in Kenya have been notified about the case. The man was eventually admitted to a treatment center in Uganda's Kween district on Oct 24, where he died the next day.

The WHO said the Marburg outbreak is localized As of Oct 29, there 6 six cases: 2 confirmed, 1 probable, and 3 suspected. The total is 3 fewer than an Oct 26 statement from Uganda's health ministry.

The WHO, however, said there are concerns about the number of high-risk contacts potentially exposed in the community, especially given the man's consultations with traditional healers in two countries. Contact tracing is still under way, but responders are grappling with the remoteness of the locations, poor roads, and some reports of resistance by community members to field teams.
Oct 29 WHO AFRO weekly outbreak and health emergencies bulletin
Oct 27 CIDRAP News story "
Uganda confirms 2nd Marburg case, isolates 2 others"


WHO: Funds needed as Madagascar plague total tops 1,500

Madagascar's plague outbreak scenario continues to improve, with cases declining in the main hot spots, but the sustainability of the response operations is a worry, given that funding is running low and that the country's plague season extends to April, WHO AFRO said in its weekly outbreak in health emergencies update today.

As of Oct 27, the country has reported 1,554 suspected cases, 113 of them fatal, keeping the case-fatality rate at 7%. So far 985 (63%) of the illnesses involve the pneumonic form of the disease. The total is up from 1,309 suspected cases reported by the WHO on Oct 26.

Though progress has been made, only 26% of the response plan has received funding, the WHO said. The country needs temperature monitoring equipment, rapid diagnostic tests, personal protective equipment, infection prevention and control supplies, and antibiotics. The group called for health partners and donors to help provide funds, logistics, and personnel to help sustain operations needed to eventually contain the outbreak.
Oct 29 WHO AFRO weekly outbreak and health emergencies bulletin
Oct 27 CIDRAP News scan on earlier numbers


Three South American countries report recent yellow fever cases

Brazil, French Guiana, and Peru have reported new yellow fever cases since the previous report on Aug 2, the Pan American Health Organization (PAHO) said in an update late last week.

Since July, Brazil has had 37 suspected cases, including 1 confirmed, fatal case. Currently, 3 cases are under investigation, and 33 cases were discarded. All cases were reported in Sao Paolo state. Sao Paulo state is also reporting new cases in non-human primates.

In French Guiana, a 43-year-old woman with unknown vaccination status was confirmed to have yellow fever after dying on Aug 9 from fulminant hepatitis. This is the first yellow fever case in that region since 1998, PAHO said.

Finally, Peru has reported a total of 16 yellow fever cases so far this year, including 3 deaths. Most cases have occurred in Junin department.

In addition to those three nations, Colombia, Ecuador, Bolivia, and Suriname all have reported suspected or confirmed yellow fever cases in 2017.
Oct 27 PAHO update


Vaxart's oral flu vaccine tablet shows promise in human challenge trial

A phase 2 human-challenge trial of an oral tablet recombinant H1 flu vaccine showed similar protection as injectable quadrivalent flu vaccine, Vaxart, Inc., said in an Oct 26 press release. The oral vaccine also showed favorable safety and tolerability profiles.

The randomized, double-blind study had three groups: one that received a single dose of the oral vaccine and placebo intramuscular injection, one injected with quadrivalent vaccine and given a placebo tablet, and one that got placebo tablet and placebo injection. Participants were challenged intranasally with an influenza A strain 90 to 120 days after vaccination.

Vaxart's oral tablet vaccine showed a 39% reduction in clinical disease, compared with 27% for the quadrivalent vaccine. Also, the tablet vaccine's safety profile was similar to placebo.

Wouter Latour, MD, MBA, chief executive officer of Vaxart, based in South San Francisco, Calif., said the results provide clinical proof of concept and noted that less than half of the 320 million eligible Americans are immunized against flu each year. "A convenient and effective tablet vaccine could significantly increase current vaccination rates and generate important public health benefits for at-risk groups and the population as a whole."

The phase 2 study was done with support from the US Department of Health and Human Services Biomedical Advanced Research Development Authority (BARDA), which awarded a $13.9 million contract to Vaxart in September 2015 to support advanced development of more effective flu vaccines as a ways of improving preparedness for seasonal and pandemic flu.
Oct 26 Vaxart press release


Poor antimicrobial prescribing noted in Australian nursing homes

Nursing homes in Australia continue to be a substantial source of inappropriate antimicrobial prescribing, with about one third of antimicrobials prescribed for residents with no indications, according to the second annual Aged Care National Antimicrobial Prescribing Survey Report (acNAPS).

The 2016 acNAPS report, published Oct 26, is produced as a collaboration between Australia's National Centre for Antimicrobial Stewardship (NCAS), the Guidance group based at Melbourne Health, and the Victorian Healthcare-Associated Infection Surveillance System (VICNISS) Co-ordinating Centre. Data were collected from 251 aged care home from Jun 27 through Sep 9, 2016. In 2015, only 186 aged care facilities had participated in the survey.

This year's report found that 32.4% of antimicrobials were prescribed for residents who showed no signs or symptoms of infection in the previous week, up a bit from the previous report (31.6%). In addition, the new report found that 67.2% of prescriptions did not meet the criteria for infection, similar to the 66.4% rate found in the 2015 survey. And 23.0% of prescriptions were administered for longer than 6 months, which was down from 31.4% in the 2015 acNAPS report.

The 2016 acNAPS report also noted poor documentation, with no stop date recorded in 49.9% of prescriptions, no indication recorded for 22.1%, and no started date documented for 3.2% of the antimicrobials.

Respiratory tract (34.5% of the total), skin or other soft-tissue (29.3%), and urinary tract (14.8%) infections were the most common indications for prescribing antimicrobials. Cefalexin (21.7%) was the most commonly prescribed antimicrobial, followed by topical clotrimazole (13.3%).

The authors of the report concluded, "The 2016 acNAPS has confirmed the 2015 pilot acNAPS results, which identified the need for improvement in practice regarding infections and antimicrobial use in Australian aged care homes."
Oct 26 acNAPS report
Oct 26 NCAS
news release
2015 acNAPS report

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