News Scan for Dec 22, 2017

Dengvaxia review planned
Saudi Arabia MERS
Drug-resistant priority pathogens
Polio in Afghanistan, Pakistan
Monkeypox effect on men

WHO advisors to conduct full review of Dengvaxia data

Today the World Health Organization (WHO) updated its Q and A document that covers developments surrounding Dengvaxia, Sanofi's dengue vaccine. It says its Strategic Advisory Groups of Experts (SAGE) will undertake a full rigorous view of new data to update its position paper on the vaccine, which won't likely be available until after April 2018.

Earlier this year the WHO made an interim recommendation that the vaccine be only used in people with a documented past dengue infection, based on the assessment of its Global Advisory Committee on vaccine safety, which met on Dec 6 and 7. WHO's interim recommendation is based on Sanofi's results from a yet unpublished test that retroactively determined seroprevalence status among vaccine recipients in phase 3 clinical trials.

After employing a new test developed by the University of Pittsburgh to infer pre-vaccination serostatus, Sanofi found that those who were seronegative at the time of vaccination were more likely to develop severe dengue infections. And earlier this month the company changed its labeling to limit use of Dengvaxia to people who have had previous exposure to dengue virus.
Dec 22 WHO updated Q and A on Dengvaxia


Another case of MERS reported in Taif, Saudi Arabia

Today the Saudi Arabian Ministry of Health (MOH) recorded a new case of MERS-CoV in Taif, the second reported in that city in as many days.

A 60-year-old Saudi man is in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus) infection. The man's source of infection is listed as "primary," meaning it's unlikely he contracted the virus from another person.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,757, including 712 deaths. Two patients are still being treated—likely the two in Taif—according to the MOH.
Dec 22 MOH report


WHO panel offers list of drug-resistant priority pathogens

A World Health Organization (WHO) working group has created a list of priority pathogens for developing new antibiotics, with multidrug-resistant tuberculosis (MDR-TB) and resistant gram-negative bacteria at the top, as well as certain species of Salmonella and Campylobacter, Neisseria gonorrheae (which causes gonorrhea), and Helicobacter pylori.

Detailing its findings in The Lancet Infectious Diseases yesterday, the WHO Pathogens Priority List Working Group used a multicriteria decision analysis method to select 20 antimicrobial-resistant bacteria. The experts then applied 10 criteria to assess priority: mortality, healthcare burden, community burden, prevalence of resistance, 10-year resistance trends, transmissibility, preventability in the community, preventability in healthcare settings, treatability, and drug pipeline. They categorized the bacteria into critical-, high-, and medium-priority groups.

The experts listed as a top priority in their own category MDR-TB and extensively drug-resistant TB. Critical-priority bacteria were carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae.

Vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus (MRSA) were the highest-ranked gram-positive bacteria. Among bacteria typically responsible for community-acquired infections, the group also included in the high-priority list clarithromycin-resistant H pylori and fluoroquinolone-resistant Campylobacter, N gonorrheae, and Salmonella.

In a commentary in the same issue, Glenn Tillotson, senior vice president of medical affairs with Cempra Pharmaceuticals in Chapel Hill, N.C., said, "The statistical approach used by Tacconelli and colleagues to establish the list of antibiotic-resistant bacteria was of the highest standard, with multiple experts enlisted to provide input into a complex process. A factor that stood out was the use of six WHO regions to support the overall process."

He notes that this is the fourth such list produced in the past 5 years, with previous efforts from the US Centers for Disease Control and Prevention, the Longitude Prize team, and the government of Canada.
Dec 21 Lancet Infect Dis report
Dec 21 Lancet Infect Dis


New polio cases reported in Afghanistan, Pakistan

Afghanistan and Pakistan have each reported a case of wild poliovirus 1 (WPV1) infection, bringing to 19 the number of such cases in the world this year, the Global Polio Eradication Initiative (GPEI) said today in its most recent update.

The case in Afghanistan is in Kandahar province. Officials also reported a WPV1-positive environmental sample in that province.

The case in Pakistan involves a person from Balochistan province. Health officials in Balochistan also filed a preliminary report on a separate case that will be officially noted in next week's GPEI report. As well, scientists have detected WPV1 in an environmental sample in Sindh province.

In addition to the 19 WPV1 cases reported in 2017, the Democratic Republic of Congo has reported 10 cases of circulating vaccine-derived poliovirus (cVDPV), and Syria has reported 74, for a total of 94 cVDPV cases. At this time last year, GPEI reported 35 WPV1 cases and 3 cVDPV cases and would go on to report 37 WPV1 and 3 cVDPV cases for the year.
Dec 22 GPEI update


WHO says monkeypox outbreak in Nigeria has hit men, young adults hard

The vast majority of monkeypox patients in Nigeria are men, and young adults have been hit hard, but no epidemiologic links between outbreak clusters have yet been discovered, according to the WHO's latest report on the outbreak.

Between Sep 4 and Dec 9, Nigeria has reported 172 suspected and 61 confirmed cases of the rare orthopoxvirus, making the current outbreak Africa's largest and the first in Nigeria since 1978. There has been one recorded death in an immunocompromised patient.

Seventy-five percent of cases have occurred in men, and most patients are ages 21 to 40, but so far there is not a clear connection between clusters described throughout 23 states in Nigeria, the agency noted. The median patient age is 30.

"Clustering of cases has occurred within states, however there is no known evidence of epidemiological linkages across states," the WHO said. "Further, genetic sequencing results of the virus isolated within and across states suggest multiple sources of introduction of the virus into the human population."

The WHO said there is no need to restrict travel or trade with Nigeria, adding that the overall risk of monkeypox transmission is low.
Dec 21 WHO report

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