Vaccine Scan for Feb 26, 2018

News brief

FDA working with CMS to look for new clues on flu vaccine protection

US Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, today weighed in on steps the FDA it taking to improve the effectiveness of seasonal flu vaccines, which includes collaborating with partners at the Centers for Medicare and Medicaid Services (CMS) to use a large database that includes information on flu vaccines given to 4 million people.

In a statement, he said an analysis of the data is still underway, but it may have some clues on effectiveness of cell-based and egg-based vaccines and may shed light on effectiveness of high-dose and adjuvanted version of the vaccines in seniors, as compared to standard flu vaccine. "What we learn about the differences in efficacy between these different vaccines might reveal information that can inform why overall effectiveness against H3N2 was lagging," Gottlieb said.

One theory is that people may require a higher amount of H3N2 antigen to prompt a better immune response, he said, adding that preliminary CMS data has suggested that cell-based flu vaccine might be somewhat more effective than egg-based vaccine. FDA scientists are combing through the data to see if there are any other reasons for the drop in vaccine effectiveness against H3N2 and are working with scientists inside and outside the government to understand the findings.

Earlier this month, US scientists released interim effectiveness estimates for this season's vaccine, which found that protection against H3N2 was 25%, less than hoped and similar to what some other countries have recently  found. The gap in protection has been especially problematic over the past few seasons, and scientists say the issue likely stems from a combination of factors, but especially an egg-adaptation that has been identified in the vaccine strain used to make egg-based vaccines.

The FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets on Mar 1 to discuss the World Health Organization's (WHO's) recently announced recommendations for the Northern Hemisphere's 2018-19 flu season.
Feb 26 FDA statement
FDA VRBPAC meeting information

 

WHO approves Shanchol cholera vaccine

Shantha Biotechnics, an India-based subsidiary of Sanofi, announced today that the WHO has approved its oral cholera vaccine Shanchol, the first of its kind that can be stored and distributed outside of the traditional cold chain, The Economic Times, an English-language paper based in India, reported today.

Shanchol is the second vaccine approved for mass campaigns to prevent and control cholera outbreaks. According to the report, the vaccine can be kept for a single period of up to 14 days at a temperature of up to 40°C just before administration, as long as it hasn't expired and the vaccine vial monitor hasn't reached the discard point.

The WHO prequalified Shanchol in 2011, and since then, 12 million doses have been sent to 25 countries, including the Democratic Republic of Congo, Haiti, Mozambique, and South Sudan.
Feb 26 Economic Times story

 

PAHO emphasizes yellow fever vaccine for travelers to affected areas

The Pan American Health Organization (PAHO) recently reiterated its recommendation that international travelers be vaccinated against yellow fever at least 10 days before visiting areas where the disease is circulating, according to a Feb 23 statement.

Between Jan 2016 and Jan 2018, seven countries or territories in the Americas have reported yellow fever cases: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Suriname. However, most of the illnesses have been reported from Brazil, with cases reported from areas where the disease hasn't been found in several decades, including Sao Paulo and Rio de Janeiro states. The WHO recommends vaccination for international travelers for 21 Brazilian states, and the group is closely monitoring for signs that new areas are at risk.

So far urban transmission via Aedes aegypti mosquitoes has not been documented, and human infections have been linked to two types of forest-dwelling mosquitoes that can spread the disease, Haemagogus and Sabethes. PAHO said travelers to affected countries should also take steps to avoid mosquito bites and seek immediate medical care if they become sick during or after their trips.
Feb 23 PAHO statement

News Scan for Feb 26, 2018

News brief

Six new MERS cases reported across Saudi Arabia

After only a handful of reports released earlier this month, Saudi Arabia's Ministry of Health (MOH) confirmed six new cases of MERS-CoV over the weekend.

On Feb 23, the MOH reported three new cases, including a fatal infection in a 75-year-old Saudi man from Riyadh. That man had direct contact with camels, a known risk factor for MERS-CoV (Middle East respiratory syndrome coronavirus). The other two patients are in stable condition, a 61-year-old Saudi man from Medina and a 45-year-old Saudi woman from Rafha. The Medina man's source of infection is listed as "primary," meaning it's unlikely he contracted the virus from another person. The MOH said the woman in Rafha had contact with a known case-patient.

The MOH announced two cases on Feb 24 that involve primary infections. A 45-year-old Saudi man from Riyadh is in stable condition, and a male expatriate, 36, living in Najran is in critical condition. On the same day, the MOH announced the death of a previously reported patient, a 15-year-old expatriate girl from Riyadh who had no preexisting disease.

Yesterday, the MOH said an 82-year-old Saudi man from Riyadh is in critical condition with MERS. The source of his infection is listed as "primary."

Saudi Arabia's MERS-CoV total cases since 2012 are 1,805, including 733 deaths. Nine people are still being treated for their infections.
Feb 23 MOH report
Feb 24 MOH report
Feb 25 MOH report

 

CDC seeks funds for new high-containment lab

The US Centers for Disease Control and Prevention (CDC) is asking Congress for $350 million to build a new high-containment lab complex on the CDC campus in Atlanta, according to a story from The Washington Post.

The lab will replace the current facility, built in 2005, and be used to contain and test some of the world's most lethal pathogens, including Ebola and avian influenza viruses. It would take about 4 years for the new lab to be constructed, and by that time, the CDC said its current facilities will be unsuitable for handling biological pathogens.

Thomas Friedman, former CDC director, told the Post, "Although the age of the labs has not contributed to any lapse in health security, CDC needs the upgrades to avoid future problems and to keep pace with improving technology and evolving threats."

The current lab is one of two places in the world that houses a live smallpox virus, and several samples of H7N9 avian flu. According to the Post, the current facility has four quadrants, with the main work centered in a biosafety level 4 lab the maximum safety level—surrounded by a suite of biosafety level 3 labs

The funding is part of the Trump administration's budget request submitted this month.
Feb 23 Washington Post story

 

Analysis finds TB screening of immigrants effective in Canada

Researchers analyzing data on more than a million Canadian immigrants report that demographic characteristics can help identify which groups are at high risk of tuberculosis (TB), according to a study today in the Canadian Medical Association Journal (CMAJ).

The investigators included all those migrating to the Canadian province of British Columbia from 1985 through 2012 in the study—a total of 1,080,908 people. They linked data from multiple administrative databases to the provincial TB registry.

They found that active TB was diagnosed in 2,804 immigrants, or 25.2 cases per 100,000 person-years. Having a live-in caregiver, being a refugee immigrant, older age, and coming from a high-TB nation were all classified as risk factors for having TB.

"Screening latent TB infection based on demographic factors at the time of immigration is a necessary first step toward eliminating TB in migrants to Canada," says James Johnston, MD, MPH, in a CMAJ news release.

The authors say their findings support Canadian guidance to target post-entry screening for and treatment of latent TB in adult refugees from high-incidence countries. They add, "Our study adds to the understanding of long-term TB incidence in migrant populations in Canada by showing that rates remain elevated up to two decades after migration."
Feb 26 CMAJ study
Feb 26 CMAJ news release

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