News Scan for Nov 15, 2018

More DRC Ebola cases
Promising new flu antiviral
Salmonella and restaurant grades

Three more Ebola cases, 1 death recorded in DRC

The Democratic Republic of the Congo's (DRC's) health ministry revised its tally of the ongoing Ebola outbreak today, noting three more cases and one additional fatality. Officials have now reported 344 cases and 202 deaths in an outbreak that begin in North Kivu and Ituri provinces in August.

The fatality number is lower than yesterday, because duplicates and listing errors were corrected, the DRC said. The revisions also added 2 more probable cases, bringing the total to 40. The three new cases are from Beni, Katwa and Kalunguta, a violence-prone "red zone," and the new confirmed death is from Katwa. The ministry said 45 suspected Ebola cases are still under investigation.

Ring vaccination campaigns with Merck's unlicensed Ebola vaccine are still under way. As of today, a total of 30,563 case contacts and contacts of contacts have been vaccinated, including 15,573 in Beni.
Nov 15 DRC update


Study: Novel antiviral pimodivir cuts viral load in patients with influenza A

A phase 2 trial of the novel antiviral drug pimodivir found reductions in viral load when given alone or with oseltamivir (Tamiflu) for patients with influenza A infections and was well tolerated. An international research team reported its findings yesterday in the Journal of Infectious Diseases.

Pimodivir, developed by Janssen Pharmaceuticals, is a polymerase inhibitor that blocks the PB2 subunit of influenza A viruses. Polymerase inhibitors signify a new antiviral class that also includes favipiravir and baloxavir. In 2017, pimodivir received US Food and Drug Administration fast-track designation.

In the double-blind phase 2b study, 223 adults with uncomplicated influenza A were randomized to receive one of four treatments twice a day for 5 days: placebo, pimodivir 300 milligrams (mg) or 600 mg, or 600 mg pimodivir with 75 mg oseltamivir.

Patients who received the pimodivir-oseltamivir combination had significantly lower viral loads than those who received 600 mg pimodivir alone. Though the finding was not statistically significant, the researchers saw a trend of greater clinical improvement in patients who received the 600 mg of pimodivir alone or with oseltamivir. Mild and transient diarrhea was the most common adverse effect.

The authors concluded that the promising virologic findings, with or without oseltamivir, support further development of the pimodivir given at the 600 mg dose.

In a commentary on the study in the same issue, two infectious disease experts wrote that the results of the trial are promising and show possible synergistic effects with oseltamivir, but future studies will need to confirm if this translates into a clinical benefit. The authors are Nelson Lee, MD, MBBS, professor in the division of infectious diseases at the University of Alberta, and Michael Ison, MD, with Northwestern University's Feinberg School of Medicine.

The experts added, however, that researchers should keep a close eye on the emergence of genetic variants when patients are treated with polymerase inhibitors. Lee and Ison concluded that the new antiviral class may prove to have important roles for treating severe flu, as well as infections caused by viruses resistant to neuraminidase inhibitors like oseltamivir.
Nov 14 J Infect Dis abstract
Nov 14 J Infect Dis commentary


Restaurant inspection grades tied to reduced Salmonella rates in New York

Posting health inspection letter grades at restaurants was associated with a lower incidence of Salmonella in New York City, according to a new study in Emerging Infectious Diseases.

Researchers compared Salmonella rates in New York City (NYC) and the rest of the state (ROS) after health department letter grading was put into place (from 2011 to 2016), to rates of the infectious foodborne pathogen from before the letter system was used (2006 to 2010), noting a 5.3% drop per year in the city following the implementation of the letter grading system.

"The period-to-period percent change after letter grading implementation was a decline of 32.6% in NYC, compared with a decline of 14.1% in the ROS," the authors said. In the period after letter grading was implemented, the mean rate of Salmonella infection was no longer significantly different (P = 0.37) in NYC (mean 12.6 cases/100,000 persons; 95% confidence interval [CI], 10.9–14.4) compared with the ROS (mean 12.0 cases/100,000 persons; 95% CI, 11.4–12.6), because the rate in NYC was higher than the ROS initially.

"NYC's experience provides a useful case study of the beneficial effect of letter grading programs," concluded the authors, Melanie J. Firestone and Craig Hedberg, PhD, of the University of Minnesota. "Although the relationship between restaurant inspections and risk for foodborne illness is not well understood and inspections represent a snapshot in time that may not represent the overall sanitary conditions in restaurants, factors related to food handling and preparation practices and food worker health and hygiene are frequent contributors to outbreaks in restaurants."
Nov 13 Emerg Infect Dis study

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