News Scan for Dec 10, 2018

Record acute flaccid myelitis cases
Salmonella in kosher chicken
Imported US measles
Flu and heart failure
Just-in-time vaccine production

CDC: 24 more AFM cases confirmed in ongoing outbreak, topping 2016

Despite last week's suggestion that the country's acute flaccid myelitis (AFM) outbreak was at its peak, new data from the US Centers for Disease Control and Prevention (CDC) show 24 more cases recorded last week, raising outbreak totals to 158. The outbreak now surpasses 2016's total of 149 confirmed cases, which was the previous high.

There is no known cause or treatment for the mysterious, polio-like illness that typically affects the gray matter surrounding the spinal cord and leads to muscle weakness. Cases of AFM seem to cluster every 2 years in the United States in the fall, and researchers are currently trying to understand what triggers the condition in children. 

Texas reported a handful of more cases in the past week, raising that state's total to 21, the most in the country. Colorado has 15 cases, Ohio has 12, and New Jersey has 10. In total, 46 states have reported at least 1 AFM case this year.

About 90% of patients with AFM report mild respiratory illness in the week prior to symptom onset.
Dec 10 CDC update


CDC notes more Salmonella cases tied to kosher chicken, calls probe over

Late last week, the CDC confirmed 8 more cases of Salmonella illnesses connected to tainted kosher chicken. Outbreak totals stand at 25 people in 6 states, including 11 patients who have been hospitalized and 1 death.

The CDC said its investigation of the outbreak is over as of Dec 7.

Patients reported symptom onset between Sep 25, 2017, and Aug 13, 2018. New York state reported the most cases, with 16, including the lone fatality. Pennsylvania reported 4 cases, Massachusetts had 2, and Maryland, Ohio, and Virginia each had 1.

Half of the patients were women, and, of 20 people interviewed, all reported eating chicken products in the week prior to illness. Of 12 people who reported brand information, 10 (83%) reported specifically eating Empire Kosher brand chicken, the CDC said.

"The outbreak strain was also identified in samples of raw chicken collected from two facilities, including one facility that processes Empire Kosher brand chicken," the CDC said. No food recalls were associated with this outbreak.

The CDC said whole-genome sequencing did not detect any antibiotic resistance in Salmonella bacteria isolated from 21 ill people and 6 chicken samples.
Dec 7 CDC update


Cases of imported measles in US have doubled in recent years

A new retrospective analysis of imported measles cases in the United States from 2001 to 2016 shows that almost two thirds of cases occurred in US residents who were infected with the virus while traveling abroad, and the rate of imported measles has more than doubled in recent years. The study appeared yesterday in The Journal of Infectious Diseases.

During the 16-year study period, 553 cases of measles were imported to the United States, an average of 28 per year, based on data collected by the CDC. Patients' ages ranged from 3 months to 75 years, with a median age of 18 years. Eighty-seven percent of the 553 case-patients were unvaccinated.

"U.S. residents (as opposed to foreign visitors) accounted for 62% of imported measles cases. Overall, 62% of all imported case-patients reported travel to countries in the Western Pacific and European Regions of the World Health Organization during their exposure periods," the authors said. India, China, and the Philippines, were the most common source countries.

The proportion of imported cases in US residents more than doubled during the study period, from 31% in 2001 to 67% in 2016.

The study authors said this finding highlights the importance of measles vaccination prior to international travel for all Americans 6 months of age and older. 
Dec 9 J Infect Dis study


Annual flu shots tied to lower risk of death in heart failure patients

Patients diagnosed as having heart failure had an 18% lower risk of death if they subsequently received the seasonal influenza vaccine, according to a study today in Circulation, a journal of the American Heart Association (AHA).

The national cohort study was based on data collected from 134,048 heart failure patients diagnosed in Denmark from 2003 to 2015. The vaccination coverage of the study cohort ranged from 16% to 54%. After adjusting for income, comorbidities, and other factors, the authors found that receiving one or more annual flu vaccinations was associated with an 18% reduced risk of all-cause and cardiovascular death, and receiving the vaccine every year was tied to a 19% reduction.

Vaccination early in the flu season (September and October) was associated with a slightly greater reduction in death. According to the authors, vaccination frequency of less than once per year but more than 0 was associated with a 13% reduced risk of all-cause death and an 8% reduced risk of cardiovascular death.

"Recent studies have indicated that the influenza vaccination coverage of patients with heart failure is inadequate," said lead study author Daniel Modin, MB, of the University of Copenhagen, in an AHA press release. "I hope that our study can assist in making physicians and cardiologists who care for patients with heart failure aware of how important influenza vaccination is for their patients. Influenza vaccination may be regarded as a standard treatment in heart failure similar to medications."
Dec 10 Circulation study

Dec 10 AHA press release


Partnership aims for rapid-response vaccines against emerging threats

The Coalition for Epidemic Preparedness Innovations (CEPI), a public-private partnership, and Imperial College London today announced an agreement worth up to $8.4 million to develop a cutting-edge vaccine platform that enables tailored, just-in-time vaccine production against multiple viral pathogens and could help with preparedness against emerging infectious diseases.

The technique uses self-amplifying RNA (saRNA) to help the body's own cell mechanics to produce an antigen (a substance that induces an immune response) rather than injecting an antigen into the body. Through the partnership, CEPI aims to develop vaccines against novel pathogens within 16 weeks from identification of the antigen to product release for clinical trials, according to a CEPI news release.

Under the agreement, Imperial will lead a consortium to develop "RapidVac," a broadly applicable saRNA vaccine platform. Imperial will use its RapidVac platform to produce vaccines against H1N1 influenza, rabies virus, and Marburg virus, with the aim of advancing these products to phase 1 clinical testing (in people). The partnership represents CEPI's first investment in rapid vaccine production technologies after announcing a call for proposals in September 2017.

Richard Hatchett, MD, CEO of CEPI, said, "Our partnership with Imperial represents a vital part of our plan to create vaccine platforms that can significantly reduce vaccine development times—from a matter of years to weeks. We cannot predict where or when Disease X [caused by the next novel pathogen] will strike, but by developing these kinds of innovative vaccine technologies we can be ready for it."

CEPI was founded last year to develop vaccines to stop future epidemics. It has reached $740 million of its $1 billion funding target and has invested $260 million of that to develop 5 vaccine candidates against Lassa virus, 4 against Middle East respiratory syndrome coronavirus (MERS-CoV), and 2 against Nipah virus.
Dec 10 CEPI news release


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