News Scan for Mar 28, 2019

New US severe-malaria preference
More Saudi MERS cases
European pandemic vaccine contract
CWD in moose in Sweden
Colorado tick fever in Oregon

CDC switches first-line treatment for severe malaria to IV artesunate

Today the US Centers for Disease Control and Prevention (CDC) switched its recommendation for first-line treatment for severe malaria to a drug not approved by the Food and Drug Administration (FDA) because the previously recommended drug will no longer be produced by the manufacturer.

Effective Apr 1, the newly recommended drug is artesunate, which the World Health Organization already recommends as first-line treatment for severe malaria. The old drug, quinidine gluconate, will no longer be made by Eli Lilly. Quinidine is the only intravenous (IV) malaria drug approved by the FDA for use in the United States.

"While at this time, artesunate is neither FDA approved nor commercially available in the United States, CDC has taken action to ensure IV artesunate is available through an expanded use investigational new drug (IND) protocol, an FDA regulatory mechanism," the CDC said in a news release. "This IND for IV artesunate allows an effective antimalarial to be available through CDC for treatment of severe malaria in the United States.

"Clinical studies have shown that IV artesunate is safe, well tolerated and can be administered to infants and children, and to pregnant women in their second and third trimesters and during lactation. In the first trimester of pregnancy, the benefits of IV artesunate treatment outweigh the risk of death and poor outcomes due to severe malaria."

Starting Apr 1, US clinicians must call the CDC's malaria hotline (770-488-7788) to obtain IV artesunate. Upon approval of the case by a CDC expert, the drug will be released for free to 1 of 10 quarantine stations the agency has stocked with artesunate across the country, where it will be available for pickup.

About 300 people each year in the United States develop severe malaria, the CDC says.
Mar 28 CDC news release
CDC artesunate website


Saudi Arabia confirms 2 more MERS infections, 1 in Hofuf

Saudi Arabia's Ministry of Health (MOH) today reported two more MERS-CoV cases in Hofuf and Riyadh, according to updates to its epidemiologic week 13 report.

A 53-year-old woman from Hofuf was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). Her case is listed as primary, meaning she likely did not contract the virus from another person, and she did not have contact with camels. This is the second primary case in Hofuf in as many days.

A 76-year-old man from Riyadh was also diagnosed as having MERS. The MOH said the man had contact with camels, a known MERS risk factor.

The cases lift Saudi Arabia's MERS-CoV total for the year to 111, which includes 57 linked to a large outbreak in Wadi ad-Dawasir that has mostly involved healthcare spread.
Mar 28 MOH report


European countries sign pandemic vaccine contract with Seqirus

The European Commission (EC) and 15 member states today signed framework contracts with Seqirus to produce and supply pandemic vaccine, according to a statement from the group.

Contracts are part of a European Union (EU) joint procurement agreement designed to improve the region's preparedness against disease threats, ensure equitable access, and ensure fairer prices for medical countermeasures. Similar negotiations are under way with another pharmaceutical company, with a second round to contracts, in an effort to maximize vaccine coverage based on the tailored needs of EU member states.

The countries are Belgium, Croatia, Cyprus, Estonia, France, Germany, Greece, Ireland, Luxembourg, Malta, the Netherlands, Portugal, Slovakia, Slovenia, and Spain. According to the EC, the countries signing the contracts make up about half of the EU population.

Vytenis Andriukaitis, the EC's commissioner for health and food safety, said in the statement, "Today's signature signals a new era in the access of EU citizens to pandemic influenza vaccines. Member States signing the contracts can rest assured that their citizens will have access to vaccines in case of an influenza pandemic at the best price available. This is one additional example where acting together we get stronger and achieve more."
Mar 28 EC statement


Sweden detects its first chronic wasting disease case

For the first time Sweden has detected chronic wasting disease (CWD)—in a moose, according to a post on ProMed mail, an infectious disease tracking site.

"The 16-year-old moose was euthanized after being observed emaciated, staggering, walking in circles, and apparently blind," said Ann Lindberg, DVM, of the National Veterinary Institute of Sweden in a post on ProMed, the reporting service of the International Society for Infectious Diseases.

CWD is one type of transmissible spongiform encephalopathy—fatal brain diseases characterized by misfolded prion protein  that affects cervids (deer, elk, moose, and caribou). North America and parts of Europe have documented cases of the disease. Sweden joins Norway and Finland as Nordic countries with documented CWD in moose.
Mar 27 ProMed mail


Colorado tick fever identified in four Oregon residents

State officials in Oregon identified four cases of Colorado tick fever (CTF) in 2018, more cases than in previous years, and no common tick exposure was found. The report was published today in the CDC's Morbidity and Mortality Weekly Report (MMWR).

Over the past decade, Oregon has averaged one case of CTF annually. The four cases occurred in three men in their 70s and one woman in her 50s who all reported spending at least 5 hours per day outside, and all reported a tick bite in the 2 weeks preceding illness.

"Symptom onset in all four patients was in May, and all had fever, leukopenia (white blood cell count <4.0 x 103/μL), and thrombocytopenia (platelet count <150 x 103/μL)," the authors said. "Three patients reported experiencing a biphasic illness, where their initial fever and symptoms diminished and then returned again a few days later. Three patients were hospitalized (range 1–3 days), and all recovered from their illness."

No common location was shared by the patients.

CTF is found in the western parts of the United States and Canada and is transmitted by infected Rocky Mountain wood ticks. Though rarely fatal, the virus can cause fever and non-specific symptoms, and up to 30% of patients require hospitalization. There is no treatment for CTF.
Mar 29 MMWR study

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