News Scan for May 03, 2019

WHO H5N1 flu confirmation
Carbapenem reduction strategy
More polio in Afghanistan, Pakistan
Flu imprinting research
Mayaro virus in South America

WHO confirms details on Nepal's first H5N1 avian flu case

The World Health Organization (WHO) office in Nepal yesterday shared more details about the country's first human H5N1 avian flu infection, a fatal case first reported by local media outlets.

The 21-year-old man was admitted to a hospital on Mar 24 with a fever and cough, and health workers who suspected he was sick with influenza obtained a throat swab and started him on oseltamivir. He died from respiratory complications on Mar 29.

Nepal's National Public Health Laboratory confirmed influenza A and sent the sample to Japan's WHO Collaborating Center for Influenza, which confirmed H5N1 avian influenza as the subtype and sent the notification to Nepalese officials on Apr 30. The WHO said the country hasn't reported any further cases.

The country's health ministry, teams from the WHO, and livestock officials have launched a detailed investigation,. Nepal has reported sporadic H5N1 outbreaks in poultry since March. Actions are under way to step up surveillance, assess the risk of spread, and share risk communications on prevention steps.
May 2 WHO Nepal office statement
May 2 CIDRAP News scan "Reports from Nepal detail country's first H5N1 case"


Less empiric carbapenem use linked to VRE reduction in leukemia patients

A carbapenem-sparing empiric antibiotic regimen at a referral center for acute leukemia patients in Utah was associated with significant reduction in vancomycin-resistant enterococci (VRE) colonization, researchers reported today in Infection Control and Hospital Epidemiology.

In the single-center study, the researchers studied 342 consecutive leukemia patients treated from September 2011 through August 2017 at LDS hospital in Salt Lake City. The aim of the study was to determine whether a change in empiric therapy for leukemia patients with febrile neutropenia had any impact on the incidence of hospital-acquired VRE colonization. In September 2015, in response to a previous study that found use of a carbapenem for empiric therapy of febrile neutropenia was an independent risk factor for VRE colonization in leukemia patients, the hospital changed the empiric antibiotic from a carbapenem to a cycling regimen of cefepime and piperacillin/tazobactam.

Of the 342 patients, 214 were admitted during the carbapenem period and 128 during the cycling period. Weekly surveillance for VRE stool colonization showed that the change in empiric antibiotics was associated with a significant decrease in VRE colonization (hazard ratio, 0.35; 95% confidence interval, 0.27 to 0.66). In addition, an analysis of representative stool samples found there was a switch in the dominant VRE multilocus sequence types (from ST664 and ST967 prior to the change to ST186 and ST896 after) and some changes in the gastrointestinal microbiome. Patients during the carbapenem period also had longer hospital stays and durations of severe neutropenia and 10% higher hospital costs.

"In conclusion, less carbapenem use was associated with a reduction in VRE colonization, a decreased duration of neutropenia, and a decrease in hospital length of hospital stay, reduced costs, as well as possibly beneficial effects on potentially important gastrointestinal microbiota such as Blautia spp," the authors of the study write.
May 3 Infect Control Hosp Epidemiol abstract


Afghanistan and Pakistan report more polio cases

In its latest weekly update, the Global Polio Eradication Initiative (GPEI) today reported three more wild poliovirus type 1 (WPV1) cases, one from Afghanistan and two from Pakistan. The countries, in addition to Nigeria, are considered endemic for WPV1.

Afghanistan's case involves a patient from Nawzad district in Helmand province whose paralysis began on Apr 3, the country's seventh case of 2019.

The cases in Pakistan—which has experienced recent attacks on polio vaccinators and their security teams—involve patients from two different districts in Khyber Pakthunkhwa province, one with an Apr 2 paralysis onset and the other with an Apr 4 onset. The country has now reported eight WPV1 cases for the year.

Also, the GPEI said 11 WPV1-positive samples have been reported by Pakistan over the past week from four provinces: Balochistan, Punjab, Khyber Pakthunkhwa, and Sindh. The samples were collected between Mar 17 and Apr 15. So far, Pakistan has reported 102 positive environmental samples for 2019.
May 3 GPEI weekly report


NIAID awards $30 million to support flu imprinting study

Cincinnati Children's Hospital Medical Center said yesterday that it will use a $30 million grant from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, to fund a cohort study to explore how the immune systems of infants and children are affected by their first exposures to flu viruses.

In a statement, the hospital said the study will help answer questions about flu immunity, clarify protection gaps with current vaccines, and assist with efforts to develop a universal flu vaccine that can provide longer-lasting coverage.

The study will probe the idea that a person's very first flu exposure guides the magnitude, durability, and breadth of immune response to all future flu exposures.

Mary Allen Staat, MD, MPH, principal investigator, said flu vaccine developers need to do better with flu vaccine effectiveness, given that most other vaccines have effectiveness rates above 90%. "To achieve that goal, we need much more data from real people. That's what our study will seek to generate. Then, the vaccine makers will have the information they need to make a better, longer-lasting vaccine," she added.

Called the IMPRINT study, the research will involve 2,000 sets of mothers and infants from the Cincinnati area and Mexico City and weekly medical testing for at least 3 years. Researchers will ask each mother to respond to texts about symptoms and provide weekly nasal swab samples. Teams will also collect blood and other samples to track responses to the vaccine and circulating flu virus exposure. The team includes researchers with systems biology expertise and partners from Emory University.
May 2 Cincinnati Children's news release


PAHO confirms Mayaro virus cases in Peru, Ecuador

Earlier this week the Pan American Health Organization (PAHO) reported that both Peru and Ecuador have recorded cases of Mayaro virus (MAYV) in 2019. The arbovirus is spread by Haemagogus mosquitoes, and often appears in humans who have recently been exposed to humid forest environments.

MAYV causes febrile illness with severe joint edema, rash, headache, and dizziness. The disease is usually self-limiting, though there has been a fatal case of encephalitis caused by MAYV documented in a Haitian child.

Two cases have been confirmed in Peru this year, in Quispicanchis and La Mar provinces. In Ecuador, five cases have been detected across a wide swath of the eastern part of the country.

"Outbreaks described in the last decade in the Americas were reported among residents of rural  communities in the Amazon region of Brazil, Bolivia, Peru, and Venezuela. The majority of    human cases occurred among persons who work or reside in tropical rainforests," PAHO said.
May 1 PAHO report

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