Flu Scan for Aug 06, 2019

News brief

High-path H5 avian flu outbreaks strike chickens in Vietnam and Taiwan

Animal health officials in Vietnam reported two outbreaks of highly pathogenic H5N6 avian flu at poultry farms in Ba Ria-Vung Tau province in the country's southeast, VN Express International, a newspaper based in Hanoi, reported today.

The report, which cites provincial officials, said the first outbreak was detected at a farm in Moc district following sudden deaths in a flock of 9,000 chickens. Poultry at another farm in the same area, which housed 1,500 birds, also tested positive for the virus.

About 10,500 birds were culled, the veterinary official said, adding that the birds may not have been fully vaccinated. Response activities include poultry vaccination in the region and tightening up the purchase, sale, and transport of birds in the affected areas.

H5N6 is an avian flu strain known to infect people, but so far no human infections have been reported in connection to Vietnam's two latest outbreak.
Aug 6 VN Express story

Meanwhile, Taiwan today reported four recent poultry outbreaks that involved highly pathogenic H5N2, part of activity that first began in 2015, according to a notification from the World Organization for Animal Health (OIE).

The events all involved farms housing native chickens or layer hens, three in Yunlin County and one in Changhua County. The outbreaks began from Jul 18 to Jul 22, killing 5,475 of 50,964 susceptible birds. Authorities culled 45,489 poultry as part of the outbreak response.
Aug 6 OIE report on H5N2 in Taiwan

Signs of flu peak or decrease in some Southern Hemisphere countries

In the Southern Hemisphere's temperate countries, flu activity appears to have peaked or decreased, though levels are still high in Australia, the World Health Organization (WHO) said yesterday in its latest global flu update, which includes data through Jul 21.

In Australia, flu patterns show geographic variability, with H3N2 viruses most common, followed by influenza B. Meanwhile, the level of flulike illness in New Zealand fell to just below the seasonal threshold.

In tropical parts of Central America, the Caribbean, and South America, flu activity is low overall, though Cuba reported rising flu detections, with all subtypes cocirculating. In tropical regions of Africa, increasing H3N2 detections were reported in Ivory Coast, Guinea, and Nigeria.

Meanwhile, in tropical Asia increased flu activity was reported in Thailand, where H3N2 and influenza B are cocirculating. Flu levels remained high in Myanmar, where the 2009 H1N1 virus is the predominant strain.

At the global level, 63.6% of viruses that tested positive for flu were influenza A and 36.4% were influenza B. Of subtyped influenza A viruses, 57.1% were H3N2 and 42.9% were 2009 H1N1.
Aug 5 WHO global flu update

News Scan for Aug 06, 2019

News brief

DRC Ebola outbreak grows by 11; GSK stops Ebola vaccine work

The Democratic Republic of the Congo (DRC) ministry of health will likely record 11 more cases of Ebola today, raising the outbreak total to 2,774, including 1,849 deaths. The death toll has grown by 6 since yesterday.

All outbreak numbers come from the World Health Organization's (WHO's) online Ebola dashboard. DRC officials have not released any reports on the outbreak since Aug 2.

In other Ebola news, British pharmaceutical giant GlaxoSmithKline (GSK) is stopping work on two Ebola vaccine candidates and a Marburg vaccine candidate and giving exclusive technology license to the Sabin Vaccine Institute in Washington, D.C, GSK said in a news release today.

"These agreements with the Sabin Vaccine Institute are an important next step in the fight against Ebola and Marburg viruses," said Thomas Breuer, MD, GSK's chief medical officer. "Enabling Sabin to build on the scientific progress GSK has delivered up to Phase II [trials] increases the likelihood these candidate vaccines may help prevent potential future outbreaks, and exemplifies GSK's approach to global health vaccines which supports partners in taking forward our innovations in a sustainable way."

One of the Ebola candidates, ChAd3 Ebola Zaire, has been through mid-stage phase 2 trials in Africa. All three vaccines, collectively known as the ChAd3 vaccines, have been shown to be safe in human trials.

"Sabin plans to continue the development and seek regulatory approval of Ebola and Marburg vaccines with our shared goal of making them available to the millions of people potentially at risk," said Sabin CEO Amy Finan.
WHO online Ebola dashboard
Aug 6 GSK press release

Study finds antibiotics used for noninfectious indications in kids

A point-prevalence study of US children's hospitals found that 1.7% of hospitalized pediatric patients received at least one antibiotic for a noninfectious indication, a team of US researchers reported in the Journal of the Pediatric Infectious Diseases Society.

In the cross-sectional study of 32 academic tertiary-care pediatric inpatient facilities, conducted from June 2016 through December 2017, researchers reviewed a total of 35,378 patient records and identified 13,215 patients (37.3%) who received at least one antimicrobial agent. Among those who received an antibiotic were 627 patients (1.7% of all admitted patients) who had a noninfectious indication. Antibiotic use for a noninfectious indication among patients who received an antibiotic ranged from 0% to 10.1% across the hospitals.

Of the twenty-nine unique antibiotics used for a noninfectious indication, the most commonly prescribed antibiotics were erythromycin (63.1%), azithromycin (19.9%), amoxicillin-clavulanate (5.5%), and metronidazole (5.2%). The most common reason for antibiotic use was gastrointestinal prokinesis (67.4%), followed by use for anti-inflammatory properties (17.5%) and small-bowel bacterial overgrowth (5.5%).

The authors of the study say the lack of national consensus guidelines for aiding decisions about when to use antibiotics for noninfectious indications makes it difficult to assess whether these prescriptions were appropriate. They also note that data are limited on whether these agents are effective for treating the noninfectious indications documented in the study, or on how their use in children affects the intestinal microbiome.

They conclude, "Multidisciplinary efforts should be taken to carefully analyze the effectiveness of these agents for their intended purpose while considering the effect on the pediatric microbiome, the harms of antimicrobials, and the potential societal effects of antimicrobial resistance within the community. Antimicrobial stewards should partner with those in other disciplines to understand and improve research into these longer-term harms."
Jul 31 J Pediatric Infect Dis Soc study

DRC measles outbreak grows as Central African Republic reports cases

According to the WHO's African regional office, both the DRC and Central African Republic (CAR) report ongoing measles outbreaks, with the DRC's growing rapidly.

Since the last report in June, 54 more health zones in the DRC have recorded transmission rates reaching the epidemic phase. From Jan 1 through Jul 21, the DRC has seen a total of 137,154 suspected measles cases, including 2,581 deaths (case-fatality rate, 1.9%). Cases have been increasing since Jul 7.

"Children less than five years old are the most affected, accounting for 77% of all reported cases and 90% of measles-associated deaths. Most (63%) of the cases had not been previously vaccinated or had unknown vaccination status," the WHO said.

Both Ituri and North Kivu provinces, the site of the DRC's ongoing Ebola crisis, are affected in the outbreak. North Kivu province is averaging 123 measles cases per week in the past 5 weeks, while Ituri is averaging 196 cases per week.

DRC has low vaccination coverage, with only 57% of the population covered by one dose of the measles, mumps, and rubella (MMR) vaccine in 2018.

In the CAR, the WHO reported another 12 cases of measles, bringing the outbreak total to 278 suspected cases, including 2 deaths, since earlier this summer. This is the eighth measles outbreak in the country since 2016. Vaccination coverage with one dose of MMR vaccine is even lower in the CAR than in the DRC, hovering around 48%.
Aug 4 WHO African regional bulletin

Philippines declares dengue epidemic

The Philippines has declared a dengue epidemic, as the country has recorded more than 146,000 cases and 622 deaths so far this year.

The case counts in 2019 represent a 98% increase from case counts in 2018, according to The South China Morning Post.

The declaration of an epidemic allows the government to use emergency funds to control the virus, which is spread by mosquitoes and is endemic in the Philippines.

The Philippines has struggled with dengue in the past, and was one of the first countries to launch a national vaccination campaign with Dengvaxia, Sanofi Pasteur's dengue vaccine. But that campaign ended in 2017 when scientists connected vaccine use to several pediatric deaths from severe dengue in those who had not previously been exposed to the disease.

According to the story, several other countries in South and Southeast Asia are also seeing high dengue levels this summer, including Malaysia, Vietnam, and Bangladesh.
Aug 6 South China Morning Post story

Kineta receives more Wellcome Trust support for Lassa drug trials

Kineta, a Seattle-based biotechnology company, today reported that it has received $1.8 million more from the Wellcome Trust for further testing of its once-daily antiviral drug LHF-535 for treating Lassa fever.

In a statement, the company said the award was based on promising phase 1a clinical trial results in healthy volunteers and that the new support will fund the phase 1b multiple ascending dose clinical trial and position LHF-535 for a phase 2 study in Lassa fever patients where no approved treatment is available.

Wellcome Trust awarded Kineta up to $7.2 million in 2016 to support the development of the Lassa fever treatment. In the phase 1a study, 48 volunteers across six cohorts received either a single oral dose of placebo or LHF-535 across six dose levels, ranging from .03 to 40 milligrams per kilogram of body weight. Researchers found that the drug was safe and well tolerated, with the frequency of adverse events similar to placebo.

The phase 1b trails is slated to begin in the third quarter of 2019. Earlier this year, Kineta announced that it had received up to $5.8 million from the National Institute of Allergy and Infectious Diseases to explore possible arenavirus indications for LHF-535.
Aug 6 Kineta press release