News Scan for Dec 13, 2019

Polio numbers climb
New FDA head
Oseltamivir for flulike illness
Dengue in Afghanistan

GPEI notes 22 vaccine-derived polio cases, 3 WPV1 infections 

According to the latest weekly update from the Global Polio Eradication Initiative (GPEI) today, Pakistan tracked three new cases of wild poliovirus type 1 (WPV1) this past week, while several African and Pacific island nations reported a total of 22 vaccine-derived polio cases.

The Pakistani cases reported symptom onset between Nov 9 and 16, with one case in Sindh province and two in Khyber Pakhtunkhwa province. There are now 94 WPV1 cases recorded this year in Pakistan, compared with 12 in 2018. That is the highest WPV1 total in Pakistan since 2014, when officials confirmed 306. The country had 54 in 2015, 20 in 2016, and only 8 in 2017.

Angola, the Democratic Republic of the Congo (DRC), Ethiopia, and the Philippines all recorded cases multiple cases of vaccine-derived poliovirus type 2 (cVDPV2). The Philippines and Malaysia also recorded one case each of vaccine-derived poliovirus type 1.

Angola, with 12 new infections, has now tracked 73 cVDPV cases in 2019, while the DRC, with 3 new cases, has seen 61. The Philippines has 3 new cVDPV2 cases and Ethiopia has 2. Their cVDPV totals have reached 10 and 5, respectively.

2019 has outpaced 2018 in polio cases; last year saw only 104 vaccine-derived cases, while this year's total now stands at 227. In 2018, officials confirmed 33 WPV1 cases. As of Dec 11, there have been 116 in 2019.
Dec 11 GPEI


Oncologist Stephen Hahn confirmed as next FDA commissioner

The US Senate yesterday confirmed Stephen M. Hahn, MD, as Food and Drug Administration (FDA) Commissioner on a 72-18 vote, the Department of Health and Human Services (HHS) announced.

In a statement, HHS Secretary Alex Azar said, "Having a confirmed FDA Commissioner of Dr. Hahn's caliber will be a major boost to the already rapid pace of the President's aggressive public health agenda. Dr. Hahn brings an impressive set of scientific and leadership qualifications to the job, and I look forward to seeing the FDA and its people thrive under his leadership."

Hahn, 59, is a well-known oncologist and the chief medical executive of the University of Texas MD Anderson Cancer Center in Houston. He replaces acting Commissioner Adm. Brett Giroir, MD. Scott Gottlieb, MD, was the previous FDA commissioner until he stepped down in April. Ned Sharpless, MD, also an oncologist, served as acting commissioner from then till Nov 1.

Mary Woolley, Research America president and CEO, said in a statement, "Dr. Hahn is a highly respected radiation oncologist and highly qualified health care leader, as most recently demonstrated by his leadership role at the esteemed MD Anderson Cancer Center."

CNN reports that several physicians and research organizations have come out in support of Hahn's nomination, and five previous FDA commissioners supported Hahn in a letter to senators.
Dec 12 Azar statement
Dec 12 Research America
Dec 12 CNN


Study finds 1-day benefit of oseltamivir for influenza-like illness

A study yesterday in The Lancet involving more than 3,000 patients with influenza-like illness (ILI) in 15 European countries found that those treated with oseltamivir (Tamiflu) recovered a day sooner on average than those managed by usual care alone, and older patients with more severe ILI demonstrated an even greater benefit.

The open-label trial involved 3,019 patients seeking care in primary care clinics, 52% of whom had lab-confirmed influenza. Of those, 1,533 received usual care plus oseltamivir, a commonly prescribed neuraminidase inhibitor antiviral drug, and 1,526 received usual care alone.

The researchers determined that time to recovery was shorter in the oseltamivir group (hazard ratio, 1.29; 95% Bayesian credible interval [BCrI], 1.20 to 1.39). They estimated an absolute mean benefit of 1.02 days (95% BCRI, 0.74 to 1.31). The benefit ranged from 0.70 days in patients younger than 12 years with milder ILI and shorter illness duration to 3.20 days in patients 65 years and older who had more severe and longer illnesses and comorbidities.

In a related commentary in the same journal, two University of Alberta experts who were not involved in the study wrote, "In an open-label trial, a placebo effect cannot be excluded; nevertheless, the differential benefits in patients with mild and severe symptoms are unlikely explainable by this alone."

They add, "As such, the results must be interpreted in the context of assessing the effect of adding neuraminidase inhibitor treatment to symptomatic treatment…. These findings should not be interpreted as efficacy of neuraminidase inhibitors for noninfluenza viruses, such as respiratory syncytial virus and parainfluenza, that cause influenza-like illness."
Dec 12 Lancet study
Dec 12 Lancet


First cases of locally transmitted dengue reported in Afghanistan 

Increasing case counts of dengue in Pakistan and India led health authorities in Afghanistan to re-test laboratory samples of patients who tested negative for Crimean-Congo hemorrhagic fever, and 14 of 40 samples tested positive for dengue, according to an update yesterday from the World Health Organization (WHO).

 "Of the 14 confirmed cases of dengue fever, seven were presumably autochthonous as the persons had no travel history to dengue endemic countries," the WHO said. One of the seven patients with autochthonous—locally acquired—dengue died due to hemorrhagic fever. Among the other cases, four people had traveled to Pakistan and two to India. 

These are the first reports of locally acquired dengue in Afghanistan; all previous dengue cases in country had been linked to travel to dengue-endemic countries. In 2018, surveillance showed that Afghanistan played to host to several Aedes mosquito strains, which are capable of transmitting dengue. 

"The current cases of autochthonous dengue fever virus in the six affected provinces pose a risk to other areas in Afghanistan where the virus has not previously been recorded. Intense population movements during the rainy season pose an increased risk of spreading or intensifying the current dengue fever outbreaks," the WHO said.
Dec 13 WHO

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