Flu Scan for Sep 17, 2014

News brief

HHS awards contract to develop portable, low-cost ventilator

A new federal contract awarded to a Pennsylvania company calls for the development of a "portable, low-cost, user-friendly" ventilator designed for use in public health emergencies, the US Department of Health and Human Services (HHS) announced today.

The agency said the "next-generation" ventilator will be developed under a 3-year, $13.8 million contract with Philips Respironics of Murrysville, Pa., with oversight from the Biomedical Advanced Research and Development Authority (BARDA).

The HHS announcement said that in a severe influenza pandemic and possibly other public health emergencies, the number of patients in need of mechanical ventilation could exceed the number of ventilators available and staff trained to operate them.

With the help of advanced technology, the ventilator will be smaller and less costly than existing models and will be designed so that health professionals can operate it without special training, HHS said. It also will be designed to be manufactured quickly in case the need for ventilators exceeds the number stockpiled.

Under the contract, the ventilator will be required to meet the needs of everyone from infants to the elderly, HHS said.

The contract includes an option to purchase 10,000 initial production ventilators for $32.8 million, or $3,280 apiece, HHS reported. It said existing ventilators with all the required features cost from $6,000 to $30,000 each.

"An affordable portable ventilator will help us meet the needs of critically ill patients during a public health emergency, whether due to a naturally occurring pandemic or an act of bioterrorism," BARDA Director Robin Robinson, PhD, said in the HHS release.
Sep 17 HHS press release

Study: H7N3 in Mexico came from reassortment involving 2 flyways

The highly pathogenic avian influenza virus (AIV) H7N3 strain responsible for major outbreaks on poultry farms in Jalisco, Mexico, during the summer of 2012 and elsewhere since then resulted from complex reassortment of low-pathogenic AIV brought there by birds migrating along two North American flyways, say results of a study published yesterday in PLoS One.

The authors, from Ireland and Scotland, conducted phylogenetic analysis of each segment of both the H7N3 outbreak sequences and a background dataset comprising all available North American H7 lineages.

They found that 5 of 8 segments on the H7N3 virus were introduced by birds migrating along the central North American flyway and the other 3 segments came from birds migrating along the western North American flyway.

They further found that the Mexico H7N3 virus was not related to any previous North American H7N3 outbreaks nor to other avian flu outbreaks in domestic birds in recent years. Rather, they say, it is a novel reassortant and Mexico may be a potential hotspot for AIV reassortment events.

"Our results are useful for identifying the threat of AIV in wild birds and indicate comprehensive surveillance in South and Central America is highly desirable," they conclude.
Sep 16 PLoS One abstract

News Scan for Sep 17, 2014

News brief

Saudi Arabia confirms another MERS-CoV case

Today Saudi Arabia's Ministry of Health (MOH) confirmed another MERS-CoV case, the sixth in just over a week and the second in as many days.

The case involves a 27-year-old Saudi man who is hospitalized in a ward in Taif in Mecca province, the MOH said. He is not a healthcare worker and had pre-existing disease and no contact with animals, the agency said. He is symptomatic. No other details were provided.

The MOH has confirmed six cases of MERS-CoV (Middle East respiratory syndrome coronavirus) since Sep 8. The other five patients were hospitalized in intensive care.

The new case brings Saudi Arabia's MERS total to 732 cases, including 302 fatalities.
Sep 17 MOH update

Study estimates 23,000 listeriosis cases globally, 5,500 deaths

Listeriosis resulted in more than 23,000 illnesses, nearly 5,500 deaths, and almost 173,000 disability-adjusted life-years (DALYs) worldwide in 2010, according to the first estimates of the disease's global burden, published yesterday in Lancet Infectious Diseases with funding from the World Health Organization (WHO).

The authors, from Belgium and the Netherlands, reviewed nearly 12,000 studies on Listeria monocytogenes infections published from Jan 1, 1990, to May 21, 2012; they included 87 in their meta-analysis. They also reviewed national surveillance data when available for WHO member-states without incidence data.

On the basis of their analysis and the world population at the time, they estimated that listeriosis caused 23,150 illnesses (credible interval [CrI], 6,061 to 91,247), 5,463 deaths (CrI, 1,401 to 21,497), and 172,823 DALYs (CrI, 44,079 to 676,465) globally in 2010. The highest incidence rate was in the subregion covering the Caribbean, Central America, and some of South America.

Perinatal cases accounted for 20.7% of the cases (95% CrI, 17.4% to 23.9%). For these cases the overall case-fatality rate (stillbirths and neonatal deaths) was 14.9%. For nonperinatal infections it was 25.9%.

Although listeriosis causes fewer infections and deaths than do several other foodborne pathogens, the fact that it is entirely foodborne, can grow in food with low moisture and high salt content, and can grow at refrigeration temperatures poses significant problems for control.

The authors acknowledge that their estimations are based on data from just over half of the world's population in that they were unable to identify incidence data for much of Africa and the Middle East as well as some Asian countries, and so had to rely on other data sources and assumptions for these gaps.

They encourage further study but state that this first attempt at quantifying the global burden of listeriosis "will enable listeriosis to be included in international prioritisation exercises."
Sep 16 Lancet Infect Dis abstract
Related editorial

Pakistan reports 13 more polio cases, raising year's total to 158

Pakistan's National Institute of Health in Islamabad today reported 13 new polio cases, raising the country's 2014 count to 158, according to media reports.

A health official said seven of the new cases were reported in the tribal regions and three in Khyber-Pakhtunkhwa province, according to a report in Punch, a Nigerian news service. Three other provinces had one case each.

The count of 158 cases this year is well ahead of the 2013 total of 93 and the 58 cases in 2012, the story said.

This year's cases include 113 reported in the tribal regions, 27 in Khyber-Pakhtunkhwa province, 12 in Sindh, 2 in Punjab, and 3 in Balochistan, according to the story.

A report in The News International, a Pakistani news service, said that all 13 of the latest case-patients are children less than 3 years old.

Pakistan is one of three nations in which polio remains endemic, along with Afghanistan and Nigeria. Vaccination efforts in some parts of the country have been crippled by assassinations and bans imposed by militants who regard the vaccination campaigns as a cover for Western spying or sabotage.
Sep 17 Punch story
Sep 17 News International story

Syrian rebels say tainted measles vaccine killed 34 children

Authorities in a rebel-held area of Syria say at least 34 children died after receiving contaminated measles vaccine doses, and they allege that the contamination might have been caused by saboteurs tied to the Syrian government, according to a report yesterday in The Guardian, a British newspaper.

Today the United Nations Children's Fund (UNICEF) and the WHO announced they would help investigate the deaths of "at least 15 young children" in areas of Syria where measles vaccinations were under way.

The Guardian said the vaccination drive has been suspended and blood samples have been sent to Turkey for analysis. It also said many children in Idlib province, in northwestern Syria, were still in intensive care on Sep 15.

"For as long as the facts remain unclear, the suspension of the immunization campaign in both Idlib and Deir Ezzour provinces is a wise step," the UN and WHO said in a joint statement.

Parents accused the rebel health authorities of supplying out-of-date vaccine and failing to store the vaccine properly, the newspaper said. But rebel officials denied this, saying the vaccines came from the UN and the WHO via the Turkish government, and that the same batch recently was used successfully to vaccinate 60,000 schoolchildren in 30 locations.

The rebel health ministry blamed the contamination on sabotage. "Primary investigations point to a limited security breach by vandals likely connected to the regime, which has been attempting to target the medical sector in Free Syria in order to spread chaos," the ministry said in a statement, according to The Guardian.

Idlib province is held by moderate rebel groups opposed to both Syria's dictator, Bashar al-Assad, and the extremist Islamic State in Iraq and Syria (ISIS), the story noted.
Sep 16 Guardian story
Sep 17 UNICEF-WHO statement