News Scan for Oct 09, 2017

News brief

More Nigerian states reporting monkeypox cases as total reaches 31

The Nigerian Centre for Disease Control (NCDC) today reported that six more states have suspected cases of monkeypox, a disease caused by a rare smallpox-like virus. There are now 31 suspected cases in seven states: Bayelsa, Rivers, Ekiti, Akwa Ibom, Lagos, Ogun, and Cross River.

All patients are currently hospitalized and improving, according to an NCDC statemen. The agency said it was first notified of a possible outbreak on Sep 22, when an 11-year-old boy from Bayelsa state presented with symptoms of the disease. Eleven people, including a doctor, were confirmed to have the virus late last week.

"Nigerians are once [again] advised to remain calm, avoid self-medication and report any suspected case to the nearest health facility. Public health authorities across the country have been well informed on what to do when a suspected case arises," said Dr. Chikwe Ihekweazu, CEO of the NCDC.

Monkeypox is transmitted through contact with infected animals and is usually self-limiting. In rare cases, infection can be fatal.
Oct 9 NCDC statement

Puerto Rico hurricane damage stretches supply of IV saline

Damage in Puerto Rico from Hurricane Maria has disrupted the nation's supply of some intravenous (IV) saline and dextrose bags, the Washington Post reported today. Baxter International, one of the makers of small-volume IV bags, widely used for rehydration and to dilute medications, said "multiple production days" were lost in the aftermath of the storm, and it has established a system to allocate the product to hospitals based on past purchases.

On Oct 6, Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, issued a statement saying the FDA is taking new steps to mitigate the impact of two recent hurricanes on the island's medical product manufacturing sector, alongside its ongoing efforts to directly assist Puerto Rico's residents. He said pharmaceutical and biological products account for about 30% of the territory's gross domestic product, and 10% of all drugs consumed by Americans are made in Puerto Rico. "And that doesn't even account for medical devices. Puerto Rico is vital to the health and wellbeing of Americans," he said.

Some facilities were hit harder than other, but the ones that sustained minor damage are running on generator power and aren't back at full production. "New shortages could result from these disruptions, and shortages that existed before the storms could potentially be extended," Gottlieb said, adding that the FDA is in close contact with senior management at the companies.

The FDA says it is monitoring 40 products on a list of critical products for which shortages could have a substantial public health impact. The FDA said it will provide more details on specific products as appropriate and as it learns more.

According to the Post story, Puerto Rico is home to more than four dozen FDA-approved drug making facilities, including ones owned by Pfizer, Merck, Eli Lilly, Johnson & Johnson, Bristol-Myers Squibb, and Amgen. A Baxter spokesman told the Post that limited IV fluid production is under way in Puerto Rico and that the company is leveraging its global production capacity to support the supply as operations are restored in Puerto Rico. Some US hospitals have said they haven't been affected by the shortage, while others said supplies are tight.
Oct 9 Washington Post story
Oct 6 FDA statement

Short-course antibiotics perform well in Enterobacteriaceae bacteremia

Scientists have determined that short courses of antibiotics yield similar clinical outcomes as prolonged courses for Enterobacteriaceae bacteremia and may protect against subsequent multidrug-resistant gram-negative bacteria, according to a new study in PLoS Medicine.

The recommended duration of antibiotic treatment for bloodstream infections caused by Enterobacteriaceae is 7 to 14 days. Researchers from the Antibacterial Resistance Leadership Group compared the outcomes of patients receiving 6 to 10 days versus 11 to 16 days of antibiotics for Enterobacteriaceae bacteremia in patients who were treated in one of three medical centers from 2008 through 2014.

The team matched 385 short-course bacteremia patients with the same number of prolonged-course patients. Median treatment duration was 8 days in the former group and 15 in the latter.

They found no difference between the groups in mortality and recurrent bloodstream infections. They detected a trend toward a protective effect of short-course antibiotic therapy on the emergence of multidrug-resistant gram-negative bacteria but not a statistically significant difference.
Oct 8 Clin Infect Dis abstract

Flu Scan for Oct 09, 2017

News brief

Avian flu may spread via aerosol, droplets during poultry slaughtering

Slaughter of chickens infected with H5N1 avian influenza can produce airborne viruses that can infect birds and mammals, according to findings from a series of animal experiments done by a research team led by the US Department of Agriculture and the Centers for Disease Control and Prevention The investigators reported their finding on Oct 6 in Emerging Infectious Diseases.

Using lab-simulated processing of chickens asymptomatically infected with human- and avian-origin H5N1 viruses, the researchers identified both airborne infectious droplets and aerosols. However, they found fewer infectious particles in experiments involving ducks.

To assess if the airborne particles could infect flu-naive poultry and ferrets, they exposed the animals to the same airspace where the infected poultry were processed. They reported infections and deaths in chickens and ferrets housed next to chicken slaughtering, but not in ducks and ferrets kept in the same airspace with duck slaughtering.

The researchers said their findings support the hypothesis that highly pathogenic avian flu viruses can transmit among poultry and from poultry to humans during slaughter of infected poultry in homes or live-poultry markets.
Oct 6 Emerg Infect Dis study

H5N8 avian flu strikes more zoos and farms in South Africa

South Africa today reported several more highly pathogenic H5N8 avian flu outbreaks on commercial farms and in other settings, according to two notifications from the World Organization for Animal Health (OIE).

Seven more outbreaks were reported on farms, two of them involving backyard facilities, two at ostrich producers, and three on other commercial poultry farms. Six of the locations are in already hard-hit Western Cape province in the southwest, while one is in Free State province in the central part of the country.

The events began from Aug 30 to Sep 23, killing 102,522 of 428,136 susceptible birds. The surviving birds are slated for culling.

In a separate report, South Africa also reported five more H5N8 outbreaks involving other types of birds in other settings. Start dates range from Sep 6 to Sep 28.

Three occurred near Cape Town, two in hobby birds at backyard farms and one at a zoo housing a variety of domestic, exotic, and indigenous birds—200 different species. Another H5N8 detection occurred in a smaller number of birds at a zoo in Johannesburg. The fifth outbreak involved Egyptian geese found dead at a location in Gauteng province. The virus killed 26 of 558 susceptible birds, and 187 birds at the Cape Town zoo were culled to curb the spread of the virus.
Oct 9 OIE report on H5N8 at South African farms
Oct 9 OIE report on H5N8 in other South African birds

In other avian flu developments, Hungary reported 13 H5N8 outbreaks that occurred at the end of 2016 through Mar 20, 2017. The detections occurred across a wide part of the country, including the city of Budapest and six counties.

Most involved wild birds or captured wild geese, but one involved a pheasant breeding farm housing 1,800 birds. Outbreak response steps included culling, temporarily halting poultry transport, and enhanced surveillance.
Oct 9 OIE report on H5N8 in Hungary

No change in flu vaccine uptake after LAIV recommendation removed

A new study in Pediatrics shows that pediatric uptake of the flu vaccine did not change after the US Centers for Disease Control (CDC) recommended children not receive the live attenuated influenza vaccine (LAIV) for the 2016-17 flu season.

Researchers used Oregon's statewide immunization registry, the ALERT Immunization Information System, to compare vaccination rates during the 2015-16 season, when LAIV was recommended for children, and the 2016-17 season, when the CDC called for a return to injectable influenza vaccine (IIV) because of low effectiveness rates among LAIV users.

Children ages 3 to 10 were 1.03 times more likely to get an injectable influenza vaccine if they had received one in the previous season than those who had received an LAIV. Older children, ages 11 to 17, with previous IIV were 1.08 times more likely to return for an IIV. Overall, 53.1% of children with previous LAIV and 56.4% with a previous IIV returned for an IIV during the 2016017 season.

"For the great majority of parents, the likelihood of getting an influenza immunization for their children in the 2016-2017 season was only weakly dependent on whether they had previously chosen an LAIV or an IIV," the authors concluded.
Oct 6 Pediatrics study