News Scan for Mar 27, 2014

News brief

CDC reports 6 more cases of Heartland virus infection

Six more cases of Heartland virus infection have been identified since the world's first two cases were detected in the summer of 2012, scientists from the Centers for Disease Control and Prevention (CDC) and two states reported today.

Five men in Missouri and one in Tennessee contracted the disease in 2012 and 2013, according to the report in Morbidity and Mortality Weekly Report (MMWR). All were 50 or older, and five of the men reported tick bites in the days or weeks before they fell ill.

One of the patients, who had multiple other health conditions, died. But officials don't know if his Heartland infection caused his death.

The patients' symptoms—which included fever, fatigue, loss of appetite, headache, nausea, and muscle and joint pain—started between May and September, which are prime tick months. Four of the patients required hospital care. Their ages ranged from 50 to 80, with a median of 58, and all were active outdoors.

The first cases of the disease were reported in August 2012 in two male Missouri farmers who were hospitalized in 2009. Last July researchers reported finding Heartland virus in 10 lone star ticks, including 9 on the land of one of the farmers, strongly implicating the species as a vector. The tick is named after the single whitish spot on its back (see CDC photo at right).

Nearly all of the newly reported cases were discovered through a study conducted by the Missouri Department of Health and Senior Services and the CDC, which are actively searching for human cases at six Missouri hospitals, according to a CDC news release. The novel virus is in the phlebovirus family.
Mar 28 MMWR report
Mar 27 CDC news release
Aug 30, 2012, CIDRAP News scan on first two cases
Jul 22, 2013, CIDRAP News story "Researchers trace novel Heartland virus to Missouri ticks"


FDA says most firms joining program to trim use of animal antibiotics

All but 1 of 26 companies that make relevant veterinary drugs plan to go along with the Food and Drug Administration's (FDA's) voluntary program to reduce the use of medically important antimicrobial drugs in animals, the FDA announced yesterday.

Under the "judicious use" program, the FDA has invited animal-drug makers to seek cancellation of approvals for the use of antimicrobials to promote animal growth, as opposed to treating disease, and to change the marketing status of products from over-the-counter to use only under veterinary supervision or by prescription.

The agency said that 25 of 26 companies affected by the program have confirmed "their intent to engage with the FDA in the program" and to have their names published. The companies account for more than 99% of the drug approvals and total product sales affected by the program, the statement said.

"FDA is encouraged by the response thus far and will continue to monitor ongoing participation and provide public updates on a periodic basis," the agency said.

The companies had been asked to notify the FDA by Mar 12 if they intended to join the program.
Mar 26 FDA announcement
Related Dec 11, 2013, CIDRAP News story


'Momentous victory' as Southeast Asia declared polio-free

Global polio eradication efforts received a boost today as the World Health Organization (WHO) declared its 11-country South-East Asia Region to be polio-free.

The region, which includes Bangladesh, Bhutan, North Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste, is the fourth of six WHO regions to be thus certified and holds one fourth of the world's population, says a WHO notice today. Other areas that have been certified as polio-free are the Americas (in 1994), Western Pacific (2000), and European (2002) regions, according to a press release from the US Agency for International Development (USAID).

Polio-free status comes upon attainment of several requirements: at least 3 years of no confirmed cases of indigenous wild poliovirus infection, excellent laboratory-based surveillance and safe containment of polioviruses in laboratories, and the capacity to detect, report, and respond to imported cases.

Said WHO Regional Director Dr. Poonam Khetrapal Singh at the 2-day certification meeting in New Delhi, "This is a momentous victory for the millions of health workers who have worked with governments, nongovernmental organizations, civil society and international partners to eradicate polio from the Region." Dr. Ariel Pablos-Mendez, assistant administrator for Global Health at USAID, called the announcement "a major milestone" and a "Herculean effort."

Singh warned, however, that until polio is eradicated everywhere, it remains a threat to all countries and that "the Region's polio-free status remains fragile" because of the potential for imported cases.

The goal of the Global Polio Eradication Initiative (GPEI) is to rid the world of polio by 2018.
Mar 27 WHO notice
Mar 27 USAID press release
GPEI home page

Flu Scan for Mar 27, 2014

News brief

H7N9 sickens one, kills another in China

China reported one new H7N9 infection today, as well as a death from the virus in a previously confirmed patient. Both are from Guangdong province, according to a health department statement translated and posted by FluTrackers, an infectious disease news message board.

The province's latest case-patient is a 55-year-old woman who is hospitalized in critical condition in Huizhou. The patient who died had an H7N9 infection that was confirmed on Mar 7, likely a 70-year-old man who had been hospitalized in critical condition in Meizhou.

The newly reported infection raises the outbreak total to 402 cases, according to a list of human infections maintained by FluTrackers. The death would bump the unofficial number of fatalities to 122. So far 266 infections have been reported in the second wave of infections that began in October, compared to 136 in the first wave last spring.
Mar 27 FluTrackers thread
FluTrackers human H7N9 case list

In related developments, the World Health Organization (WHO) filled in more details on reports of six H7N9 cases that it received from China from Mar 20 to Mar 25. All the patients are men, ranging from 32 to 82 years old. The group includes four from Guangdong province, along with one each from Anhui and Hunan provinces.

Illness onsets range from Mar 10 to Mar 18. Four of the patients are in critical condition, and two are listed in severe condition. Three of them had been exposed to poultry before they got sick.
Mar 27 WHO statement


Study finds vaccine 74% effective against ICU flu in kids

In a first effort to measure flu vaccine effectiveness (VE) against flu-related pediatric intensive care unit (PICU) hospitalization, US researchers found the seasonal vaccine to be 74% effective in a study yesterday in the Journal of Infectious Diseases (JID) that involved 44 case-patients, 8 of whom had been fully vaccinated.

Researchers from the Centers for Disease Control and Prevention (CDC) and various states analyzed medical records from kids ages 6 months through 17 years in 21 US PICUs who had acute severe respiratory illness during the 2010-11 and 2011-12 flu seasons. Of the 216 patients studied, 44 had lab-confirmed influenza, and the remaining 172 served as PICU controls.

Fifty-five percent of case-patients had at least one underlying chronic condition that placed them at higher risk of serious flu-related complications. The investigators were able to verify that 18% of case-patients (8 children) and 31% of controls (54 children) were fully vaccinated against flu.

Compared with unvaccinated kids, those who were fully vaccinated were 74% less likely to have flu compared with the PICU controls (95% confidence interval [CI], 19%-91%). When compared with 93 community controls, VE rose to 82% (95% CI, 23% to 96%).

Among the limitations of the study that the authors list is the small number of cases. However, Alicia Fry, MD, MPH, a medical officer in CDC's Influenza Division, said in a CDC press release, "These study results underscore the importance of an annual flu vaccination, which can keep your child from ending up in the intensive care unit."
Mar 26 JID study
Mar 27 CDC press release


HAI titer of 1:40 may not reflect 50% protection against flu

A hemagglutination-inhibition antibody (HAI) titer of 1:40 is generally correlated with 50% protection against influenza, but a JID study yesterday found that measure to be associated with only 31% protection against the pre-pandemic H1N1 and H3N2 strains among household contacts.

Hong Kong researchers analyzed data on 182 index patients with seasonal H1N1 from January 2008 through August 2009 and 115 index patients with H3N2 during the same period. In the households of the H1N1 index patients, 146 of 558 (26%) provided serum specimens, compared with 52 of 337 (15%) in household contacts of the H3N2 index patients.

They found that HAI titers of 1:40 were both associated with 31% protection against lab-confirmed H1N1 and H3N2 infection (95% CI, 13%-46% for H1N1 and 1%-53% for H3N2). By comparison, a microneutralization titer of 1:40 against H3N2 was associated with 49% protection (95% CI, 7% to 81%).

The authors surmise that the lower protection seen with the HAI assay may result from exposures of greater duration or intensity in confined household settings.
Mar 26 JID study

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