News Scan for Apr 16, 2020

News brief

Study finds high Zika awareness in US pregnant women during outbreak

A study of new mothers in 16 US states and 1 city published yesterday in Emerging Infectious Diseases found that, while over 90% of women pregnant during the 2016 Zika virus outbreak knew about the risks posed by infection, only half discussed it with their doctors.

A mosquito-borne virus, Zika can cause microcephaly (abnormally small head) and other defects in babies born to infected women.

Researchers from the US Centers for Disease Control and Prevention (CDC) used the agency's Pregnancy Risk Assessment Monitoring System, a state-specific, a monitoring program that surveys a random sample of mothers 2 to 6 months after a live birth.

Of the 8,711 women who responded to the survey, most were 25 to 34 years old (59.7%), were non-Hispanic white (56.9%), had more than a high school education (65.1%), were married (61.3%), and had private insurance that paid for the delivery (55.8%).

The vast majority (91.9%) said they were aware of CDC advisories to avoid travel to regions endemic with Zika while pregnant. Of the women who had heard of Zika, 58.8% said they had talked to a clinician about it, with 63.5% reporting that the clinician brought it up.

Only 8.8% of women said they had not heard of the Zika virus while they were pregnant. These women were more likely than those who had heard of the virus to be non-Hispanic black, have no more than a high school education, say that Medicaid paid for the delivery, and be uninsured at delivery.

"These differences suggest the opportunity to promote patient advocacy so that patients of all backgrounds feel comfortable asking about key topics if they are not raised by the provider, especially in the case of public health threats," the authors wrote.
Apr 15 Emerg Infect Dis study


Pennsylvania notes brucellosis illness linked to raw milk

A paper today in Morbidity and Mortality Weekly Reports (MMWR) describes a case of brucellosis linked to raw (unpasteurized) milk produced in Pennsylvania in 2018. The patient, who lived in New York state, bought the milk from a dairy farm in Pennsylvania.

Brucellosis is a serious disease caused by the Brucella bacteria. This case was caused by Brucella abortus RB51, the live-attenuated vaccine strain used to prevent brucellosis in cattle. While brucellosis can cause fever and chronic illness in any person, it can cause miscarriage and stillbirths in pregnant women.

The Pennsylvania Department of Agriculture identified the cows carrying Brucella abortus RB51 during environmental sampling of the dairy. RB51 was detected and isolated in milk samples collected from the dairy's bulk tank and a single cow.

The report also notes that a New Jersey man tested positive for the RB51 strain in 2017 after drinking raw milk, but the milk source of his infection was not pinpointed.

The authors recommend that all milk be pasteurized before consumption, in line with longstanding public health advice. "During 2007–2012, the number of raw milk outbreaks in the United States increased; 66 (81%) of 81 reported outbreaks occurred in states where raw milk sale is legal," they said.
Apr 17 MMWR report

Ebola Scan for Apr 16, 2020

News brief

WHO weighs in on recent DRC cases, notes vaccine supply challenges

The World Health Organization (WHO) today fleshed out more details on the three recently reported Ebola cases in the Democratic Republic of the Congo (DRC) city of Beni, noting that all are epidemiologically linked and that samples have been sent for genetic testing to see if they are part of a known transmission chain.

In its update, the WHO said two of the patients died in the community after visiting several healthcare facilities, a situation known to raise the risk of virus spread. The third patient is being treated at an Ebola treatment center.

So far, 332 contacts have been identified, and 200 have been vaccinated. Though there are about 6,000 vaccine doses in Beni, the WHO said the supply pipeline is likely challenged because of COVID-19 flight restrictions.

Other challenges are armed groups and limited access in some areas, with possible under-reporting. On Apr 9, health officials validated two probable cases in patients who were sick in November and December.

So far, the DRC has reported 3,458 cases since August 2018, of which 3,313 are lab-confirmed, with 2,277 deaths.
Apr 16 WHO statement


FDA accepts Regeneron Ebola drug for fast-track review

Regeneron announced today that the US Food and Drug Administration (FDA) has granted priority review for its monoclonal antibody cocktail drug for treating Ebola.

The drug, REGN-EB3, is a triple-antibody drug that was studied in Ebola treatment centers in the current Democratic Republic of the Congo (DCR) outbreak and was one of two drugs that stood out as more effective than other options.

In a statement today, Regeneron, based in Tarrytown, New York, said the target dates for the FDA decision is Oct 25, 2020. It said its licensing data are based on a randomized controlled study in the DRC that was stopped early in August 2019 when it showed pre-specified superiority over the control drug ZMapp. The company said it has also used the same approach to develop an antibody drug to treat COVID-19, with clinical trials expected to be begin in June.

REGN-EB3 had already received orphan drug and breakthrough designation from the FDA. The drug was developed through a collaboration with the Biomedical Advanced Research and Development Authority (BARDA).
Apr 16 Regeneron press release
Nov 27, 2019, CIDRAP News story "New data highlight promise of 2 Ebola treatments"

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