Flu Scan for Feb 13, 2014

News brief

New fatal H10N8 case reported in China

Health officials in China's Jiangxi province today reported their third recent human case of H10N8 avian flu, which proved fatal, according to a provincial statement in Chinese translated and posted by FluTrackers, an infectious disease news message board.

The patient, a 75-year-old man from the capital city of Nanchang, got sick on Feb 4 and was hospitalized with severe pneumonia. He died on Feb 8.

The two other recent cases include the first detection in the middle of December, in a 73-year-old woman who died from her infection, and a nonfatal case in a 55-year-old woman whose illness was reported in late January.

The virus is low pathogenic in birds but, like the H7N9 virus, appears to cause severe disease in people. A recent study in The Lancet urged health officials not to underestimate the pandemic potential of H10N8.
Feb 13 FluTrackers thread
Feb 4 CIDRAP News story "Study: H10N8 virus in first human case is novel strain"

H5N1 strikes flocks in Cambodia, Vietnam

Cambodia has reported an H5N1 avian flu outbreak at a village in Kampong Cham province, according to a report today from the World Organization for Animal Health (OIE).

The virus was detected by animal health officials who were called to investigate sickness and death in the village's duck flocks. The outbreak began on Feb 7. Of 5,250 susceptible birds, 4,466 deaths were reported, and the remaining 784 ducks were destroyed to curb the spread of the virus.

The outbreak was Cambodia's first since August 2013. The country has reported three H5N1 illnesses in humans so far this year, all in children. Two of the cases, reported yesterday, were in siblings who died from their infections, but one was not tested. The siblings lived in Kampong Cham province.
Feb 13 OIE report on Cambodia outbreak

Elsewhere, Vietnam's agriculture ministry today reported six H5N1 outbreaks from six different provinces, according to a separate OIE report. They range from Nam Dinh, located in the more northern part of the country, to more southern provinces, including Tay Ninh, Khanh Hoa, Quang Ngai, Kon Tum, and Ca Mau.

The outbreak dates range from Feb 7 to Feb 11, affecting village flocks. Of 18,981 susceptible birds, 9,181 died, and the remaining 9,800 were destroyed to control disease spread.
Feb 13 OIE report on Vietnam outbreaks

H7N3 vaccine trial shows promise, potential for use against H7N9

A phase 1 clinical trial of a candidate H7N3 live-attenuated influenza vaccine (LAIV) developed in Russia found that two doses were immunogenic and produced antibodies that were reactive not only to wild-type avian H7N3, but also to the new H7N9 virus that is infecting humans in China, according to a study yesterday in PLoS One.

A Russian and US team administered two doses of the vaccine to 30 of 40 randomly divided subjects, 10 of them receiving placebo. Among patients who got the LAIV doses, researchers found the majority (86.2%) of vaccine recipients developed serum and local antibody responses and generated antigen-specific CD4 and CD8 memory T cells. They also found that the vaccine was safe and well tolerated.

In addition, they found that sera from some of the vaccinated patients prompted an antibody response that was able to neutralize the new H7N9 virus. The team also found clues that most B cells and cytotoxic T cells induced by the H7N3 virus are likely to recognize the H7N9 virus.

They concluded that the H7N3 LAIV strain could be used in a priming vaccine strategy in the event of a pandemic until specific H7N9 vaccines are available.
Feb 12 PLoS One study

Rapid flu tests appear to guide antiviral decisions for outpatients

Clinicians in outpatient facilities often use the results of rapid influenza diagnostic tests (RIDTs) in making decisions regarding the use of antivirals, but these decisions are not always in line with treatment guidelines from the US Centers for Disease Control and Prevention (CDC), according to a study yesterday in the Journal of Clinical Virology.

The authors sent surveys to randomly selected physicians' offices, emergency departments, and community clinics in 2008 (pre–2009 H1N1 pandemic) and 2010 (post-pandemic) to assess RIDT testing practices; 5,064 surveys were sent in 2008 and 5,063 in 2010. In the post-pandemic survey, questions were included to evaluate any changes in RIDT practices in various risk groups.

The response rate was lower in 2010 than in 2008 (18% vs 41%), but a higher percentage of respondents reported RIDT use in 2010 (73%) than in 2008 (20%) for all facility types.

In both survey years, antivirals were prescribed for more than two thirds of patients with flu-like symptoms who had a positive RIDT result within 48 hours of onset (69% pre-pandemic, 67% post-pandemic). An "H1N1 effect" was seen in 2010, meaning higher treatment levels in high-risk patients, but the numbers fell short of CDC recommendations (eg, 31% of children under 2 years of age, 23% of children 2 to 5, and 37% of pregnant patients).
Feb 12 J Clin Virol abstract

Study: Self-applied microneedle vaccine patches well tolerated

Most patients attempting self-vaccination with microneedle patches were successful, particularly when a snap-based device was used, and most would prefer to self-vaccinate given the choice, says a study in Vaccine that the authors claim is the first to assess usability and acceptability of the method.

The study group comprised 91 venue-recruited adults. They self-administered placebo-containing microneedle patches three times, had one placebo microneedle patch applied by an investigator, and had an intramuscular injection of saline.

Those in the first group, comprising 70 participants, were given patches that are applied with thumb pressure alone. Usability was evaluated by counting needle insertion sites after swabbing the skin with stain. They showed wide variability in the number of insertion points as well as a learning curve (more insertion points on the third attempt than the first).

The authors took this to mean that subjects needed a device to assist with correct needle insertion, so they repeated the regimen on 21 subjects with devices that snapped shut when the appropriate application pressure was reached.

The best usability was attained by those using the snap devices; over three repetitions, this group had a median success rate of 93% to 96% with little variability among individuals. All patch vaccinations were well tolerated.

Subjects' intent to be vaccinated in the next flu season increased from 44% before the trial to 65% afterward (confidence interval, 55% to 74%). Among those expressing an intent to be vaccinated, 76% preferred microneedle-patch vaccination over injection and 64% preferred self-vaccination over patches applied by a healthcare worker.
Feb 11 Vaccine abstract

News Scan for Feb 13, 2014

News brief

Study: 2 HPV doses protect against genital warts, but 3 better

Two doses of quadrivalent (four-strain) human papillomavirus (HPV) vaccine provide good protection against genital warts (condylomata), but three doses are better, according to a large Swedish study published yesterday in the Journal of the American Medical Association (JAMA).

Current US recommendations call for three shots of HPV vaccine over 6 months. Two vaccines are approved for use in the United States: the two-strain Cervarix, which protects against HPV types 16 and 18, which cause most cervical cancer, and the four-strain Gardasil, which also protects against types 6 and 11, which cause most genital warts in females and males, according to the Centers for Disease Control and Prevention (CDC).

The researchers in the current study, from the Karolinska Institutet in Stockholm, analyzed data from all girls and women 10 to 24 years old in Sweden from 2006 to 2010—1,045,165 in all. The authors studied the occurrence of genital warts because "condyloma related to HPV types 6 and 11 . . . represents the earliest measurable preventable disease outcome for the HPV vaccine," they write.

The team noted 20,383 cases of genital warts during the study period, including 322 cases after receipt of at least one vaccine dose.

For girls 10 to 16 at first vaccination, three quadrivalent vaccine doses were associated with a genital wart incident rate ratio of 0.18, compared with 0.29 for two doses and 0.31 for one dose. A three-dose vaccine regimen was projected to prevent 459 condylomata cases per 100,000 person-years, compared with 400 for two doses.

"When it comes to the vaccine's ability to protect against genital warts in girls between 10 and 16 years of age, we can see that two doses provide good protection, up to 71%, but that three doses is better, up to 82%," said lead author Lisen Arnheim Dahlstrom, PhD, of Karolinska Institutet in a Karolinska news release.

"Our results suggest that we should continue with the recommended three doses, but open up for a future two-dose schedule after more studies have been conducted," she added.
Feb 12 JAMA study
Feb 11 Karolinska Institutet news release

CDC: MSM may be at higher risk of resistant Shigella

Men who have sex with men (MSM), especially if they have HIV, may be at increased risk of infection with Shigella that has decreased susceptibility to azithromycin (DSA-Shigella), according to a CDC report on all known DSA-Shigella cases today in Morbidity and Mortality Weekly Report (MMWR).

Azithromycin, the most frequently prescribed antibiotic in the United States, is recommended for both children and adults for multidrug-resistant Shigella, the CDC said in the report.

Among 55 patients from 17 states infected with DSA-Shigella that the CDC identified, ages ranged from 1 to 89 years (median: 42 years), 80% were men, and seven (13%) were children. All but one patient lived in an urban area, and only one child and none of 29 adults for whom information was available reported international travel. Four patients were part of an outbreak.

Of those with available information, 13 of 16 men (81%) were HIV-positive, and 11 of 14 (79%) identified as MSM. Four men reported recent high-risk sexual practices, and five had a history of syphilis.
Feb 14 MMWR report