Flu Scan for May 16, 2017

News brief

China reports second H9N2 case of the year

Tests have confirmed another H9N2 avian influenza infection, in a 32-year-old Beijing man who had symptoms such as fever, cough, and sore throat but has since recovered, according to a notice from the Beijing Centers for Disease Control (Beijing CDC) translated and posted by FluTrackers, an infectious disease news message board.

The man is an outdoor worker. His illness marks China's second H9N2 case of the year. The first involved an 11-month-old boy from Gansu province who was sick in early February. Most H9N2 illnesses have been seen in children, unlike H7N9, which is primarily detected in adults.

In its report, Beijing CDC also said it has reported 19 H7N9 cases in the city this year, 11 of them local and 8 imported. The city and adjacent areas in northern China have seen a late-season increase in H7N9 cases over the past few weeks.
May 16 FluTrackers post
Apr 26 CIDRAP News scan "H9N2 avian flu infects baby in China"

Phase 2 trial show promise for immune plasma in treating severe flu

Using immune plasma—a blood product that contains antibodies against flu—might be a tool to combat severe cases of influenza, according to the first randomized controlled trial of its kind, published yesterday in The Lancet Respiratory Medicine.

The study, which was funded by the US National Institutes of Health, involved 113 patients (including children and pregnant women) in 29 academic medical centers across the country. The patients, who had severe influenza A or B, were randomly assigned standard therapy plus immune plasma (which contained antibody titers of 1:80 or more of the infecting strain) or standard therapy alone.

The researchers found no significant difference between the groups in achieving the primary end point of the phase 2 trial, which was normalization of breathing, but the treatment was found to be safe and well tolerated. The team also reported significant improvement in clinical status at 7 days in the immune plasma patients and non-significant improvements in other clinical end points, including reduced death rates (2% vs10%).

In an accompanying commentary, US scientists not involved in the study, including two from the Food and Drug Administration, wrote, "Severe zoonotic influenza A virus infections, like the ongoing A(H7N9) outbreak in China, urgently need improved therapies and are events in which survivors as potential plasma donors should be easy to identify."

But they added, "The logistical hurdles to collection of large amounts of convalescent plasma and the scarcity of experience of most blood collection centres with using plasma as an immunotherapeutic raises concerns about the feasibility of obtaining therapeutic plasma for large numbers of patients, particularly in less well-resourced settings."
May 15 Lancet Respir Med study
May 15 Lancet Respir Med commentary

Flu starts to pick up in Southern Hemisphere

Though flu activity in the Southern Hemisphere is still low, levels have reached seasonal thresholds in some countries, as disease activity in the Northern Hemisphere continued to ebb in many regions, such as North America and Europe, the World Health Organization (WHO) said yesterday in an update.

Bolivia has reported a rise in flu over the past few weeks, with H3N2 as the dominant strain. Chile's flulike illness activity continued to increase and has now passed the country's seasonal threshold.

In India, 2009 H1N1 activities continues to be reported, but other parts of South Asia such as Iran and Sri Lanka are reporting low flu activity, with influenza B predominant. Most of Southeast Asia reported low flu activity, except for Singapore, which noted increases over recent weeks.

West Africa's flu activity continued, with a mix of 2009 H1N1 and influenza B.

At the global level, influenza B is the dominant strain, making up 65.3% of positive specimens tested in the last half of April. The subtyped B viruses were nearly evenly split between Yamagata and Victoria lineages. Of the subtyped influenza A viruses from recent sampling, 54.9% were H3N2 and 45.1% were 2009 H1N1.
May 15 WHO global flu update

News Scan for May 16, 2017

News brief

Brazil's outbreak yellow fever virus has mutated significantly

The yellow fever virus that has caused a large outbreak in Brazil has undergone substantial mutations, but these changes should not affect vaccine effectiveness, Brazilian investigators said, according to a story today in Brazil's O Globo newspaper.

A Google-translated version of the report says that scientists from the nation's public health research center, Oswaldo Cruz Institute /Oswaldo Cruz Foundation (IOC/Fiocruz) have sequenced the complete genome of the yellow fever virus from two howler monkeys from Espirito Santo state. They describe eight mutations never before reported in this lineage.

Espirito Santo is one of six affected states.

"These changes are mainly grouped into functional non-structural domains of the virus, so it's very unlikely that they will affect the effectiveness of the vaccine," says Myrna Bonaldo, DSc, head of the IOC's Flavivirus Molecular Biology Laboratory and one of the coordinators of the study. Seven of the mutations are in the portion of the virus's genome linked to replication, and the other is in the assembly of the virus capsid, which stores genetic material. The vaccine targets the virus envelope, or outer coating.

The IOC/Fiocruz scientists don't know what affect these mutations have on virus transmission and infection. They plan to study that next, the story said.
May 16 O Globo report

Grocery chains get poor marks for antibiotics policies

America's leading grocery chains are failing to address overuse of antibiotics in chicken, according to a report today from the Natural Resources Defense Council (NRDC).

The report evaluates and grades the five largest grocery retailers in North America—Costco, Publix, Walmart, Albertsons/Safeway, and Kroger—on their offerings of chicken brands from producers with responsible antibiotics practices and their public commitment to appropriate antibiotic use in food animals. In addition, it examines store signage and informational material directing consumers to chicken raised without antibiotics or from producers who've committed to phasing the drugs out.

The five chains each averaged a "D" grade. While all five offered at least one brand of chicken reflective of responsible antibiotic use practices, and some offered several brands, the report found that none of the chains had made a public commitment to eliminating routine use of antibiotics in their chicken supply chains, few had signage to direct consumers to antibiotic-free or responsible-use options, and most antibiotic-use claims lacked third-party verification. Walmart had the largest proportion of chicken brand choices sourced from producers who've committed to eliminating antibiotics in their chicken supply.

In the last few years, large chicken producers like Perdue and Tyson Farms have committed to phasing out the routine use of medically important antibiotics in their chickens, and several fast-food chains have pledged to purchase chicken raised without antibiotics. Now, the report adds, grocery retailers need to step up and meet consumer demand by promoting responsible use of antibiotics in their supply chains.

"In the absence of action at the federal level, consumers have been driving the move toward meat raised with responsible antibiotics use," NRDC staff scientist Carmen Cordova, PhD, said in a news release from the organization. "The fast food industry has been leading the way—but people want to be able to eat better meat [at] home, too. Our report shows that grocery stores have a lot of catching up to do."

The report recommends that grocery chains develop responsible antibiotic use policies and communicate them to consumers, improve signage, and advocate for third-party verification.
May 16 NRDC report
May 16 NRDC news release