News Scan for Feb 05, 2018

News brief

Sanofi refuses to refund millions to Philippines

Today the French pharmaceutical company, Sanofi Pasteur, said they would not pay the Philippines millions of dollars in return for Dengvaxia vaccines, after the country halted a national vaccination program in light of concerns the vaccine can cause severe infection in dengue-immune recipients.

According to an Agence France-Presse (AFP) story, the Philippines asked Sanofi to refund 3.2 billion pesos ($62 million) the government spent on a national immunization program for school-age children. A total of 830,000 schoolchildren were injected with Dengvaxia before Sanofi said the vaccine should not be used in people without prior evidence of a dengue infection, an announcement the company made last December.

"Agreeing to refund the used doses of Dengvaxia would imply that the vaccine is ineffective, which is not the case," Sanofi Pasteur said in a statement.

Also today, the Public Attorney's Office of the Philippines joined forces with the parents of a 10-year-old girl who died after receiving Dengvaxia to sue Sanofi for 4.2 million pesos ($81,600) in damages. The girl died of excessive bleeding after becoming ill with a virus following routine immunization with Dengvaxia.
Feb 5 AFP story
Feb 5 Reuters story

Nigeria confirms 15 new cases of Lassa fever and 2 deaths

The Nigerian Centre for Disease Control (NCDC) said there were 15 new cases of Lassa fever and two deaths caused by the virus in the last week of January. Between Jan 1 and Jan 25, there have been a total of 297 suspected cases in 13 Nigerian states, including 22 deaths.

The NCDC has confirmed 77 of those cases, stating the case-fatality rate of this outbreak is 27.6%. Twenty-one of the 22 deaths reported in connection with the outbreak have been confirmed. The NCDC is currently following 415 case contacts.

Ten of the confirmed cases have occurred in healthcare workers, and the NCDC said the country has activated its emergency operations center to coordinate the outbreak response.

Lassa fever is a hemorrhagic virus endemic in West Africa. Person-to-person transmission can occur if someone comes into contact with infected bodily fluid, but most often the virus is transmitted by rats.
Jan 28 NCDC update

Swiss farm worker diagnosed with H1N1v after contact with pigs

The World Health Organization (WHO) said a Swiss man was diagnosed with variant H1N1 (H1N1v) influenza after coming into contact with infected swine. This case was noted in the WHO's monthly report on flu at the animal-human interface.

On Dec 20, the 48-year-old farm worker presented with acute but mild respiratory symptoms. A nasal swab was obtained and the virus analyzed and partially sequenced was closely related to European avian-like swine influenza A (H1N1), according to the WHO.

Swine housed on the farm tested positive for the virus. This is the sixth year Switzerland has reported swine influenza A (H1N1) in humans. Past years included 2003, 2009, 2010, 2011, and 2016.

"Most human cases are exposed to swine influenza viruses through contact with infected swine or contaminated environments. Human infection tends to result in mild clinical illness," the WHO said. "Since these viruses continue to be detected in swine populations, further human cases can be expected."
Jan 25 WHO report

H5N6 strikes birds in Iran and South Korea; Nigeria reports H5N8

Iran today reported a highly pathogenic H5N6 avian flu outbreak in wild ducks, the first detection involving that strain in the Middle East, as South Korea reported another H5N6 outbreak at a poultry farm. In other developments, Nigeria reported a H5N8 outbreak, its first since August 2017.

In a report from the World Organization for Animal Health (OIE), Iran's agriculture ministry didn't say if the virus is the same reassortant recently found in a handful of Asian countries and some in Europe, as well.

The report said on Jan 31 unexpected deaths were reported in wild ducks in a nature park near the Gilan province city of Kiashahr in northern Iran. Migratory birds overwinter in the area. Of about 50,000 susceptible birds, 1,200 birds were found dead and 100 were found sick. Authorities destroyed the sick birds. Veterinary officials said they would continue to monitor the situation and are urging poultry flock owners to be vigilant about biosecurity measures.

Elsewhere, South Korea—which has reported several outbreaks involving the H5N6 reassortant—confirmed another event in poultry, the first to affect South Chungcheong province. The outbreak began on Feb 4 at a broiler farm, killing 103 of 24,000 susceptible birds. The remaining ones were culled to curb the spread of the virus.
Feb 5 OIE report on H5N6 in Iran
Feb 5 OIE report on H5N6 in South Korea

In other avian flu developments, Nigeria reported an H5N8 outbreak at a broiler and cockerel farm in Nasarawa state, according to a Feb 2 report from the OIE.

The outbreak began on Jan 25, killing nearly all of the 1,150 susceptible birds. Officials destroyed the 45 survivors as part of the outbreak response steps.

An investigation found that the outbreak began after unsold birds taken to a market were returned to the farm.
Feb 2 OIE report on H5N8 in Nigeria

Stewardship / Resistance Scan for Feb 05, 2018

News brief

PAHO: cephalosporin-resistant gonorrhea present in 4 Americas countries

The United States, Brazil, Argentina, and now Canada, have all reported cases of cephalosporin-resistant gonorrhea, according to the latest situation report published by the Pan American Health organization (PAHO).

Gonorrhea has the ability to develop resistance to nearly all major antibiotics used for first-line empiric treatment of sexually transmitted infection, and extended-spectrum cephalosporins are the last available monotherapy used to treat infections caused by Neisseria gonorrhoeae.

In 2017, an asymptomatic Canadian woman was found to be infected with cephalosporin-resistant gonorrhea that was also resistant to ceftriaxone, cefixime, ciprofloxacin, and tetracycline. Her infection was susceptible to azithromycin.

PAHO said clinicians should be aware of any local resistance patterns when choosing an antibiotic to treat gonorrhea. So far, the bacterium is still susceptible to dual treatment with ceftriaxone and azithromycin.
Feb 2 PAHO report

Chinese study finds 45% cure rate for second-line MDR-TB treatment

A large Chinese study determined that less than half of patients with multidrug-resistant tuberculosis (MDR-TB) were cured with second-line treatment, according to a report in the Journal of Infection.

Of 2,322 MDR-TB patients identified in 2008 through 2010, 1,542 received standardized second-line TB drugs. Of those patients, 688 (44.6%) were cured. The researchers also reported that the percentage of patients who had a favorable outcome was 57.6% in previously untreated patients and 46.1% in patients who had received previous TB therapy. And women had a higher rate of favorable outcome (52.0%) than did men (45.8%). Favorable outcomes were also significantly decreased in elderly patients.

The authors concluded, "More attention should be paid to the MDR-TB population at high-risk of poor clinical outcome, including male, elderly age, and those who have received prior treatment."
Feb 2 J Infect study