News Scan for Oct 24, 2018

News brief

DRC records 3 new cases, 2 deaths in Beni, Butembo

The Democratic Republic of the Congo (DRC) confirmed three more cases of Ebola and recorded two new deaths in the ongoing outbreak in North Kivu province.

Two of the new cases and both deaths occurred in Beni, the hots pot of the outbreak that saw violent attacks by rebel forces over the weekend. One new case was recorded in Butembo.

There are now 247 cases in the outbreak, including 159 deaths. Forty-eight suspected cases are still under investigation.

DRC officials said vaccination is once again underway after being halted due to the violence and subsequent protests in Beni. Vaccination rings in Mutwanga and Kalunguta also ended, as all expected targets in those towns have been vaccinated. A total of 21,553 in the eastern DRC have been vaccinated during this outbreak with Merck's unlicensed Ebola vaccine.

In other news, Peter Salama, MD, the deputy director-general for emergency preparedness and response at the World Health Organization (WHO) said on Twitter that the Beni is also experiencing an acute malaria outbreak, with 2,000 cases diagnosed each week. According to Salama, the WHO will be organizing an age-targeted mass drug administration campaign.
Oct 24 DRC update
Peter Salama Twitter feed

New Jersey adenovirus outbreak kills 7 at pediatric hospital

The New Jersey Department of Health (NJDH) said an adenovirus outbreak at a pediatric rehabilitation hospital sickened 18 patients and killed 7.

In a statement yesterday, the NJDH said The Wanaque Center for Nursing and Rehabilitation in Haskell is not admitting any new patients until the outbreak is over. At that time, 6 patients had died from their infection. In an update today, the department said another child who was hospitalized because of an adenovirus infection has died, raising the number of deaths to 7.

State health officials have been at the facility since Oct 21, when an inspection team found minor handwashing deficiencies. The NJDH said it working closely with the facility on infection control issues.

Adenoviruses typically cause mild symptoms, especially in young children. However, the outbreak strain—adenovirus 7—is affecting medically fragile children who have severely compromised immune systems. "The strain has been particularly associated with disease in communal living arrangements and can be more severe," the health department said.

Adenoviruses are common in places that house large groups of children, such as child care centers, schools, and summer camps, according to a backgrounder from the NJDH. The viruses are very contagious and can be spread to others by close personal contact, coughing or sneezing, and touching contaminated surfaces. Patients can experience a range of symptoms, including cold-like symptoms, sore throat, bronchitis, pneumonia, diarrhea, pink eye, fever, bladder infection, gastrointestinal inflammation, and neurologic conditions.
Oct 23 NJDH statement
Oct 24 NJDH update

ACIP approves hepatitis A vaccine recommendation for homeless

The US Centers for Disease Control and Prevention's (CDC's) vaccine advisory group today approved a recommendation for routine hepatitis A vaccine for all people experiencing homelessness.

In a unanimous vote, the Advisory Committee on Immunization Practices (ACIP) approved the measure, which applies to all homeless people age 1 and older with a two-dose recommendation to prevent the disease.

The new recommendation comes in the wake of investigations by the CDC and state health departments into hepatitis A outbreaks in several states. Some of the hardest hit-states include California, Utah, Missouri, Arkansas, Michigan, Indiana, Kentucky, Tennessee, Ohio, West Virginia, North Carolina, and Massachusetts.

In June, the CDC issued a Health Alert Network notice that said from January 2017 to April 2018 it had received more than 2,500 reports of hepatitis A associated with person-to-person transmission from multiple states. Of 1,900 reports that listed known risk factors, 1,300 (68%) reported injectable drug use, homelessness, or both. Ongoing outbreaks led to increased vaccine use, which put pressure on supplies. The CDC added, however, that the available stocks improved as some jurisdictions made progress controlling outbreaks, and it and manufacturers are closely monitoring the demand.

A recommendation for hepatitis A vaccination in people who use injections and other drugs has been in place since 1996. Outbreaks of hepatitis A in homeless populations had been reported in other countries before, but not in the United States, the CDC said.

Hepatitis A transmission in people who report drug use or homelessness can result from contaminated needles or other injection equipment, specific sexual contact or practices, or from poor sanitary conditions, said the CDC, which typically adopts ACIP recommendations.
CDC ACIP meeting information
Jun 11 CDC HAN notice
CDC hepatitis outbreak page

Study: 26% of online HPV messaging has information on cancer prevention

A new content analysis of messaging for the human papillomavirus (HPV) vaccine showed that most online information about the vaccine was long (44 words or more) and was written at a high reading level. The study was published in Vaccine.

Two independent reviewers analyzed 267 unique messages about HPV vaccination in the fall of 2016 gathered from government websites, medical professional sites, and educational material clearinghouses.

They found only 32% of messages were shorter than 25 words, and 12% had a readability at or below grade 6. Messages about cancer prevention were present 26% of the time, while 62% of messages attempted to address common parent questions and concerns.

"Messages were markedly varied but the majority were [sic] generally long and would not be easy for most people to read," the authors concluded.

In 2016, only 66% of 13- to 17-year-olds in the United States had initiated HPV vaccination, and only 49% had completed the multi-dose series, which is far short of the national Healthy People 2020 goal of 80%.
Oct 23 Vaccine study

Flu Scan for Oct 24, 2018

News brief

FDA approves Xofluza, a novel single-dose drug to treat influenza

Today the US Food and Drug Administration (FDA) approved Xofluza (baloxavir marboxil) for the treatment of flu in patients ages 12 years and older who have been symptomatic for no more than 48 hours.

Xofluza is the first novel flu treatment approved by the FDA in nearly 20 years; the FDA approved the neuraminidase inhibitors oseltamivir and zanamivir in 1999.

In September, the New England Journal of Medicine published results of phase 2 and phase 3 trials of the drug, which showed it reduced flu symptoms by 1 day and significantly reduced viral loads. Xofluza is administered orally, in a single dose.

"With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option," said FDA Commissioner Scott Gottlieb, MD, in a press release.

Japan's health ministry has already approved the drug, which was developed in that country and manufactured by Shionogi & Co.
Oct 24 FDA press release
Sep 5 CIDRAP News story "New single-dose antiviral cuts flu symptoms, viral loads"

Study: Paid sick leave tied to higher flu vaccination, care for symptoms

An analysis of a survey conducted during the 2009 H1N1 pandemic found that only 61% of working adults reported having paid sick leave (PSL), and those without PSL were less likely to be vaccinated against flu or seek medical care when sick with influenza-like illness (ILI). A team led by scientists with the US Centers for Disease Control and Prevention (CDC) reported its findings in Vaccine.

The investigators based their findings on the 2009 National H1N1 Flu Survey, which sampled households via landline or cell phone in all 50 states and the District of Columbia. Of 70,944 responses, researchers focused on 15,933 adults who were employed full time, completed the survey January 2010 through June 2010, and answered the PSL questions.

During the 2009-10 pandemic, 61% of employed adults had PSL benefits, and being female, younger, Hispanic, less educated, or in farm or blue-collar occupations were associated with reduced likelihood of having PSL. Researchers also found that those without PSL were less likely to be vaccinated against flu or see a doctor when sick with ILI.

They found, however, that workers with PSL benefits who had recently been sick with ILI and sought treatment weren't more likely than their peers without benefits to take 1 day or more off from work. "This finding suggests that many workers may choose to go to work despite being sick or before being fully recovered from sickness regardless of whether or not they have PSL benefits," they wrote.
Oct 22 Vaccine abstract