World flu activity continues to rise, mainly from H3N2

News brief

Global flu activity rose in the first half of November, mainly due to rising levels in North America, parts of Europe, and a few locations in other regions, the World Health Organization said this week in a regular update.

The United States and Canada are experiencing earlier-than-expected flu surges at levels higher than in prepandemic years. Europe's activity is also rising, with many countries above their epidemic thresholds and Germany and Portugal reporting widespread activity.

Elsewhere, flu detections rose in parts of the Middle East, especially in Iran. And in temperate South America, flu activity remained elevated in Argentina and Chile.

Testing respiratory specimens at global flu labs reveals that influenza A made up 95.2% of samples during the first half of November. Of the subtyped influenza A viruses, 83.7% were H3N2. Of the characterized influenza B viruses, all belonged to the Victoria lineage.

Babies exposed to Zika before birth may have brain issues in early childhood

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Preschool-aged Colombian children who were exposed to the Zika virus while in the womb but were never diagnosed as having Zika-related birth defects or congenital Zika syndrome may still display differences in some aspects of cognitive development, mood, and mobility in early childhood, reports a study in Pediatric Research.

The study compared 55 children aged 3 to 5 years who were exposed to Zika in the womb in Sabanalarga, Colombia, and compared them to 70 control children aged 4 to 5 years who had not been exposed to Zika prenatally during the 2015-2017 Zika outbreak in South America.

Doctors assessed each group's motor skills and school-readiness skills (identifying colors, letters, numbers, and shapes) between December 2020 and February 2021. Parents were also asked to assess a child's mood and any behavioral or physical concerns.

Though cognitive function scores and manual dexterity scores were not significantly different between the two groups, parents of 6 (11%) Zika-exposed children reported mood problems, compared to 1 (1%) of control children. Parents of Zika-exposed children were also significantly more likely to report parental distress.

"There are still many unanswered questions about the long-term impacts of Zika on children exposed in utero," said Sarah Mulkey, MD, PhD, the study's first author, in a press release. "These findings are another piece of the puzzle that provides insight into the long-term neurodevelopment of children with prenatal Zika virus exposure. Further evaluation is needed as these children get older."

CDC announces $3.2 billion to build up public health system

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The Centers for Disease Control and Prevention (CDC) yesterday announced that it has awarded $3.2 billion in funding directly to state, local, and territorial health departments to boost staffing, services, and systems to protect communities. The CDC said the first-of-its-kind funding includes $3 billion from the American Rescue Plan Act, the COVID-19 stimulus bill passed and signed into law in March 2021.

Rochelle Walensky, MD, MPH, the CDC's director, said the pandemic severely stressed health departments, which were already weakened by neglect and underfunding. The funding is tailored to meet community needs, help marginalized communities, and modernize data systems.

"This grant gives these agencies critical funding and flexibility to build and reinforce the nation’s public health workforce and infrastructure, and protect the populations they serve," she said. "We are meeting them where they are and trusting them to know what works best for their communities."

Much of the funding is geared toward recruiting, training, and retraining the public health workforce. It also includes $140 million from a new appropriation to strengthen the public health infrastructure and $65 million in technical assistance for jurisdictions that are strengthening their services.

The Association of State and Territorial Health Officials (ASTHO), the National Network of Public Health Institutes, and the Public Health Accreditation Board have been awarded grants as partners in the CDC's funding to help support health departments.

In a statement, Michael Fraser, PhD, ASTHO's chief executive officer, said the investment in public health is historic and will help the country prepare for the next pandemic. "We will be helping states address training needs, supporting recruitment and retention efforts, and bringing subject matter experts and leaders together to build up their public health systems," he said.

EU global health strategy highlights antimicrobial resistance

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A new document outlining the European Union (EU) global health strategy indicates that intensifying the fight against antimicrobial resistance (AMR) will be among the bloc's priorities.

Citing global health as an essential pillar of EU external policy—and AMR as a leading global health threat—the document, written by the European Commission's Directorate-General for Health and Food Safety, lists tackling AMR via a comprehensive, multisectoral, and transdisciplinary "One Health" approach as one of its guiding principles. The One Health framework views human, animal, plant, and environmental health as intrinsically linked, and encourages AMR mitigation efforts to address how antimicrobials are used in humans, animals, and plants.

To support this principle, the document recommends the EU intensify its work with the Quadripartite (the World Health Organization, the Food and Agriculture Agency of the United Nations [UN], the World Organization for Animal Health, and the UN Environment Programme) to implement its One Health Joint Plan of Action, a 5-year program that seeks to improve the health of humans, animals, plants, and the environment while contributing to sustainable development.

It also calls on the EU to help build a robust global surveillance system to identify and address resistant bacteria and other zoonotic pathogens before they cross from animals to humans, to work towards the inclusion of concrete provisions on AMR in international pandemic agreements, and to support the development of and access to new antimicrobials, vaccines, and diagnostics.

"A quantum leap in health security will be achieved with a permanent mechanism that enhances equity in development of and access to tools such as vaccines, a global surveillance network which fully embodies One Health principles, and robust international rules, including enhanced measures to tackle anti-microbial resistance," the document states.

Paxlovid safe for pregnant COVID patients, fetuses, study finds

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Pregnant women can safely take the antiviral drug Paxlovid to reduce the risk of serious COVID-19 pregnancy or fetal complications, according to a small study published yesterday in JAMA Network Open.

Johns Hopkins researchers conducted a case series of 47 pregnant women with mild or moderate COVID-19 who were given nirmatrelvir-ritonavir (Paxlovid) and delivered at the Johns Hopkins Health System from Dec 22, 2021, to Aug 20, 2022. Median patient age was 34 years, 17% were Black, and 11% were Hispanic.

Sixteen patients (34.0%) had received the primary COVID-19 vaccination series, 21 (44.7%) had received one booster, and 3 (6.4%) had gotten two boosters. Thirty patients (63.8%) given Paxlovid had an underlying illness that may have put them at high risk for severe COVID-19.

The women were given Paxlovid a median of 1 day after COVID-19 symptom onset. Two patients (4.3%) didn't finish the course because of adverse effects.

Of the 47 patients, 25 (53.2%) delivered after Paxlovid treatment, and 12 (48.0%) of them had cesarean deliveries, of which 9 (75.0%) had been scheduled and weren't related to treatment. Two women (4.3%) were hospitalized for comorbidity-related conditions.

"In this case series, pregnant patients who were treated with nirmatrelvir and ritonavir tolerated treatment well, although there was an unexpectedly high rate of cesarean deliveries," the study authors wrote.

In a Johns Hopkins Medicine news release, co-senior author Irina Burd, MD, PhD, now at the University of Maryland, said that the clinical trials that enabled Paxlovid's emergency use authorization showed that infected participants who took the drug were 89% less likely to become severely ill or die than nonrecipients. "However, people who were pregnant weren’t among the participants, and pregnancy is now known to be a condition placing patients at risk of severe disease," she said.

Co-senior author Kelly Gebo, MD, MPH, said that although the results need confirmation, "We feel that even at this time, the medication should be strongly considered for pregnant patients who are unvaccinated or at risk for progression to severe COVID disease or not likely to have drug-drug interactions."

Fatal H5N1 avian flu case reported in China

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China has reported a fatal H5N1 avian flu case, its first since 2015, according to a notification from Hong Kong's Centre for Health Protection (CHP).

The woman is from Guangxi province in southern China. Her symptoms began on Sep 22, and she was hospitalized 3 days later. She died on Oct 18. The report doesn't say which H5N1 clade is involved, but human infections involving the earlier Asian clade are often severe or fatal. Human infections involving the Eurasian H5N1 strain, which over the past few years has spread to poultry across several world regions, are mild.

An investigation revealed that the woman had been exposed to live poultry before she got sick.

The CHP said that China has reported 54 human H5N1 cases since 2005.

In its latest update, the World Health Organization said the global H5N1 total is 865 cases, including 456 deaths.

Single dose of acoziborole 95% effective in treating sleeping sickness

News brief

A new study in The Lancet Infectious Diseases finds that a single oral dose of the drug acoziborole is 95% effective 18 months after treatment for sleeping sickness in adults and adolescents, regardless of disease stage.

Human African trypanosomiasis (HAT), more commonly known as sleeping sickness, is a neglected tropical disease most often seen in west and central Africa, especially the Democratic Republic of the Congo (DRC). The disease is caused by the parasite trypanosomes.

Though treatments exist, they are cumbersome: either a daily injection for at least 7 days during the early stages of the disease or an intravenous drip administered while hospitalized if the disease is caught in later stages. In 2019, a 10-day oral medication was introduced, but it requires extensive medical supervision.

In the current study, acoziborole, a drug co-developed by the Drugs for Neglected Diseases initiative (DNDi) and Sanofi, was given just once at a dose of 950 milligrams to 208 participants, including 167 people with late-stage disease and 41 with early- or intermediate-stage illness. Participants were followed for 18 months.

After 18 months, 95% (159 of 167) of patients with late-stage sleeping sickness treated with acoziborole were cured (no trypanosomes were present in body fluids), and all participants with early to intermediate illness were cured.

The authors acknowledged there was no control arm in the study. However, the positive results could lead the drug to help halt HAT by 2030.

In a commentary, Jacques Pepin, PhD, of the University of Sherbrooke, Canada, wrote, "Acoziborole represents an extraordinary advancement in the treatment of this neglected disease and might be key to the interruption of HAT transmission."

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