News Scan for Jan 27, 2015

News brief

Tuberculosis rates decrease in majority of EU countries

Tuberculosis cases decreased by 6% during 2012 in 29 European countries, while hot spots in northern Europe and the Baltic states remained, according to a report issued today by the European Centre for Disease Prevention and Control (ECDC)

The ECDC's Annual Epidemiological Report states that 68,423 cases of tuberculosis (TB) were reported in 29 European Union/European Economic Area (EU/EEA) countries during 2012. TB rates decreased in 19 countries, and the overall rate of new cases was 13.5 per 100,000 population.

Of the cases reported, 80% were newly diagnosed. Pulmonary TB accounted for 71% of cases, 23% were extrapulmonary, and 6% of cases were both pulmonary and extrapulmonary. HIV co-infection was present in 5% of TB cases.

Six countries accounted for 38% of all TB cases, with the highest rates of TB per 100,000 population occurring in Romania (85.2 per 100,000), followed by Lithuania (59.2), Latvia (48.6), Bulgaria (31.1), Portugal (25.2), and Estonia (21.6).

Multidrug-resistant (MDR) TB accounted for 5% of cases, although the proportion of MDR TB increased to 19% in patients who had received previous TB treatment. Of the 978 MDR TB cases reported, 14% of patients had extensively drug resistant (XDR) TB. MDR TB was present in 11% to 21% of new cases and 33% to 50% of previously treated cases in the Baltic States of Estonia, Latvia, and Lithuania.

People of foreign origin accounted for 27% of TB cases in the EU/EEA. The countries that experienced an increase or a stable number of cases during 2012 (Cyprus, Iceland, Luxembourg, Norway, Sweden, and the United Kingdom) all reported that at least 70% of their TB cases occurred in people of foreign origin.

TB in children under the age of 15 continued to decrease, and the ECDC reports that only 4% of cases in 2012 occurred in children. Males were overrepresented in all age groups, except in Iceland.

The ECDC reports that as of 2012, 75% of TB cases were successfully treated after 12 months, 34% of MDR cases finished treatment after 24 months, and 25% of XDR cases were fully treated after 36 months.
Jan 27 ECDC press release
Jan 27 ECDC report

Pfizer lowers price of pneumococcal vaccine for developing countries

Pfizer announced yesterday that it plans to offer its pneumococcal conjugate vaccine (PCV) Prevenar 13 in developing countries at a price of $3.10 per dose, a 6% cut, according to a Reuters story yesterday.

Pfizer's decision to reduce the cost of PCV in poor countries comes as it renews its commitment to the GAVI global vaccine alliance, which is currently meeting to discuss future funding efforts. The GAVI conference in Berlin this week is expected to raise $7.5 billion in support of immunizing 300 million children in developing countries through 2020.

Pfizer also promised to freeze its reduced price for Prevenar 13 through 2025, regardless of economic growth in poor countries where PCV is distributed.

Last week, the organization Doctors without Borders (MSF) urged vaccine manufacturers to reduce PCV prices to $5 per child in developing countries. Because children need three doses of PCV, MSF said in a statement yesterday to The Guardian that Pfizer's price-per-dose reduction is still inadequate.

MSF also urged Pfizer and other vaccine manufacturers that profit substantially from PCV sales to reveal country-specific prices for their vaccines and increase transparency in all parts of the vaccine research and production process.
Jan 26 Reuters story
Jan 26 Guardian article

Policeman guarding polio vaccinators in Pakistan killed

A Karachi policeman has become the latest victim of violence targeting polio vaccination teams in Pakistan, The News International, the country's largest newspaper, reported today.

The 22-year-old officer was shot to death yesterday by two unidentified assailants on motorcycles as he guarded a vaccination team near the Abbasi Shaheed Hospital in Nazimabad, a Karachi suburb. Officials could not immediately explain why the policeman was not part of a police team, as is standard procedure, the story said.

The attackers did not harm the vaccinators, who were administering oral polio vaccine to children on the fourth day of a vaccination drive.

As many as 883 polio workers are scheduled to administer polio vaccine in 11 regions, but officials fear that many of them would not report to work because of the attack, the story said.

In 2014 more than 60 polio workers or security personnel were killed in Pakistan, where certain factions consider polio vaccination to be a Western plot to sterilize Muslims. Pakistan is one of only three countries in which polio is still endemic.
Jan 27 News International story

AAP tweaks recommendations for flu, other childhood vaccines

The American Academy of Pediatrics (AAP) yesterday tweaked guidance for live-attenuated flu vaccines (LAIVs) in kids and for other childhood vaccines. The group revises its guidance annually.

The AAP Committee on Infectious Diseases added a column to the immunization schedule for 2- to 8-year-olds to emphasize the availability of LAIVs, as well as the need for two doses for some children in this age-group. It also noted when two doses are needed for 9- and 10-year-olds.

The group also made these changes:

Minor, clarifying word changes for catch-up doses of Haemophilus influenzae type b; pneumococcal conjugate; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed; hepatitis A; hepatitis B; polio; meningococcal; measles, mumps, and rubella; and varicella vaccines.
Minor, simplifying word changes regarding diphtheria-tetanus-acellular pertussis and pneumococcal conjugate vaccines.
Updated wording to reflect revised contraindications and precautions for LAIV.
Clarification of appropriate dosing schedules for high-risk infants and children receiving meningococcal vaccines.

Jan 26 AAP statement in Pediatrics

Flu Scan for Jan 27, 2015

News brief

Husband of Canadian H7N9 patient probably was infected, officials say

The husband of a British Columbia woman who was found to have the first H7N9 avian flu case in North America probably was infected with the virus too, according to a Canadian Press (CP) report today.

British Columbia officials said test results are still pending for the man, but he may test negative for the illness because he had already recovered when samples were taken, according to the story.

The story revealed that the couple, who have not been identified, returned to Canada from China Jan 12. The man got sick with flu-like symptoms 2 days later, and his wife fell ill a day after that. She decided to seek treatment, but her husband did not. They had typical flu symptoms, including fever and a cough.

The woman's physician decided to order a flu test, which was positive for influenza A, the story said. The doctor prescribed oseltamivir (Tamiflu) for the woman and her husband, and both recovered uneventfully, said Bonnie Henry, MD, British Columbia's deputy provincial health officer.

The British Columbia Centre for Disease Control (BCCDC) tried to type the woman's virus and found that it wasn't an H3N2 or H1N1 strain, the two type A seasonal flu subtypes. Further testing showed it was an H7, which prompted notification of national health authorities and additional testing that identified the virus as H7N9.

Henry said the man is likely to test negative because of his recovery, but there are plans to test both patients' blood for H7N9 antibodies, according to the story.

The couple reported visiting a number of places in China where chickens were present, but it probably won't be possible to determine just when and where they were infected, Henry told the CP. Most H7N9 patients have reported exposure to poultry.

No illnesses have been reported among contacts of the two patients, the story said. Person-to-person transmission of H7N9 has been reported only rarely, and Canadian officials have said they don't expect to see any further cases.
Jan 27 CP story
Jan 26 CIDRAP News story on woman's case
Jun 27, 2014, CIDRAP News story on H7N9 family clusters

H7N9 hospitalizes two more in China

The H7N9 avian influenza virus has sickened two more people in China's Guangdong province, according to a health department statement translated and posted by FluTrackers, an infectious disease news message board.

One is a 75-year-old woman from Longhua district who is hospitalized in critical condition in Shenzhen, and the other is a 62-year-old woman from Meijiang district who is in critical condition at a hospital in the city of Meizhou. The report didn't give dates for the illness onsets but said the cases were diagnosed yesterday.

Guangdong has reported cases each day for the past 6 days. The two new cases lift the global H7N9 total to 533, according to a case list maintained by FluTrackers.
Jan 27 FluTrackers thread on Guangdong province cases
FluTrackers H7N9 case list