News Scan for Jun 22, 2017

News brief

Highest EU court says no proof needed when ruling on vaccine side effects

Even in the absence of scientific pro, the highest court of the European Union (EU) said yesterday that courts can decide whether a vaccination led to someone developing an illness without definitive scientific proof, the New York Times reported.

The decision was based on a French case that involved a man who was immunized against hepatitis B in the late 1990s and later developed multiple sclerosis. The man sued the vaccine manufacturer, Sanofi Pasteur, in 2006 for damages.

France's Court of Appeal dismissed the case based on a lack of causal evidence between hepatitis B vaccine administration and multiple sclerosis.

But the EU's top court said that if there was "specific and consistent evidence" between vaccine administration and illness onset, a vaccine could be considered defective. The court said some factors could lead a national court to conclude that "the administering of the vaccine is the most plausible explanation" for the disease and that "the vaccine therefore does not offer the safety that one is entitled to expect.”

According to the story, the court did rule specifically on the French case.
Jun 21 New York Times story

NDM-1 gene identified in CRE isolates at Mexican hospital

Researchers have identified four Enterobacteriaceae species harboring the carbapenem-resistance gene NDM-1 among isolates collected at a tertiary care hospital in Mexico, according to a study yesterday in PLoS One.

Of the more than 3,000 isolates collected at the hospital from September 2014 to July 2015 following detection of an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), 86 (2.83%) were found to be carbapenem resistant and carbapenemase producers, and 52 isolates (one per patient) were selected for further study. Carbapenemase-producing species included Klebsiella pneumoniae (46 isolates), Enterobacter cloacae (3), Escherichia coli (1), Providencia rettgeri (1), and Citrobacter freundii (1). Fifty-one of the 52 isolates were classified as multidrug-resistant.

The NDM-1 gene was detected in 46 K pneumoniae isolates, 3 E cloacae isolates, 1 E coli isolate, and 1 P rettgeri isolate, for a total of 51. Other carbapenemase genes detected included VIM, IMP, and KPC. The transfer of plasmids harboring the NDM-1 gene was obtained in eight transconjugants.

Analysis of clonal diversity revealed that 60% of the K pneumoniae isolates belonged to clone A, corresponding to the ST392 strain. The ST307, ST309, ST846, ST2399, and ST2400 strains were also detected in K pneumoniae. The E coli isolate corresponded to ST10, and the E cloacae isolate corresponded to ST182.

"The results obtained in this study indicate that blaNDM-1 was disseminated horizontally among different species in a tertiary care hospital in Mexico, also with proof of strain spread predominantly of K. pneumoniae ST392," the authors write. "We have provided evidence of plasmid transfer but, given the variation in plasmid sizes, complex rearrangements must also be occurring."

The authors note that while the detection of more than one CRE species and multiple carbapenemase genes in the same hospital in the same period has previously been reported, it's been in countries distant from Mexico (China and Kuwait). "Because of this, our report underscores the importance of active surveillance in all enterobacterial species," they write.
Jun 21 PLoS One study

Suspected cholera cases in Yemen top 185,000

In an update today on a large cholera outbreak in Yemen that has been under way since October 2016, the World Health Organization (WHO) Eastern Mediterranean regional office (WHO EMRO) said today that 37,079 more suspected cases were reported last week, along with 196 related deaths.

As of yesterday, the outbreak total stands at 185,301 suspected cases and 1,233 deaths, the WHO said. It added that the overall case-fatality rate is 0.7%, though the percentage is higher in people older than 60. The WHO and its partners have established 18 diarrhea treatment facilities and 28 oral rehydration centers in response to the outbreak.

Though the disease is endemic in Yemen, the country has seen a surge in cholera cases since late April. The cholera outbreak has struck 268 districts in 20 of 21 Yemeni governorates.
Jun 22 WHO update

Flu Scan for Jun 22, 2017

News brief

Study finds no link between flu in pregnancy, autism in babies

Researchers have found no elevated risk of autism in babies born to woman in Norway infected with influenza during pregnancy, a study yesterday in mSphere reported.

Scientists from Columbia University's Mailman School of Public Health analyzed questionnaires and blood samples from 338 mothers of children with autism spectrum disorder (ASD) and 348 matched controls as part of the Autism Birth Cohort Study, a prospective birth cohort in Norway. They collected blood samples from the women at mid-pregnancy and after delivery, and the mothers also reported their cold and flu symptoms during pregnancy.

Neither influenza A or B was associated with an increased risk of ASD. When the researchers integrated reports of symptoms of influenza-like illness with serology they estimated an increase in risk for influenza-seropositive women who had symptoms, but this increase did not achieve statistical significance.

The study is the first to assess the risk for ASD based on lab-verified maternal flu and not just on survey data or medical records, according to a Columbia University press release.

"Symptoms are important because they may indicate the extent to which the mother's immune system is fighting the flu," said first author Milada Mahic, PhD, a research scientist, in the release. "If infection is contributing to increased risk [of ASD], it likely comes from inflammation related to maternal immune system response rather than the flu infection itself. Further research is warranted."
Jun 21 mSphere study
Jun 21 Columbia University news release

South Africa reports it first H5N8 avian flu outbreak

South Africa today reported its first highly pathogenic H5N8 avian flu outbreak, becoming the eighth African nation to detect the virus. According to a notification from government officials to the World Organization for Animal Health (OIE), the event began on Jun 19 at a commercial broiler-breeder farm Mpumalanga province in the country's eastern region.

The virus killed 5,000 of 24,000 susceptible birds, and authorities are culling the surviving ones to curb the spread of the outbreak. Other measures include quarantine, establishing a surveillance zone, and disinfecting the facility.

Two other African nations—the Democratic Republic of Congo and Zimbabwe—reported their first H5N8 outbreaks over the past few weeks. Other African countries affected by the virus over the past several months are Cameroon, Niger, Nigeria, Tunisia, and Uganda.
Jun 22 OIE report on H5N8 in South Africa

In other H5N8 developments, Belgium reported three more outbreaks, according to separate reports to the OIE. One began on Jun 20 at a location in West Flanders province where a trader raises birds intended for hobbyists. All 972 birds were culled, and officials said the source of the virus was introduction of new live animals and fomites such as humans, vehicles, or feed.

The other two outbreaks also began on Jun 20 and involved birds not classified as poultry, which could mean wild birds or those at zoos or park reserves. Affected locations were Hainaut and Namur provinces in the west. Between the two events, the virus killed 57 of 167 birds.
Jun 21 OIE report on H5N8 in Belgian hobby birds
Jun 21 OIE report on H5N8 in Belgian nonpoultry

Survey finds words, graphics shape flu perceptions, intent to vaccinate

Flu threats involving strains having more exotic names, compared with scientific and animal-origin nomenclature, were more likely to raise concerns and motivate people to be vaccinated, according to survey findings published yesterday in Emerging Infectious Diseases.

A team from three American universities and their collaborators in the Netherlands randomly recruited adults from the United States and 10 European countries and asked them to read a mock news article from a health organization about the spread of a pandemic strain in their country, which contained information about symptoms, severity, and vaccine development. They tested three different versions of the materials, each with a different hypothetical influenza name: H11N3, "horse flu," or Yarraman flu. The latter is the Australian aboriginal name for horse.

Based on responses from 16,510 participants, the team found that the exotic-sounding and scientific names elicited greater worry and intent to vaccinate than did the strain named after an animal reservoir.

As part of the survey, the same group also examined perceptions of graphics that depict the spread of infectious diseases. Heat maps showing hot spots were more likely to generate concern than bar graphs or dot maps. The researchers had reported the graphics findings Jun 12 in Vaccine.

Taken together, the findings suggest that the way health information is communicated matters.

Angie Fagerlin, PhD, a study coauthor and chair of population health sciences at University of Utah Health, said in a press release from the school, "Our results highlight that choices for public communications about health issues cannot be made simply by convenience or without consideration. If we can present information in ways that increase the public's understanding, it's a win for everybody."
Jun 21 Emerg Infect Dis report
Jun 12 Vaccine abstract
Jun 21 University of Utah Health press release