News Scan for Feb 27, 2018

News brief

Nigeria Lassa fever outbreak grows, with 68 new cases reported

The Lassa fever outbreak in Nigeria continues this week with 68 new confirmed cases, including 4 deaths, according to the latest weekly update by the World Health Organization (WHO) Regional Office for Africa. That's up from 19 confirmed cases the week before.

Between Jan 1 and Feb 18, Nigeria has reported a total of 913 suspected cases and 73 deaths (case-fatality rate, 8%). The median age is 32, and two thirds of patients are male.

Though 17 states have reported suspected cases, Edo, Ondo and Ebonyi states are the outbreak hot spots, with Edo and Ondo accounting for 74% of confirmed cases. Those three states have established Lassa fever treatment centers, the WHO said. A total of 14 healthcare workers have been infected during this outbreak, 4 of them fatally.

Lassa fever is endemic in Nigeria, but this is an unusually large outbreak. The virus, which can cause hemorrhagic symptoms that mimic Ebola, is generally spread through contact with infected rats or via the bodily fluids of an infected person.
Feb 23 WHO update

Chikungunya outbreak strikes Kenya's second-largest city

The WHO today said a chikungunya outbreak that began in the middle of December in Mombasa, Kenya's second-largest city, has so far sickened 453 people, with 32 of the cases confirmed by lab tests.

This is the first time that active chikungunya circulation has been confirmed in Mombasa, which has a population of 1.2 million and is rapidly growing, leading to overcrowding. The WHO said numerous dump sites, inadequate drainage, and stagnant water offer ample breeding sites for the mosquitoes that transmit the disease. The WHO also said vector-control programs are inadequate.

Health officials first noticed the outbreak when an increasing number of patients in Mombasa County sought medical care for high-grade fever, joint pain, and weakness. Of eight blood samples collected on Dec 13, 2017, and tested at a lab in Nairobi, four were positive for dengue and four for chikungunya. Of 32 more samples collected in early January, 27 were positive for chikungunya.

In response to the outbreak, the WHO said it is helping Kenya's health ministry write a chikungunya response plan and assist the national emergency operations center in analyzing data and developing situation reports. Authorities are stepping up vector control, and health officials have sent alerts and fact sheets to health facilities in affected areas.

The WHO said it can't rule out the risk of more transmission in affected areas and spread to unaffected areas.
Feb 27 WHO statement

Study: Drug-resistant Pseudomonas aeruginosa spreads on hospital wards

A new single-center study shows that most antibiotic-resistant Pseudomonas aeruginosa infections were transmitted on hospital wards, but researchers failed to identify a persistent source for the bacteria. The study was published today in Antimicrobial Resistance & Infection Control.

In 2003, multidrug-resistant strains of P aeruginosa emerged as a growing concern in the Dutch hospital studied, as they led to high rates of morbidity and mortality in hospitalized patients, especially those being treated in intensive care units (ICUs). This study aimed to identify epidemiologic relationships between patients infected with this strain and common transmission routes.

The researchers retrospectively matched cases at the Erasmus MC University Medical Centre in Rotterdam from 2003 to 2015. Of the 144 case-patients identified, 87 (60.4%) acquired their infection in general adult ICUs. But no relationship was identified between infection and room sharing, patient admission date, or medical staff.

"Our hypothesis is that persistent sources in the innate environment play an important role in the route of transmission of this pathogen," the authors said. "This is in agreement with current knowledge on the behaviour of this bacterium, as well as previous outbreak reports that identified the environment as source/reservoir."
Feb 27 Antimicrob Resist Infect Control study

Zika Scan for Feb 27, 2018

News brief

Study highlights shortcomings of Zika testing

A report on two babies born in the Brownsville, Tex., area with congenital Zika infections showed that testing on their mothers during pregnancy and lab tests on babies don't always match up. Researchers from Driscoll Children's Hospital in Corpus Christi, Tex., where both babies were evaluated and treated, described their findings yesterday in Emerging Infectious Diseases.

The two cases were among 18 possible cases of Zika infection in pregnant women that were identified after enhanced testing and screening began in the Brownsville area in the wake of the first confirmed local Zika infection in November 2016. Both of the babies were born to mothers who had spent time in Matamoros, Mexico, during their pregnancies. One spent the first 4 months of her pregnancy in the city, and the other traveled there weekly during early pregnancy.

In both babies, microcephaly was detected during prenatal ultrasound, with findings confirmed after birth.

For the first baby's mother, probable filovirus infection wasn't found on lab testing until the third trimester, and the researchers said earlier immunoglobulin M (IgM) screening at 28 weeks' gestation might have shown a false-negative result. After birth, however, a blood test on her baby was positive for Zika IgM, and tests on the placenta were positive for Zika, confirming the infection in the mother.

In the second case-patient, the mother tested positive for Zika virus infection at 23 weeks, but blood tests on samples from her baby were negative, despite severe congenital Zika features.

The team said the findings for the two case-patients underscore the complexity and challenges of screening and testing for congenital Zika virus infection, as well as the importance of clinical findings and epidemiologic history.
Feb 26 Emerg Infect Dis study

Emergent, Valneva announce launch of phase 1 Zika vaccine trial

Emergent BioSolutions and Paris-based Valneva yesterday announced the launch of a phase 1 clinical trial to gauge the safety and immunogenicity of VLA1601, an inactivated Zika vaccine candidate that was developed based on Valneva's Japanese encephalitis vaccine platform.

In a statement, the companies said the study will involve 65 healthy adults and will evaluate two dose levels using two different vaccination schedules. Initial data are expected at the end of 2018 or in early 2019.

After phase 1 data are available, Emergent BioSolutions has the option to continue developing and commercializing the vaccine under a licensing agreement with Valneva for a milestone payment of $6.1 million. Valneva would receive additional milestone payments based on further development, approval, commercialization, product sales, and royalties.

Thomas Lingelbach, president and chief executive officer of Valneva said, "We are delighted that our collaboration with Emergent has resulted in the clinical progression of a very promising vaccine candidate. This vaccine candidate has already demonstrated an excellent preclinical profile comparable to Valneva's licensed Japanese Encephalitis vaccine."
Feb 26 Emergent BioSolutions press release