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Richard Pizzi is editor of The Hospitalist. He has been an editor at Frontline Medical Communications since 2015, and previously served as editor of MDedge publications Hospitalist News and ID Practitioner. He has also worked as an editor and in editorial management roles for HIMSS Media, MedTech Media, and the American Association for Clinical Chemistry. Follow him on Twitter @richpizzi
Chlorhexidine baths help hospitals control extensively drug-resistant pathogen
With an outbreak of the extensively drug-resistant pathogen Acinetobacter baumannii (XDR-Ab), patient screening and daily chlorhexidine baths were part of a comprehensive outbreak control strategy, a new study suggested.
XDR-Ab transmission within hospitals has been documented via direct and indirect patient contact, inadequate sterilization of medical devices, contamination of rooms, and colonized health care workers, said Dr. Yves Longtin, chair of the infection prevention and control unit at Jewish General Hospital in Montreal. Dr. Longtin and his coauthors described the epidemiology and control of an XDR-Ab outbreak that involved multiple units of a large Canadian hospital in a recent article published in the Journal of Hospital Infection.
The outbreak was the result of a single clonal strain of XDR-Ab that colonized or infected 29 patients, 5 of whom died of XDR-Ab bacteremia. Transmission occurred primarily on two wards, either directly between patients or indirectly through staff, shared equipment, or the environment, investigators found. There is currently no consensus on optimal screening procedures, nor on the best combination of interventions to prevent transmission among patients, Dr. Longtin and his colleagues said.
The outbreak described in the study ended following the application of intensive screening, environmental disinfection, source control, reinforcement of routine hygiene, and isolation procedures including cohorting and unit closure. Intensive screening – screening of rectum, groin, throat, urine (in catheterized patients), wounds, and other catheter sites – revealed that 57% of infected patients were rectal carriers of the bacterium. Thus, a single rectal screening, considered standard for detection of carbapenem-resistant Enterobacteriaceae, would not have been sufficient to detect all infected patients.
Colonized patients received daily chlorhexidine baths, a strategy that is a useful tool in the control of other antibiotic-resistant nosocomial pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, but is not mentioned in the recent acinetobacter-specific guidelines or reviews, Dr. Longtin and coauthors said. They hypothesized that the prompt resolution of the outbreak may have been due in part to the use of the chlorhexidine baths.
Read the full study in the Journal of Hospital Infection (doi: 10.1016/j.jhin.2015.12.013).
On Twitter @richpizzi
With an outbreak of the extensively drug-resistant pathogen Acinetobacter baumannii (XDR-Ab), patient screening and daily chlorhexidine baths were part of a comprehensive outbreak control strategy, a new study suggested.
XDR-Ab transmission within hospitals has been documented via direct and indirect patient contact, inadequate sterilization of medical devices, contamination of rooms, and colonized health care workers, said Dr. Yves Longtin, chair of the infection prevention and control unit at Jewish General Hospital in Montreal. Dr. Longtin and his coauthors described the epidemiology and control of an XDR-Ab outbreak that involved multiple units of a large Canadian hospital in a recent article published in the Journal of Hospital Infection.
The outbreak was the result of a single clonal strain of XDR-Ab that colonized or infected 29 patients, 5 of whom died of XDR-Ab bacteremia. Transmission occurred primarily on two wards, either directly between patients or indirectly through staff, shared equipment, or the environment, investigators found. There is currently no consensus on optimal screening procedures, nor on the best combination of interventions to prevent transmission among patients, Dr. Longtin and his colleagues said.
The outbreak described in the study ended following the application of intensive screening, environmental disinfection, source control, reinforcement of routine hygiene, and isolation procedures including cohorting and unit closure. Intensive screening – screening of rectum, groin, throat, urine (in catheterized patients), wounds, and other catheter sites – revealed that 57% of infected patients were rectal carriers of the bacterium. Thus, a single rectal screening, considered standard for detection of carbapenem-resistant Enterobacteriaceae, would not have been sufficient to detect all infected patients.
Colonized patients received daily chlorhexidine baths, a strategy that is a useful tool in the control of other antibiotic-resistant nosocomial pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, but is not mentioned in the recent acinetobacter-specific guidelines or reviews, Dr. Longtin and coauthors said. They hypothesized that the prompt resolution of the outbreak may have been due in part to the use of the chlorhexidine baths.
Read the full study in the Journal of Hospital Infection (doi: 10.1016/j.jhin.2015.12.013).
On Twitter @richpizzi
With an outbreak of the extensively drug-resistant pathogen Acinetobacter baumannii (XDR-Ab), patient screening and daily chlorhexidine baths were part of a comprehensive outbreak control strategy, a new study suggested.
XDR-Ab transmission within hospitals has been documented via direct and indirect patient contact, inadequate sterilization of medical devices, contamination of rooms, and colonized health care workers, said Dr. Yves Longtin, chair of the infection prevention and control unit at Jewish General Hospital in Montreal. Dr. Longtin and his coauthors described the epidemiology and control of an XDR-Ab outbreak that involved multiple units of a large Canadian hospital in a recent article published in the Journal of Hospital Infection.
The outbreak was the result of a single clonal strain of XDR-Ab that colonized or infected 29 patients, 5 of whom died of XDR-Ab bacteremia. Transmission occurred primarily on two wards, either directly between patients or indirectly through staff, shared equipment, or the environment, investigators found. There is currently no consensus on optimal screening procedures, nor on the best combination of interventions to prevent transmission among patients, Dr. Longtin and his colleagues said.
The outbreak described in the study ended following the application of intensive screening, environmental disinfection, source control, reinforcement of routine hygiene, and isolation procedures including cohorting and unit closure. Intensive screening – screening of rectum, groin, throat, urine (in catheterized patients), wounds, and other catheter sites – revealed that 57% of infected patients were rectal carriers of the bacterium. Thus, a single rectal screening, considered standard for detection of carbapenem-resistant Enterobacteriaceae, would not have been sufficient to detect all infected patients.
Colonized patients received daily chlorhexidine baths, a strategy that is a useful tool in the control of other antibiotic-resistant nosocomial pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, but is not mentioned in the recent acinetobacter-specific guidelines or reviews, Dr. Longtin and coauthors said. They hypothesized that the prompt resolution of the outbreak may have been due in part to the use of the chlorhexidine baths.
Read the full study in the Journal of Hospital Infection (doi: 10.1016/j.jhin.2015.12.013).
On Twitter @richpizzi
FROM THE JOURNAL OF HOSPITAL INFECTION
HIV research update: Late January 2016
A large volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Researchers have identified the molecular mechanisms by which the Tat protein made by HIV interacts with the host cell to activate or repress several hundred human genes. “The findings clearly suggest that blocking Tat activity may be of therapeutic value to HIV patients,” said Dr. Iván D’Orso of the department of microbiology at University of Texas Southwestern, Dallas, who is senior author of the study. The study provides insights into HIV’s ability to survive despite antiretroviral therapy, findings that could lead to new therapeutic targets or ways to make current therapies more effective.
A study published in Nature found that HIV is still replicating in lymphoid tissue, even when it is undetectable in the blood of patients on antiretroviral drugs. The findings provide a new perspective on how the HIV virus rapidly rebounds in the blood if patients stop antiretroviral therapy. This suggests that long-lived latently infected cells and/or ongoing low levels of HIV replication maintain these viral reservoirs.
A research team at the University of Maryland, Baltimore, explored a potential interrelationship between smoking, highly active antiretroviral therapy (HAART), and HIV immune status. They discovered that HIV-positive status, along with concurrent tobacco smoking, is associated with declines in pulmonary function test in HIV-infected women, but that the use of HAART in patients appears to mitigate the increases in IL-8 levels in relation to immune status, based on CD4 count.
New research published in the Journal of Hospital Infection suggests that a treatment regimen of two nucleoside reverse transcriptase inhibitors plus efavirenz should not be used for HIV prophylaxis following occupational exposure, particularly in resource-limited settings. The study indicates that such a regimen was significantly associated with premature discontinuation of occupational postexposure prophylaxis among health care workers.
A study in the journal Sexually Transmitted Diseases suggests that adolescent environmental influences and individual characteristics drive some sexual risk behaviors and may be more effective targets for sexually transmitted infection and HIV prevention interventions than do proximal risk behaviors.
Immediate antiretroviral therapy initiation is expected to substantially lower mortality among persons recently diagnosed with HIV in the United States, according to new research published in the International Journal of Epidemiology. Investigators also demonstrated a method by which concerns about generalizability can be addressed and evaluated quantitatively.
Researchers discovered that, compared with hepatitis C virus antibody–negative status, chronic HCV infection was associated with lower CD4/CD8 ratios when HIV viral load was suppressed to the lower limit of quantification. Cleared HCV, but not IFNL4-[DELTA]G genotype or HCV viral load, was also associated with lower CD4/CD8 ratios when HIV viral load was suppressed to the LLQ.” The results support the use of CD4/CD8 ratio for routine monitoring of immune activation and inflammation in HIV+ patients, including those with HIV/HCV coinfection.
On Twitter @richpizzi
A large volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Researchers have identified the molecular mechanisms by which the Tat protein made by HIV interacts with the host cell to activate or repress several hundred human genes. “The findings clearly suggest that blocking Tat activity may be of therapeutic value to HIV patients,” said Dr. Iván D’Orso of the department of microbiology at University of Texas Southwestern, Dallas, who is senior author of the study. The study provides insights into HIV’s ability to survive despite antiretroviral therapy, findings that could lead to new therapeutic targets or ways to make current therapies more effective.
A study published in Nature found that HIV is still replicating in lymphoid tissue, even when it is undetectable in the blood of patients on antiretroviral drugs. The findings provide a new perspective on how the HIV virus rapidly rebounds in the blood if patients stop antiretroviral therapy. This suggests that long-lived latently infected cells and/or ongoing low levels of HIV replication maintain these viral reservoirs.
A research team at the University of Maryland, Baltimore, explored a potential interrelationship between smoking, highly active antiretroviral therapy (HAART), and HIV immune status. They discovered that HIV-positive status, along with concurrent tobacco smoking, is associated with declines in pulmonary function test in HIV-infected women, but that the use of HAART in patients appears to mitigate the increases in IL-8 levels in relation to immune status, based on CD4 count.
New research published in the Journal of Hospital Infection suggests that a treatment regimen of two nucleoside reverse transcriptase inhibitors plus efavirenz should not be used for HIV prophylaxis following occupational exposure, particularly in resource-limited settings. The study indicates that such a regimen was significantly associated with premature discontinuation of occupational postexposure prophylaxis among health care workers.
A study in the journal Sexually Transmitted Diseases suggests that adolescent environmental influences and individual characteristics drive some sexual risk behaviors and may be more effective targets for sexually transmitted infection and HIV prevention interventions than do proximal risk behaviors.
Immediate antiretroviral therapy initiation is expected to substantially lower mortality among persons recently diagnosed with HIV in the United States, according to new research published in the International Journal of Epidemiology. Investigators also demonstrated a method by which concerns about generalizability can be addressed and evaluated quantitatively.
Researchers discovered that, compared with hepatitis C virus antibody–negative status, chronic HCV infection was associated with lower CD4/CD8 ratios when HIV viral load was suppressed to the lower limit of quantification. Cleared HCV, but not IFNL4-[DELTA]G genotype or HCV viral load, was also associated with lower CD4/CD8 ratios when HIV viral load was suppressed to the LLQ.” The results support the use of CD4/CD8 ratio for routine monitoring of immune activation and inflammation in HIV+ patients, including those with HIV/HCV coinfection.
On Twitter @richpizzi
A large volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Researchers have identified the molecular mechanisms by which the Tat protein made by HIV interacts with the host cell to activate or repress several hundred human genes. “The findings clearly suggest that blocking Tat activity may be of therapeutic value to HIV patients,” said Dr. Iván D’Orso of the department of microbiology at University of Texas Southwestern, Dallas, who is senior author of the study. The study provides insights into HIV’s ability to survive despite antiretroviral therapy, findings that could lead to new therapeutic targets or ways to make current therapies more effective.
A study published in Nature found that HIV is still replicating in lymphoid tissue, even when it is undetectable in the blood of patients on antiretroviral drugs. The findings provide a new perspective on how the HIV virus rapidly rebounds in the blood if patients stop antiretroviral therapy. This suggests that long-lived latently infected cells and/or ongoing low levels of HIV replication maintain these viral reservoirs.
A research team at the University of Maryland, Baltimore, explored a potential interrelationship between smoking, highly active antiretroviral therapy (HAART), and HIV immune status. They discovered that HIV-positive status, along with concurrent tobacco smoking, is associated with declines in pulmonary function test in HIV-infected women, but that the use of HAART in patients appears to mitigate the increases in IL-8 levels in relation to immune status, based on CD4 count.
New research published in the Journal of Hospital Infection suggests that a treatment regimen of two nucleoside reverse transcriptase inhibitors plus efavirenz should not be used for HIV prophylaxis following occupational exposure, particularly in resource-limited settings. The study indicates that such a regimen was significantly associated with premature discontinuation of occupational postexposure prophylaxis among health care workers.
A study in the journal Sexually Transmitted Diseases suggests that adolescent environmental influences and individual characteristics drive some sexual risk behaviors and may be more effective targets for sexually transmitted infection and HIV prevention interventions than do proximal risk behaviors.
Immediate antiretroviral therapy initiation is expected to substantially lower mortality among persons recently diagnosed with HIV in the United States, according to new research published in the International Journal of Epidemiology. Investigators also demonstrated a method by which concerns about generalizability can be addressed and evaluated quantitatively.
Researchers discovered that, compared with hepatitis C virus antibody–negative status, chronic HCV infection was associated with lower CD4/CD8 ratios when HIV viral load was suppressed to the lower limit of quantification. Cleared HCV, but not IFNL4-[DELTA]G genotype or HCV viral load, was also associated with lower CD4/CD8 ratios when HIV viral load was suppressed to the LLQ.” The results support the use of CD4/CD8 ratio for routine monitoring of immune activation and inflammation in HIV+ patients, including those with HIV/HCV coinfection.
On Twitter @richpizzi
Hepatitis B vaccine protection lasts 30 years
Ninety percent of patients in a 1981 hepatitis B vaccine trial still had evidence of immune protection 30 years later, according to a study in the Journal of Infectious Diseases.
The duration of protection after vaccination with hepatitis B virus vaccine is not well understood, although HBV vaccines have been effective at preventing infection, said authors of a new study led by Dr. Michael Bruce of the division of preparedness and emerging infections at the Centers for Disease Control and Prevention. To better assess the duration of protection offered by the plasma-derived hepatitis B vaccine, investigators performed a follow-up study of 1,578 Alaska Native adults and children aged at least 6 months who had been vaccinated in 1981 with three doses of the HBV vaccine.
Dr. Bruce and his colleagues recruited 243 members of the original cohort who responded to the original primary vaccine series but received no subsequent doses during the 30-year period. The researchers tested cohort members for antibody to hepatitis B surface antigen (anti-HBs) levels. Those with levels less than 10 mIU/mL received one booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days after the booster.
Of the patients tested, 125 (51%) had anti-HBs levels greater than or equal to 10 mIU/mL. Among participants with anti-HBs levels below 10 mIU/mL who were available for follow-up, 75 of 85 (88%) responded to a booster dose with an anti-HBs level greater than or equal to 10 mIU/mL at 30 days.
Dr. Bruce and his colleagues concluded that, based on anti-HBs level greater than or equal to 10 mIU/mL at 30 years and an 88% booster dose response, at least 90% of participants had evidence of protection 30 years later, and thus HBV vaccine booster doses are not needed for persons 30 years out from a primary HBV vaccine series.
Read the full study in the Journal of Infectious Diseases (J Infect Dis. 2016 Jan 21. doi: 10.1093/infdis/jiv748).
On Twitter @richpizzi
Ninety percent of patients in a 1981 hepatitis B vaccine trial still had evidence of immune protection 30 years later, according to a study in the Journal of Infectious Diseases.
The duration of protection after vaccination with hepatitis B virus vaccine is not well understood, although HBV vaccines have been effective at preventing infection, said authors of a new study led by Dr. Michael Bruce of the division of preparedness and emerging infections at the Centers for Disease Control and Prevention. To better assess the duration of protection offered by the plasma-derived hepatitis B vaccine, investigators performed a follow-up study of 1,578 Alaska Native adults and children aged at least 6 months who had been vaccinated in 1981 with three doses of the HBV vaccine.
Dr. Bruce and his colleagues recruited 243 members of the original cohort who responded to the original primary vaccine series but received no subsequent doses during the 30-year period. The researchers tested cohort members for antibody to hepatitis B surface antigen (anti-HBs) levels. Those with levels less than 10 mIU/mL received one booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days after the booster.
Of the patients tested, 125 (51%) had anti-HBs levels greater than or equal to 10 mIU/mL. Among participants with anti-HBs levels below 10 mIU/mL who were available for follow-up, 75 of 85 (88%) responded to a booster dose with an anti-HBs level greater than or equal to 10 mIU/mL at 30 days.
Dr. Bruce and his colleagues concluded that, based on anti-HBs level greater than or equal to 10 mIU/mL at 30 years and an 88% booster dose response, at least 90% of participants had evidence of protection 30 years later, and thus HBV vaccine booster doses are not needed for persons 30 years out from a primary HBV vaccine series.
Read the full study in the Journal of Infectious Diseases (J Infect Dis. 2016 Jan 21. doi: 10.1093/infdis/jiv748).
On Twitter @richpizzi
Ninety percent of patients in a 1981 hepatitis B vaccine trial still had evidence of immune protection 30 years later, according to a study in the Journal of Infectious Diseases.
The duration of protection after vaccination with hepatitis B virus vaccine is not well understood, although HBV vaccines have been effective at preventing infection, said authors of a new study led by Dr. Michael Bruce of the division of preparedness and emerging infections at the Centers for Disease Control and Prevention. To better assess the duration of protection offered by the plasma-derived hepatitis B vaccine, investigators performed a follow-up study of 1,578 Alaska Native adults and children aged at least 6 months who had been vaccinated in 1981 with three doses of the HBV vaccine.
Dr. Bruce and his colleagues recruited 243 members of the original cohort who responded to the original primary vaccine series but received no subsequent doses during the 30-year period. The researchers tested cohort members for antibody to hepatitis B surface antigen (anti-HBs) levels. Those with levels less than 10 mIU/mL received one booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days after the booster.
Of the patients tested, 125 (51%) had anti-HBs levels greater than or equal to 10 mIU/mL. Among participants with anti-HBs levels below 10 mIU/mL who were available for follow-up, 75 of 85 (88%) responded to a booster dose with an anti-HBs level greater than or equal to 10 mIU/mL at 30 days.
Dr. Bruce and his colleagues concluded that, based on anti-HBs level greater than or equal to 10 mIU/mL at 30 years and an 88% booster dose response, at least 90% of participants had evidence of protection 30 years later, and thus HBV vaccine booster doses are not needed for persons 30 years out from a primary HBV vaccine series.
Read the full study in the Journal of Infectious Diseases (J Infect Dis. 2016 Jan 21. doi: 10.1093/infdis/jiv748).
On Twitter @richpizzi
FROM THE JOURNAL OF INFECTIOUS DISEASES
Ebola research update: January 2016
The struggle to defeat Ebola virus disease continues globally, although it may not always make the headlines. To catch up on what you may have missed, here are some notable news items and journal articles published over the past few weeks that are worth a second look.
Individuals from areas of poverty were associated with high rates of transmission and spread of Ebola to other regions, according to a study in PLOS Neglected Tropical Diseases. A research team at the Yale School of Public Health analyzed the heterogeneity of Ebola incidence and transmission factors among 300 communities, categorized by socioeconomic status, within Montserrado County, Liberia, and found that infected individuals from communities of middle and low socioeconomic status were associated with 1.5 and 3.5 times as many secondary cases as those from communities of high socioeconomic status. This suggests Ebola could most effectively be prevented or contained if disease interventions were targeted to areas of extreme poverty and funding were dedicated to development projects that meet basic needs.
A recent study published online in the Journal of Virology shows a promising mechanism for attacking the Ebola virus. A team at the Texas Biomedical Research Institute used ultradeep sequencing to reveal that the spontaneous mutation frequency for Ebola virus was high and similar to that of other RNA viruses, although the Ebola virus had very limited ability to tolerate spontaneous changes in the genome. Testing the drug ribavirin in mouse and monkey models of postexposure therapy, researchers delayed the time to subject death and increased survival.
Dr. Tom Koch, a medical geographer at the University of British Columbia, Vancouver, reflects in a review essay in the International Journal of Epidemiology on what could have been done differently in the efforts to prevent the Ebola epidemic in 2014. He said the limits of patient location and travel mapping are reasons why it was difficult to contain Ebola from spreading. Maps and census data were almost nonexistent for the region in Guinea where the outbreak occurred, and aggressive quarantine programs were not quickly enacted.
A clinical team at an Ebola treatment unit in Sierra Leone has published guidelines for the treatment of children with Ebola virus disease. The aggressive approach they recommend calls for giving children fluids intravenously; treating other possible infections; feeding them highly fortified food; and greatly increasing the amount of bedside care they receive.
A rapid screening assay has been used for the first time in a standard open laboratory to identify and test promising anti-Ebola drugs. Research on new Ebola therapies has been limited by an inability to compare antiviral effectiveness, since cell model systems, treatment regimens and results are so varied that it is difficult to compare effectiveness amongst the compounds.
Researchers reported in Emerging Infectious Diseases that polymerase chain reaction–based testing for Plasmodium spp. parasitemia can be implemented easily and safely in laboratories performing Ebola virus disease diagnostics to assist with case-patient management during EVD outbreaks in malaria-endemic areas.
A researcher team at Vanderbilt University Medical Center, Nashville, Tenn., and the University of Texas Medical Branch in Galveston reported in the journal Cell that they have isolated human monoclonal antibodies from Ebola survivors that can neutralize multiple species of the virus. Investigators said the results provide a “roadmap to develop a single antibody-based treatment.”
In a letter to the editor of Emerging Infectious Diseases, clinicians who worked during the Ebola virus disease outbreak in West Africa recommend that Ebola virus–positive women stop breastfeeding immediately and that breastfeeding not be resumed until two negative reverse transcription polymerase chain reaction tests of the breast milk have been confirmed.
A report in MMWR describes the design and implementation of the Ebola active monitoring program established by the New York City Department of Health and Mental Hygiene (DOHMH) during its first 6 months (October 2014-April 2015) of operation.
On Twitter @richpizzi
The struggle to defeat Ebola virus disease continues globally, although it may not always make the headlines. To catch up on what you may have missed, here are some notable news items and journal articles published over the past few weeks that are worth a second look.
Individuals from areas of poverty were associated with high rates of transmission and spread of Ebola to other regions, according to a study in PLOS Neglected Tropical Diseases. A research team at the Yale School of Public Health analyzed the heterogeneity of Ebola incidence and transmission factors among 300 communities, categorized by socioeconomic status, within Montserrado County, Liberia, and found that infected individuals from communities of middle and low socioeconomic status were associated with 1.5 and 3.5 times as many secondary cases as those from communities of high socioeconomic status. This suggests Ebola could most effectively be prevented or contained if disease interventions were targeted to areas of extreme poverty and funding were dedicated to development projects that meet basic needs.
A recent study published online in the Journal of Virology shows a promising mechanism for attacking the Ebola virus. A team at the Texas Biomedical Research Institute used ultradeep sequencing to reveal that the spontaneous mutation frequency for Ebola virus was high and similar to that of other RNA viruses, although the Ebola virus had very limited ability to tolerate spontaneous changes in the genome. Testing the drug ribavirin in mouse and monkey models of postexposure therapy, researchers delayed the time to subject death and increased survival.
Dr. Tom Koch, a medical geographer at the University of British Columbia, Vancouver, reflects in a review essay in the International Journal of Epidemiology on what could have been done differently in the efforts to prevent the Ebola epidemic in 2014. He said the limits of patient location and travel mapping are reasons why it was difficult to contain Ebola from spreading. Maps and census data were almost nonexistent for the region in Guinea where the outbreak occurred, and aggressive quarantine programs were not quickly enacted.
A clinical team at an Ebola treatment unit in Sierra Leone has published guidelines for the treatment of children with Ebola virus disease. The aggressive approach they recommend calls for giving children fluids intravenously; treating other possible infections; feeding them highly fortified food; and greatly increasing the amount of bedside care they receive.
A rapid screening assay has been used for the first time in a standard open laboratory to identify and test promising anti-Ebola drugs. Research on new Ebola therapies has been limited by an inability to compare antiviral effectiveness, since cell model systems, treatment regimens and results are so varied that it is difficult to compare effectiveness amongst the compounds.
Researchers reported in Emerging Infectious Diseases that polymerase chain reaction–based testing for Plasmodium spp. parasitemia can be implemented easily and safely in laboratories performing Ebola virus disease diagnostics to assist with case-patient management during EVD outbreaks in malaria-endemic areas.
A researcher team at Vanderbilt University Medical Center, Nashville, Tenn., and the University of Texas Medical Branch in Galveston reported in the journal Cell that they have isolated human monoclonal antibodies from Ebola survivors that can neutralize multiple species of the virus. Investigators said the results provide a “roadmap to develop a single antibody-based treatment.”
In a letter to the editor of Emerging Infectious Diseases, clinicians who worked during the Ebola virus disease outbreak in West Africa recommend that Ebola virus–positive women stop breastfeeding immediately and that breastfeeding not be resumed until two negative reverse transcription polymerase chain reaction tests of the breast milk have been confirmed.
A report in MMWR describes the design and implementation of the Ebola active monitoring program established by the New York City Department of Health and Mental Hygiene (DOHMH) during its first 6 months (October 2014-April 2015) of operation.
On Twitter @richpizzi
The struggle to defeat Ebola virus disease continues globally, although it may not always make the headlines. To catch up on what you may have missed, here are some notable news items and journal articles published over the past few weeks that are worth a second look.
Individuals from areas of poverty were associated with high rates of transmission and spread of Ebola to other regions, according to a study in PLOS Neglected Tropical Diseases. A research team at the Yale School of Public Health analyzed the heterogeneity of Ebola incidence and transmission factors among 300 communities, categorized by socioeconomic status, within Montserrado County, Liberia, and found that infected individuals from communities of middle and low socioeconomic status were associated with 1.5 and 3.5 times as many secondary cases as those from communities of high socioeconomic status. This suggests Ebola could most effectively be prevented or contained if disease interventions were targeted to areas of extreme poverty and funding were dedicated to development projects that meet basic needs.
A recent study published online in the Journal of Virology shows a promising mechanism for attacking the Ebola virus. A team at the Texas Biomedical Research Institute used ultradeep sequencing to reveal that the spontaneous mutation frequency for Ebola virus was high and similar to that of other RNA viruses, although the Ebola virus had very limited ability to tolerate spontaneous changes in the genome. Testing the drug ribavirin in mouse and monkey models of postexposure therapy, researchers delayed the time to subject death and increased survival.
Dr. Tom Koch, a medical geographer at the University of British Columbia, Vancouver, reflects in a review essay in the International Journal of Epidemiology on what could have been done differently in the efforts to prevent the Ebola epidemic in 2014. He said the limits of patient location and travel mapping are reasons why it was difficult to contain Ebola from spreading. Maps and census data were almost nonexistent for the region in Guinea where the outbreak occurred, and aggressive quarantine programs were not quickly enacted.
A clinical team at an Ebola treatment unit in Sierra Leone has published guidelines for the treatment of children with Ebola virus disease. The aggressive approach they recommend calls for giving children fluids intravenously; treating other possible infections; feeding them highly fortified food; and greatly increasing the amount of bedside care they receive.
A rapid screening assay has been used for the first time in a standard open laboratory to identify and test promising anti-Ebola drugs. Research on new Ebola therapies has been limited by an inability to compare antiviral effectiveness, since cell model systems, treatment regimens and results are so varied that it is difficult to compare effectiveness amongst the compounds.
Researchers reported in Emerging Infectious Diseases that polymerase chain reaction–based testing for Plasmodium spp. parasitemia can be implemented easily and safely in laboratories performing Ebola virus disease diagnostics to assist with case-patient management during EVD outbreaks in malaria-endemic areas.
A researcher team at Vanderbilt University Medical Center, Nashville, Tenn., and the University of Texas Medical Branch in Galveston reported in the journal Cell that they have isolated human monoclonal antibodies from Ebola survivors that can neutralize multiple species of the virus. Investigators said the results provide a “roadmap to develop a single antibody-based treatment.”
In a letter to the editor of Emerging Infectious Diseases, clinicians who worked during the Ebola virus disease outbreak in West Africa recommend that Ebola virus–positive women stop breastfeeding immediately and that breastfeeding not be resumed until two negative reverse transcription polymerase chain reaction tests of the breast milk have been confirmed.
A report in MMWR describes the design and implementation of the Ebola active monitoring program established by the New York City Department of Health and Mental Hygiene (DOHMH) during its first 6 months (October 2014-April 2015) of operation.
On Twitter @richpizzi
Zika Virus Lessons From Colombia
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
FROM EMERGING INFECTIOUS DISEASES
Zika virus lessons from Colombia
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
On Twitter @richpizzi
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
On Twitter @richpizzi
Two recent research letters from Colombia offer U.S. clinicians insight into the challenges of battling Zika virus on the front lines of the growing pandemic.
In a letter to the journal Emerging Infectious Diseases, researchers at the University of Wisconsin, Madison, and Universidad de Sucre in Sincelejo, Colombia, described an ongoing Zika virus outbreak in Sincelejo, a city of 218,000 residents in northern Colombia. During October to November 2015, a total of 22 patients presenting to hospital emergency departments with symptoms of an acute viral “denguelike” illness. The symptoms included maculopapular rash, fever, myalgia/arthralgia, and conjunctivitis – all characteristic of dengue, chikungunya, and Zika virus infection. (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.160023)
Blood samples from the emergency department patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and found to be negative for the dengue and chikungunya viruses. However, samples from nine (41%) patients were positive for Zika virus. According to the investigators, phylogenetic analyses rooted with Spondweni virus showed that the Zika sequences belonged to the Asian lineage and were closely related to strains isolated during the 2015 outbreak in Brazil. The sequences also showed 99% identity with sequences from a Zika virus isolate from French Polynesia.
The authors concluded that the Zika virus circulating in Sincelejo could have been imported from Brazil, most likely as a result of tourism activities on Colombia’s northern coast, where the first reported case was identified.
Since detection of the Zika virus in Sincelejo in 2015, a total of 13,500 cases have been identified in 28 of Colombia’s 32 territorial entities, all of which have abundant populations of Aedes aegypti mosquitoes and cocirculation of the dengue and chikungunya viruses. The authors say these circumstances “highlight the need for accurate laboratory diagnostics and suggest that monitoring whether the virus spreads into neighboring countries (e.g., Ecuador, Peru, Venezuela, and Panama) is imperative.”
A fatal infection
Much of the medical literature on Zika virus suggests that symptoms experienced by infected patients are relatively mild, consisting predominantly of maculopapular rash, fever, arthralgia, myalgia, and conjunctivitis, and only one in five individuals with a Zika virus infection actually develops symptoms.
But because the current epidemic is rapidly evolving, the “spectrum of clinical disease remains uncertain” wrote the Colombia-based coauthors of another research letter to Emerging Infectious Diseases detailing a fatal case of Zika virus infection in a girl with sickle cell disease (Emerg Infect Dis. 2016 Jan. doi: 10.3201/eid2205.151934).
The patient, a 15-year-old girl, came to the outpatient clinic of a northern Colombian hospital in October 2015 with a high fever, arthralgia, retro-ocular pain, abdominal pain, myalgia, and jaundice for the previous 4 days. She’d had sickle cell disease for 5 years, but no previous hospitalizations or episodes of vaso-occlusive crises, and she had never had dengue, chikungunya, or acute chest syndrome.
The coauthors note that chronic diseases, such as sickle cell disorders, are considered to be a risk factor for development of severe dengue and chikungunya, but no cases have been reported in association with Zika fever. Initially diagnosed with dengue infection and admitted to hospital, the patient was transferred to a pediatric intensive care unit with severe acute respiratory distress syndrome and progressive hypoxemia, and died within days. Vaso-occlusion, triggered by inflammation, and severe splenic sequestration was noted as the probable cause of death.
The authors conclude that this case indicates that patients with sickle cell disorders and suspected Zika virus infection should be closely monitored, and clinicians should assess atypical and severe manifestations and concurrent conditions in patients to prevent additional deaths.
On Twitter @richpizzi
FROM EMERGING INFECTIOUS DISEASES
FDA approves new treatment for chronic HCV genotypes 1 and 4
The U.S. Food and Drug Administration has approved Zepatier (elbasvir and grazoprevir) with or without ribavirin for the treatment of chronic hepatitis C virus genotypes 1 and 4 infections in adults.
Zepatier, marketed by Merck, was granted breakthrough therapy designation for the treatment of chronic HCV genotype 1 infection in patients with end stage renal disease on hemodialysis and for the treatment of chronic HCV genotype 4 infection. Breakthrough therapy designation is a program designed to expedite the development and review of drugs that are intended to treat a serious condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy on a clinically significant endpoint.
“Today’s approval provides another oral treatment option for patients with genotypes 1 and 4 HCV infections without requiring use of interferon,” said Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research in a statement.
The safety and efficacy of Zepatier with or without ribavirin was evaluated in clinical trials of 1,373 participants with chronic HCV genotype 1 or 4 infections with and without cirrhosis. The participants received Zepatier with or without ribavirin once daily for 12 or 16 weeks. The studies were designed to measure whether a participant’s hepatitis C virus was no longer detected in the blood 12 weeks after finishing treatment (sustained virologic response), suggesting a participant’s infection had been cured.
The overall sustained virologic response rates ranged from 94% to 97% in genotype 1–infected subjects and from 97% to 100% in genotype 4–infected subjects across trials for the approved treatment regimens.
The FDA recommends clinicians screen genotype 1a–infected patients for certain viral genetic variations prior to starting treatment with Zepatier to determine dosage regimen and duration. Zepatier carries a warning alerting patients and health care providers that elevations of liver enzymes to greater than five times the upper limit of normal occurred in approximately 1% of clinical trial participants, generally at or after treatment week 8. The FDA says liver-related blood tests should be performed prior to starting therapy and at certain times during treatment.
Zepatier is not intended for patients with moderate or severe liver impairment.
On Twitter @richpizzi
The U.S. Food and Drug Administration has approved Zepatier (elbasvir and grazoprevir) with or without ribavirin for the treatment of chronic hepatitis C virus genotypes 1 and 4 infections in adults.
Zepatier, marketed by Merck, was granted breakthrough therapy designation for the treatment of chronic HCV genotype 1 infection in patients with end stage renal disease on hemodialysis and for the treatment of chronic HCV genotype 4 infection. Breakthrough therapy designation is a program designed to expedite the development and review of drugs that are intended to treat a serious condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy on a clinically significant endpoint.
“Today’s approval provides another oral treatment option for patients with genotypes 1 and 4 HCV infections without requiring use of interferon,” said Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research in a statement.
The safety and efficacy of Zepatier with or without ribavirin was evaluated in clinical trials of 1,373 participants with chronic HCV genotype 1 or 4 infections with and without cirrhosis. The participants received Zepatier with or without ribavirin once daily for 12 or 16 weeks. The studies were designed to measure whether a participant’s hepatitis C virus was no longer detected in the blood 12 weeks after finishing treatment (sustained virologic response), suggesting a participant’s infection had been cured.
The overall sustained virologic response rates ranged from 94% to 97% in genotype 1–infected subjects and from 97% to 100% in genotype 4–infected subjects across trials for the approved treatment regimens.
The FDA recommends clinicians screen genotype 1a–infected patients for certain viral genetic variations prior to starting treatment with Zepatier to determine dosage regimen and duration. Zepatier carries a warning alerting patients and health care providers that elevations of liver enzymes to greater than five times the upper limit of normal occurred in approximately 1% of clinical trial participants, generally at or after treatment week 8. The FDA says liver-related blood tests should be performed prior to starting therapy and at certain times during treatment.
Zepatier is not intended for patients with moderate or severe liver impairment.
On Twitter @richpizzi
The U.S. Food and Drug Administration has approved Zepatier (elbasvir and grazoprevir) with or without ribavirin for the treatment of chronic hepatitis C virus genotypes 1 and 4 infections in adults.
Zepatier, marketed by Merck, was granted breakthrough therapy designation for the treatment of chronic HCV genotype 1 infection in patients with end stage renal disease on hemodialysis and for the treatment of chronic HCV genotype 4 infection. Breakthrough therapy designation is a program designed to expedite the development and review of drugs that are intended to treat a serious condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy on a clinically significant endpoint.
“Today’s approval provides another oral treatment option for patients with genotypes 1 and 4 HCV infections without requiring use of interferon,” said Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research in a statement.
The safety and efficacy of Zepatier with or without ribavirin was evaluated in clinical trials of 1,373 participants with chronic HCV genotype 1 or 4 infections with and without cirrhosis. The participants received Zepatier with or without ribavirin once daily for 12 or 16 weeks. The studies were designed to measure whether a participant’s hepatitis C virus was no longer detected in the blood 12 weeks after finishing treatment (sustained virologic response), suggesting a participant’s infection had been cured.
The overall sustained virologic response rates ranged from 94% to 97% in genotype 1–infected subjects and from 97% to 100% in genotype 4–infected subjects across trials for the approved treatment regimens.
The FDA recommends clinicians screen genotype 1a–infected patients for certain viral genetic variations prior to starting treatment with Zepatier to determine dosage regimen and duration. Zepatier carries a warning alerting patients and health care providers that elevations of liver enzymes to greater than five times the upper limit of normal occurred in approximately 1% of clinical trial participants, generally at or after treatment week 8. The FDA says liver-related blood tests should be performed prior to starting therapy and at certain times during treatment.
Zepatier is not intended for patients with moderate or severe liver impairment.
On Twitter @richpizzi
Experts: WHO failing to lead on Zika pandemic
The World Health Organization has failed to act decisively in response to the growing Zika virus outbreak, global health experts said in a JAMA viewpoint article published Jan. 27.
While the global public health dimensions of Zika are quite clear, the WHO is “still not taking a leadership role in the crisis,” wrote coauthors Dr. Daniel R. Lucey of Georgetown University and Lawrence O. Gostin of Georgetown University Law Center, both in Washington. They called on the WHO to convene an emergency committee to advise Director-General Margaret Chan about the conditions necessary to declare a Public Health Emergency of International Concern, a process that would catalyze international attention, funding, and research.
“WHO headquarters has thus far not been proactive, given potentially serious ramifications,” the coauthors said. They encouraged the WHO to learn lessons from its handling of the Ebola epidemic, a key one being the need for an “intermediate-level response to emerging crises,” thus avoiding overreaction while still galvanizing global action.
In the interim, Dr. Lucey and Mr. Gostin assert that the international community cannot wait for the WHO to act, as infectious disease modeling anticipates significant international spread by travelers from Brazil – the epicenter of the current outbreak – to the rest of the Americas, Europe, and Asia. The coauthors emphasize seven key international health system strategies that countries should adopt and fund in preparation for a Zika pandemic. These strategies are critical for countries already affected by the virus and those with significant Aedes mosquito populations – the vectors for Zika virus.
The seven health system strategies recommended by Dr. Lucey and Mr. Gostin are:
• Vector control. Mosquito-borne diseases require reducing source populations, including physical and biological controls. Effective mosquito surveillance is also essential to ensure focused interventions.
• Risk communication. Health information campaigns should advise the public to avoid mosquito exposure.
• Enhanced Zika surveillance. The International Health Regulations (IHR) require countries to report unusual Zika-related cases. Countries must train health workers to observe and report Zika-related disease and create robust systems for collecting and analyzing surveillance data to complement public health strategies.
• Travel advisories. To minimize harm to high-risk travelers, agencies should consider issuing travel advisories, which include guidance on reducing mosquito exposure and greater awareness of symptoms. On returning home, symptomatic individuals should report their travel histories to their physician.
• Clinical management. An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days. On Jan. 19, the U.S. Centers for Disease Control and Prevention issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing.
• Accelerated research and development. When Zika infection was seen as usually asymptomatic and self-limited, the coauthors say researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications have altered this equation, making research on new vaccines urgent. However, a safe and effective Zika virus vaccine is probably 3-10 years away, even with accelerated research.
• Public health emergency declarations. The coauthors say that a national declaration of a public health emergency could help to focus political attention, while financing a surge in resources. They suggest that countries experiencing major Zika virus outbreaks could invoke heightened emergency powers.
Read the complete viewpoint essay in JAMA (2016 Jan 27. doi: 10.1001/jama.2016.0904)
On Twitter @richpizzi
The World Health Organization has failed to act decisively in response to the growing Zika virus outbreak, global health experts said in a JAMA viewpoint article published Jan. 27.
While the global public health dimensions of Zika are quite clear, the WHO is “still not taking a leadership role in the crisis,” wrote coauthors Dr. Daniel R. Lucey of Georgetown University and Lawrence O. Gostin of Georgetown University Law Center, both in Washington. They called on the WHO to convene an emergency committee to advise Director-General Margaret Chan about the conditions necessary to declare a Public Health Emergency of International Concern, a process that would catalyze international attention, funding, and research.
“WHO headquarters has thus far not been proactive, given potentially serious ramifications,” the coauthors said. They encouraged the WHO to learn lessons from its handling of the Ebola epidemic, a key one being the need for an “intermediate-level response to emerging crises,” thus avoiding overreaction while still galvanizing global action.
In the interim, Dr. Lucey and Mr. Gostin assert that the international community cannot wait for the WHO to act, as infectious disease modeling anticipates significant international spread by travelers from Brazil – the epicenter of the current outbreak – to the rest of the Americas, Europe, and Asia. The coauthors emphasize seven key international health system strategies that countries should adopt and fund in preparation for a Zika pandemic. These strategies are critical for countries already affected by the virus and those with significant Aedes mosquito populations – the vectors for Zika virus.
The seven health system strategies recommended by Dr. Lucey and Mr. Gostin are:
• Vector control. Mosquito-borne diseases require reducing source populations, including physical and biological controls. Effective mosquito surveillance is also essential to ensure focused interventions.
• Risk communication. Health information campaigns should advise the public to avoid mosquito exposure.
• Enhanced Zika surveillance. The International Health Regulations (IHR) require countries to report unusual Zika-related cases. Countries must train health workers to observe and report Zika-related disease and create robust systems for collecting and analyzing surveillance data to complement public health strategies.
• Travel advisories. To minimize harm to high-risk travelers, agencies should consider issuing travel advisories, which include guidance on reducing mosquito exposure and greater awareness of symptoms. On returning home, symptomatic individuals should report their travel histories to their physician.
• Clinical management. An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days. On Jan. 19, the U.S. Centers for Disease Control and Prevention issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing.
• Accelerated research and development. When Zika infection was seen as usually asymptomatic and self-limited, the coauthors say researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications have altered this equation, making research on new vaccines urgent. However, a safe and effective Zika virus vaccine is probably 3-10 years away, even with accelerated research.
• Public health emergency declarations. The coauthors say that a national declaration of a public health emergency could help to focus political attention, while financing a surge in resources. They suggest that countries experiencing major Zika virus outbreaks could invoke heightened emergency powers.
Read the complete viewpoint essay in JAMA (2016 Jan 27. doi: 10.1001/jama.2016.0904)
On Twitter @richpizzi
The World Health Organization has failed to act decisively in response to the growing Zika virus outbreak, global health experts said in a JAMA viewpoint article published Jan. 27.
While the global public health dimensions of Zika are quite clear, the WHO is “still not taking a leadership role in the crisis,” wrote coauthors Dr. Daniel R. Lucey of Georgetown University and Lawrence O. Gostin of Georgetown University Law Center, both in Washington. They called on the WHO to convene an emergency committee to advise Director-General Margaret Chan about the conditions necessary to declare a Public Health Emergency of International Concern, a process that would catalyze international attention, funding, and research.
“WHO headquarters has thus far not been proactive, given potentially serious ramifications,” the coauthors said. They encouraged the WHO to learn lessons from its handling of the Ebola epidemic, a key one being the need for an “intermediate-level response to emerging crises,” thus avoiding overreaction while still galvanizing global action.
In the interim, Dr. Lucey and Mr. Gostin assert that the international community cannot wait for the WHO to act, as infectious disease modeling anticipates significant international spread by travelers from Brazil – the epicenter of the current outbreak – to the rest of the Americas, Europe, and Asia. The coauthors emphasize seven key international health system strategies that countries should adopt and fund in preparation for a Zika pandemic. These strategies are critical for countries already affected by the virus and those with significant Aedes mosquito populations – the vectors for Zika virus.
The seven health system strategies recommended by Dr. Lucey and Mr. Gostin are:
• Vector control. Mosquito-borne diseases require reducing source populations, including physical and biological controls. Effective mosquito surveillance is also essential to ensure focused interventions.
• Risk communication. Health information campaigns should advise the public to avoid mosquito exposure.
• Enhanced Zika surveillance. The International Health Regulations (IHR) require countries to report unusual Zika-related cases. Countries must train health workers to observe and report Zika-related disease and create robust systems for collecting and analyzing surveillance data to complement public health strategies.
• Travel advisories. To minimize harm to high-risk travelers, agencies should consider issuing travel advisories, which include guidance on reducing mosquito exposure and greater awareness of symptoms. On returning home, symptomatic individuals should report their travel histories to their physician.
• Clinical management. An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days. On Jan. 19, the U.S. Centers for Disease Control and Prevention issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing.
• Accelerated research and development. When Zika infection was seen as usually asymptomatic and self-limited, the coauthors say researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications have altered this equation, making research on new vaccines urgent. However, a safe and effective Zika virus vaccine is probably 3-10 years away, even with accelerated research.
• Public health emergency declarations. The coauthors say that a national declaration of a public health emergency could help to focus political attention, while financing a surge in resources. They suggest that countries experiencing major Zika virus outbreaks could invoke heightened emergency powers.
Read the complete viewpoint essay in JAMA (2016 Jan 27. doi: 10.1001/jama.2016.0904)
On Twitter @richpizzi
FROM JAMA
Trial results for hepatitis C antivirals not generalizable to coinfected HIV/HCV patients
Clinical trial results for direct-acting antivirals against hepatitis C virus (HCV) may have limited generalizability for patients coinfected with HIV and HCV, a recent study suggested.
A research team led by Dr. Marina Klein of the division of infectious diseases at McGill University Health Centre, Montreal, determined it was important to assess the generalizability of clinical trial results for direct-acting antivirals (DAA) since the drugs have been described as revolutionary treatments for HCV. Clinical trial results have generally shown that DAAs are well tolerated, more conveniently dosed, and highly efficacious, compared with earlier, interferon-based HCV therapies.
The Canadian researchers noted, however, that DAA trials have included relatively small numbers of participants (subgroups ranging from 6 to 60) and have applied very strict eligibility criteria, likely excluding a substantial segment of the coinfected patient population.
To assess DAA trial generalizability, investigators applied the eligibility criteria from five efficacy trials evaluating simeprevir; sofosbuvir; ombitasvir, paritaprevir/ritonavir, and dasabuvir (3D); sofosbuvir/ledipasvir; and daclatasvir/sofosbuvir to the Canadian Co-Infection Cohort, representing about 23% of the total coinfected Canadian population in care.
The results confirmed the researchers’ suspicions, as only 5.9% of coinfected patients in the cohort would have been eligible for enrollment in the simeprevir trial, 9.8% in the sofosbuvir trial, 6.3% in the 3D trial, and 8.1% in the sofosbuvir/ledipasvir trial. Eligibility into the daclatasvir/sofosbuvir study was more inclusive – 43% of the cohort would have been eligible. The most exclusive eligibility criteria across all trials, with the exception of the daclatasvir/sofosbuvir study, were restriction to specific antiretroviral therapies (63%-79%) and active illicit drug use (53%-55%).
The exclusions “appeared to be related to improving treatment outcomes by not including those at higher risk of poor adherence and reinfection – individuals for whom real world data is urgently needed,” Dr. Klein and her coauthors concluded.
Read the full report in Clinical Infectious Diseases (Clin Infect Dis. 2016 Jan 6. doi: 10.1093/cid/civ1222).
On Twitter @richpizzi
Clinical trial results for direct-acting antivirals against hepatitis C virus (HCV) may have limited generalizability for patients coinfected with HIV and HCV, a recent study suggested.
A research team led by Dr. Marina Klein of the division of infectious diseases at McGill University Health Centre, Montreal, determined it was important to assess the generalizability of clinical trial results for direct-acting antivirals (DAA) since the drugs have been described as revolutionary treatments for HCV. Clinical trial results have generally shown that DAAs are well tolerated, more conveniently dosed, and highly efficacious, compared with earlier, interferon-based HCV therapies.
The Canadian researchers noted, however, that DAA trials have included relatively small numbers of participants (subgroups ranging from 6 to 60) and have applied very strict eligibility criteria, likely excluding a substantial segment of the coinfected patient population.
To assess DAA trial generalizability, investigators applied the eligibility criteria from five efficacy trials evaluating simeprevir; sofosbuvir; ombitasvir, paritaprevir/ritonavir, and dasabuvir (3D); sofosbuvir/ledipasvir; and daclatasvir/sofosbuvir to the Canadian Co-Infection Cohort, representing about 23% of the total coinfected Canadian population in care.
The results confirmed the researchers’ suspicions, as only 5.9% of coinfected patients in the cohort would have been eligible for enrollment in the simeprevir trial, 9.8% in the sofosbuvir trial, 6.3% in the 3D trial, and 8.1% in the sofosbuvir/ledipasvir trial. Eligibility into the daclatasvir/sofosbuvir study was more inclusive – 43% of the cohort would have been eligible. The most exclusive eligibility criteria across all trials, with the exception of the daclatasvir/sofosbuvir study, were restriction to specific antiretroviral therapies (63%-79%) and active illicit drug use (53%-55%).
The exclusions “appeared to be related to improving treatment outcomes by not including those at higher risk of poor adherence and reinfection – individuals for whom real world data is urgently needed,” Dr. Klein and her coauthors concluded.
Read the full report in Clinical Infectious Diseases (Clin Infect Dis. 2016 Jan 6. doi: 10.1093/cid/civ1222).
On Twitter @richpizzi
Clinical trial results for direct-acting antivirals against hepatitis C virus (HCV) may have limited generalizability for patients coinfected with HIV and HCV, a recent study suggested.
A research team led by Dr. Marina Klein of the division of infectious diseases at McGill University Health Centre, Montreal, determined it was important to assess the generalizability of clinical trial results for direct-acting antivirals (DAA) since the drugs have been described as revolutionary treatments for HCV. Clinical trial results have generally shown that DAAs are well tolerated, more conveniently dosed, and highly efficacious, compared with earlier, interferon-based HCV therapies.
The Canadian researchers noted, however, that DAA trials have included relatively small numbers of participants (subgroups ranging from 6 to 60) and have applied very strict eligibility criteria, likely excluding a substantial segment of the coinfected patient population.
To assess DAA trial generalizability, investigators applied the eligibility criteria from five efficacy trials evaluating simeprevir; sofosbuvir; ombitasvir, paritaprevir/ritonavir, and dasabuvir (3D); sofosbuvir/ledipasvir; and daclatasvir/sofosbuvir to the Canadian Co-Infection Cohort, representing about 23% of the total coinfected Canadian population in care.
The results confirmed the researchers’ suspicions, as only 5.9% of coinfected patients in the cohort would have been eligible for enrollment in the simeprevir trial, 9.8% in the sofosbuvir trial, 6.3% in the 3D trial, and 8.1% in the sofosbuvir/ledipasvir trial. Eligibility into the daclatasvir/sofosbuvir study was more inclusive – 43% of the cohort would have been eligible. The most exclusive eligibility criteria across all trials, with the exception of the daclatasvir/sofosbuvir study, were restriction to specific antiretroviral therapies (63%-79%) and active illicit drug use (53%-55%).
The exclusions “appeared to be related to improving treatment outcomes by not including those at higher risk of poor adherence and reinfection – individuals for whom real world data is urgently needed,” Dr. Klein and her coauthors concluded.
Read the full report in Clinical Infectious Diseases (Clin Infect Dis. 2016 Jan 6. doi: 10.1093/cid/civ1222).
On Twitter @richpizzi
FROM CLINICAL INFECTIOUS DISEASES
New population testing algorithm may improve hepatitis C surveillance
A new testing algorithm that accurately estimates the population-level incidence of hepatitis C virus infection may help improve the impact of public health efforts in high-risk populations.
A research team led by Oliver Laeyendecker, Ph.D., staff scientist at the National Institute of Allergy and Infectious Diseases (NIAID) and assistant professor of medicine and epidemiology at Johns Hopkins University, Baltimore, developed a hepatitis C virus (HCV) IgG antibody avidity assay by modifying the Ortho 3.0 HCV ELISA. Researchers tested 997 serum or plasma samples from 568 people who inject drugs (PWID) enrolled in prospective cohort studies. They discovered that, in various simulated high-risk populations, the multi-assay avidity-based testing algorithm had greater than 80% power to detect a 50% reduction in HCV incidence.
“Application of an avidity-based testing algorithm to estimate [HCV] incidence from a cross-sectional survey can enhance current sentinel surveillance systems,” wrote Dr. Laeyendecker and his coauthors. “Among other emerging epidemics, the CDC has reported that HCV incidence is markedly on the rise among PWID in the U.S.
“However, in light of new information regarding the underreporting of newly acquired HCV cases to the CDC, these epidemics may be even more advanced than previously expected,” the researchers noted. “Individual acute HCV screening practices in combination with an avidity-based algorithm may collectively help to estimate incidence through practical sample sizes.”
Avidity-based testing algorithms have the capacity to quickly identify and confirm emerging HCV epidemics in many PWID populations, the investigators concluded.
Read the full study in the Journal of Infectious Diseases (J Infect Dis. 2016 Jan 14; doi: 10.1093/infdis/jiw005).
On Twitter @richpizzi
A new testing algorithm that accurately estimates the population-level incidence of hepatitis C virus infection may help improve the impact of public health efforts in high-risk populations.
A research team led by Oliver Laeyendecker, Ph.D., staff scientist at the National Institute of Allergy and Infectious Diseases (NIAID) and assistant professor of medicine and epidemiology at Johns Hopkins University, Baltimore, developed a hepatitis C virus (HCV) IgG antibody avidity assay by modifying the Ortho 3.0 HCV ELISA. Researchers tested 997 serum or plasma samples from 568 people who inject drugs (PWID) enrolled in prospective cohort studies. They discovered that, in various simulated high-risk populations, the multi-assay avidity-based testing algorithm had greater than 80% power to detect a 50% reduction in HCV incidence.
“Application of an avidity-based testing algorithm to estimate [HCV] incidence from a cross-sectional survey can enhance current sentinel surveillance systems,” wrote Dr. Laeyendecker and his coauthors. “Among other emerging epidemics, the CDC has reported that HCV incidence is markedly on the rise among PWID in the U.S.
“However, in light of new information regarding the underreporting of newly acquired HCV cases to the CDC, these epidemics may be even more advanced than previously expected,” the researchers noted. “Individual acute HCV screening practices in combination with an avidity-based algorithm may collectively help to estimate incidence through practical sample sizes.”
Avidity-based testing algorithms have the capacity to quickly identify and confirm emerging HCV epidemics in many PWID populations, the investigators concluded.
Read the full study in the Journal of Infectious Diseases (J Infect Dis. 2016 Jan 14; doi: 10.1093/infdis/jiw005).
On Twitter @richpizzi
A new testing algorithm that accurately estimates the population-level incidence of hepatitis C virus infection may help improve the impact of public health efforts in high-risk populations.
A research team led by Oliver Laeyendecker, Ph.D., staff scientist at the National Institute of Allergy and Infectious Diseases (NIAID) and assistant professor of medicine and epidemiology at Johns Hopkins University, Baltimore, developed a hepatitis C virus (HCV) IgG antibody avidity assay by modifying the Ortho 3.0 HCV ELISA. Researchers tested 997 serum or plasma samples from 568 people who inject drugs (PWID) enrolled in prospective cohort studies. They discovered that, in various simulated high-risk populations, the multi-assay avidity-based testing algorithm had greater than 80% power to detect a 50% reduction in HCV incidence.
“Application of an avidity-based testing algorithm to estimate [HCV] incidence from a cross-sectional survey can enhance current sentinel surveillance systems,” wrote Dr. Laeyendecker and his coauthors. “Among other emerging epidemics, the CDC has reported that HCV incidence is markedly on the rise among PWID in the U.S.
“However, in light of new information regarding the underreporting of newly acquired HCV cases to the CDC, these epidemics may be even more advanced than previously expected,” the researchers noted. “Individual acute HCV screening practices in combination with an avidity-based algorithm may collectively help to estimate incidence through practical sample sizes.”
Avidity-based testing algorithms have the capacity to quickly identify and confirm emerging HCV epidemics in many PWID populations, the investigators concluded.
Read the full study in the Journal of Infectious Diseases (J Infect Dis. 2016 Jan 14; doi: 10.1093/infdis/jiw005).
On Twitter @richpizzi
FROM THE JOURNAL OF INFECTIOUS DISEASES
