In case you missed them, here is a round-up of the top 5 articles for the week of March 5, 2017.
This week’s Top 5 articles focused on mosquito-borne infections, most specifically a new vaccine against these devastating diseases and the impact of the deadly yellow fever outbreak in Brazil. In addition, Contagion® covered a new initiative out of Egypt that aims to completely eradicate hepatitis C infections around the world, while simultaneously boosting travel to major tourism centers in the country. An interesting commentary on antimicrobial resistance in pets by Contagion® contributor, Saskia v. Popescu, MPH, MA, CIC and a look at the recent mumps outbreak in the NHL round out the top two articles of the week.
Although, mosquito-borne diseases are a known problem throughout much of the developing world, an increase in travel, and some say, global warming, has brought these deadly diseases to the door-step of the industrialized world as well. In order to discuss the multitude of vector-borne disease that impact millions of individuals around the world and treatments for these diseases, Contagion® recently sat down with Matthew J. Memoli, MD, MS, director of the Laboratory of Infectious Disease Clinical Studies Unit, National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.
In the interview, Dr. Memoli discussed a phase 1 trial that he is leading which will investigate the effectiveness of a new vaccine designed to provide broad protection against many mosquito-borne diseases. The vaccine is known as AGS-v and is created using mosquito saliva. More specifically, the vaccine is designed to create an immune response against the mosquito saliva in the affected host. By targeting the saliva instead of the specific infectious organism carried by the mosquito, the vaccine has the potential to protect against multiple mosquito-borne diseases at the same time. Such broad-reaching vaccines could be extremely lucrative when deployed in the developing world where it is difficult to administer many vaccines and the cost of doing so is high.
The technology being used to create the vaccine is the same currently used to create an HIV an influenza vaccine (both of which are in phase 2 trials.)
A total of about 60 participants, ranging in age from 18 to 50 years, will participate in the double-blind study. The participants will be randomized into three groups: those who will receive injections of the vaccine, the vaccine plus an adjuvant, or placebo (sterile water). Injections will be given twice, 21 days apart. Twenty-one days after receiving the second injection, the participants will receive was is called a “clean mosquito feeding,” where they will be exposed to 5-10 biting mosquitoes that have been breed in controlled conditions and are tested to be free of diseases.
Blood samples taken from the participants before treatment, after treatment, and after being bitten will be compared to assess the safety of the vaccine and the participants’ immune responses.
To read more about this trial for a new vaccine against mosquito-borne diseases, click here.
Hepatitis viral infections, particularly hepatitis B and C (HCV), are a significant public health burden. For example, each year, up to 10 million individuals are infected with chronic HCV and almost 1.5 million individuals die from the infection. In a move to eliminate these infections, the World Health Organization (WHO) created the Global Health Sector Strategy on Viral Hepatitis 2016-2021. The initiative describes collaborative efforts that will work to reach the goal of “eliminating viral hepatitis as a major public health threat by 2030.”
Although, HCV is a global public health threat, some countries are known as virtual epicenter of HCV infection, with the Eastern Mediterranean Region boasting some of the highest rates of hepatitis in the world. One of the countries in this region, Egypt, had an estimated prevalence of 7% in adults in 2015; the highest in the region. As such, officials in the country have moved to put forth several efforts in an attempt to curtail and decrease these infections. One such effort discussed this week is called, “Tour n’ Cure,” a new Egyptian initiative aimed at completely eradicating the disease through providing a low-cost treatment to participants, while simultaneously boosting tourism at the country’s tourism capitals.
During a week-long trip at a destination of their choice, participants receive a full medical exam and blood testing to determine the best treatment for their HCV infection. The receive the first course of treatment during their stay and they are then provided with the remaining treatment regimen after they return home. In addition, participants are required to provide follow-up blood work at 1 after initial treatment and 3 months after final treatment dose to ensure “that the virus has been completely eradicated” from their bodies.
Tour n’ Cure is promoting the program to help end HCV infection in Egypt through a social media campaign as well, promising that for every 1000 mentions of the hashtag #StoptheWait, one patient will receive free treatment. So far, the campaign has received 2000 mentions. Soccer star, Lionel Messi, is the celebrity ambassador for the initiative.
Learn more about the Tour n’ Cure initiative here.
Citing a recent outbreak of leptospirosis in dogs in Phoenix, Arizona, Contagion® contributor, Saskia v. Popescu, MPH, MA, CIC, a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital, encouraged infectious disease professionals to reevaluate the potential threat of domestic pets and antimicrobial resistance. Most of the research studies on animals and incidence of multi-drug resistant organisms (MDRO’s) focuses on livestock. This is without surprise as a recent report from the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) noted “extremely high” levels of multidrug resistance in Salmonella in humans, “food-producing animals,” and food across Europe.
However, with increasing reports of animals being afflicted with MDRO’s, as in the case of the recent death of the infamous SeaWorld orca, Tilikum, from a “persistent and complicated bacterial lung infection,” and the death of the author’s own dog from a drug-resistant pneumonia, an exploration into the potential for the transmission of MDRO’s from pets to humans does not seem so far-fetched. Indeed, bats and non-human primates are notorious sources of emerging infectious diseases.
Even though the risk of transmission of antimicrobial resistance from animals to human remains low, the use of antibiotics in companion animals is quite high, with The Journal of the American Veterinary Medical Association noting that in terms of antibiotic usage, it “’seems likely that the amount of inappropriate use in companion animal settings is close to the most recent estimates in human medicine—50%.” The US Food and Drug Administration has already taken steps to curtail the inappropriate use of antibiotics in food animals through the Veterinary Feed Directive which restricts the use of certain drugs to only be administered under the guidance of a licensed veterinarian. However, companion animals have been largely left out of the conversation and they are not even included in the National Antimicrobial Resistance Monitoring System.
As the threat of antibiotic resistance continues to grow, infectious disease professionals need to leave no stone unturned in their quest to search for the answers to this deadly problem. Read more about antimicrobial resistance and companion animals here.
The threat of a massive yellow fever outbreak in South America was already looming last year, when the Pan American Health Organization (PAHO) declared an epidemiological alert for yellow fever in the area. At that time, experts warned that unless the World Health Organization moved forward with an emergency response plan that involved “a surge in vaccine production,” the yellow fever outbreak in 2016 would result in a global epidemic similar to that of the Ebola virus and the ongoing Zika crisis.
Now, on the heels of a Level 2 Travel Alert issued by the Centers for Disease Control and Prevention last month for Brazil as a result of the ongoing outbreak, PAHO is reporting that there have been over 1300 cases of yellow fever infection and over 200 deaths. Although an effective vaccine currently exists for yellow fever, it is not widely available and usually reserved for administration in areas with the highest risk of infection.
“We have a number of vaccines that [we] planned ahead [for] to protect our population during the whole year,” but if there is a rapid increase of cases or new areas identified to have active transmission that were not planned for, there will not be enough vaccines to go around," Marta Cavalcanti, MD, PhD, a physician at Infectious Disease Clinic, Hospital Universitario Clementino Fraga Filho, UFRJ in Brazil told Contagion® in an exclusive interview.
It is important to note that yellow fever is not only transmitted via the Aedes aegypti mosquito. The virus can also be transmitted through the bite of a Haemagogus mosquito which was infected by either a human or non-human carrier of the disease. In addition, there are three transmission cycles of yellow fever. According to PAHO, “to date, Aedes aegypti has not been reported to have a role in transmission.”
Learn more about the Yellow Fever outbreak in Brazil here.
Although hockey fans are used to living through their share of upsets (such as the Ottawa Senators’ 2015 comeback), this season two National Hockey League (NHL) teams are being impacted by an upset of the infectious kind, not by points. An outbreak of mumps has sidelined teammates on both the Minnesota Wild and the Vancouver Canucks. Two forwards, an assistant coach, and a team services staff member on the Wild were diagnosed last month, and 7 players and one trainer have recently been diagnosed and isolated on the Canucks.
Individuals are typically immunized against the highly contagious virus through the measles-mumps-rubella (MMR) vaccine regimen, which is typically administered before kindergarten. Two doses of the vaccine can render protection against the virus up to 88%; however, with the increase in global travel and incidence of unvaccinated individuals in the United States, outbreaks of mumps are popping up more frequently. Indeed, the outbreaks of the virus that impacted multiple states in 2016 will go down as the largest mumps outbreak in a decade!
According to the NHL, teams are taking no chances against the viral infection. Any players suspected of infection are being held out of games and isolated for a period of 5 days while diagnosis is confirmed. In addition, those who are diagnosed (included coaches, trainers, and referees) will miss at least 3 games. The Wild is taking it a step further by using a “Sani Sport” machine to sanitize and disinfect equipment. Twenty-eight teams in the league also use the device which can reduce and eliminate “the spread of bacterial and viral infections, such as mumps, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus (MRSA), that might otherwise thrive in a sweaty, moist environment with a high volume of saliva, mucus, and blood.”
Vaccinations are being provided to all players via team doctors. At the time the article was published, only one player was eligible to return to active play after recovering from the infection, but he has yet to do so.
More about the mumps outbreak in NHL teams is available here.