World Unprepared for Avian Flu, Experts Warn

1 November (Reuters Health [Maggie Fox])—The current US flu vaccine shortage shows perfectly how poorly the world is prepared to handle the next global epidemic of influenza, health experts said.

There are few vaccines or drugs to fight the flu, and it takes months to make them, so when the pandemic comes, it could wreak havoc for a long time, the experts told a conference.

To prepare for a pandemic, countries first have to be ready for the regular yearly epidemics of influenza. That means having vaccines, drugs, and data on whom the disease sickens and kills, Dr. Kathleen Neuzil of the University of Washington School of Medicine told the joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.

Dr. Klaus Stohr, influenza coordinator for the World Health Organization (WHO), believes the world is overdue for a pandemic that could kill millions, and he believes the H5N1 virus now killing off tens of millions of birds in Asia is the most likely source.

“There is this new subtype in Asia circulating in poultry. It appears it is only a question of time until this subtype moves into humans,” Stohr told a news conference.

So far, the H5N1 flu has infected 44 people and killed 32 of them, Stohr said. Other studies presented to the conference show the virus has not yet acquired the ability to move from human to human.

Once it does, experts agree, it could spread quickly and kill millions.

The best way to fight such a new flu would be to quickly vaccinate against it, Neuzil said. But only the United States is working on such a vaccine, through National Institutes of Health contracts to Aventis Pasteur, Inc., and Chiron Corp., under which 2.4 million doses will be produced.

Chiron's woes with standard influenza vaccine show just how badly wrong things can go. British regulators stopped Chiron from selling flu vaccine made at its plant in Liverpool earlier this month because of contamination.

Stohr said the WHO had just 120,000 doses of amantadine and rimantadine. Roche only has 4 million doses of Tamiflu available, and there are even fewer doses of Relenza.

Tamiflu Effective against H5N1 Avian Virus

1 November (Reuters Health)—Roche AG's Tamiflu anti-influenza drug has been proven to work against the H5N1 avian virus, which the World Health Organization says could become the source of an influenza pandemic.

In a study, researchers from the Queen Mary Hospital in London said the neuraminidase inhibitor Tamiflu (oseltamivir) is effective against avian and human forms of the virus.

These are the first “data to show oseltamivir to be effective against this highly pathogenic strain, which is currently circulating in Vietnam and Thailand,” the researchers reported.

The WHO has already identified Tamiflu as its drug of choice to protect against bird flu and in the case of a human flu pandemic. It was previously proven effective in managing an outbreak of the H7N7 avian strain in The Netherlands in 2003, which infected around 1000 people, the researchers said.

“High Levels” of Bacteria Found in Bottled Mineral Water: Study

1 November (Reuters Health [Megan Rauscher])—Bottled mineral water, generally considered more pure than tap water, is often contaminated with bacteria and fungi, a researcher warned in a report to the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), a meeting of the American Society for Microbiology.

“Hospital water is increasingly accepted as a source for pathogens,” Dr. Rocus R. Klont from University Medical Center Nijmegen, The Netherlands, told Reuters Health. “Immunocompromised patients often receive bottled mineral water under the assumption that it is safer than tap water.”

To determine the risk of infection from bottled water, Dr. Klont and colleagues looked for bacterial and fungal contamination in 68 commercial mineral waters, 1 tap water, and 1 water sample from a natural well from 9 European and 7 non-European countries.

“We found high levels of bacterial contamination in commercially bottled mineral water,” Dr. Klont told Reuters Health.

Overall, 40% of all samples showed evidence of contamination with either bacteria (37%) or fungi (4%). Bacteria grew from 21 samples, including cultures of 8 coagulase-negative staphylococci, 10 gram-negative nonfermenters, and 9 gram-positive rods.

Legionella DNA was detected in 6 samples and Legionella antigen in 6 others. Molds were detected in 3 samples.

“These findings indicate that the general perception that bottled water is safe and clean is not true,” Dr. Klont noted in comments to Reuters Health.

“The risk of disease to healthy individuals may be limited, but immunocompromised patients are generally more susceptible to infection and therefore might be at higher risk of becoming infected,” he added.

Editor's comment. This is not new information. Bottled spring water has been shown in the past to contain bacteria, fungi, and/or protozoa. Furthermore, I have seen waiters in a tropical country (not to be named) filling bottles with tap water that is known not to be safe to drink. Carbonated bottled water is safer. It cannot come from the tap, and the low pH makes survival of potential pathogens less likely.

W.H.O. Urged to Allow Gene-Modified Smallpox Research

11 November (Reuters Health [Maggie Fox])—Advisers to the World Health Organization (WHO) have pressed the body to allow a few scientists to genetically modify the smallpox virus to make it easier to study, a WHO spokesman said.

It may take weeks or months for the WHO to decide on the emotive issue.

WHO spokesman Dick Thompson said an international panel of scientific advisers made the recommendation to the WHO last week. “The idea was to insert a fluorescent gene in the virus to help speed up screening,” Thompson said in a telephone interview.

“The panel ... thought that it was a good idea for several reasons. First it reduces the amount of time that lab workers have to be exposed to the virus,” he said. “Most important, it moves us closer to the day that we can destroy the remaining stock of smallpox.”

While smallpox was eradicated by a global vaccination program led by WHO in 1979, bioterrorism experts argued that several nations had tried to make smallpox into a weapon, and that stocks may still exist outside the careful control of the WHO and US Centers for Disease Control and Prevention (CDC).

Therefore, work proceeds at a very few labs on a new and better smallpox vaccine. For instance, the US Army Medical Research Institute of Infectious Diseases, or USAMRIID, works with smallpox virus at its top-security facility in Ft. Detrick, Maryland, and the CDC also has a specially equipped lab.

Researchers working with smallpox must work in Biosafety 4 labs, which have special controls to help ensure no one accidentally becomes infected. But experts agree that the less time spent working with such a dangerous virus, the better.

Thompson said WHO had made no decision on the recommendation and said it would undergo several levels of review. “This whole thing moves at a thoughtful pace,” he said.

Editor's comment. Depending on the country and laboratory chosen, it may be less than comforting to have an expansion of laboratories working with smallpox virus. The recent laboratory accidents with severe acute respiratory syndrome (SARS) virus in Singapore and Taiwan, the use of weaponized anthrax (presumably from Ft. Detrick) in the United States, and the fact that nuclear scientists have been known to export secrets all serve as warnings.

MRSA May Be Transmitted via Breast Milk

1 November (Reuters Health [Megan Rauscher])—Medical epidemiologists in Los Angeles have identified breast milk as the source of transmission of methicillin resistant Staphylococcus aureus (MRSA) infection in 2 MRSA outbreaks in neonatal intensive care units (NICUs).

Dr. Dawn M. Terashita, of the Los Angeles County Health Department described the cases in Washington, D.C., at the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), a meeting of the American Society for Microbiology.

Infants in the NICU are a “vulnerable population,” she told Reuters Health. MRSA outbreaks are common in the NICU, and the main mode of transmission is thought to be person-to-person via hand contact.

Earlier this year, Dr. Terashita and colleagues investigated 2 separate MRSA situations in NICUs in which they suspected vertical transmission via breast milk. One case involved a 35-year-old mother who delivered premature quadruplets. One day after delivery, she developed mastitis and was treated with dicloxacillin. Her breast milk was collected and fed to all 4 newborns.

Sixteen days after birth, 1 of the quadruplets died of MRSA sepsis. The 3 siblings and the mother all had nasopharyngeal cultures demonstrating MRSA colonization. Frozen breast milk samples obtained during the first week postpartum were also MRSA positive.

Pulsed-field gel electrophoresis of MRSA isolates from the 4 infants and breast milk were identical.

Surveillance cultures performed on 18 other NICU infants turned up 1 additional MRSA colonization—a male infant who developed MRSA sepsis 8 days after birth. Breast milk from his mother was also MRSA positive.

The role of breast milk in the transmission of MRSA from mother to infant remains unclear, Dr. Terashita noted in comments to Reuters Health.

“In the NICU, maternal risk factors, such as mastitis and skin lesions, should be assessed,” she said. “Before ingestion by the infant, NICU staff should consider culturing breast milk and discarding if MRSA positive,” she added. “Lastly, good hand hygiene should always be reinforced to prevent spread to other infants.”