New Virulent Adenovirus Type 14 Variant Emerging in U.S.: CDC

15 November 2007 (Reuters Health)— A rare strain of adenovirus (serotype 14; Ad14) that can cause severe and sometimes fatal acute respiratory illness in people of all ages— including healthy young adults— is becoming more common in the United States, health officials warn in the Morbidity and Mortality Weekly Report published by the US Centers for Disease Control and Prevention (CDC).

State and local public health officials “should be alert to the possibility of outbreaks caused by Ad14,” the report emphasizes.

In May 2006, a 12-day-old infant in New York died from acute respiratory illness caused by Ad14. Between March and June 2007, a total of 140 additional cases of confirmed Ad14 respiratory illness were identified in groups of patients in Oregon, Washington, and Texas.

Fifty-three of these patients were hospitalized, including 24 who were admitted to intensive care units. Nine patients died.

According the report, “Ad14 isolates from all 4 states were identical by sequence data from the full hexon and fiber genes. However, the isolates were distinct from the Ad14 reference strain from 1955, suggesting the emergence and spread of a new Ad14 variant in the United States.”

According to the report, “No epidemiologic evidence of direct transmission linking the New York case or any of the clusters was identified.”

CDC officials say medical providers may want to explore testing for adenovirus or Ad14 in a patient with severe or worsening respiratory symptoms. They suggest that clinicians with questions related to testing of patients for adenovirus or Ad14 contact their state health department, which can provide assistance.

State health departments and military facilities are encouraged to contact CDC to report unusual clusters of severe adenoviral disease or cases of Ad14.

Source: Morb Mortal Wkly Rep CDC Surveill Summ 2007; 56:1181– 4.

U.S. Rates of Chlamydia, Gonorrhea, Syphilis Up in 2006: CDC

13 November 2007 (Reuters Health [Megan Rauscher])— Reported cases of chlamydia, gonorrhea, and syphilis increased between 2005 and 2006 in the United States, according to the Centers for Disease Control and Prevention' s (CDC's) 2006 Sexually Transmitted Disease (STD) Surveillance report.

In 2006, 1,030,911 cases of chlamydia were reported to CDC. “This represents an all-time high for reported chlamydia cases and accounts for the largest number of cases reported to CDC for any condition,” said Dr. John M. Douglas, Jr., director of the division of STD prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at CDC. It also represents a 5.6% increase from the 976,445 cases reported in 2005.

“While this may reflect a rise in actual infections, much of this recent increase is most likely due to expanded chlamydia screening in the US as well as the increased use of more sensitive testing technology,” Dr. Douglas noted. “Even with these improvements, however, most cases of chlamydia in the US remain undiagnosed and unreported.”

Young women aged 15– 19 years had the highest chlamydia rates, followed by women aged 20– 24 years. African-American women are disproportionately affected by chlamydia.

For gonorrhea, 358,366 cases were reported to CDC in 2006, making it the second most commonly reported infectious disease in the US after chlamydia. In 2006, the gonorrhea rate was 120.9 cases per 100,000 population, an increase of 5.5% since 2005. “This is the second year of increases in gonorrhea rates following relative stability since 1997,” Dr. Douglas noted.

“The racial disparities in diagnoses of gonorrhea are stark,” he also pointed out, with African Americans accounting for 69% of reported gonorrhea cases in 2006.

Overall, 13.8% of gonorrhea isolates tested in 2006 demonstrated resistance to fluoroquinolones, further supporting the CDC' s April 2007 announcement that this class of antibiotics should no longer be used to treat any cases of gonorrhea in the US.

As for primary and secondary syphilis, rates declined throughout the 1990s and reached an all-time low in 2000, but over the past 6 years, the syphilis rate in the US has been climbing, driven largely by increases among men who have sex with men.

Between 2005 and 2006, rates increased 13.8%, from 2.9 to 3.3 cases per 100,000 population. A total of 9756 cases of primary and secondary syphilis were reported in 2006, up from 8724 in 2005.

“Rates of syphilis still remain at an extremely low level; however, the recent increases point to the need for ongoing vigilance in addressing this recent resurgence,” Dr. Douglas said.

W.H.O. Fails to Reach Deal on Sharing Bird Flu Virus

23 November 2007 (Reuters Health)— Health officials have failed to reach agreement on a new system to ensure developing countries benefit more from sharing avian influenza viruses used to develop vaccines, the World Health Organization (WHO) said.

Officials will probably meet again in a smaller working group ahead of the WHO' s annual assembly in May.

The WHO agreed last May to revamp its 50-year-old system for sharing influenza virus samples and is seeking accord on new rules for sharing them with researchers and drug companies.

But Indonesia, the country hardest hit by bird flu, has said poor nations risked not getting the benefits of any vaccines developed from their virus samples.

It argues that countries who share bird flu virus samples should have full control of their use and access to vaccines developed from them.

Sixteen companies are licensing a vaccine against H5N1, the virus most experts suspect could spark a pandemic. They include Novartis, Glaxo, Denka Seiken, Baxter, CSL, and Sanofi Pasteur.

Editor's comment. As human cases continue to occur, it is critical to study the latest isolates to be able to track mutations of the H5N1 virus. This is the only way that relevant vaccine development can proceed. Unfortunately, Indonesia, where most cases are currently occurring, has not been sharing their isolates.

Washington Has Severe HIV Epidemic, Report Finds

27 November 2007 (Reuters Health [Maggie Fox])— Washington, D.C., has the highest rate of AIDS in the United States, and more babies are born with the AIDS virus in Washington than in other US cities.

People living in Washington also are not getting tested for HIV and show up with advanced infections that progress quickly to AIDS, the report by city health officials found.

The report found that Washington, with a population of ∼ 600,000 people, has a rate of 128 AIDS cases per 100,000 people in 2006, compared with a national rate of 14 cases per 100,000. The city accounted for 9% of all pediatric AIDS cases in the United States during 2005.

“The District' s rate for newly reported AIDS cases is higher than rates in Baltimore, Philadelphia, New York City, Detroit, and Chicago,” the report said.

Of the 12,428 people infected with HIV in Washington, 80% are black, the report found. More than 8300 had fully progressed to AIDS, and 224 died of AIDS in 2006.

“Heterosexual contact in the District is the leading mode of HIV transmission at 37% of newly reported infections, while nationally men who have sex with men lead new transmissions,” it said.

The report, the first to look at the HIV epidemic in Washington specifically, found that nearly 70% of all people with HIV developed full-blown AIDS within a year after diagnosis, which means they were diagnosed years after having been infected.

This compares with 39% nationally.

Dr. Shannon Hader of Washington' s Department of Health said the city has adopted a policy of routine HIV testing, which means people should get the test whenever they get a check-up or visit an emergency room.

Currently, people usually have to specifically ask to be tested for HIV.

Hader said the city aimed to reduce mother-to-child transmission of HIV to zero by 2009 with better testing and treatment of pregnant women. Women who take HIV drugs around the time of delivery are far less likely to transmit the virus to their babies.

FDA Staff Urges Psych Warning for Flu Drug Labels

23 November 2007 (Reuters Health)— US Food and Drug Administration (FDA) staff are recommending new warnings about psychiatric events observed in patients on Roche Holding AG' s Tamiflu and GlaxoSmithKline Plc' s Relenza.

An FDA advisory panel will be discussing the recommendations for these influenza drugs at a meeting on the drugs' safety. The FDA held a similar meeting 2 years ago on Tamiflu, after reports of deaths of children in Japan linked to abnormal psychiatric behavior.

Experts 2 years ago were unable to find a connection between the drug and the deaths.

In documents prepared for the meeting next week and posted on the FDA Web site, FDA staff recommend that Tamiflu' s label be changed to note “some cases in Japanese adult and pediatric patients resulted in a fatal outcome.”

The FDA staff also reviewed Relenza, in the same drug class as Tamiflu, recommending its label be changed to note “reports of hallucinations, delirium, and abnormal behavior” observed in some patients taking the drug.