#Clinical #Management of #Ebola Virus Disease in the #US and #Europe (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Original Article

Clinical Management of Ebola Virus Disease in the United States and Europe [      ]

Timothy M. Uyeki, M.D., M.P.H., M.P.P., Aneesh K. Mehta, M.D., Richard T. Davey, Jr., M.D., Allison M. Liddell, M.D., Timo Wolf, M.D., Pauline Vetter, M.D., D.T.M.&H., Stefan Schmiedel, M.D., Thomas Grünewald, M.D., Ph.D., Michael Jacobs, M.B., B.S., Ph.D., D.T.M.&H., Jose R. Arribas, M.D., Laura Evans, M.D., Angela L. Hewlett, M.D., Arne B. Brantsaeter, M.D., Ph.D., M.P.H., Giuseppe Ippolito, M.D., Christophe Rapp, M.D., Ph.D., Andy I.M. Hoepelman, M.D., Ph.D., and Julie Gutman, M.D. for the Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe

N Engl J Med 2016; 374:636-646 / February 18, 2016 / DOI: 10.1056/NEJMoa1504874

 

Abstract

Background

Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.

Methods

We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.

Results

A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.

Conclusions

Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

Keywords: Research; Abstracts; Ebola; USA; European Region.

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Early #influenza #vaccine #effectiveness #results 2015-16: I-MOVE multicentre case-control study (@eurosurveillanc, edited)

[Source: Eurosurveillance, full page: (LINK). Edited.]

Eurosurveillance, Volume 21, Issue 6, 11 February 2016  / News

Early influenza vaccine effectiveness results 2015-16: I-MOVE multicentre case-control study [      ]

E Kissling 1, M Valenciano 1

Author affiliations: 1. EpiConcept, Paris, France

Correspondence: Esther Kissling ( e.kissling@epiconcept.fr)

Citation style for this article: Kissling E, Valenciano M. Early influenza vaccine effectiveness results 2015-16: I-MOVE multicentre case-control study. Euro Surveill. 2016;21(6):pii=30134. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.6.30134

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On 11 February 2016, the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) published the 2015–16 interim vaccine effectiveness (VE) estimates against influenza from a multi-centre case control study in 10 study sites: Germany, France, Hungary, Ireland, Italy, Poland, Portugal, Spain, Sweden and the Netherlands, on their website [1].

Adjusted VE interim results against any influenza among all ages were at 46.3% (95% confidence interval (CI): 4.9–69.7%) and 45.2% (95% CI: -12.5–73.3%) among the 18–64 year olds. Among those aged 65 years and older, there were only 14 influenza cases in the study. The adjusted VE against influenza A(H1N1)pdm09 was at 44.2% (95% CI: -3.1–69.8%) among all ages and thus lower compared with end of season estimates published in previous years (55.5% in 2010–11, 50.4% in 2012–13; 47.5% in 2013–14, 54.2% in 2014–15).

Early season influenza VE was measured against medically-attended laboratory-confirmed influenza from week 41/2015 to week 3/2016 using a test-negative design as described in the I-MOVE generic protocol [2] and in the I-MOVE multicentre case–control publications [3]. Some 1,933 influenza-like illness patients among whom 348 were positive to influenza were included: four cases of influenza A not subtyped, 246 A(H1N1)pdm09, 21 A(H3N2), and 77 influenza B cases. Among the 37 influenza B cases where lineage was available, 36 (97.3%) were of the Victoria lineage, a lineage not included in the trivalent vaccine.

For this interim analysis, there was no information on genetic characterisation of the viruses. The recently published European Centre for Disease Prevention and Control risk assessment [4] reported that all A(H1N1)pdm09 viruses characterised in the European Union up to week three belonged to the 6B subgroup.

The interim estimates should be interpreted with caution. The 2015–16 season started late in the participating countries and the sample size for these interim estimates is low, resulting in low precision. The final estimates will be available at the end of the influenza season.

Read more here .

 

References

1) Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE). Interim 2015-16 influenza vaccine effectiveness results, I-MOVE multicentre case-control study. I-MOVE; 2016. Available from: https://sites.google.com/site/epiflu/Home/2015-16-interim-results

2) European Centre for Disease Prevention and Control (ECDC). Protocol for case control studies to measure pandemic and seasonal vaccine effectiveness in the European Union and European Economic Area. Stockholm: ECDC; 2010. Available from: http://www.ecdc.europa.eu/en/publications/Publications/0907_TED_Influenza_AH1N1_Measuring_Influenza_Vaccine_Effectiveness_Protocol_Case_Control_Studies.pdf

3) Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE). I-MOVE website list of publications 2007-2015. I-MOVE; 2016. Available from: https://sites.google.com/site/epiflu/list-of-i-move-publications

4) European Centre for Disease Prevention and Control (ECDC). Risk Assessment: Seasonal influenza 2015-16 in the EU/EEA countries. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/publications/Publications/seasonal-influenza-risk-assessment-2015-2016.pdf

Keywords: Research; European Region; Seasonal Influenza; H1N1pdm09; Vaccines.

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Reconstruction of the #Evolutionary #History and Dispersal of #Usutu #Virus, a Neglected Emerging #Arbovirus in #Europe and #Africa (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

Reconstruction of the Evolutionary History and Dispersal of Usutu Virus, a Neglected Emerging Arbovirus in Europe and Africa [      ]

Dimitri Engel a, Hanna Jöst a, Michael Wink b, Jessica Börstler a, Stefan Boschc, Mutien-Marie Garigliany d, Artur Jöst e, Christina Czajka a,e, Renke Lühken a, Ute Ziegler f, Martin H. Groschup f, Martin Pfeffer g, Norbert Becker e, Daniel Cadar a, Jonas Schmidt-Chanasit a,h

Author Affiliations: aBernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany bInstitute of Pharmacy and Molecular Biotechnology, Heidelberg University, Heidelberg, Germany cNature and Biodiversity Conservation Union (NABU), Stuttgart, Germany dDepartment of Veterinary Pathology, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium eGerman Mosquito Control Association (KABSeV), Speyer, Germany fFriedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Novel and Emerging Infectious Diseases, Greifswald-Insel Riems, Germany gFaculty of Veterinary Medicine, Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany hGerman Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany

Address correspondence to Daniel Cadar, danielcadar@gmail.com.

D.E., H.J., D.C., and J.S.-C. contributed equally to this article.

Editor Xiang-Jin Meng, Virginia Polytechnic Institute and State University

 

ABSTRACT

Usutu virus (USUV), one of the most neglected Old World encephalitic flaviviruses, causes epizootics among wild and captive birds and sporadic infection in humans. The dynamics of USUV spread and evolution in its natural hosts are unknown. Here, we present the phylogeny and evolutionary history of all available USUV strains, including 77 newly sequenced complete genomes from a variety of host species at a temporal and spatial scaled resolution. The results showed that USUV can be classified into six distinct lineages and that the most recent common ancestor of the recent European epizootics emerged in Africa at least 500 years ago. We demonstrated that USUV was introduced regularly from Africa into Europe in the last 50 years, and the genetic diversity of European lineages is shaped primarily by in situ evolution, while the African lineages have been driven by extensive gene flow. Most of the amino acid changes are deleterious polymorphisms removed by purifying selection, with adaptive evolution restricted to the NS5 gene and several others evolving under episodic directional selection, indicating that the ecological or immunological factors were mostly the key determinants of USUV dispersal and outbreaks. Host-specific mutations have been detected, while the host transition analysis identified mosquitoes as the most likely origin of the common ancestor and birds as the source of the recent European USUV lineages. Our results suggest that the major migratory bird flyways could predict the continental and intercontinental dispersal patterns of USUV and that migratory birds might act as potential long-distance dispersal vehicles.

 

IMPORTANCE

Usutu virus (USUV), a mosquito-borne flavivirus of the Japanese encephalitis virus antigenic group, caused massive bird die-offs, mostly in Europe. There is increasing evidence that USUV appears to be pathogenic for humans, becoming a potential public health problem. The emergence of USUV in Europe allows us to understand how an arbovirus spreads, adapts, and evolves in a naive environment. Thus, understanding the epidemiological and evolutionary processes that contribute to the emergence, maintenance, and further spread of viral diseases is the sine qua non to develop and implement surveillance strategies for their control. In this work, we performed an expansive phylogeographic and evolutionary analysis of USUV using all published sequences and those generated during this study. Subsequently, we described the genetic traits, reconstructed the potential pattern of geographic spread between continents/countries of the identified viral lineages and the drivers of viral migration, and traced the origin of outbreaks and transition events between different hosts.

 

Footnotes

Citation Engel D, Jöst H, Wink M, Börstler J, Bosch S, Garigliany M, Jöst A, Czajka C, Lühken R, Ziegler U, Groschup MH, Pfeffer M, Becker N, Cadar D, Schmidt-Chanasit J. 2016. Reconstruction of the evolutionary history and dispersal of Usutu virus, a neglected emerging arbovirus in Europe and Africa. mBio 7(1):e01938-15. doi:10.1128/mBio.01938-15.

Received 6 November 2015 – Accepted 28 December 2015 – Published 2 February 2016

Copyright © 2016 Engel et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords: Research; Abstracts; Usutu Virus; Arbovirus; Flavivirus; Africa; Europe.

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#Mediterranean Fin #Whales (Balaenoptera physalus) Threatened by #Dolphin #MorbilliVirus (@CDC_EIDjournal, abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 22, Number 2—February 2016  / Dispatch

Mediterranean Fin Whales (Balaenoptera physalus) Threatened by Dolphin MorbilliVirus  [      ]

Sandro Mazzariol, Cinzia Centelleghe, Giorgia Beffagna, Michele Povinelli, Giuliana Terracciano, Cristiano Cocumelli, Antonio Pintore, Daniele Denurra, Cristina Casalone, Alessandra Pautasso, Cristina Esmeralda Di Francesco, and Giovanni Di Guardo

Author affiliations: University of Padova, Padua, Italy (S. Mazzariol, C. Centelleghe, G. Beffagna, M. Povinelli); Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, Rome, Italy (G. Terracciano, C. Cocumelli); Istituto Zooprofilattico Sperimentale della Sardegna, Sassari, Italy (A. Pintore, D. Denurra); Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta, Turin, Italy (C. Casalone, A. Pautasso); University of Teramo Faculty of Veterinary Medicine, Teramo, Italy (C.E. Di Francesco, G. Di Guardo)

 

Abstract

During 2011–2013, dolphin morbillivirus was molecularly identified in 4 stranded fin whales from the Mediterranean Sea. Nucleoprotein, phosphoprotein, and hemagglutinin gene sequences of the identified strain were highly homologous with those of a morbillivirus that caused a 2006–2007 epidemic in the Mediterranean. Dolphin morbillivirus represents a serious threat for fin whales.

Keywords: Research; Abstracts; European Region; Whales; Morbillivirus.

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#KPC-like #carbapenemase-producing #Enterobacteriaceae colonizing #patients across #Europe and #Israel (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

KPC-like carbapenemase-producing Enterobacteriaceae colonizing patients across Europe and Israel [      ]

A. Baraniak 1, R. Izdebski 1, J. Fiett 1, M. Herda 1, L. P. G. Derde 2, M. J. M. Bonten 2, A. Adler 3, Y. Carmeli 3, H. Goossens 4, W. Hryniewicz 1, C. Brun-Buisson 5 and M. Gniadkowski 1* on behalf of the MOSAR WP2 & WP3 groups WP5 study

Author Affiliations: 1National Medicines Institute, Warsaw, Poland 2University Medical Center Utrecht, Utrecht, The Netherlands 3Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel 4University of Antwerp, Antwerp, Belgium 5INSERM U957 & Université Paris-Est, Créteil, France

 

ABSTRACT

In a 2008-11 survey, 17,945 patients in 18 hospital units in Europe and Israel were screened for carriage of KPC-producing Enterobacteriaceae, resulting in identification of 124 positive patients. The isolates were dominated by Klebsiella pneumoniae ST258 KPC-2 and ST512 KPC-3, mainly from Greece and Italy, respectively, whereas Israeli isolates were of diverse species, clones and KPC variants. Various blaKPC platforms were observed, among which IncFIIK+FIBK plasmids with blaKPC-2/-3 genes in the Tn4401a transposon prevailed.

 

FOOTNOTES

*Corresponding author: Marek Gniadkowski, National Medicines Institute, ul. Chełmska 30/34, 00-725 Warsaw, Poland. Fax: (+48) 22 – 841 29 49. E-mail: gniadkow@cls.edu.pl

Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Keywords: Research; Abstracts; Antibiotics; Drugs Resistance; Carbapenem; Enterobacteriaceae; European Region; Israel.

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