PANDEMIC PREPAREDNESS

#Pandemic: tracking #contagions (The Lancet Resp. Med., summary)

[Source: The Lancet Respiratory medicine, full page: (LINK). Summary.]

Spotlight

Pandemic: tracking contagions

Talha Khan Burki

Published Online: 15 March 2016 / Publication stage: In Press Corrected Proof / DOI: http://dx.doi.org/10.1016/S2213-2600(16)00107-7

______

In retrospect, the emergence of SARS was inevitable. If there was a setting designed to hone and amplify pathogens, it is the Chinese open-air, or “wet”, markets where wild animals are sold to consumers with a taste for exotic meat. When science journalist Sonia Shah visited one such market in 2011, part of the impressive research she undertook for Pandemic, she discovered “row after row of animals who’d rarely if ever encounter each other in the wild…breathing, urinating, defecating, and eating next to each other”.

(…)

–

Keywords: Research; Abstracts; Pandemic Preparedness.

——-

#Model-Based Comprehensive #Analysis of #School #Closure #Policies for Mitigating #Influenza #Epidemics and #Pandemics (PLoS Comput Biol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS Comput Biol. 2016 Jan 21;12(1):e1004681. doi: 10.1371/journal.pcbi.1004681. eCollection 2016.

Model-Based Comprehensive Analysis of School Closure Policies for Mitigating Influenza Epidemics and Pandemics. [ ]

Fumanelli L¹, Ajelli M¹, Merler S¹, Ferguson NM², Cauchemez S³.

Author information: ¹Bruno Kessler Foundation, Trento, Italy. ²MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, London, United Kingdom. ³Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France.

Abstract

School closure policies are among the non-pharmaceutical measures taken into consideration to mitigate influenza epidemics and pandemics spread. However, a systematic review of the effectiveness of alternative closure policies has yet to emerge. Here we perform a model-based analysis of four types of school closure, ranging from the nationwide closure of all schools at the same time to reactive gradual closure, starting from class-by-class, then grades and finally the whole school. We consider policies based on triggers that are feasible to monitor, such as school absenteeism and national ILI surveillance system. We found that, under specific constraints on the average number of weeks lost per student, reactive school-by-school, gradual, and county-wide closure give comparable outcomes in terms of optimal infection attack rate reduction, peak incidence reduction or peak delay. Optimal implementations generally require short closures of one week each; this duration is long enough to break the transmission chain without leading to unnecessarily long periods of class interruption. Moreover, we found that gradual and county closures may be slightly more easily applicable in practice as they are less sensitive to the value of the excess absenteeism threshold triggering the start of the intervention. These findings suggest that policy makers could consider school closure policies more diffusely as response strategy to influenza epidemics and pandemics, and the fact that some countries already have some experience of gradual or regional closures for seasonal influenza outbreaks demonstrates that logistic and feasibility challenges of school closure strategies can be to some extent overcome.

PMID: 26796333 [PubMed – in process]

–

Keywords: Research; Abstracts; Pandemic Preparedness; School Closures.

——-

Applying #Science: Opportunities to Inform #Disease #Management #Policy with Cooperative #Research within a #OneHealth #Framework (Front Public Health., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Front Public Health. 2016 Jan 8;3:276. doi: 10.3389/fpubh.2015.00276. eCollection 2015.

Applying Science: Opportunities to Inform Disease Management Policy with Cooperative Research within a One Health Framework. [ ]

Blackburn JK 1, Kracalik IT 1, Fair JM 2.

Author information: ¹Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. ²Cooperative Biological Engagement Program, Defense Threat Reduction Agency , Fort Belvoir, VA , USA.

Abstract

The ongoing Ebola outbreak in West Africa and the current saiga antelope die off in Kazakhstan each represent very real and difficult to manage public or veterinary health crises. They also illustrate the importance of stable and funded surveillance and sound policy for intervention or disease control. While these two events highlight extreme cases of infectious disease (Ebola) or (possible) environmental exposure (saiga), diseases such as anthrax, brucellosis, tularemia, and plague are all zoonoses that pose risks and present surveillance challenges at the wildlife-livestock-human interfaces. These four diseases are also considered important actors in the threat of biological terror activities and have a long history as legacy biowarfare pathogens. This paper reviews recent studies done cooperatively between American and institutions within nations of the Former Soviet Union (FSU) focused on spatiotemporal, epidemiological, and ecological patterns of these four zoonoses. We examine recent studies and discuss the possible ways in which techniques, including ecological niche modeling, disease risk modeling, and spatiotemporal cluster analysis, can inform disease surveillance, control efforts, and impact policy. Our focus is to posit ways to apply science to disease management policy and actual management or mitigation practices. Across these examples, we illustrate the value of cooperative studies that bring together modern geospatial and epidemiological analyses to improve our understanding of the distribution of pathogens and diseases in livestock, wildlife, and humans. For example, ecological niche modeling can provide national level maps of pathogen distributions for surveillance planning, while space-time models can identify the timing and location of significant outbreak events for defining active control strategies. We advocate for the need to bring the results and the researchers from cooperative studies into the meeting rooms where policy is negotiated and use these results to inform future disease surveillance and control or eradication campaigns.

KEYWORDS: anthrax; brucellosis; disease modeling; disease surveillance; one health; plague; tularemia

PMID: 26779471 [PubMed]

–

Keywords: Research; Abstracts; Pandemic Preparedness.

——

A #response adaptive #randomization #platform #trial for efficient evaluation of #Ebola #virus #treatments: A model for #pandemic response (Clin Trials, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Trials. 2016 Jan 14. pii: 1740774515621721. [Epub ahead of print]

A response adaptive randomization platform trial for efficient evaluation of Ebola virus treatments: A model for pandemic response. [ ]

Berry SM 1, Petzold EA 2, Dull P 3, Thielman NM 4, Cunningham CK 5, Corey GR 4, McClain MT 5, Hoover DL 6, Russell J 7, Griffiss JM 6, Woods CW 8.

Author information: ¹Berry Consultants LLC, Austin, TX, USA University of Kansas Medical Center, Kansas City, KS, USA. ²Duke Clinical Research Institute, Durham, NC, USA. ³Bill & Melinda Gates Foundation, Seattle, WA, USA. ⁴Duke Global Health Institute, Duke University, Durham, NC, USA. ⁵Duke University School of Medicine, Durham, NC, USA. ⁶Clinical Research Management, Inc., Hinckley, OH, USA. ⁷Connaught Hospital, Freetown, Sierra Leone. ⁸Duke Clinical Research Institute, Durham, NC, USA Duke Global Health Institute, Duke University, Durham, NC, USA Duke University School of Medicine, Durham, NC, USA Chris.woods@duke.edu.

Abstract

The outbreak of Ebola virus disease in West Africa is the largest ever recorded. Numerous treatment alternatives for Ebola have been considered, including widely available repurposed drugs, but initiation of enrollment into clinical trials has been limited. The proposed trial is an adaptive platform design. Multiple agents and combinations will be investigated simultaneously. Additionally, new agents may enter the trial as they become available, and failing agents may be removed. In order to accommodate the many possible agents and combinations, a critical feature of this design is the use of response adaptive randomization to assign treatment regimens. As the trial progresses, the randomization ratio evolves to favor the arms that are performing better, making the design also suitable for all-cause pandemic preparedness planning. The study was approved by US and Sierra Leone ethics committees, and reviewed by the US Food and Drug Administration. Additionally, data management, drug supply lines, and local sites were prepared. However, in response to the declining epidemic seen in February 2015, the trial was not initiated. Sierra Leone remains ready to rapidly activate the protocol as an emergency response trial in the event of a resurgence of Ebola. (ClinicalTrials.gov Identifier: NCT02380625.) In summary, we have designed a single controlled trial capable of efficiently identifying highly effective or failing regimens among a rapidly evolving list of proposed therapeutic alternatives for Ebola virus disease and to treat the patients within the trial effectively based on accruing data. Provision of these regimens, if found safe and effective, would have a major impact on future epidemics by providing effective treatment options.

KEYWORDS: Ebola virus disease; response adaptive randomization; therapeutics platform trial

PMID: 26768569 [PubMed – as supplied by publisher]

–

Keywords: Research; Abstracts; Ebola; Pandemic Preparedness.

——

The Neglected Dimension of #Global #Security — A #Framework for Countering #Infectious-Disease #Crises (N Engl J Med., extract)

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

Special Report

The Neglected Dimension of Global Security — A Framework for Countering Infectious-Disease Crises [ ]

Peter Sands, M.P.A., Carmen Mundaca-Shah, M.D., Dr.P.H., and Victor J. Dzau, M.D.

January 13, 2016 / DOI: 10.1056/NEJMsr1600236

______

Pandemics and epidemics have ravaged human societies throughout history. The plague, cholera, and smallpox killed tens of millions of people and destroyed civilizations. In the past 100 years, the “Spanish Flu” of 1918–1919 and HIV–AIDS caused the deaths of nearly 100 million people. Advances in medicine have transformed our defenses against the threat of infectious disease. Better hygiene, antibiotics, diagnostics, and vaccines have given us far more effective tools for preventing and responding to outbreaks. Yet the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS), and the recent West African Ebola outbreak show that we cannot be complacent Infectious-disease outbreaks that turn into epidemics and potential pandemics can cause massive loss of life and huge economic disruption.

(…)

–

Keywords: Research; Abstracts; Pandemic Preparedness; International Cooperation.

——-

Use of #neuraminidase #inhibitors for #prophylaxis and #treatment of #pandemic #influenza: #summary of a Faculty of #Public #Health #meeting (J Public Health (Oxf)., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Public Health (Oxf). 2015 Dec 29. pii: fdv196. [Epub ahead of print]

Use of neuraminidase inhibitors for prophylaxis and treatment of pandemic influenza: summary of a Faculty of Public Health meeting. [ ]

Haroon S¹, Middleton J², Milne E³.

Author information: ¹Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK. ²Department of Public Health, University of Wolverhampton, Wolverhampton WV11LY, UK. ³School of Medicine and Health, Durham University, Durham DH13LE, UK.

Abstract

On 15th December 2014, a meeting was held at the Faculty of Public Health (FPH) to gain views and where possible consensus on the prophylactic use among the general population of neuraminidase inhibitors (NIs) for pandemic influenza. These perspectives were to be used to help inform the FPH’s position on current policy. This was felt to be necessary in response to the controversy that followed the publication of the updated Cochrane systematic review of the use of oseltamivir for seasonal influenza by Jefferson et al. (Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. 2014) and the disparate views held by members of the FPH on its implications for the relative benefits and harms of mass chemoprophylaxis for pandemic influenza.

KEYWORDS: communicable diseases; population-based and preventative services; public health

PMID: 26715256 [PubMed – as supplied by publisher]

–

Keywords: Research; Abstracts; Pandemic Influenza; Pandemic Preparedness; Antivirals; Oseltamivir; Zanamivir; Peramivir.

——-

#Strategies for Early #Vaccination During Novel #Influenza #Outbreaks (Sci Rep., abstract)

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

Article | Open

Strategies for Early Vaccination During Novel Influenza Outbreaks [ ]

M. Laskowski, Y. Xiao, N. Charland […] & S. M. Moghadas

Scientific Reports 5, Article number: 18062 (2015) / doi:10.1038/srep18062

Received: 17 June 2015 – Accepted: 03 November 2015 – Published online: 14 December 2015

Abstract

Ongoing research and technology developments hold the promise of rapid production and large-scale deployment of strain-specific or cross-protective vaccines for novel influenza viruses. We sought to investigate the impact of early vaccination on age-specific attack rates and evaluate the outcomes of different vaccination strategies that are influenced by the level of single or two-dose vaccine-induced protections. We developed and parameterized an agent-based model for two population demographics of urban and remote areas in Canada. Our results demonstrate that there is a time period before and after the onset of epidemic, during which the outcomes of vaccination strategies may differ significantly and are highly influenced by demographic characteristics. For the urban population, attack rates were lowest for children younger than 5 years of age in all vaccination strategies. However, for the remote population, the lowest attack rates were obtained for adults older than 50 years of age in most strategies. We found that the reduction of attack rates following the start of vaccination campaigns during the epidemic depends critically on the disease transmissibility, suggesting that for a sufficiently high transmissibility, vaccine delivery after the onset of epidemic has little or no effect, regardless of the population demographics.

–

Keywords: Research; Abstracts; Pandemic Influenza; Pandemic Preparedness; Vaccines.

——

Evaluation of the #Safety and #Immunogenicity of a Candidate #Pandemic Live Attenuated #Influenza #Vaccine (pLAIV) Against #Influenza A(#H7N9) (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Evaluation of the Safety and Immunogenicity of a Candidate Pandemic Live Attenuated Influenza Vaccine (pLAIV) Against Influenza A(H7N9) [ ]

Mahdee Sobhanie 1, Yumiko Matsuoka 2, Sinthujan Jegaskanda 2,4, Theresa Fitzgerald 1, Raburn Mallory 3, Zhongying Chen 3, Catherine Luke 2, John Treanor 1 and Kanta Subbarao 2

Author Affiliations: ¹Department of Medicine, University of Rochester Medical Center, New York ²Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda ³Medimmune, Gaithersburg, Maryland⁴Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Victoria, Australia

Correspondence: J. Treanor, Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rm 3–6208, Rochester, NY 14642 (john_treanor@urmc.rochester.edu).

Abstract

Background.

We evaluated a candidate A/Anhui/2013(H7N9) pandemic live attenuated influenza vaccine (pLAIV) in healthy adults, and assessed the ability of 1 or 2 doses to induce immune memory.

Methods.

Healthy subjects in 2 age groups (18–49 years and 50–70 years) with undetectable hemagglutination-inhibiting (HAI) antibody to H7N9 were enrolled. Younger subjects received either 1 or 2 intranasal doses of 10^7.0 fluorescent focus units of A/Anhui/1/2013 pLAIV, while older subjects received a single dose. All subjects received a single 30-µg dose of unadjuvanted, antigenically matched A/Shanghai2/2013(H7N9) pandemic inactivated influenza vaccine (pIIV) 12 weeks after their first dose of pLAIV.

Results.

Both vaccines were well tolerated. Serum HAI antibody responses were detected in 0 of 32 younger subjects and 1 of 17 older subjects after 1 dose of pLAIV and in 2 of 16 younger subjects after a second dose. Strong serum antibody responses were detected after a single subsequent dose of pIIV that was broadly reactive against H7 influenza viruses.

Conclusions.

An A(H7N9) pLAIV candidate was safe in both age groups. Priming with pLAIV resulted in responses to subsequent pIIV that exceeded those seen in naive subjects in previous reports. The A(H7N9) pLAIV induces strong immune memory that can be demonstrated by exposure to subsequent antigenic challenge.

Clinical Trial Registration. NCT01995695 and NCT02274545.

Key words: pandemic influenza – live vaccine – immune memory

Received August 28, 2015. Accepted October 30, 2015.

–

Keywords: Research; Abstracts; H7N9; Avian Influenza; Vaccines; Pandemic Preparedness.

——-

Live-attenuated #H7N9 #influenza #vaccine is #weak, yet #strong (The Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Comment

Live-attenuated H7N9 influenza vaccine is weak, yet strong [ ]

Mark Zanin, Richard Webby

Published Online: 07 December 2015 / Publication stage: In Press Corrected Proof / DOI: http://dx.doi.org/10.1016/S1473-3099(15)00425-9

Summary

Pandemic influenza vaccines have come a long way in the past decade. The use of adjuvants and the exploration of prime boost strategies have made the prospect of mass vaccination in the face of an emerging influenza pandemic more palatable than with the two 90 μg doses suggested as necessary by some of the first A H5N1 vaccines trials.¹ Nevertheless, immunogenicity of vaccines based on avian influenza viruses, which are generally poorly immunogenic, remains an issue, and global capacity and distribution is suboptimum.

–

Keywords: Research; Abstracts; H7N9; Avian Influenza; Vaccines; Pandemic Preparedness.

——–

#H7N9 live attenuated #influenza #vaccine in healthy #adults: a randomised, double-blind, placebo-controlled, phase 1 trial (The Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Articles

H7N9 live attenuated influenza vaccine in healthy adults: a randomised, double-blind, placebo-controlled, phase 1 trial [ ]

Larisa Rudenko, Irina Isakova-Sivak, Anatoly Naykhin, Irina Kiseleva, Marina Stukova, Mariana Erofeeva, Daniil Korenkov, Victoria Matyushenko, Erin Sparrow, Marie-Paule Kieny

Published Online: 07 December 2015 / Publication stage: In Press Corrected Proof / DOI: http://dx.doi.org/10.1016/S1473-3099(15)00378-3

Summary

Background

H7N9 avian influenza viruses characterised by high virulence and presence of mammalian adaptation markers have pandemic potential. Specific influenza vaccines remain the main defence. We assessed the safety and immunogenicity of an H7N9 live attenuated influenza vaccine (LAIV) candidate in healthy adult volunteers.

Methods

We did a phase 1, double-blind, randomised, placebo-controlled trial in Saint Petersburg, Russia. Eligible participants were healthy adults aged 18–49 years. The participants were randomised 3:1 to receive live vaccine or placebo, according to a computer-generated randomisation scheme. Two doses of vaccine or placebo were administered intranasally 28 days apart, each followed by 7 day stays in hospital. Immune responses were assessed in nasal swabs, saliva, and serum specimens collected before and 28 days after each vaccine dose. The primary outcome was the safety profile. This trial is registered with ClinicalTrials.gov, number NCT02480101.

Findings

Between Oct 21, 2014, and Oct 31, 2014, 40 adults were randomised, of whom 39 (98%) were included in the per-protocol analysis (29 in the vaccine group and ten in the placebo group). The frequency of adverse events did not differ between the vaccine and placebo groups. Seroconversion of neutralising antibodies was seen in 14 participants after the first vaccine dose (48%, 95% CI 29·4–67·5) and 21 after the second vaccine dose (72%, 52·8–87·3). Immune responses were seen in 27 of 29 recipients (93%, 95% CI 77·2–99·2). Adverse effects were seen in 19 (63%) vaccine recipients and nine (90%) placebo recipients after the first dose and in nine (31%) and four (40%), respectively, after the second dose. These effects were mainly local and all were mild.

Interpretation

The H7N9 LAIV was well tolerated and safe and showed good immunogenicity.

Funding

WHO.

–

Keywords: Research; Abstracts; H7N9; Avian Influenza; Vaccines; Pandemic Preparedness.

——-

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this: