Immune globulin shows promise for severe Zika thrombocytopeniaAn analysis of Puerto Rican Zika patients who had thrombocytopenia, a rare complication, found that, in those with the severest cases, immune treatments may be more effective than platelet transfusion. A team from the US Centers for Disease Control and Prevention (CDC) and Puerto Rico reported its findings today in Open Forum Infectious Diseases.The researchers scoured the medical records of 37,878 patients infected with Zika virus in 2016 and found that 47 (0.1%) had thrombocytopenia, including 12 people who had a severe form of the complication, which is marked by low blood platelets. Most patients were adults, and 53% were male. For patients with severe disease, platelet levels were at their lowest at a median 6 days after symptom onset, and for those with the milder form, platelet levels were lowest a median of 5 days post onset.Of those with severe thrombocytopenia, all had bleeding, 4 (33%) were admitted to the intensive care unit, and 1 (8%) died. Of the 12 patients, 11 received intravenous immune globulin (IVIG) or corticosteroids, and 9 responded to clinical treatment.Of five patients with severe thrombocytopenia who received intravenous immunoglobulin, median platelet increase was 112 X 109/L (range, 65 to 202 X 109/L), which was higher than four patients who received receive platelet transfusion, for whom the median platelet count increase was 8.5 X 109 (range, -6 to 52 X 109/L), which the researchers said resulted in minimal response.The investigators said the cases from the Puerto Rico series nearly doubles the number of documented cases of severe thrombocytopenia in Zika patients that could be due to immune thrombocytopenia (ITP). They also noted the investigation is the first to determine the population incidence of Zika virus (ZIKV)-linked thrombocytopenia, which was 1.4 cases per 100,000 population.”Regardless of the mechanism, the findings from this investigation demonstrate that timely diagnosis of ITP among patients with ZIKV associated severe thrombocytopenia is crucial to initiating life-saving interventions,” they wrote.Dec 3 Open Forum Infect Dis abstract WHO reports successful end to polio outbreak in SyriaThe World Health Organization (WHO) announced that a polio outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) detected in Syria 18 months ago has been successfully stopped.The outbreak began in June of 2017 in the Deir ez-Zor governorate in eastern Syria. A total of 74 polio cases were linked to the outbreak, and the most recent patient suffered onset of paralysis on Sep 21, 2017. No international spread was noted, the WHO said.”Surveillance is stronger today than it was 18 months ago, when the initial cases were detected,” said Chris Maher, the manager for polio eradication for the WHO’s Eastern Mediterranean Region. “Access for both surveillance and immunization is dramatically better, and immunity levels have been increased as a result of the comprehensive outbreak response conducted across Syria.”In 2013, the same region of Syria was affected by an outbreak of wild poliovirus type 1 (WPV1).The WHO warned that Syria is at risk for re-infection because of a deteriorated health infrastructure, ongoing fighting, and internal population movements. Dec 2 WHO news release UK announces vaccine innovation center; Canada boosts CEPI coffersIn hopes of speeding the development of vaccines against emerging infectious disease threats, UK officials announced a dedicated Vaccines Manufacturing Innovation Center (VMIC), which will be led by the University of Oxford’s Jenner Institute, and at the G20 meeting over the weekend in Buenos Aires, Canadian Minister Justin Trudeau announced $1 million ($765,750 in US dollars) more for the Coalition for Epidemic Preparedness Innovations (CEPI).A news release today from the University of Oxford said the VMIC signals a major commercial opportunity and way to protect the nation against pandemic threats. It is designed to address a gap in late-stage vaccine manufacturing and will allow the development and production of vaccines for clinical trials and at moderate scale for epidemic threats to the UK population.The center is slated to begin operations by 2022 and will be located on a new site at The Oxford Science Park. It is funded through £66 million ($84 million) from the UK Government’s Industrial Strategy Challenge Funds Medicines Manufacturing Challenge. Additional funding of £10 million ($12.7 million) will come from commercial and other partners. Three academic centers will run the VMIC: the University of Oxford, Imperial College, and the London School of Hygiene and Tropical Medicine.Meanwhile, CEPI’s CEO Richard Hatchett, MD, said in a statement yesterday that the group is grateful that Canada has increased its contribution and that the current Ebola outbreak in the Democratic Republic of the Congo is a timely reminder of the devastation diseases can cause. “It’s only through collective action that we can hope to protect the world from the threat of epidemics and we warmly welcome Canada’s contribution to that effort,” he said.Canada was one of the groups that provided an initial investment after CEPI was formed in 2017 with a goal of streamlining and funding vaccine candidates targeting three diseases: Middle East respiratory syndrome coronavirus (MERS-CoV), Lassa virus, and Nipah virus. So far, CEPI has received $630 milllion from Australia, Belgium, Canada, the European Commission, Germany, Japan, Norway, the Bill & Melinda Gates Foundation, and Wellcome Trust.Dec 3 Oxford press release Dec 2 CEPI statement Report: TB research funding climbed to new heights in 2017 but still lagsResearch and development funding for tuberculosis (TB) rose to $772 million in 2017, the highest ever and the second year in a row that funding topped $700 million but still well short of what is needed, according to a new report released today by Treatment Action Group (TAG) and the United Nations–hosted Stop TB Partnership.During the first-ever United Nations High-Level Meeting on TB, held during the UN General Assembly in September 2018, TAG reported a $1.3 billion gap annually, which represents the difference between what the Stop TB Partnership says the world needs to invest in TB R&D from 2016 to 2020 (a total of $9 billion, or about $2 billion per year) and current funding.”In order to hit $9 billion in funding for the 2016-2020 period, the world will now have to invest almost as much ($7.5 billion) in the three years from 2018 to 2020, since investments in 2016 and 2017 only amounted to $1.5 billion combined,” TAG said in a press release.That money will likely come in the form of government commitments, as more than 60% of current TB funding comes from the public sector. Dec 3 TAG press release
Don’t let life’s lemons sour your summer. Use them to sour your beer, instead.It’s what’s called a shandy, a refreshing drink that classically is beer mixed with lemonade, though other flavors can be used. It has been a seasonal staple in Europe since at least the mid-1800s when British drinkers ordered their “shandygaff,” often beer mixed with ginger ale.But lately it’s been showing up on American cocktail menus and supermarket shelves, with new bottled and canned varieties on the market and bartenders experimenting with their own fruity beer combos.“Shandies have gained tremendous momentum the past several years, and we don’t see this slowing down anytime soon,” says Danelle Kosmal, vice president, alcoholic beverages, for market research firm Nielsen.This June 15, 2015 photo shows MillerCoors’ Leinenkugel’s Summer Shandy, Shock Top Lemon Shandy from Anheuser-Busch, Harpoon Brewery’s UFO Big Squeeze Shandy and Curious Traveler Lemon Shandy from The Traveler Beer Co. in Concord, N.H. The shandy, classically beer mixed with lemonade, though other flavors can be used, has been a seasonal staple in Europe since at least the mid-1800s. (AP Photo/Matthew Mead)In fact, while shandy sales remain a tiny niche of the overall multibillion dollar beer market, sales have grown 15 percent by volume and 18 percent by value over the past 52 weeks, Nielsen data show.Brands on the market include MillerCoors’ Leinenkugel’s Summer Shandy and Samuel Adams Porch Rocker from Boston Beer Co., as well as Shock Top Lemon Shandy from Anheuser-Busch. Also in stores, Narragansett Del’s Shandy, made in collaboration with Del’s Lemonade, a Rhode Island institution, and Curious Traveler Lemon Shandy from The Traveler Beer Co., part of Boston Beer Co.’s Vermont-based Alchemy & Science subsidiary.Lemon mixes are a zesty classic, but shandies aren’t always made with lemonade, and they aren’t always called shandy.In Germany, the drink is known as radler, or bicyclist, because the fruity, lower-alcohol drink was considered just the thing to refresh a weary cyclist, says Armin Buehler, senior market manager for Radeberger Gruppe USA, which introduced Schofferhofer Grapefruit Hefeweizen (wheat beer) in 2013.It sounds a little out there. Grapefruit? Beer? But in the case of Schofferhofer, the grapefruit shandy is refreshing with a strong but not overpowering taste of citrus harmonizing with the yeasty beer. And grapefruit turns out to be a trend within a trend. Other recent releases include Leinenkugel Grapefruit Shandy and Illusive Traveler Grapefruit Ale.Buehler likes Schofferhoffer Grapefruit as an outdoor drink. “I envision myself being on a rooftop seeing the sun go down, drinking that,” he says, though he also finds it makes a great mixer.Beer cocktails have been a trend for a while now and the shandy surge is giving them an extra kick.Take the Shandy slushy, a summer offering of Narragansett lager and lemon shaved ice that is on the summer menu at the New York City branch of Toro, the Barcelona-inspired tapas bar from chefs Ken Oringer and Jamie Bissonnette.Beverage Director Caitlin Doonan, who has spent some time on Rhode Island beaches, was inspired by the popularity of the frozen Del’s Lemonade sold there in summer to create Shandy slushy, a mix of Narragansett beer with a house-made lemon shaved ice. Depending on how well the slushy does, she’s got a few other variations in mind, including grapefruit.The idea is to have fun with a drink that’s a little bit lower in alcohol and a departure from some of the oh-so-serious drinks that have been dominating cocktail menus recently.“This was a way for us to have something that’s a little bit tongue in cheek,” Doonan says.