Whitney McKnight

CHICAGO – Chances are good that if your patient presents with eyelid dermatitis, allergic contact with gold or nickel is the culprit.

"Gold is not thought to be easily released from jewelry, which would be the typical exposure with eyelids, unless it comes into contact with sweat, friction, or abrasives," Dr. Amber Reck Atwater told attendees of a session on facial dermatoses at the American Academy of Dermatology summer meeting.

Courtesy Wikimedia Commons/Linuxerist/Creative Commons License

However, when gold comes into contact with titanium dioxide, a common active ingredient in many cosmetics such as eye shadow, patients are at risk for eyelid irritation.

"If I am wearing a gold ring, and I put this on my eyelids using my finger, the gold will be more easily released, and I will be more likely to get a reaction on my lids," said Dr. Atwater, of the department of dermatology at Duke University, Durham, N.C.

Nickel is another leading cause of eyelid dermatitis, Dr. Atwater said. She warned of the metal’s pernicious tendency to hide in personal care products such as eyelash curlers that do not list it as an active or inactive ingredient.

A simple and relatively inexpensive dimethylglyoxime test, which Dr. Atwater said can be purchased on the consumer market, can help identify items that may contain nickel. Rub a drop of dimethylglyoxime onto an item, such as a house key, with a cotton swab. If the key turns bright pink, then you know it has nickel in it.

"So you can imagine that if I am holding my keys in my hands, I could be transferring nickel from the keys to my eyelids," said Dr. Atwater.

Other potential sources of nickel include faucets, sunglasses with metal frames, barbells, and other weight-lifting equipment.

Other common causes of eyelid dermatitis are products that contain fragrance, including balsam of Peru, neomycin (typically found in antibacterial eye drops), formaldehyde and bronopol (preservatives that are found in certain cosmetics), skin care products, and topicals.

Allergic contact dermatitis in the eyelid can present in an upper, lower, unilateral, or bilateral fashion on the eyelids alone, but typically presents in combination with dermatitis on other areas of the face, or even other areas of the body, according to Dr. Atwater.

"You should be highly suspicious that it’s contact dermatitis when you see eyelid dermatitis with other parts of the body involved," she said.

When the dermatitis presents in the eyelids alone, other factors such as seborrheic dermatitis or aspecific xerotic dermatitis could be the cause.

"Still, a good 30%-50% of our patients will have allergic contact dermatitis when we see them with eyelid dermatitis alone," Dr. Atwater said.

The eyelids are particularly susceptible to irritation in part because the skin is extremely thin – 0.55 mm – compared with other facial areas where the average skin thickness is about 2 mm, Dr. Atwater explained.

"And it’s really easy to transfer substances from our hands to our eyes. People rub their eyes and their faces a lot throughout the day," she noted.

Dr. Atwater had no financial conflicts to disclose.

[email protected]

On Twitter @whitneymcknight

CHICAGO – Chances are good that if your patient presents with eyelid dermatitis, allergic contact with gold or nickel is the culprit.

"Gold is not thought to be easily released from jewelry, which would be the typical exposure with eyelids, unless it comes into contact with sweat, friction, or abrasives," Dr. Amber Reck Atwater told attendees of a session on facial dermatoses at the American Academy of Dermatology summer meeting.

Courtesy Wikimedia Commons/Linuxerist/Creative Commons License

However, when gold comes into contact with titanium dioxide, a common active ingredient in many cosmetics such as eye shadow, patients are at risk for eyelid irritation.

"If I am wearing a gold ring, and I put this on my eyelids using my finger, the gold will be more easily released, and I will be more likely to get a reaction on my lids," said Dr. Atwater, of the department of dermatology at Duke University, Durham, N.C.

Nickel is another leading cause of eyelid dermatitis, Dr. Atwater said. She warned of the metal’s pernicious tendency to hide in personal care products such as eyelash curlers that do not list it as an active or inactive ingredient.

A simple and relatively inexpensive dimethylglyoxime test, which Dr. Atwater said can be purchased on the consumer market, can help identify items that may contain nickel. Rub a drop of dimethylglyoxime onto an item, such as a house key, with a cotton swab. If the key turns bright pink, then you know it has nickel in it.

"So you can imagine that if I am holding my keys in my hands, I could be transferring nickel from the keys to my eyelids," said Dr. Atwater.

Other potential sources of nickel include faucets, sunglasses with metal frames, barbells, and other weight-lifting equipment.

Other common causes of eyelid dermatitis are products that contain fragrance, including balsam of Peru, neomycin (typically found in antibacterial eye drops), formaldehyde and bronopol (preservatives that are found in certain cosmetics), skin care products, and topicals.

Allergic contact dermatitis in the eyelid can present in an upper, lower, unilateral, or bilateral fashion on the eyelids alone, but typically presents in combination with dermatitis on other areas of the face, or even other areas of the body, according to Dr. Atwater.

"You should be highly suspicious that it’s contact dermatitis when you see eyelid dermatitis with other parts of the body involved," she said.

When the dermatitis presents in the eyelids alone, other factors such as seborrheic dermatitis or aspecific xerotic dermatitis could be the cause.

"Still, a good 30%-50% of our patients will have allergic contact dermatitis when we see them with eyelid dermatitis alone," Dr. Atwater said.

The eyelids are particularly susceptible to irritation in part because the skin is extremely thin – 0.55 mm – compared with other facial areas where the average skin thickness is about 2 mm, Dr. Atwater explained.

"And it’s really easy to transfer substances from our hands to our eyes. People rub their eyes and their faces a lot throughout the day," she noted.

Dr. Atwater had no financial conflicts to disclose.

[email protected]

On Twitter @whitneymcknight

CHICAGO – Chances are good that if your patient presents with eyelid dermatitis, allergic contact with gold or nickel is the culprit.

"Gold is not thought to be easily released from jewelry, which would be the typical exposure with eyelids, unless it comes into contact with sweat, friction, or abrasives," Dr. Amber Reck Atwater told attendees of a session on facial dermatoses at the American Academy of Dermatology summer meeting.

Courtesy Wikimedia Commons/Linuxerist/Creative Commons License

However, when gold comes into contact with titanium dioxide, a common active ingredient in many cosmetics such as eye shadow, patients are at risk for eyelid irritation.

"If I am wearing a gold ring, and I put this on my eyelids using my finger, the gold will be more easily released, and I will be more likely to get a reaction on my lids," said Dr. Atwater, of the department of dermatology at Duke University, Durham, N.C.

Nickel is another leading cause of eyelid dermatitis, Dr. Atwater said. She warned of the metal’s pernicious tendency to hide in personal care products such as eyelash curlers that do not list it as an active or inactive ingredient.

A simple and relatively inexpensive dimethylglyoxime test, which Dr. Atwater said can be purchased on the consumer market, can help identify items that may contain nickel. Rub a drop of dimethylglyoxime onto an item, such as a house key, with a cotton swab. If the key turns bright pink, then you know it has nickel in it.

"So you can imagine that if I am holding my keys in my hands, I could be transferring nickel from the keys to my eyelids," said Dr. Atwater.

Other potential sources of nickel include faucets, sunglasses with metal frames, barbells, and other weight-lifting equipment.

Other common causes of eyelid dermatitis are products that contain fragrance, including balsam of Peru, neomycin (typically found in antibacterial eye drops), formaldehyde and bronopol (preservatives that are found in certain cosmetics), skin care products, and topicals.

Allergic contact dermatitis in the eyelid can present in an upper, lower, unilateral, or bilateral fashion on the eyelids alone, but typically presents in combination with dermatitis on other areas of the face, or even other areas of the body, according to Dr. Atwater.

"You should be highly suspicious that it’s contact dermatitis when you see eyelid dermatitis with other parts of the body involved," she said.

When the dermatitis presents in the eyelids alone, other factors such as seborrheic dermatitis or aspecific xerotic dermatitis could be the cause.

"Still, a good 30%-50% of our patients will have allergic contact dermatitis when we see them with eyelid dermatitis alone," Dr. Atwater said.

The eyelids are particularly susceptible to irritation in part because the skin is extremely thin – 0.55 mm – compared with other facial areas where the average skin thickness is about 2 mm, Dr. Atwater explained.

"And it’s really easy to transfer substances from our hands to our eyes. People rub their eyes and their faces a lot throughout the day," she noted.

Dr. Atwater had no financial conflicts to disclose.

[email protected]

On Twitter @whitneymcknight

BETHESDA, MD. – We visited the office of Dr. Steven A. Rosenberg, chief of the Surgery Branch at the National Cancer Institute, and a pioneer of adoptive cell transfer using tumor infiltrating lymphocytes (TILs) in melanoma patients. We asked for his thoughts on recently published work on TILs in breast cancer and on the future of immunotherapy for breast cancer.

He explained that the success of immunotherapy for breast cancer, he believes, lies in being able to identify the mutations driving tumor growth and manipulating the immune system to recognize those mutations. Dr. Rosenberg began studies in July to investigate this hypothesis.

Listen to the wide-ranging discussion with Dr. Rosenberg on issues from the immunogenicity of epithelial tumors to checkpoint inhibitors and the future of chemotherapy.

Dr. Rosenberg had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

BETHESDA, MD. – We visited the office of Dr. Steven A. Rosenberg, chief of the Surgery Branch at the National Cancer Institute, and a pioneer of adoptive cell transfer using tumor infiltrating lymphocytes (TILs) in melanoma patients. We asked for his thoughts on recently published work on TILs in breast cancer and on the future of immunotherapy for breast cancer.

He explained that the success of immunotherapy for breast cancer, he believes, lies in being able to identify the mutations driving tumor growth and manipulating the immune system to recognize those mutations. Dr. Rosenberg began studies in July to investigate this hypothesis.

Listen to the wide-ranging discussion with Dr. Rosenberg on issues from the immunogenicity of epithelial tumors to checkpoint inhibitors and the future of chemotherapy.

Dr. Rosenberg had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

BETHESDA, MD. – We visited the office of Dr. Steven A. Rosenberg, chief of the Surgery Branch at the National Cancer Institute, and a pioneer of adoptive cell transfer using tumor infiltrating lymphocytes (TILs) in melanoma patients. We asked for his thoughts on recently published work on TILs in breast cancer and on the future of immunotherapy for breast cancer.

He explained that the success of immunotherapy for breast cancer, he believes, lies in being able to identify the mutations driving tumor growth and manipulating the immune system to recognize those mutations. Dr. Rosenberg began studies in July to investigate this hypothesis.

Listen to the wide-ranging discussion with Dr. Rosenberg on issues from the immunogenicity of epithelial tumors to checkpoint inhibitors and the future of chemotherapy.

Dr. Rosenberg had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

Adult tertiary epilepsy centers often lack the-resources to manage young adult patients transitioning from pediatric centers, based on a study published online (Epilepsia doi.10.1111/epi.12752).

“These transitioned patients require more resources and services than other young patients with epilepsy” that are being cared for in the community, wrote the authors of the study. In addition, the researchers reported that adult neurologists, “even those specialized in epilepsy, may not feel that they are adequately prepared to diagnose and treat part of this complex population.”

For the retrospective study, Dr. Felippe Borlot, an epilepsy fellow at the University of Toronto (Canada), and his colleagues reviewed the records of all young adults, ages 18 through 25 years, with childhood-onset epilepsy seen over a 6-year period at a single adult tertiary epilepsy care site. The researchers reviewed patient demographic data, etiologies, and treatment regimens before sorting patients into two groups.

The first group of 170 patients had been referred from a pediatric epilepsy tertiary care center; the second group of 132 patients was age-matched with that group and consisted of those referred by community physicians, including pediatric neurologists, to the adult tertiary center. The mean age for Group 1 was 21.9 years and the mean age for Group 2 was 23.2 years.

The first group had earlier seizure onset, longer epilepsy duration, more symptomatic etiologies, epileptic encephalopathy, and cognitive delay (P less than .001 for all). The first group also required more care from other specialists (P = .001), as well as polytherapies (P = .003), epilepsy surgery (P less than .001), a ketogenic diet (P less than .001), and the use of a vagus nerve stimulator (P less than .001).

Patients from tertiary centers present more complex health care needs and require more resources than age-matched patients from the community, said Dr. Borlot and his co-investigators.

The researchers also surveyed 86 adult neurologists and 29 pediatric neurologists. On a scale of one (not comfortable at all) to five (very comfortable), the neurologists were asked to rate their comfort level in dealing with several types of epilepsy. The survey also addressed how the neurologists felt about treating attendant issues such as intellectual disabilities and autistic features.

Survey results, while not validated, showed that adult neurologists had less confidence diagnosing and treating more severe forms of childhood-onset epilepsies (P less than .001), as well as epilepsy associated with cognitive delay (P less than .001).

The study lacked data validating a successful transition from pediatric to adult care. Also, it did not include patients who were not assessed in the 12 months prior to the study, meaning it was not possible to determine the percentage of patients lost to follow-up. Nevertheless, the investigators concluded that the data were useful since no previous evaluation of transition of care in the epileptic setting was available.

Dr. Borlot and his co-authors concluded that transition of care for patients with epilepsy may be enhanced by efforts to “make childhood-onset epilepsies part of adult neurologists’ training and certification requirements.”

Adult tertiary epilepsy centers often lack the-resources to manage young adult patients transitioning from pediatric centers, based on a study published online (Epilepsia doi.10.1111/epi.12752).

“These transitioned patients require more resources and services than other young patients with epilepsy” that are being cared for in the community, wrote the authors of the study. In addition, the researchers reported that adult neurologists, “even those specialized in epilepsy, may not feel that they are adequately prepared to diagnose and treat part of this complex population.”

For the retrospective study, Dr. Felippe Borlot, an epilepsy fellow at the University of Toronto (Canada), and his colleagues reviewed the records of all young adults, ages 18 through 25 years, with childhood-onset epilepsy seen over a 6-year period at a single adult tertiary epilepsy care site. The researchers reviewed patient demographic data, etiologies, and treatment regimens before sorting patients into two groups.

The first group of 170 patients had been referred from a pediatric epilepsy tertiary care center; the second group of 132 patients was age-matched with that group and consisted of those referred by community physicians, including pediatric neurologists, to the adult tertiary center. The mean age for Group 1 was 21.9 years and the mean age for Group 2 was 23.2 years.

The first group had earlier seizure onset, longer epilepsy duration, more symptomatic etiologies, epileptic encephalopathy, and cognitive delay (P less than .001 for all). The first group also required more care from other specialists (P = .001), as well as polytherapies (P = .003), epilepsy surgery (P less than .001), a ketogenic diet (P less than .001), and the use of a vagus nerve stimulator (P less than .001).

Patients from tertiary centers present more complex health care needs and require more resources than age-matched patients from the community, said Dr. Borlot and his co-investigators.

The researchers also surveyed 86 adult neurologists and 29 pediatric neurologists. On a scale of one (not comfortable at all) to five (very comfortable), the neurologists were asked to rate their comfort level in dealing with several types of epilepsy. The survey also addressed how the neurologists felt about treating attendant issues such as intellectual disabilities and autistic features.

Survey results, while not validated, showed that adult neurologists had less confidence diagnosing and treating more severe forms of childhood-onset epilepsies (P less than .001), as well as epilepsy associated with cognitive delay (P less than .001).

The study lacked data validating a successful transition from pediatric to adult care. Also, it did not include patients who were not assessed in the 12 months prior to the study, meaning it was not possible to determine the percentage of patients lost to follow-up. Nevertheless, the investigators concluded that the data were useful since no previous evaluation of transition of care in the epileptic setting was available.

Dr. Borlot and his co-authors concluded that transition of care for patients with epilepsy may be enhanced by efforts to “make childhood-onset epilepsies part of adult neurologists’ training and certification requirements.”

Adult tertiary epilepsy centers often lack the-resources to manage young adult patients transitioning from pediatric centers, based on a study published online (Epilepsia doi.10.1111/epi.12752).

“These transitioned patients require more resources and services than other young patients with epilepsy” that are being cared for in the community, wrote the authors of the study. In addition, the researchers reported that adult neurologists, “even those specialized in epilepsy, may not feel that they are adequately prepared to diagnose and treat part of this complex population.”

For the retrospective study, Dr. Felippe Borlot, an epilepsy fellow at the University of Toronto (Canada), and his colleagues reviewed the records of all young adults, ages 18 through 25 years, with childhood-onset epilepsy seen over a 6-year period at a single adult tertiary epilepsy care site. The researchers reviewed patient demographic data, etiologies, and treatment regimens before sorting patients into two groups.

The first group of 170 patients had been referred from a pediatric epilepsy tertiary care center; the second group of 132 patients was age-matched with that group and consisted of those referred by community physicians, including pediatric neurologists, to the adult tertiary center. The mean age for Group 1 was 21.9 years and the mean age for Group 2 was 23.2 years.

The first group had earlier seizure onset, longer epilepsy duration, more symptomatic etiologies, epileptic encephalopathy, and cognitive delay (P less than .001 for all). The first group also required more care from other specialists (P = .001), as well as polytherapies (P = .003), epilepsy surgery (P less than .001), a ketogenic diet (P less than .001), and the use of a vagus nerve stimulator (P less than .001).

Patients from tertiary centers present more complex health care needs and require more resources than age-matched patients from the community, said Dr. Borlot and his co-investigators.

The researchers also surveyed 86 adult neurologists and 29 pediatric neurologists. On a scale of one (not comfortable at all) to five (very comfortable), the neurologists were asked to rate their comfort level in dealing with several types of epilepsy. The survey also addressed how the neurologists felt about treating attendant issues such as intellectual disabilities and autistic features.

Survey results, while not validated, showed that adult neurologists had less confidence diagnosing and treating more severe forms of childhood-onset epilepsies (P less than .001), as well as epilepsy associated with cognitive delay (P less than .001).

The study lacked data validating a successful transition from pediatric to adult care. Also, it did not include patients who were not assessed in the 12 months prior to the study, meaning it was not possible to determine the percentage of patients lost to follow-up. Nevertheless, the investigators concluded that the data were useful since no previous evaluation of transition of care in the epileptic setting was available.

Dr. Borlot and his co-authors concluded that transition of care for patients with epilepsy may be enhanced by efforts to “make childhood-onset epilepsies part of adult neurologists’ training and certification requirements.”

WASHINGTON – For adults with Haemophilus influenzae-related community acquired pneumonia, fluoroquinolones were significantly associated with early clinical response rates that were better than those seen with other antibiotics, based on the findings of a German study.

“Initial treatment with any fluoroquinolone was the only positive predictor of early clinical response, and use of macrolide monotherapy was the only negative predictor of early clinical response,” Dr. Christina Forstner, a researcher at the Medical University of Vienna in Austria, said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Courtesy Dr. W.A. Clark/CDC

The multi-center, observational, prospective, cohort study was conducted between 2002 and 2012 in 171 adults who had community acquired pneumonia and tested positive for H.influenzae. In 124 patients, H.influenzae was the sole pathogen detected, whereas 47 patients had at least one other co-infection.

The primary end point of the study was an early clinical response ‑ clinical stability by day 4 of treatment. The secondary end point was clinical cure anywhere at day 14. The choice of antimicrobial treatment was left to the discretion of individual clinicians.

Early clinical response rates were seen for 46 of 47 patients (97.6%) given any fluoroquinolone, with 100% clinical cure by day 14. Fluoroquinolone monotherapy achieved a nearly 100% early clinical response rate (39 out of 40 patients), and complete clinical cure was seen in all patients by day 14. The rates were significantly different from those seen with other antibiotics (P = .01).

An early clinical response rate was seen in 92 of 108 patients (85.2%) given any beta-lactam. Beta-lactam monotherapy achieved an early clinical response rate in 63 out of 74 cases, with a clinical cure rate at day 14 in 68 out of 74 cases.

An early clinical response rate was seen in 29 of 36 patients (80.6%) who received any macrolide; an early clinical response rate was seen in 8 of 12 patients given monotherapy with a macrolide. Clinical cure rate at day 14 was 32 out of 36 patients given any macrolide, and 11 out of 12 given macrolide monotherapy.

The median duration of therapy was, according to Dr. Forstner, “quite long” at 10 days. Monotherapy was used in 78.4% of patients, and oral treatments in 63.7%.

The overall early clinical response rate was 88%, with an overall clinical cure of 93% on day 14, and of 95.9% on day 28.

A univariate analysis of age, body mass index, severity of disease, co-infection, and treatments used indicated the only factor associated with an early clinical response was the use of any fluoroquinolone (odds ration, 8.8). Macrolide monotherapy was associated with a negative clinical response (OR, 0.239).

WASHINGTON – For adults with Haemophilus influenzae-related community acquired pneumonia, fluoroquinolones were significantly associated with early clinical response rates that were better than those seen with other antibiotics, based on the findings of a German study.

“Initial treatment with any fluoroquinolone was the only positive predictor of early clinical response, and use of macrolide monotherapy was the only negative predictor of early clinical response,” Dr. Christina Forstner, a researcher at the Medical University of Vienna in Austria, said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Courtesy Dr. W.A. Clark/CDC

The multi-center, observational, prospective, cohort study was conducted between 2002 and 2012 in 171 adults who had community acquired pneumonia and tested positive for H.influenzae. In 124 patients, H.influenzae was the sole pathogen detected, whereas 47 patients had at least one other co-infection.

The primary end point of the study was an early clinical response ‑ clinical stability by day 4 of treatment. The secondary end point was clinical cure anywhere at day 14. The choice of antimicrobial treatment was left to the discretion of individual clinicians.

Early clinical response rates were seen for 46 of 47 patients (97.6%) given any fluoroquinolone, with 100% clinical cure by day 14. Fluoroquinolone monotherapy achieved a nearly 100% early clinical response rate (39 out of 40 patients), and complete clinical cure was seen in all patients by day 14. The rates were significantly different from those seen with other antibiotics (P = .01).

An early clinical response rate was seen in 92 of 108 patients (85.2%) given any beta-lactam. Beta-lactam monotherapy achieved an early clinical response rate in 63 out of 74 cases, with a clinical cure rate at day 14 in 68 out of 74 cases.

An early clinical response rate was seen in 29 of 36 patients (80.6%) who received any macrolide; an early clinical response rate was seen in 8 of 12 patients given monotherapy with a macrolide. Clinical cure rate at day 14 was 32 out of 36 patients given any macrolide, and 11 out of 12 given macrolide monotherapy.

The median duration of therapy was, according to Dr. Forstner, “quite long” at 10 days. Monotherapy was used in 78.4% of patients, and oral treatments in 63.7%.

The overall early clinical response rate was 88%, with an overall clinical cure of 93% on day 14, and of 95.9% on day 28.

A univariate analysis of age, body mass index, severity of disease, co-infection, and treatments used indicated the only factor associated with an early clinical response was the use of any fluoroquinolone (odds ration, 8.8). Macrolide monotherapy was associated with a negative clinical response (OR, 0.239).

WASHINGTON – For adults with Haemophilus influenzae-related community acquired pneumonia, fluoroquinolones were significantly associated with early clinical response rates that were better than those seen with other antibiotics, based on the findings of a German study.

“Initial treatment with any fluoroquinolone was the only positive predictor of early clinical response, and use of macrolide monotherapy was the only negative predictor of early clinical response,” Dr. Christina Forstner, a researcher at the Medical University of Vienna in Austria, said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Courtesy Dr. W.A. Clark/CDC

The multi-center, observational, prospective, cohort study was conducted between 2002 and 2012 in 171 adults who had community acquired pneumonia and tested positive for H.influenzae. In 124 patients, H.influenzae was the sole pathogen detected, whereas 47 patients had at least one other co-infection.

The primary end point of the study was an early clinical response ‑ clinical stability by day 4 of treatment. The secondary end point was clinical cure anywhere at day 14. The choice of antimicrobial treatment was left to the discretion of individual clinicians.

Early clinical response rates were seen for 46 of 47 patients (97.6%) given any fluoroquinolone, with 100% clinical cure by day 14. Fluoroquinolone monotherapy achieved a nearly 100% early clinical response rate (39 out of 40 patients), and complete clinical cure was seen in all patients by day 14. The rates were significantly different from those seen with other antibiotics (P = .01).

An early clinical response rate was seen in 92 of 108 patients (85.2%) given any beta-lactam. Beta-lactam monotherapy achieved an early clinical response rate in 63 out of 74 cases, with a clinical cure rate at day 14 in 68 out of 74 cases.

An early clinical response rate was seen in 29 of 36 patients (80.6%) who received any macrolide; an early clinical response rate was seen in 8 of 12 patients given monotherapy with a macrolide. Clinical cure rate at day 14 was 32 out of 36 patients given any macrolide, and 11 out of 12 given macrolide monotherapy.

The median duration of therapy was, according to Dr. Forstner, “quite long” at 10 days. Monotherapy was used in 78.4% of patients, and oral treatments in 63.7%.

The overall early clinical response rate was 88%, with an overall clinical cure of 93% on day 14, and of 95.9% on day 28.

A univariate analysis of age, body mass index, severity of disease, co-infection, and treatments used indicated the only factor associated with an early clinical response was the use of any fluoroquinolone (odds ration, 8.8). Macrolide monotherapy was associated with a negative clinical response (OR, 0.239).

WASHINGTON – Immunizing expectant mothers with the Tdap vaccine booster shot resulted in higher cord serum levels of pertussis toxin antibodies, according to a study from Argentina.

"The results of this study [indicate] that children would be protected from pertussis until they receive the usual immunization schedule," study coauthor Dr. Aurelia Fallo, a researcher at the Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, said in an interview.

©AvailableLight/istockphoto.com

The Tdap vaccine for pregnant women was introduced in Argentina in 2012 to help decrease infant morbidity and mortality, according to Dr. Eduardo Lopez, director of pediatric infectious diseases at the hospital, who presented the data during the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

This was the first Latin American study to measure the effect of maternal vaccination with Tdap, he said. Argentina’s recommended schedule for maternal Tdap vaccination is during the third trimester before gestational week 38. Since 2011, the U.S. Centers for Disease Control and Prevention also has recommended that pregnant women receive the Tdap vaccine, after 20 weeks’ gestation.

At a single site in Buenos Aires, Dr. Fallo, Dr. Lopez, and their colleagues took serum samples and maternal cord serum samples at delivery from 88 mothers immunized with the Tdap vaccine. The investigators also took serum samples and maternal cord serum samples at delivery from 108 pairs of non–Tdap-immunized mothers. Serum samples were drawn from 69 nonpregnant women controls as well.

While all of the study participants, including controls, had received their full Tdap vaccination schedules as children, it wasn’t until 2011 that Argentina added the Tdap booster at 11 years of age to the national immunization schedule; therefore, except for the mothers who had received the maternal booster shot, no one in the study had been immunized against pertussis since the age of 6 years, Dr. Fallo said.

In the United States, the Tdap booster is recommended at age 11 years, with Td booster shots to follow every 10 years.

The mean age for all mothers was 26 years. Mothers who received their Tdap booster did so on average at gestational week 25 (standard deviation, 6 weeks).

Each mother/cord sample pair was blinded and measured for IgG-PT (pertussis toxin) antibodies using a validated enzyme-linked immunosorbent assay (ELISA) test. A measurement of 5 EU/mL was considered protective.

The mean concentration of IgG-PT in maternal cord sera taken from vaccinated mothers was 57.2 EU/mL, versus 12.3 EU/mL in unvaccinated mothers (P less than .001).

The mean concentration of IgG-PT in the vaccinated serum samples taken at delivery was 41.1 EU/mL. For the nonimmunized group, the mean IgG-PT concentration was 10.7 EU/mL (P less than .0001).

In the nonimmunized group, 19% had IgG-PT serum levels of less than 5 EU/mL, compared with 2.3% of the mothers who had been immunized (P = .001). Less than 5 EU/mL of IgG-PT was found in 3% of controls (P = .004).

The placenta antibody ratio in immunized mothers was 1.39, versus 1.1 for nonimmunized mothers (P = .01).

Whitney McKnight/Frontline Medical News

According to Dr. Lopez, there was a significant difference for mothers vaccinated before the third trimester, when the mean concentration of IgG-PT was 25.8 EU/mL, compared with the mean 41.9 EU/mL of IgG-PT for mothers in the third trimester (P = .002).

In all, Dr. Lopez said these data indicated that the maternal Tdap vaccination program in Argentina had greatly reduced infant mortality there. "When you compare the mortality rates from 2011 to 2013 in Argentina, there is an 87% reduction," he said. The number of pertussis-related infant deaths went from 76 in 2011 to 10 in 2013, according to official Argentina Ministry of Health records.

"The key point is that maternal Tdap immunization after 20 weeks of gestation seems to be a good strategy to protect infants," Dr. Fallo said.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Immunizing expectant mothers with the Tdap vaccine booster shot resulted in higher cord serum levels of pertussis toxin antibodies, according to a study from Argentina.

"The results of this study [indicate] that children would be protected from pertussis until they receive the usual immunization schedule," study coauthor Dr. Aurelia Fallo, a researcher at the Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, said in an interview.

©AvailableLight/istockphoto.com

The Tdap vaccine for pregnant women was introduced in Argentina in 2012 to help decrease infant morbidity and mortality, according to Dr. Eduardo Lopez, director of pediatric infectious diseases at the hospital, who presented the data during the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

This was the first Latin American study to measure the effect of maternal vaccination with Tdap, he said. Argentina’s recommended schedule for maternal Tdap vaccination is during the third trimester before gestational week 38. Since 2011, the U.S. Centers for Disease Control and Prevention also has recommended that pregnant women receive the Tdap vaccine, after 20 weeks’ gestation.

At a single site in Buenos Aires, Dr. Fallo, Dr. Lopez, and their colleagues took serum samples and maternal cord serum samples at delivery from 88 mothers immunized with the Tdap vaccine. The investigators also took serum samples and maternal cord serum samples at delivery from 108 pairs of non–Tdap-immunized mothers. Serum samples were drawn from 69 nonpregnant women controls as well.

While all of the study participants, including controls, had received their full Tdap vaccination schedules as children, it wasn’t until 2011 that Argentina added the Tdap booster at 11 years of age to the national immunization schedule; therefore, except for the mothers who had received the maternal booster shot, no one in the study had been immunized against pertussis since the age of 6 years, Dr. Fallo said.

In the United States, the Tdap booster is recommended at age 11 years, with Td booster shots to follow every 10 years.

The mean age for all mothers was 26 years. Mothers who received their Tdap booster did so on average at gestational week 25 (standard deviation, 6 weeks).

Each mother/cord sample pair was blinded and measured for IgG-PT (pertussis toxin) antibodies using a validated enzyme-linked immunosorbent assay (ELISA) test. A measurement of 5 EU/mL was considered protective.

The mean concentration of IgG-PT in maternal cord sera taken from vaccinated mothers was 57.2 EU/mL, versus 12.3 EU/mL in unvaccinated mothers (P less than .001).

The mean concentration of IgG-PT in the vaccinated serum samples taken at delivery was 41.1 EU/mL. For the nonimmunized group, the mean IgG-PT concentration was 10.7 EU/mL (P less than .0001).

In the nonimmunized group, 19% had IgG-PT serum levels of less than 5 EU/mL, compared with 2.3% of the mothers who had been immunized (P = .001). Less than 5 EU/mL of IgG-PT was found in 3% of controls (P = .004).

The placenta antibody ratio in immunized mothers was 1.39, versus 1.1 for nonimmunized mothers (P = .01).

Whitney McKnight/Frontline Medical News

According to Dr. Lopez, there was a significant difference for mothers vaccinated before the third trimester, when the mean concentration of IgG-PT was 25.8 EU/mL, compared with the mean 41.9 EU/mL of IgG-PT for mothers in the third trimester (P = .002).

In all, Dr. Lopez said these data indicated that the maternal Tdap vaccination program in Argentina had greatly reduced infant mortality there. "When you compare the mortality rates from 2011 to 2013 in Argentina, there is an 87% reduction," he said. The number of pertussis-related infant deaths went from 76 in 2011 to 10 in 2013, according to official Argentina Ministry of Health records.

"The key point is that maternal Tdap immunization after 20 weeks of gestation seems to be a good strategy to protect infants," Dr. Fallo said.

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On Twitter @whitneymcknight

WASHINGTON – Immunizing expectant mothers with the Tdap vaccine booster shot resulted in higher cord serum levels of pertussis toxin antibodies, according to a study from Argentina.

"The results of this study [indicate] that children would be protected from pertussis until they receive the usual immunization schedule," study coauthor Dr. Aurelia Fallo, a researcher at the Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, said in an interview.

©AvailableLight/istockphoto.com

The Tdap vaccine for pregnant women was introduced in Argentina in 2012 to help decrease infant morbidity and mortality, according to Dr. Eduardo Lopez, director of pediatric infectious diseases at the hospital, who presented the data during the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

This was the first Latin American study to measure the effect of maternal vaccination with Tdap, he said. Argentina’s recommended schedule for maternal Tdap vaccination is during the third trimester before gestational week 38. Since 2011, the U.S. Centers for Disease Control and Prevention also has recommended that pregnant women receive the Tdap vaccine, after 20 weeks’ gestation.

At a single site in Buenos Aires, Dr. Fallo, Dr. Lopez, and their colleagues took serum samples and maternal cord serum samples at delivery from 88 mothers immunized with the Tdap vaccine. The investigators also took serum samples and maternal cord serum samples at delivery from 108 pairs of non–Tdap-immunized mothers. Serum samples were drawn from 69 nonpregnant women controls as well.

While all of the study participants, including controls, had received their full Tdap vaccination schedules as children, it wasn’t until 2011 that Argentina added the Tdap booster at 11 years of age to the national immunization schedule; therefore, except for the mothers who had received the maternal booster shot, no one in the study had been immunized against pertussis since the age of 6 years, Dr. Fallo said.

In the United States, the Tdap booster is recommended at age 11 years, with Td booster shots to follow every 10 years.

The mean age for all mothers was 26 years. Mothers who received their Tdap booster did so on average at gestational week 25 (standard deviation, 6 weeks).

Each mother/cord sample pair was blinded and measured for IgG-PT (pertussis toxin) antibodies using a validated enzyme-linked immunosorbent assay (ELISA) test. A measurement of 5 EU/mL was considered protective.

The mean concentration of IgG-PT in maternal cord sera taken from vaccinated mothers was 57.2 EU/mL, versus 12.3 EU/mL in unvaccinated mothers (P less than .001).

The mean concentration of IgG-PT in the vaccinated serum samples taken at delivery was 41.1 EU/mL. For the nonimmunized group, the mean IgG-PT concentration was 10.7 EU/mL (P less than .0001).

In the nonimmunized group, 19% had IgG-PT serum levels of less than 5 EU/mL, compared with 2.3% of the mothers who had been immunized (P = .001). Less than 5 EU/mL of IgG-PT was found in 3% of controls (P = .004).

The placenta antibody ratio in immunized mothers was 1.39, versus 1.1 for nonimmunized mothers (P = .01).

Whitney McKnight/Frontline Medical News

According to Dr. Lopez, there was a significant difference for mothers vaccinated before the third trimester, when the mean concentration of IgG-PT was 25.8 EU/mL, compared with the mean 41.9 EU/mL of IgG-PT for mothers in the third trimester (P = .002).

In all, Dr. Lopez said these data indicated that the maternal Tdap vaccination program in Argentina had greatly reduced infant mortality there. "When you compare the mortality rates from 2011 to 2013 in Argentina, there is an 87% reduction," he said. The number of pertussis-related infant deaths went from 76 in 2011 to 10 in 2013, according to official Argentina Ministry of Health records.

"The key point is that maternal Tdap immunization after 20 weeks of gestation seems to be a good strategy to protect infants," Dr. Fallo said.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Potentially pathogenic nasopharyngeal bacterial colonization was associated with more severe respiratory syncytial virus–related bronchiolitis in infants, according to a study.

"We found that [colonization] was significantly more common and almost double in the RSV patients, compared with controls," said Dr. Eleanora Bunsow, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, who presented the data at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. "And RSV patients were frequently colonized with more than one pathogenic bacteria."

Additionally, the use of polymerase chain reaction (PCR) assays to assess bacterial colonization types and levels was found to outperform the accuracy of cultures.

"The PCR showed an increased capacity for bacteria detection and had the ability to quantitate the bacterial load in infant RSV bronchiolitis," Dr. Bunsow said.

While the majority of infants hospitalized with RSV bronchiolitis are previously healthy with no known risk factors, about 15% will require intensive care. The role of pathogenic bacteria has, until recently, been explored only in animal studies, Dr. Bunsow said.

From December 2010 to May 2012, 294 children (median age, 2.5 years) were enrolled at a single site. Of these, 47 were age-matched healthy controls, 182 were inpatient, and 65 were admitted to the ICU. Both inpatient and ICU admissions tended to include twice as many boys as girls (1.6:1 and 1.7:1, respectively). A total of 47% of the control group were African Americans.

Cultures and PCR assays were performed on all study participants for the detection of gram-positive Staphylococcus aureus and Streptococcus pneumoniae, and gram-negative Moraxella catarrhalis and Haemophilus influenzae.

PCR had a 1.4-fold higher level of sensitivity (95% confidence interval, 91%-98%) and equal specificity when compared with cultures for identifying all four bacteria tested.

Polymicrobial bacterial colonization of both gram-positive and gram-negative species was found in 13% of RSV patients, compared with no potentially pathogenic bacterial colonizations in the control group (P = .004).

Rates of colonization were also higher in those with severe RSV infections of the lower respiratory tract who were admitted to the pediatric ICU (PICU), compared with inpatients with less severe disease (53.8% vs. 39%; P = .038). The median clinical disease severity score for those with potentially pathogenic bacterial colonization was 5, compared with a median score of 4 in those without colonization (P = .187).

Colonization with gram-negative bacteria was associated with a "significantly higher" need for up to 3 days of ICU oxygen support, compared with needing only up to 2 days of oxygen for colonization with gram-positive bacteria (P = .039), Dr. Bunsow noted.

Also, H. influenzae was identified in 54% of PICU patients, compared with 39% of inpatient ones. Higher H. influenzae loads correlated with PICU lengths of stay (P = .03).

"Our future study will include outpatients ... and will analyze the impact of the microbiome in these patients," Dr. Bunsow said.

Dr. Bunsow said she had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Potentially pathogenic nasopharyngeal bacterial colonization was associated with more severe respiratory syncytial virus–related bronchiolitis in infants, according to a study.

"We found that [colonization] was significantly more common and almost double in the RSV patients, compared with controls," said Dr. Eleanora Bunsow, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, who presented the data at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. "And RSV patients were frequently colonized with more than one pathogenic bacteria."

Additionally, the use of polymerase chain reaction (PCR) assays to assess bacterial colonization types and levels was found to outperform the accuracy of cultures.

"The PCR showed an increased capacity for bacteria detection and had the ability to quantitate the bacterial load in infant RSV bronchiolitis," Dr. Bunsow said.

While the majority of infants hospitalized with RSV bronchiolitis are previously healthy with no known risk factors, about 15% will require intensive care. The role of pathogenic bacteria has, until recently, been explored only in animal studies, Dr. Bunsow said.

From December 2010 to May 2012, 294 children (median age, 2.5 years) were enrolled at a single site. Of these, 47 were age-matched healthy controls, 182 were inpatient, and 65 were admitted to the ICU. Both inpatient and ICU admissions tended to include twice as many boys as girls (1.6:1 and 1.7:1, respectively). A total of 47% of the control group were African Americans.

Cultures and PCR assays were performed on all study participants for the detection of gram-positive Staphylococcus aureus and Streptococcus pneumoniae, and gram-negative Moraxella catarrhalis and Haemophilus influenzae.

PCR had a 1.4-fold higher level of sensitivity (95% confidence interval, 91%-98%) and equal specificity when compared with cultures for identifying all four bacteria tested.

Polymicrobial bacterial colonization of both gram-positive and gram-negative species was found in 13% of RSV patients, compared with no potentially pathogenic bacterial colonizations in the control group (P = .004).

Rates of colonization were also higher in those with severe RSV infections of the lower respiratory tract who were admitted to the pediatric ICU (PICU), compared with inpatients with less severe disease (53.8% vs. 39%; P = .038). The median clinical disease severity score for those with potentially pathogenic bacterial colonization was 5, compared with a median score of 4 in those without colonization (P = .187).

Colonization with gram-negative bacteria was associated with a "significantly higher" need for up to 3 days of ICU oxygen support, compared with needing only up to 2 days of oxygen for colonization with gram-positive bacteria (P = .039), Dr. Bunsow noted.

Also, H. influenzae was identified in 54% of PICU patients, compared with 39% of inpatient ones. Higher H. influenzae loads correlated with PICU lengths of stay (P = .03).

"Our future study will include outpatients ... and will analyze the impact of the microbiome in these patients," Dr. Bunsow said.

Dr. Bunsow said she had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Potentially pathogenic nasopharyngeal bacterial colonization was associated with more severe respiratory syncytial virus–related bronchiolitis in infants, according to a study.

"We found that [colonization] was significantly more common and almost double in the RSV patients, compared with controls," said Dr. Eleanora Bunsow, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, who presented the data at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. "And RSV patients were frequently colonized with more than one pathogenic bacteria."

Additionally, the use of polymerase chain reaction (PCR) assays to assess bacterial colonization types and levels was found to outperform the accuracy of cultures.

"The PCR showed an increased capacity for bacteria detection and had the ability to quantitate the bacterial load in infant RSV bronchiolitis," Dr. Bunsow said.

While the majority of infants hospitalized with RSV bronchiolitis are previously healthy with no known risk factors, about 15% will require intensive care. The role of pathogenic bacteria has, until recently, been explored only in animal studies, Dr. Bunsow said.

From December 2010 to May 2012, 294 children (median age, 2.5 years) were enrolled at a single site. Of these, 47 were age-matched healthy controls, 182 were inpatient, and 65 were admitted to the ICU. Both inpatient and ICU admissions tended to include twice as many boys as girls (1.6:1 and 1.7:1, respectively). A total of 47% of the control group were African Americans.

Cultures and PCR assays were performed on all study participants for the detection of gram-positive Staphylococcus aureus and Streptococcus pneumoniae, and gram-negative Moraxella catarrhalis and Haemophilus influenzae.

PCR had a 1.4-fold higher level of sensitivity (95% confidence interval, 91%-98%) and equal specificity when compared with cultures for identifying all four bacteria tested.

Polymicrobial bacterial colonization of both gram-positive and gram-negative species was found in 13% of RSV patients, compared with no potentially pathogenic bacterial colonizations in the control group (P = .004).

Rates of colonization were also higher in those with severe RSV infections of the lower respiratory tract who were admitted to the pediatric ICU (PICU), compared with inpatients with less severe disease (53.8% vs. 39%; P = .038). The median clinical disease severity score for those with potentially pathogenic bacterial colonization was 5, compared with a median score of 4 in those without colonization (P = .187).

Colonization with gram-negative bacteria was associated with a "significantly higher" need for up to 3 days of ICU oxygen support, compared with needing only up to 2 days of oxygen for colonization with gram-positive bacteria (P = .039), Dr. Bunsow noted.

Also, H. influenzae was identified in 54% of PICU patients, compared with 39% of inpatient ones. Higher H. influenzae loads correlated with PICU lengths of stay (P = .03).

"Our future study will include outpatients ... and will analyze the impact of the microbiome in these patients," Dr. Bunsow said.

Dr. Bunsow said she had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – A single injected dose of the neuraminidase inhibitor peramivir safely alleviated flu-like symptoms in adults when administered within 48 hours of onset of illness, an analysis of phase II and phase III clinical trial data indicates.

No single-dose treatment for influenza is currently available in the United States. Approval of the investigational drug would help protect those for whom influenza poses a higher than average risk, such as the elderly, the very young, and those who have other underlying illness such as chronic obstructive pulmonary disease, according to Dr. Richard Whitley, distinguished professor of pediatrics and microbiology at the University of Alabama, Birmingham.

©Micah Young/istockphoto.com

"Historically, we would have said the disease only afflicts [certain populations], but what we learned in the H1N1 pandemic was that ... we can’t ignore influenza. It’s here to stay." He made his comments during a media conference at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In two placebo-controlled, multicenter studies of a combined 427 adults with acute, uncomplicated influenza, peramivir 300 mg reduced flu symptoms within a median of 22 hours, and resolved fever within 24 hours, compared with placebo (both findings were significant). Symptoms included lethargy, cough, sore throat, headache, and myalgia. Though for time-to-symptom reduction, statistical significance fell away (P = .161), after adjustment for smoking behavior, influenza season, and virus type, the peramivir did significantly reduce nasal viral shedding within 48 hours following treatment, compared with placebo, Dr. Whitley reported

Results were based on patient-reported data using a four-point severity scale recorded over 14 days. Prior to injection, all patients were confirmed to have flu using rapid antigen detection testing, and none had any underlying illnesses or compromised autoimmunity. The drug was administered intramuscularly within 48 hours of onset of illness.

"If you ask me to put that into perspective with the other neuraminidase inhibitors, the level of benefit is virtually identical," said Dr. Whitley.

Currently, only two neuraminidase inhibitors are approved by the Food and Drug Administration: oral oseltamivir and inhaled zanamivir. Both are administered twice daily over 5 days.

Peramivir was determined to be generally safe, well tolerated, and with rates of adverse events such as mild to moderate diarrhea and dizziness similar in both the treatment and placebo arms. A separate study of the drug in a pediatric population is underway, said Dr. William Sheridan, chief medical officer of BioCryst, maker of peramivir.

"Influenza is associated with significant mortality and morbidity," Dr. Whitley said. In addition to annual immunization, "we need antivirals to keep people out of hospitals and to keep people from dying."

Annually, about a quarter million Americans are hospitalized with influenza, and nearly 36,000 die from it, according to the Centers for Disease Control and Prevention.

Peramivir has been approved in Japan and Korea since 2010. If approved by the FDA, it would be the first neuraminidase inhibitor approved in this country in more than a decade.

Pain and practicality

According to Dr. Sheridan, a New Drug Application to the FDA is currently under review with an assigned Prescription Drug User Fee Act action date of December 23, 2014. The indication, if approved, will be for influenza in adults. Dr. Sheridan also spoke during the media briefing.

Dr. Sheridan said that the application to the FDA is for an intravenous infusion that is the bioequivalent of the intramuscular version used in the trials because of the lack of practicality of intramuscular delivery.

"It hurts to get an intramuscular injection. In fact, it hurts a fair bit. We had to have our study subjects lay flat because if you stand up and feel faint after an injection like that, it’s probably a bad thing.

‘Real-world issues’ remain

If approved, the drug could also benefit underserved communities, the panelists agreed.

"If you see the patient once, you’re lucky," said Dr. Whitley. "If you give him a prescription, and you expect him to get it filled, the probability of that happening is maybe 20%-25%. So, if you’re worried about that individual, direct-observed therapy in the health care provider’s office is a good way to help solve this problem."

The shelf life of the drug, according to Dr. Sheridan, is about 5 years, if stored at room temperature.

Because there is less work for the end user, including finding a drug store that has sufficient supplies of the antiviral, "this drug, from a public health perspective, sounds even better than the oral medication," said the media briefing’s host, Dr. Michael Schmidt, professor and vice chair of immunology at the Medical University of South Carolina in Charleston.

"Front-line health care providers should have the availability of the medication so they can treat patients right in the office, without having to worry about filling prescriptions," Dr. Whitley said.

In theory, intravenous peramivir should be "relatively easy for any physician’s office that can handle relatively short IV infusions," according to Dr. Sheridan, who said that physicians would have a choice of using either a butterfly needle on the back of the hand, or an IV cannula in any other accessible vein, infusing the drug in between 15 and 30 minutes.

But questions about what to do if a doctor’s schedule can’t accommodate a patient or if the only access to a provider is through a so-called "minute clinic" are the domain of public health officials.

"There are always these real-world issues, and if there is a pandemic, then public health officials will have to look at the trade-offs," Dr. Schmidt said.

Dr. Whitley reported having no relevant disclosures, but noted that he is on the board of Gilead Sciences, maker of oseltamivir. Dr. Sheridan is the chief medical officer of BioCryst Pharmaceuticals, maker of peramivir. The two international studies were funded by the U.S. Department of Health & Human Services and BioCryst and were conducted at multiple centers in consecutive flu seasons between 2006 and 2008.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – A single injected dose of the neuraminidase inhibitor peramivir safely alleviated flu-like symptoms in adults when administered within 48 hours of onset of illness, an analysis of phase II and phase III clinical trial data indicates.

No single-dose treatment for influenza is currently available in the United States. Approval of the investigational drug would help protect those for whom influenza poses a higher than average risk, such as the elderly, the very young, and those who have other underlying illness such as chronic obstructive pulmonary disease, according to Dr. Richard Whitley, distinguished professor of pediatrics and microbiology at the University of Alabama, Birmingham.

©Micah Young/istockphoto.com

"Historically, we would have said the disease only afflicts [certain populations], but what we learned in the H1N1 pandemic was that ... we can’t ignore influenza. It’s here to stay." He made his comments during a media conference at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In two placebo-controlled, multicenter studies of a combined 427 adults with acute, uncomplicated influenza, peramivir 300 mg reduced flu symptoms within a median of 22 hours, and resolved fever within 24 hours, compared with placebo (both findings were significant). Symptoms included lethargy, cough, sore throat, headache, and myalgia. Though for time-to-symptom reduction, statistical significance fell away (P = .161), after adjustment for smoking behavior, influenza season, and virus type, the peramivir did significantly reduce nasal viral shedding within 48 hours following treatment, compared with placebo, Dr. Whitley reported

Results were based on patient-reported data using a four-point severity scale recorded over 14 days. Prior to injection, all patients were confirmed to have flu using rapid antigen detection testing, and none had any underlying illnesses or compromised autoimmunity. The drug was administered intramuscularly within 48 hours of onset of illness.

"If you ask me to put that into perspective with the other neuraminidase inhibitors, the level of benefit is virtually identical," said Dr. Whitley.

Currently, only two neuraminidase inhibitors are approved by the Food and Drug Administration: oral oseltamivir and inhaled zanamivir. Both are administered twice daily over 5 days.

Peramivir was determined to be generally safe, well tolerated, and with rates of adverse events such as mild to moderate diarrhea and dizziness similar in both the treatment and placebo arms. A separate study of the drug in a pediatric population is underway, said Dr. William Sheridan, chief medical officer of BioCryst, maker of peramivir.

"Influenza is associated with significant mortality and morbidity," Dr. Whitley said. In addition to annual immunization, "we need antivirals to keep people out of hospitals and to keep people from dying."

Annually, about a quarter million Americans are hospitalized with influenza, and nearly 36,000 die from it, according to the Centers for Disease Control and Prevention.

Peramivir has been approved in Japan and Korea since 2010. If approved by the FDA, it would be the first neuraminidase inhibitor approved in this country in more than a decade.

Pain and practicality

According to Dr. Sheridan, a New Drug Application to the FDA is currently under review with an assigned Prescription Drug User Fee Act action date of December 23, 2014. The indication, if approved, will be for influenza in adults. Dr. Sheridan also spoke during the media briefing.

Dr. Sheridan said that the application to the FDA is for an intravenous infusion that is the bioequivalent of the intramuscular version used in the trials because of the lack of practicality of intramuscular delivery.

"It hurts to get an intramuscular injection. In fact, it hurts a fair bit. We had to have our study subjects lay flat because if you stand up and feel faint after an injection like that, it’s probably a bad thing.

‘Real-world issues’ remain

If approved, the drug could also benefit underserved communities, the panelists agreed.

"If you see the patient once, you’re lucky," said Dr. Whitley. "If you give him a prescription, and you expect him to get it filled, the probability of that happening is maybe 20%-25%. So, if you’re worried about that individual, direct-observed therapy in the health care provider’s office is a good way to help solve this problem."

The shelf life of the drug, according to Dr. Sheridan, is about 5 years, if stored at room temperature.

Because there is less work for the end user, including finding a drug store that has sufficient supplies of the antiviral, "this drug, from a public health perspective, sounds even better than the oral medication," said the media briefing’s host, Dr. Michael Schmidt, professor and vice chair of immunology at the Medical University of South Carolina in Charleston.

"Front-line health care providers should have the availability of the medication so they can treat patients right in the office, without having to worry about filling prescriptions," Dr. Whitley said.

In theory, intravenous peramivir should be "relatively easy for any physician’s office that can handle relatively short IV infusions," according to Dr. Sheridan, who said that physicians would have a choice of using either a butterfly needle on the back of the hand, or an IV cannula in any other accessible vein, infusing the drug in between 15 and 30 minutes.

But questions about what to do if a doctor’s schedule can’t accommodate a patient or if the only access to a provider is through a so-called "minute clinic" are the domain of public health officials.

"There are always these real-world issues, and if there is a pandemic, then public health officials will have to look at the trade-offs," Dr. Schmidt said.

Dr. Whitley reported having no relevant disclosures, but noted that he is on the board of Gilead Sciences, maker of oseltamivir. Dr. Sheridan is the chief medical officer of BioCryst Pharmaceuticals, maker of peramivir. The two international studies were funded by the U.S. Department of Health & Human Services and BioCryst and were conducted at multiple centers in consecutive flu seasons between 2006 and 2008.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – A single injected dose of the neuraminidase inhibitor peramivir safely alleviated flu-like symptoms in adults when administered within 48 hours of onset of illness, an analysis of phase II and phase III clinical trial data indicates.

No single-dose treatment for influenza is currently available in the United States. Approval of the investigational drug would help protect those for whom influenza poses a higher than average risk, such as the elderly, the very young, and those who have other underlying illness such as chronic obstructive pulmonary disease, according to Dr. Richard Whitley, distinguished professor of pediatrics and microbiology at the University of Alabama, Birmingham.

©Micah Young/istockphoto.com

"Historically, we would have said the disease only afflicts [certain populations], but what we learned in the H1N1 pandemic was that ... we can’t ignore influenza. It’s here to stay." He made his comments during a media conference at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In two placebo-controlled, multicenter studies of a combined 427 adults with acute, uncomplicated influenza, peramivir 300 mg reduced flu symptoms within a median of 22 hours, and resolved fever within 24 hours, compared with placebo (both findings were significant). Symptoms included lethargy, cough, sore throat, headache, and myalgia. Though for time-to-symptom reduction, statistical significance fell away (P = .161), after adjustment for smoking behavior, influenza season, and virus type, the peramivir did significantly reduce nasal viral shedding within 48 hours following treatment, compared with placebo, Dr. Whitley reported

Results were based on patient-reported data using a four-point severity scale recorded over 14 days. Prior to injection, all patients were confirmed to have flu using rapid antigen detection testing, and none had any underlying illnesses or compromised autoimmunity. The drug was administered intramuscularly within 48 hours of onset of illness.

"If you ask me to put that into perspective with the other neuraminidase inhibitors, the level of benefit is virtually identical," said Dr. Whitley.

Currently, only two neuraminidase inhibitors are approved by the Food and Drug Administration: oral oseltamivir and inhaled zanamivir. Both are administered twice daily over 5 days.

Peramivir was determined to be generally safe, well tolerated, and with rates of adverse events such as mild to moderate diarrhea and dizziness similar in both the treatment and placebo arms. A separate study of the drug in a pediatric population is underway, said Dr. William Sheridan, chief medical officer of BioCryst, maker of peramivir.

"Influenza is associated with significant mortality and morbidity," Dr. Whitley said. In addition to annual immunization, "we need antivirals to keep people out of hospitals and to keep people from dying."

Annually, about a quarter million Americans are hospitalized with influenza, and nearly 36,000 die from it, according to the Centers for Disease Control and Prevention.

Peramivir has been approved in Japan and Korea since 2010. If approved by the FDA, it would be the first neuraminidase inhibitor approved in this country in more than a decade.

Pain and practicality

According to Dr. Sheridan, a New Drug Application to the FDA is currently under review with an assigned Prescription Drug User Fee Act action date of December 23, 2014. The indication, if approved, will be for influenza in adults. Dr. Sheridan also spoke during the media briefing.

Dr. Sheridan said that the application to the FDA is for an intravenous infusion that is the bioequivalent of the intramuscular version used in the trials because of the lack of practicality of intramuscular delivery.

"It hurts to get an intramuscular injection. In fact, it hurts a fair bit. We had to have our study subjects lay flat because if you stand up and feel faint after an injection like that, it’s probably a bad thing.

‘Real-world issues’ remain

If approved, the drug could also benefit underserved communities, the panelists agreed.

"If you see the patient once, you’re lucky," said Dr. Whitley. "If you give him a prescription, and you expect him to get it filled, the probability of that happening is maybe 20%-25%. So, if you’re worried about that individual, direct-observed therapy in the health care provider’s office is a good way to help solve this problem."

The shelf life of the drug, according to Dr. Sheridan, is about 5 years, if stored at room temperature.

Because there is less work for the end user, including finding a drug store that has sufficient supplies of the antiviral, "this drug, from a public health perspective, sounds even better than the oral medication," said the media briefing’s host, Dr. Michael Schmidt, professor and vice chair of immunology at the Medical University of South Carolina in Charleston.

"Front-line health care providers should have the availability of the medication so they can treat patients right in the office, without having to worry about filling prescriptions," Dr. Whitley said.

In theory, intravenous peramivir should be "relatively easy for any physician’s office that can handle relatively short IV infusions," according to Dr. Sheridan, who said that physicians would have a choice of using either a butterfly needle on the back of the hand, or an IV cannula in any other accessible vein, infusing the drug in between 15 and 30 minutes.

But questions about what to do if a doctor’s schedule can’t accommodate a patient or if the only access to a provider is through a so-called "minute clinic" are the domain of public health officials.

"There are always these real-world issues, and if there is a pandemic, then public health officials will have to look at the trade-offs," Dr. Schmidt said.

Dr. Whitley reported having no relevant disclosures, but noted that he is on the board of Gilead Sciences, maker of oseltamivir. Dr. Sheridan is the chief medical officer of BioCryst Pharmaceuticals, maker of peramivir. The two international studies were funded by the U.S. Department of Health & Human Services and BioCryst and were conducted at multiple centers in consecutive flu seasons between 2006 and 2008.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Respiratory syncytial virus followed an epidemic pattern, particularly in infants, from May through July across 13 years, a study has shown.

The virus also was found more often in infants less than 3 months old who had bronchiolitis or hypoxemia at time of hospital admission, according to Dr. Maria F. Lucion, who presented the data during the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

"This is a really valuable study with a very large number of cases. We don’t have a lot of information on this virus." Dr. Keith Klugman, director of global health at the Bill and Melinda Gates Foundation, Seattle, said during the discussion after the presentation.

From March 2000 to November 2013, 12,555 patients admitted for suspected acute lower respiratory infections to a single center in Argentina were tested for respiratory syncytial virus (RSV), adenovirus, influenza, and parainfluenza using either assays of nasopharyngeal aspirates or real-time polymerase chain reaction.

Of the 4,798 patients who tested positive for infection, 3,924 of all those admitted were found to have RSV (ranging between 71% and 82% across the years), with an annual seasonal epidemic pattern in evidence from May through July.

Independent predictors of RSV included being 3 months or younger (odds ratio 2.8, P less than .01); having bronchiolitis as a clinical presentation (OR 1.54, P less than .01); and the presence of hypoxemia at time of admission (OR 1.84, P less than .01), said Dr. Lucion of Ricardo Gutierrez Children’s Hospital, Buenos Aires.

The overall hospitalization rate for those with bronchiolitis was 39 per 1,000, with a peak in 2003 of 48 per 1,000. Bronchiolitis as a result of RSV was diagnosed in a median 15 patients per 1,000 (8.0-19.4).

The majority of admissions were male (56%), and the median age was 7 months, although nearly half (43%) were less than 6 months old (74.2% were less than 1 year old). Bronchiolitis occurred 61% of the time, and the nosocomial infection rate was 6.6%. The mortality rate was just under 2% (74/3,888).

"The most frequent complication was respiratory distress requiring the use of a ventilator," Dr. Lucion said. "That was most associated with the children who died."

An additional genetic analysis indicated that RSV subtypes A and B were in the pediatric population, with the exceptions of 2000 when only subtype A was present, and 2005, when only subtype B was present.

"The most common genotypes were GA2, GA5, ON1, and NA1 for subtype A and genotype-BA for subtype B," Dr. Lucion said.

Dr. Lucion said she had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Respiratory syncytial virus followed an epidemic pattern, particularly in infants, from May through July across 13 years, a study has shown.

The virus also was found more often in infants less than 3 months old who had bronchiolitis or hypoxemia at time of hospital admission, according to Dr. Maria F. Lucion, who presented the data during the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

"This is a really valuable study with a very large number of cases. We don’t have a lot of information on this virus." Dr. Keith Klugman, director of global health at the Bill and Melinda Gates Foundation, Seattle, said during the discussion after the presentation.

From March 2000 to November 2013, 12,555 patients admitted for suspected acute lower respiratory infections to a single center in Argentina were tested for respiratory syncytial virus (RSV), adenovirus, influenza, and parainfluenza using either assays of nasopharyngeal aspirates or real-time polymerase chain reaction.

Of the 4,798 patients who tested positive for infection, 3,924 of all those admitted were found to have RSV (ranging between 71% and 82% across the years), with an annual seasonal epidemic pattern in evidence from May through July.

Independent predictors of RSV included being 3 months or younger (odds ratio 2.8, P less than .01); having bronchiolitis as a clinical presentation (OR 1.54, P less than .01); and the presence of hypoxemia at time of admission (OR 1.84, P less than .01), said Dr. Lucion of Ricardo Gutierrez Children’s Hospital, Buenos Aires.

The overall hospitalization rate for those with bronchiolitis was 39 per 1,000, with a peak in 2003 of 48 per 1,000. Bronchiolitis as a result of RSV was diagnosed in a median 15 patients per 1,000 (8.0-19.4).

The majority of admissions were male (56%), and the median age was 7 months, although nearly half (43%) were less than 6 months old (74.2% were less than 1 year old). Bronchiolitis occurred 61% of the time, and the nosocomial infection rate was 6.6%. The mortality rate was just under 2% (74/3,888).

"The most frequent complication was respiratory distress requiring the use of a ventilator," Dr. Lucion said. "That was most associated with the children who died."

An additional genetic analysis indicated that RSV subtypes A and B were in the pediatric population, with the exceptions of 2000 when only subtype A was present, and 2005, when only subtype B was present.

"The most common genotypes were GA2, GA5, ON1, and NA1 for subtype A and genotype-BA for subtype B," Dr. Lucion said.

Dr. Lucion said she had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Respiratory syncytial virus followed an epidemic pattern, particularly in infants, from May through July across 13 years, a study has shown.

The virus also was found more often in infants less than 3 months old who had bronchiolitis or hypoxemia at time of hospital admission, according to Dr. Maria F. Lucion, who presented the data during the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

"This is a really valuable study with a very large number of cases. We don’t have a lot of information on this virus." Dr. Keith Klugman, director of global health at the Bill and Melinda Gates Foundation, Seattle, said during the discussion after the presentation.

From March 2000 to November 2013, 12,555 patients admitted for suspected acute lower respiratory infections to a single center in Argentina were tested for respiratory syncytial virus (RSV), adenovirus, influenza, and parainfluenza using either assays of nasopharyngeal aspirates or real-time polymerase chain reaction.

Of the 4,798 patients who tested positive for infection, 3,924 of all those admitted were found to have RSV (ranging between 71% and 82% across the years), with an annual seasonal epidemic pattern in evidence from May through July.

Independent predictors of RSV included being 3 months or younger (odds ratio 2.8, P less than .01); having bronchiolitis as a clinical presentation (OR 1.54, P less than .01); and the presence of hypoxemia at time of admission (OR 1.84, P less than .01), said Dr. Lucion of Ricardo Gutierrez Children’s Hospital, Buenos Aires.

The overall hospitalization rate for those with bronchiolitis was 39 per 1,000, with a peak in 2003 of 48 per 1,000. Bronchiolitis as a result of RSV was diagnosed in a median 15 patients per 1,000 (8.0-19.4).

The majority of admissions were male (56%), and the median age was 7 months, although nearly half (43%) were less than 6 months old (74.2% were less than 1 year old). Bronchiolitis occurred 61% of the time, and the nosocomial infection rate was 6.6%. The mortality rate was just under 2% (74/3,888).

"The most frequent complication was respiratory distress requiring the use of a ventilator," Dr. Lucion said. "That was most associated with the children who died."

An additional genetic analysis indicated that RSV subtypes A and B were in the pediatric population, with the exceptions of 2000 when only subtype A was present, and 2005, when only subtype B was present.

"The most common genotypes were GA2, GA5, ON1, and NA1 for subtype A and genotype-BA for subtype B," Dr. Lucion said.

Dr. Lucion said she had no relevant disclosures.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Laws that mandate mental illness should be covered by insurance in the same way as any other illness should be viewed on par with the Civil Rights Act, and they should be enforced with the same dedication, according to the former federal lawmaker who authored the Mental Health Parity and Addiction Equity Act of 2008.

Biases against mental illness are built into society at virtually every level, former U.S. Rep. Patrick J. Kennedy (D-R.I.) noted. Although it’s important to "avoid pathologizing" the human experience, he added, recognizing that mental illness affects all Americans at some level will not only save money, but will also make the nation healthier overall.

In a video interview at the annual meeting of the National Alliance on Mental Illness, Mr. Kennedy also shared what he believes are the necessary tools to start – and finish – a health care revolution, tools that already exist or are soon to be developed.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Laws that mandate mental illness should be covered by insurance in the same way as any other illness should be viewed on par with the Civil Rights Act, and they should be enforced with the same dedication, according to the former federal lawmaker who authored the Mental Health Parity and Addiction Equity Act of 2008.

Biases against mental illness are built into society at virtually every level, former U.S. Rep. Patrick J. Kennedy (D-R.I.) noted. Although it’s important to "avoid pathologizing" the human experience, he added, recognizing that mental illness affects all Americans at some level will not only save money, but will also make the nation healthier overall.

In a video interview at the annual meeting of the National Alliance on Mental Illness, Mr. Kennedy also shared what he believes are the necessary tools to start – and finish – a health care revolution, tools that already exist or are soon to be developed.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Laws that mandate mental illness should be covered by insurance in the same way as any other illness should be viewed on par with the Civil Rights Act, and they should be enforced with the same dedication, according to the former federal lawmaker who authored the Mental Health Parity and Addiction Equity Act of 2008.

Biases against mental illness are built into society at virtually every level, former U.S. Rep. Patrick J. Kennedy (D-R.I.) noted. Although it’s important to "avoid pathologizing" the human experience, he added, recognizing that mental illness affects all Americans at some level will not only save money, but will also make the nation healthier overall.

In a video interview at the annual meeting of the National Alliance on Mental Illness, Mr. Kennedy also shared what he believes are the necessary tools to start – and finish – a health care revolution, tools that already exist or are soon to be developed.

[email protected]

On Twitter @whitneymcknight

Despite some signs of hope, the "window of opportunity" to contain and end the current Ebola virus outbreak in West Africa is shutting, causing the situation to worsen "significantly," according to officials at the Centers for Disease Control and Prevention.

"This is really the first epidemic of Ebola the world has ever known," Dr. Thomas Frieden, CDC director, said during a media briefing.

CDC/Cynthia Goldsmith

The prevailing belief, according to Dr. Frieden, is that the virus’s rapid spread is not due to mutation but instead to cultural and logistical obstacles.

"It’s not spreading in new ways, according to everything that we know," Dr. Frieden said. "It’s spreading through just two routes: people caring for other people ... and unsafe burial practices. ... That is really the Achilles’ heel. We know how it spreads; we know how to stop it. The challenge is to do that everywhere it is needed."

The Ebola virus is transmitted primarily through body fluids, but it also can be spread through contact with contaminated objects such as needles. Ebola is not spread through the air or by water.

Noting that rapid response is essential, and that data are lacking as to the actual numbers of those infected with the virus, Dr. Frieden outlined three key things that are needed to stem the epidemic: more resources; technical expertise in both health care management and logistics; and a coordinated global approach to ending the outbreak.

Dr. Frieden said it was a paradox that "the more the world isolates these countries, the harder it will be for them to control these outbreaks, the more cases there will be, and the less safe other countries will be. Like it or not, we’re connected."

The area currently experiencing outbreaks includes the countries of Guinea, Liberia, Sierra Leone, and Nigeria, with what Dr. Frieden said is a "dense, forested region that is the epicenter" located where the borders of all but Nigeria meet. The remote area is not serviced by radio or television and is rife with what Dr. Frieden called "misconceptions" about how the disease is transmitted.

"We can turn this around. Sometimes the problem can seem so large, it’s hard to get started, but we can chip away at the challenges, one by one," he said, inviting anyone with experience working in austere conditions, either as a health care provider or manager of an under-resourced facility, to consider volunteering his or her services, noting that the longer the crisis continues, the less stable the local communities will be.

© CDC

In addition to nearly $20 million in aid from the U.S. Agency for International Development, for goods ranging from personal protection gear to resources for safer burials, the CDC will continue to support efforts by the World Health Organization (WHO) to contain the epidemic within the year, by deploying top CDC epidemic intelligence teams to help with tracking, treatment, and screening, he said.

The need for global coordination is not due to a lack of willingness from local officials and personnel to respond, according to Dr. Frieden.

"The countries are willing. In an Ebola treatment unit run by Doctors Without Borders, more than 90% of the staff are locals," Dr. Frieden said of one of the stops on his tour of West Africa. "Each of the presidents [of the affected countries] said the same thing to me: ‘Tell us what to do and we will do it. If we can’t do it, help us to do it. Teach us to care for Ebola patients and to manage the system more effectively.’ They need the world to work with them."

According to WHO, more than 1,400 patients have died of Ebola virus infection to date in this outbreak, making this the largest Ebola outbreak ever recorded. There are still "significant gaps in reporting in some intense transmission areas," and that the number of cases ultimately may top 20,000, according to WHO, which noted this outbreak has featured the infection and deaths of "an unprecedented number of health care workers."

There are no vaccines for Ebola approved by the Food and Drug Administration, although the National Institute of Allergy and Infectious Diseases currently is attempting to develop one.

As to treatments, ZMapp, a trio of monoclonal antibodies that was successfully used to treat two American health workers who were infected with Ebola, also has shown promise in a controlled trial with primates. According to ZMapp’s manufacturer, Mapp Biopharmaceuticals, the supply of the drug is currently exhausted and there is as yet no date for when more will be available.

[email protected]

On Twitter @whitneymcknight

Despite some signs of hope, the "window of opportunity" to contain and end the current Ebola virus outbreak in West Africa is shutting, causing the situation to worsen "significantly," according to officials at the Centers for Disease Control and Prevention.

"This is really the first epidemic of Ebola the world has ever known," Dr. Thomas Frieden, CDC director, said during a media briefing.

CDC/Cynthia Goldsmith

The prevailing belief, according to Dr. Frieden, is that the virus’s rapid spread is not due to mutation but instead to cultural and logistical obstacles.

"It’s not spreading in new ways, according to everything that we know," Dr. Frieden said. "It’s spreading through just two routes: people caring for other people ... and unsafe burial practices. ... That is really the Achilles’ heel. We know how it spreads; we know how to stop it. The challenge is to do that everywhere it is needed."

The Ebola virus is transmitted primarily through body fluids, but it also can be spread through contact with contaminated objects such as needles. Ebola is not spread through the air or by water.

Noting that rapid response is essential, and that data are lacking as to the actual numbers of those infected with the virus, Dr. Frieden outlined three key things that are needed to stem the epidemic: more resources; technical expertise in both health care management and logistics; and a coordinated global approach to ending the outbreak.

Dr. Frieden said it was a paradox that "the more the world isolates these countries, the harder it will be for them to control these outbreaks, the more cases there will be, and the less safe other countries will be. Like it or not, we’re connected."

The area currently experiencing outbreaks includes the countries of Guinea, Liberia, Sierra Leone, and Nigeria, with what Dr. Frieden said is a "dense, forested region that is the epicenter" located where the borders of all but Nigeria meet. The remote area is not serviced by radio or television and is rife with what Dr. Frieden called "misconceptions" about how the disease is transmitted.

"We can turn this around. Sometimes the problem can seem so large, it’s hard to get started, but we can chip away at the challenges, one by one," he said, inviting anyone with experience working in austere conditions, either as a health care provider or manager of an under-resourced facility, to consider volunteering his or her services, noting that the longer the crisis continues, the less stable the local communities will be.

© CDC

In addition to nearly $20 million in aid from the U.S. Agency for International Development, for goods ranging from personal protection gear to resources for safer burials, the CDC will continue to support efforts by the World Health Organization (WHO) to contain the epidemic within the year, by deploying top CDC epidemic intelligence teams to help with tracking, treatment, and screening, he said.

The need for global coordination is not due to a lack of willingness from local officials and personnel to respond, according to Dr. Frieden.

"The countries are willing. In an Ebola treatment unit run by Doctors Without Borders, more than 90% of the staff are locals," Dr. Frieden said of one of the stops on his tour of West Africa. "Each of the presidents [of the affected countries] said the same thing to me: ‘Tell us what to do and we will do it. If we can’t do it, help us to do it. Teach us to care for Ebola patients and to manage the system more effectively.’ They need the world to work with them."

According to WHO, more than 1,400 patients have died of Ebola virus infection to date in this outbreak, making this the largest Ebola outbreak ever recorded. There are still "significant gaps in reporting in some intense transmission areas," and that the number of cases ultimately may top 20,000, according to WHO, which noted this outbreak has featured the infection and deaths of "an unprecedented number of health care workers."

There are no vaccines for Ebola approved by the Food and Drug Administration, although the National Institute of Allergy and Infectious Diseases currently is attempting to develop one.

As to treatments, ZMapp, a trio of monoclonal antibodies that was successfully used to treat two American health workers who were infected with Ebola, also has shown promise in a controlled trial with primates. According to ZMapp’s manufacturer, Mapp Biopharmaceuticals, the supply of the drug is currently exhausted and there is as yet no date for when more will be available.

[email protected]

On Twitter @whitneymcknight

Despite some signs of hope, the "window of opportunity" to contain and end the current Ebola virus outbreak in West Africa is shutting, causing the situation to worsen "significantly," according to officials at the Centers for Disease Control and Prevention.

"This is really the first epidemic of Ebola the world has ever known," Dr. Thomas Frieden, CDC director, said during a media briefing.

CDC/Cynthia Goldsmith

The prevailing belief, according to Dr. Frieden, is that the virus’s rapid spread is not due to mutation but instead to cultural and logistical obstacles.

"It’s not spreading in new ways, according to everything that we know," Dr. Frieden said. "It’s spreading through just two routes: people caring for other people ... and unsafe burial practices. ... That is really the Achilles’ heel. We know how it spreads; we know how to stop it. The challenge is to do that everywhere it is needed."

The Ebola virus is transmitted primarily through body fluids, but it also can be spread through contact with contaminated objects such as needles. Ebola is not spread through the air or by water.

Noting that rapid response is essential, and that data are lacking as to the actual numbers of those infected with the virus, Dr. Frieden outlined three key things that are needed to stem the epidemic: more resources; technical expertise in both health care management and logistics; and a coordinated global approach to ending the outbreak.

Dr. Frieden said it was a paradox that "the more the world isolates these countries, the harder it will be for them to control these outbreaks, the more cases there will be, and the less safe other countries will be. Like it or not, we’re connected."

The area currently experiencing outbreaks includes the countries of Guinea, Liberia, Sierra Leone, and Nigeria, with what Dr. Frieden said is a "dense, forested region that is the epicenter" located where the borders of all but Nigeria meet. The remote area is not serviced by radio or television and is rife with what Dr. Frieden called "misconceptions" about how the disease is transmitted.

"We can turn this around. Sometimes the problem can seem so large, it’s hard to get started, but we can chip away at the challenges, one by one," he said, inviting anyone with experience working in austere conditions, either as a health care provider or manager of an under-resourced facility, to consider volunteering his or her services, noting that the longer the crisis continues, the less stable the local communities will be.

© CDC

In addition to nearly $20 million in aid from the U.S. Agency for International Development, for goods ranging from personal protection gear to resources for safer burials, the CDC will continue to support efforts by the World Health Organization (WHO) to contain the epidemic within the year, by deploying top CDC epidemic intelligence teams to help with tracking, treatment, and screening, he said.

The need for global coordination is not due to a lack of willingness from local officials and personnel to respond, according to Dr. Frieden.

"The countries are willing. In an Ebola treatment unit run by Doctors Without Borders, more than 90% of the staff are locals," Dr. Frieden said of one of the stops on his tour of West Africa. "Each of the presidents [of the affected countries] said the same thing to me: ‘Tell us what to do and we will do it. If we can’t do it, help us to do it. Teach us to care for Ebola patients and to manage the system more effectively.’ They need the world to work with them."

According to WHO, more than 1,400 patients have died of Ebola virus infection to date in this outbreak, making this the largest Ebola outbreak ever recorded. There are still "significant gaps in reporting in some intense transmission areas," and that the number of cases ultimately may top 20,000, according to WHO, which noted this outbreak has featured the infection and deaths of "an unprecedented number of health care workers."

There are no vaccines for Ebola approved by the Food and Drug Administration, although the National Institute of Allergy and Infectious Diseases currently is attempting to develop one.

As to treatments, ZMapp, a trio of monoclonal antibodies that was successfully used to treat two American health workers who were infected with Ebola, also has shown promise in a controlled trial with primates. According to ZMapp’s manufacturer, Mapp Biopharmaceuticals, the supply of the drug is currently exhausted and there is as yet no date for when more will be available.

[email protected]

On Twitter @whitneymcknight