Top 5 Infectious Disease News of the Week—May 13, 2018

#5: Hepatitis A Running Rampant Throughout the United States

Since March 2017, several state and local heart departments across the country have been struggling with hepatitis A outbreaks.

Since our last update, 2 more states have reported outbreaks: Indiana and West Virginia.

The Indiana State Department of Health (ISDH) identified an increase in hepatitis A cases in the southern region of the state, back in November 2017. Many of the cases are thought to be tied to the large outbreak in Louisville, Kentucky, where 356 cases and 2 deaths have been reported.

As of May 11, 2018, the ISDH has reported a total of 94 cases in several counties throughout Indiana, with the majority of cases occurring in Clark and Floyd counties. Of the 94 cases, almost half (46) have required hospitalization for their illnesses.

Read more about the hepatitis A outbreaks happening in the United States.

For the most recent case counts, be sure to visit the Contagion^® Outbreak Monitor.

#4: Invasive Aspergillosis Prevalence Increasing in the United States

Though invasive aspergillosis (IA) remains rare, a new analysis shows the illness is becoming more prevalent, increases mortality and hospital readmission rates, and may add up to $600 million to the nation’s health care costs each year.

Those are the top-line conclusions from a new study out this month in the journal Clinical Infectious Diseases.

IA is a rarity among immunocompetent patients, though it impacts up to 13% of immunocompromised patients in the hospital. The illness can be a major problem among patients who undergo stem cell or organ transplants, in particular. It has been more than two decades since a large, national study was undertaken to assess the prevalence and mortality rates of IA.

Read more about invasive aspergillosis.

#3: Already Reeling Venezuela Faces a New Challenge: An HIV Outbreak—Public Health Watch

In October 2016, Human Rights Watch first described Venezuela as being in the midst of a “humanitarian crisis”—and things haven’t gotten any better in the nearly 2 years since.

The government of President Nicolas Maduro has stifled dissent, sometimes using violent means to do so. Vital medicines are in short supply. Food and some basic necessities are scarce and, when available, are sold at exorbitant prices. Indeed, throughout the South American country, inflation has far outpaced wage growth. And, then there is the matter of refugees, with the nation’s poor crossing the border in droves into neighboring Colombia, seeking food, medical care, and, ultimately, better lives.

Now there are reports suggesting that there is an outbreak of HIV/AIDS among an isolated population of indigenous peoples, according to The New York Times.

Read more about the HIV outbreak in Venezuela.

#2: Ebola Outbreak in DRC Spreads to Wangata

Concerns about the burgeoning Ebola outbreak in the Democratic Republic of Congo (DRC) continue to increase as the World Health Organization (WHO) reported that a new case has been identified in the northwestern city of Wangata, which is home to nearly 1.2 million individuals. The WHO put out a tweet this morning, which underscores the importance of this finding: “WHO concerned as one #Ebola case confirmed in an urban area of Democratic Republic of the Congo #DRC.”

The case was confirmed through laboratory tests conducted by the Institut National de Recherche Biomédicale (INRB).

Read more about the Ebola outbreak in the DRC.

#1: FDA Approves Truvada for Use in Adolescents

The US Food and Drug Administration (FDA) has approved Gilead's once-daily oral Truvada (emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) to reduce the risk of sexually acquired HIV-1 in at-risk adolescents weighing at least 35kg when used in combination with safe sex practices. When taken consistently, pre-exposure prophylaxis, such as Truvada, can reduce the risk of HIV infection by 92%.

According to the US Centers for Disease Control and Prevention (CDC), adolescents and young adults 13 to 24 years of age comprised 21% of all new infections in the United States in 2016. A total of 81% of those infections were among young men who have sex with men (YMSM). Previous studies have shown that HIV testing remains low in young individuals between the ages of 13 and 24, compared with other age groups. Only about 10% of sexually-active high school students in the United States have been tested for HIV. Perhaps even more troubling is that of the 60,900 younger individuals who were living with HIV in 2013, according to the CDC, about 51% had not even received a diagnosis. The organization states that is “the highest rate of undiagnosed HIV in any age group,” and that, out of all age groups, this group is the “least likely” to be linked with the care that they need, perhaps due to the lack of testing.

The addition of the adolescent indication is based on a single-arm, open-label clinical trial in HIV-negative individuals 15 to 17 years of age conducted by the Adolescent Medicine Trials Network for HIV/AIDS, a research network funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). A total of 67 HIV-1 negative young men who have sex with men (YMSM) in the trial received oral Truvada once daily, for PrEP. According to a press release on the approval, "The Truvada safety profile in the study was similar to the safety profile that has been observed in adult trials of Truvada for PrEP, in which the most common side effects were headache, abdominal pain, and weight loss. Bone mineral density (BMD) was also monitored and 4 study participants had a decrease in BMD through 48 weeks (3 adolescents had a modest decrease and 1 had a >4 percent decline in total BMD at Week 24)."

Sybil Hosek, PhD, clinical psychologist at the Cook County Health and Hospital System's Stroger Hospital, Chicago, and lead investigator of the study stated in a press release that, "Study ATN113 has demonstrated that Truvada for PrEP is a well-tolerated prevention option for adolescents who are vulnerable to HIV. In addition to traditional risk-reduction strategies, healthcare providers and community advocates are now equipped with another tool to help address the incidence of HIV in younger at-risk populations."

Read more about Truvada.