Top Infectious Disease News of the Week—July 8, 2018

#5: HIV Vaccine Candidate Produces Robust Immune Response in Healthy Adults

An experimental HIV-1 vaccine regimen, mosaic adenovirus serotype 26 (Ad26) was well-tolerated and produced immune responses against HIV in humans and rhesus monkeys, according to findings from a phase 1/2a clinical trial published in the Lancet.

In the APPROACH trial, 393 individuals with a low risk of HIV were recruited to receive either 1 of 7 vaccine combinations or a placebo; they were given 4 vaccinations over 48 weeks. To stimulate an initial immune response, each participant received an injection of Ad26.Mos.HIV at the advent of the study and 12 weeks later. Two additional vaccinations were given at week 24 and week 48 using combinations of Ad26.Mos.HIV or a different vaccine component referred to as modified Vaccinia Ankara (MVA) with or without 2 different doses of clade C HIV gp140 protein. The researchers found that all vaccine regimens were well-tolerated and were able to induce anti-HIV immune responses in healthy individuals. Similar systemic reactions were reported in all groups included in the trial.

Read more about the HIV vaccine candidate.

#4: Leptospirosis Outbreak Declared in Metro Manila, Philippines

A difficult-to-diagnose, zoonotic bacterial disease has been running rampant in the Philippines this year. On Thursday, July 5, Francisco T. Duque III, secretary of the Department of Health of the Philippines declared a leptospirosis outbreak in Metro Manila neighborhoods.

Data from the Philippines Epidemiology Bureau of the Department of Health indicate that in 2018 there have been 1,030 cases of leptospirosis in the Philippines and 93 deaths as of June 9; this is a 41% increase in reported cases in comparison with the first 6 months of 2017.

Read more about leptospirosis in the Philippines.

#3: Is There A Link Between Lyme Disease and Chronic Fatigue Syndrome?

Samuel, Shor, MD, FACP, past president, International Lyme and Associated Diseases Society, discusses the potential link between chronic fatigue syndrome and Lyme disease.

Interview Transcript (modified slightly for readability):

“To begin with, chronic fatigue syndrome is a diagnosis of exclusion, which means that you have to rule out other causes of chronic fatigue, whether it be hepatitis, hypothyroid, etc. There are no markers for chronic fatigue syndrome per se. Lyme disease is a potential cause of chronic fatigue and there is no test that can absolutely rule out chronic Lyme disease.

I published a paper in 2011 in an attempt to evaluate my patients who were presenting with a complex myriad of symptoms including chronic fatigue, fractured non-restorative sleep, autonomic blood pressure problems, chronic pain, [and] cognitive impairment. In an attempt to better evaluate and treat them, I made a connection with the potential that some of them may have Lyme disease.

Read more about Lyme disease.

#2: Tuberculosis, HAZMAT Suits, and Tons of Confusion

Most hospital infection prevention and control programs have a handful of stories regarding an incident involving an infectious disease that resulted in a lot of hysteria and not a lot of critical thinking. As an infection preventionist in both adult and pediatric acute care, I’ve seen health care workers brazenly walk into the room of a patient who is under isolation precautions for horribly resistant infections like CRE (Carbapenem-resistant Enterobacteriaceae) without wearing 1 piece of personal protective equipment (PPE); however, they will then wear every scrap of protection they can find (including a coverall suit, shoe covers, etc) when caring for a patient with bed bugs. Threat perception and understanding is a serious issue when it comes to infectious diseases.

The latest example of this occurred at the prestigious Johns Hopkins Hospital in Baltimore, Maryland. Last Thursday afternoon, 2 buildings were evacuated and employees within a certain area were isolated and medically-evaluated because of a potential infectious-disease related incident. HAZMAT suits were involved and of course, a lot of press coverage.

Read more about tuberculosis.

#1: Abandoned Genital Herpes Vaccine GEN-003 Found to Reduce Lesions, Decrease Viral Shedding at Varying Doses

GEN-003, a vaccine comprised of a transmembrane deletion mutant of glycoprotein D and a saponin-derived adjuvant, is clinically effective at doses of 60 µg/50 µg and 60 µg /75 µg for reducing viral shedding at up to 1 year in adults with symptomatic genital herpes simplex virus 2 (HSV-2) infection, according to a study in The Journal of Infectious Diseases (JID). Additionally, the investigators saw a reduction in lesion rates following administration of GEN-003 at varying doses of the study vaccine.

“Currently available therapeutic options for recurrent HSV-2 infections include short-term treatment beginning with the first signs of recurrence, or chronic daily suppression with nucleoside analogues, valacyclovir, acyclovir, or famciclovir,” the investigators, led by Nicholas Van Wagoner, MD, PhD, of the University of Alabama at Birmingham, wrote. “However, chronic daily therapy does not completely suppress outbreaks, has cost implications, and requires daily adherence. With a high global prevalence, an established link between HSV-2 and subsequent HIV acquisition, the often-overlooked psychological effects of genital HSV infection, and the inability of antiviral oral treatments to completely eliminate viral shedding, there is a clear need for new therapeutic options.”

Adult patients between 18 and 50 years of age with genital HSV-2 for more than 1 year were enrolled in this randomized, placebo-controlled study (N = 310). Investigators randomized patients to normal saline placebo (n = 45) or GEN-003 vaccine doses of either 30 µg/25 µg (n = 44), 30 µg/50 µg (n = 45), 30 µg/75 µg (n = 44), 60 µg/25 µg (n = 44), 60 µg/50 µg (n = 44), or 60 µg/75 µg (n = 44). Participants were given 3 intramuscular infections of their assigned dose every 21 days. The investigators compared each dose in regard to the participants’ associated rates of viral shedding at baseline and following the 3-dose treatment regimen.

At baseline, the viral shedding rates were 22.2% for placebo and between 13.6% and 27.1% for the active doses. Approximately 12 months following the last dose, significant reductions in viral shedding were found for the 30/75 dose (rate ratio [RR] 0.34; 95% CI 0.1-0.61); P =.0003), 60/50 dose (RR 0.38; 95% CI 0.25-0.57; P <.0001), and 60/75 dose (RR 0.43; 95% CI 0.23-0.82; P =.01). According to a ranking analysis of the change from baseline to the immediate post-vaccination period, both the 60/50 and 60/75 dosing combinations demonstrated the greatest viral shedding reductions.

Read more about the genital herpes vaccine.