Influenza: treatment and prophylaxis using antiviral agents updated

The change note says the update “incorporates new evidence on the treatment of critically ill patients with oseltamivir and updated recommendations on renal dosing”. Critical influenza is defined as needing ICU-level organ support (NIV, invasive ventilation and/or vasopressors). Oseltamivir remains first line, with the greatest benefit within 48 hours; starting up to 5 days after onset is off-label but may help. A new note says preliminary REMAP-CAP data in critically ill patients over 12 years show a lack of benefit from oseltamivir monotherapy in established critical illness, where it was started a median of 5 days after onset. Where oseltamivir can’t be started promptly or given, consider baloxavir (alone or with oseltamivir), or zanamivir INH/IV if baloxavir is unsuitable, under specialist advice.

• Renal: don’t reduce oseltamivir treatment doses in mild-to-moderate impairment (eGFR 31–60); keep 75 mg twice daily. If eGFR is the only value available, don’t delay treatment. Use CrCl, not eGFR, for IV zanamivir.

Action: update local flu treatment pathways and ICU and renal dosing tables before the season gets going.

We read the critically ill and renal sections but didn’t compare them line by line with the previous version. Check the tables before you change local doses.

Collection › · Full guidance ›

Ebola imports to Kenya and Nigeria: overall EU/EEA risk remains very low

• For people from the EU/EEA living in or travelling to affected areas of Kenya and Nigeria, the likelihood of infection is low if they follow recommended precautions. Further spread after an imported case in Europe is very unlikely.
• ECDC asks countries to keep preparing for imported cases: raise awareness among clinicians, and make sure hospitals and laboratories are ready to identify and safely manage suspected cases. A readiness checklist for national authorities is provided. No travel restrictions are recommended.
• The Nigeria case flew in from Uganda on 3 Oct, with onset on 7 Oct, admission on 11 Oct and confirmation on 20 Oct.

The week 43 CDTR wasn’t on the ECDC archive at compile time; the latest there is week 42 (16 Oct). There was no new Eurosurveillance content in the window.

ECDC news › · Threat assessment brief › · CDTR ›

Kenya: second death among nine cases

• MoH (official, on X): the ministry “mourns the death of a 65-year-old woman who was receiving care for Bundibugyo Ebola”. “Seven patients continue to receive care. All nine cases remain within one cluster, with no evidence of community spread.”
• Press (BBC, Daily Nation, The Standard, AP, Reuters): she was the third confirmed case and a close family member and direct contact of the index case. She developed symptoms in quarantine on 13 Oct and was admitted the same day. The seven still in care are three relatives of the index case, three health workers and a hospital cleaner (BBC). Kenya has traced 135 contacts, all quarantined (Reuters).

Doesn’t add up: the BBC and Reuters give 5 Oct for the first death, the Daily Nation 6 Oct. Reuters says four countries are affected; WHO counts five (DRC, Uganda, France, Kenya, Nigeria).

@MOH_Kenya › · BBC › · Daily Nation › · The Standard › · AP › · Reuters (via Internazionale) ›

Nigeria: patient “showing signs of recovery”; Swiss ministry says she didn’t visit DRC

• Federal Ministry of Health (via Channels TV, TheCable): the patient is showing signs of recovery and there’s no evidence of community spread. Contact tracing, quarantine and monitoring continue.
• Swiss foreign ministry (via Channels TV/AFP): she is the wife of a Swiss member of staff at the Swiss embassy in Abuja. Infection may have happened on a trip to Uganda about two weeks earlier, and neither she nor her husband went to DRC. He is in isolation without symptoms, and repatriation to Switzerland is being considered.
• Africa CDC (on X, 24 Oct): there is “no validated information yet” that she travelled to DRC. Africa CDC is convening African health ministers on 28 Oct.
• WHO DON: 44 contacts identified and monitored as of 20 Oct. Vanguard reports 46 contacts on an aviation no-fly list (44 hospital contacts plus 2 domestic staff).

Check before quoting: this is press-reported. The Swiss statement calls her a “Swiss woman”, while Africa CDC said earlier that she was Ugandan-born; the reports aren’t necessarily incompatible but haven’t been reconciled. We found no NCDC situation report.

Channels TV › · TheCable › · Vanguard › · @AfricaCDC › · FMoH statement (20 Oct) ›

Ebola disease caused by Bundibugyo virus: DRC, Kenya and Nigeria

• DRC (to 20 Oct): 9,704 confirmed cases, 4,687 deaths and 2,595 recoveries (CFR 48.3%), across 66 health zones in eight provinces. 976 cases and 482 deaths since the 8 Oct DON; 307 of those deaths were in the community and 175 in treatment centres. 67 new cases in the latest 24 h. Ituri 7,040 cases / 3,271 deaths; Nord-Kivu 2,146 / 1,199 (CFR 55.9%). Dakwa (Haut-Uélé) is the most recently affected zone.
• Contact follow-up was 79.7% (24,017 of 30,130), below the 95% target; Nord-Kivu was 73.3%.
• Vaccine: the TUMAINI Phase 2/3 trial of Bundibugyo vaccine candidates enrolled its first participants in Bunia on 23 Oct.
• Risk: still as assessed on 14 Aug (very high for DRC, high for neighbouring countries, low for the rest of the region and globally); the rapid risk assessment is being revised. WHO advises against travel or trade restrictions.

Doesn’t add up: Tshopo is given as 83.7% (1,077/12,086), but 1,077/12,086 is 8.9%. The provincial denominators as printed sum to 40,930, not 30,130; a Tshopo denominator of about 1,287 would fit both figures. The Kenya data stop at 20 Oct (one death).

Takeaway: 63% of recent deaths occurred in the community, so late presentation is still the problem. Keep a high index of suspicion for febrile travellers from DRC, Uganda, Kenya (Nairobi) and Nigeria (Abuja).

WHO DON622 ›

Cefepime–zidebactam for carbapenem-resistant Gram-negative infections, including MBL producers: phase 2, open-label, single-arm

72 adults treated for 7–21 days. Of 68 qualifying isolates, 56 (82.4%) were MBL producers, mostly NDM. Investigator-assessed clinical cure at test of cure (CME, n=60) was 91.7% (95% CI 81.6–97.2%), and 93.9% in MBL infections. External adjudication gave 86.7%. 28-day mortality was 2.8%, and treatment-related adverse events occurred in 15.3%.

Takeaway: promising activity against NDM, but there was no comparator, and the adjudicated cure rate was about five points lower than investigators’. It isn’t a replacement for aztreonam–avibactam outside trials yet.

Article ›

TLC-ART 101: an injectable lopinavir/ritonavir/tenofovir nanoparticle

A single subcutaneous dose in 12 people without HIV. Lopinavir was detectable for about two months (median t½ 17 days at the highest dose). Systemic hypersensitivity was common: one anaphylaxis and four non-serious events.

Article ›