News Scan for Mar 08, 2018

News brief

Study finds widespread, arbitrary antimicrobial use in Cambodian pigs

A study yesterday in Antimicrobial Resistance and Infection Control reports widespread and arbitrary use of antibiotics on small-scale pig farms in Cambodia.

In the study, a team of Swedish and Cambodian researchers conducted a survey of small-scale pig farms in and around Phnom Penh to assess the farmers' knowledge, attitudes, and practices related to antibiotic use in pig production. In addition to asking the farmers to fill out a questionnaire, the researchers collected fecal samples from three healthy pigs at each farm, isolated Escherichia coli isolates from those samples, and tested the susceptibility of the isolates to 14 antibiotics.

The results showed that at least 70 different brands of antimicrobial drugs were used on the farms, with amoxicillin, tylosin, gentamicin, and colistin being the most commonly mentioned or kept by the farmers. While nearly all the respondents (99%) said antimicrobial use was necessary to keep pigs healthy, knowledge of antimicrobials and how they work was low, and antimicrobial use was mainly based on farmers' experiences. Around 66% of the farmers reported frequently self-adjusting treatment duration and dosage. Fewer than half (45%) had heard the term antimicrobial resistance.

The E coli isolates exhibited high prevalence of resistance to several antimicrobials considered critical for human medicine, including ampicillin (75%), ciprofloxacin (59%), and colistin (20%), and multidrug-resistance was found in 79% of the samples. Isolates on farms where antimicrobials were administered preventatively showed a higher prevalence of resistance, as did those from farms where entire groups of pigs were treated, rather than just sick individuals.

"These results confirm the hypothesis that non-rational use of antimicrobials results in higher prevalence of AMR and highlight the need for professional animal health systems that involve medically rational use of antimicrobials in emerging economies such as Cambodia," the authors conclude.
Mar 7 Antimicrob Resist Infect Control study

 

MERS hospital outbreak grows in Riyadh

Yesterday the Saudi Arabian Ministry of Health (MOH) confirmed another case of MERS-CoV acquired during the patient's stay at a Riyadh hospital.

A 60-year-old Saudi man from Riyadh is in stable condition after being diagnosed as having a  MERS-CoV (Middle East respiratory syndrome coronavirus) infection. This is the fifth case in a presumed hospital-based outbreak that has included three other patients and one healthcare provider. All of the recent cases have involved men.

The MOH also announced the death of a previously reported patient, an 82-year-old Saudi man from Riyadh. It does not appear that the man was part of the current hospital-related cluster.

Saudi Arabia's MERS-CoV total cases since 2012 have now reached 1,814, including 736 deaths. Ten people are still being treated for their infections.
Mar 7 Saudi MOH report

 

More yellow fever in Brazil as case totals top 800

The Brazilian MOH yesterday reported 123 new confirmed cases of yellow fever, including 23 deaths, last week.

The new cases brings the totals for the current season, which began on Jul 1, 2017, to 846, with 260 deaths. There have also been 3,234 suspected cases reported during this period.

The case count is a significant jump from the previous season. Between Jul 1, 2016, and Mar 6, 2017, there were 597 confirmed cases and 190 deaths from infection with the flavivirus.

The reason this year's outbreak is bigger, the ministry said, is because the virus is concentrated in Bahia, Sao Paulo and Rio de Janeiro states, home to Brazil's largest cities and unvaccinated populations. The government is continuing a yellow fever vaccine campaign it began in February to target citizens in those states.

As of Mar 6, 17.3 million inhabitants of those states have been vaccinated, representing 76% of the targeted populations. The ministry said 8.4 million (90%) of people were vaccinated in Sao Paulo and 7.1 million (71.5%) in Rio de Janeiro. In Bahia, 1.8 million people were vaccinated, which makes up 55% of the target population.
Mar 7 Brazilian MOH
update

 

105 more sickened in Salmonella outbreak linked to chicken salad

The Centers for Disease Control and Prevention (CDC) announced today 105 more cases of Salmonella infections linked to contaminated chicken salad sold at grocery stores in the Upper Midwest. Now there are 170 cases in seven states.

So far 62 people have been hospitalized but no deaths have been reported in this outbreak. Illnesses-onset dates ranged from Jan 8 to Feb 18, and 66% of patients are female. Two new states—Indiana and South Dakota—have reported cases since the CDC's first report on the outbreak on Feb 21.

Of 159 people interviewed, 82% reported eating chicken salad from Fareway stores in the week prior to illness. According to the CDC, Triple T Specialty Meats, Inc. produced the chicken salad that ill people reported eating.

On Feb 21, Triple T Specialty Meats, Inc. recalled all chicken salad produced from Jan 2 to Feb 7, the CDC said. The chicken salad was sold at the deli counter in stores in Illinois, Iowa, Minnesota, Nebraska, and South Dakota from Jan 4 to Feb 9. The CDC currently recommends that people do not eat recalled chicken salad sold at Fareway grocery stores.

"If you don't remember the date when you purchased chicken salad from Fareway, don't eat it. Throw it away or return it to the store," the CDC said.
Mar 8 CDC
update

Flu Scan for Mar 08, 2018

News brief

Schoolchildren study finds lower protection after repeated flu vaccination

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Editor's Note: This scan was updated on Mar 9 to better reflect the limitations of the study, especially statistically insignificant data. Many thanks to New Zealand–based risk and policy adviser Ron Law for his astute observations after this item was published.

A study of the impact of prior flu vaccination on effectiveness in the current season in Japanese schoolchildren found a significant association between reduced vaccine effectiveness (VE) against medically attended flu and repeated vaccination, but the study findings were limited because of statistically insignificant findings in study subgroups, use of rapid diagnostic tests (RDTs), and other factors.

The findings come as experts in the United States and other countries are trying to untangle the reasons for a drop in effectiveness against the H3N2 strain over the past few seasons, some of which is likely related to egg-mediated mutations in the vaccine production process. However, other factors may play a role. Japanese researchers reported their findings today in Clinical Infectious Diseases.

Their study took place in children ages 9 to 18 who were seen for flulike illness at a community hospital on a remote island in Japan over the 2011-12 through 2013-14 flu seasons. Vaccine coverage on the island is high, past vaccination status is recorded in a vaccine registry, and information from clinic visits and rapid diagnostic tests results are part of the electronic medical record.

Over the three seasons, the researchers analyzed 1,668 flulike illness episodes, of which 421 were confirmed as influenza A and 358 were confirmed as influenza B. They found a dose-dependent attenuation by earlier vaccination against both influenza A and B.

For influenza A, adjusted VE was 96% in those who hadn't been vaccinated in the previous season, with the level falling to 48% in those with 1 earlier dose, 52% in those who got 2 earlier doses, and 21% in kids who received 3 previous doses. For influenza B, the levels were 66% VE in those who hadn't previously been vaccinated, 48% in those who had gotten 1 earlier dose, 34% in those who had 2 prior doses, and -7% in those who had received 3 earlier doses. The investigators also saw a protective effect from natural flu infection in previous seasons.

However, VE reached statistical significance in only one of the eight subgroups of children: against influenza A in children who had received 2 previous doses. For all the other subsets, the 95% confidence interval dipped into negative numbers, and all confidence intervals were wide, reflecting weaker findings.

The team wrote that their report is the first to show a statistically significant association between the attenuated effects of flu VE and prior vaccine doses. They noted that the findings might not be generalizable to other age-groups, given that schoolchildren typically have high immune responses to vaccines, and added that more studies are needed to confirm the findings. They also detail several shortcomings of their research, including an observational design and the use of RDTs, which are not as sensitive as polymerase chain reaction, the gold standard for influenza.
Mar 8 Clin Infect Dis abstract

 

Study: 4-strain flu vaccine cuts flu, other health burdens in youngest kids

A phase 3 trial of GlaxoSmithKline's (GSK's) quadrivalent (four-strain) flu vaccine (Fluarix Tetra) in children ages 6 to 35 months not only found high efficacy against moderate-to-severe flu, but also a reduction in health utilization indicators, such as antibiotic use, clinic visits, and parental work absences.

The study, which spanned 13 countries in Europe, Central America, and Asia, was conducted during the 2011-12 and 2012-13 flu seasons in the Northern Hemisphere and 2012 to 2014 flu seasons in the Southern Hemisphere. An international research team reported its findings this week in The Lancet Child & Adolescent Health.

In January, the United States Food and Drug Administration (FDA) approved an expanded indication for Fluarix Tetra, allowing it to be used for children ages 6 to 35 months.

The study enrolled 12,018 children, 6,006 who had received the quadrivalent vaccine and 6,012 who had received vaccines against other diseases. There were 356 lab-confirmed flu cases (6%) in the flu vaccine group and 693 (12%) confirmed flu cases in the control group.

Against moderate-to-severe flu, vaccine efficacy was 63.2%, and against flu of any severity, efficacy was 49.8%.

Thomas Breuer, MD, MSc, GSK's chief medical officer, said in a press release from the company that the study is the first to evaluate vaccine efficacy for a quadrivalent vaccine in young children. He noted that young kids are in the high-risk group for flu complications and play a major role in community spread. "It adds to the growing body of evidence to support universal vaccination including all children from 6 months of age to help prevent influenza in this age group, as well as the spread of influenza across the community," Breuer said.

Among the other findings, the team determined that the vaccine was associated with a 50% reduction in antibiotic, 47% cut in clinic visits, 79% less emergency department visits, 54% lower rate of parent work absence, and 55% lower missed childcare days. The safety profiles of the flu vaccine and control vaccines were similar.
Mar 5 Lancet Child Adolesc Health abstract
Mar 6 GSK press release

 

H5N1 avian flu outbreak strikes poultry in India

India's agriculture ministry has reported a highly pathogenic H5N1 avian influenza outbreak in backyard poultry in Orissa state in the eastern part of the country, according to a notification yesterday from the World Organization for Animal Health (OIE).

The event began on Feb 11, and all 1,823 birds were culled as part of the response, which also includes increased surveillance, movement control, and disinfection. So far, investigators haven't found the source of the outbreak.

India's last H5N1 in poultry occurred in June 2017, but last week the virus was detected in house crows in the same district of Orissa state.
Mar 7 OIE report in H5N1 in India

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Editor's Note: This scan was updated on Mar 9 to better reflect the limitations of the study, especially statistically insignificant data. Many thanks to New Zealand–based risk and policy adviser Ron Law for his astute observations after this item was published.

A study of the impact of prior flu vaccination on effectiveness in the current season in Japanese schoolchildren found a significant association between reduced vaccine effectiveness (VE) against medically attended flu and repeated vaccination, but the study findings were limited because of statistically insignificant findings in study subgroups, use of rapid diagnostic tests (RDTs), and other factors.

The findings come as experts in the United States and other countries are trying to untangle the reasons for a drop in effectiveness against the H3N2 strain over the past few seasons, some of which is likely related to egg-mediated mutations in the vaccine production process. However, other factors may play a role, such as reduced immune response correlated to earlier exposure to the vaccine or the disease. Japanese researchers reported their findings today in Clinical Infectious Diseases.

Their study took place in children ages 9 to 18 who were seen for flulike illness at a community hospital on a remote island in Japan over the 2011-12 through 2013-14 flu seasons. Vaccine coverage on the island is high, past vaccination status is recorded in a vaccine registry, and information from clinic visits and rapid diagnostic tests results are part of the electronic medical record.

Over the three seasons, the researchers analyzed 1,668 flulike illness episodes, of which 421 were confirmed as influenza A and 358 were confirmed as influenza B. They found a dose-dependent attenuation by earlier vaccination against both influenza A and B.

For influenza A, adjusted VE was 96% in those who hadn't been vaccinated in the previous season, with the level falling to 48% in those with 1 earlier dose, 52% in those who got 2 earlier doses, and 21% in kids who received 3 previous doses. For influenza B, the levels were 66% VE in those who hadn't previously been vaccinated, 48% in those who had gotten 1 earlier dose, 34% in those who had 2 prior doses, and -7% in those who had received 3 earlier doses. The investigators also saw a protective effect from natural flu infection in previous seasons.

However, VE reached statistical significance in only one of the eight subgroups of children: against influenza A in children who had received 2 previous doses. For all the other subsets, the 95% confidence interval dipped into negative numbers, and all confidence intervals were wide, reflecting weaker findings.

The team wrote that their report is the first to show a statistically significant association between the attenuated effects of flu VE and prior vaccine doses. They noted that the findings might not be generalizable to other age-groups, given that schoolchildren typically have high immune responses to vaccines, and added that more studies are needed to confirm the findings. They also detail several shortcomings of their research, including an observational design and the use of RDTs, which are not as sensitive as polymerase chain reaction, the gold standard for influenza.
Mar 8 Clin Infect Dis abstract

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