NEWS SCAN: Animal-antimicrobial sales, H1N1 in China, typhoid fever in Indiana, fungal meningitis debate, global public health

Feb 6, 2013

Sales of antimicrobials for animals edged higher in 2011
Total US sales of antimicrobials intended for use in animals increased about 2.3% in 2011, according to data in an annual report released by the US Food and Drug Administration (FDA) yesterday. The total for the year came to about 29.9 million pounds (13.5 million kilograms), compared with 29.2 million pounds in 2010. Sales of some antimicrobial classes rose while others declined. Tetracyclines were the biggest sellers, at about 12.4 million pounds, which was up 0.9% from 2010. Sales of macrolides were up 5.2%, while sulfa drug sales were down 26.7%. Sales of ionophores, which are not used in human medicines, were up 7.9%. To help the FDA track resistance to antimicrobials used in both humans and animals, the animal Drug User Fee Amendments of 2008 require drug companies to report to the agency the amounts of antimicrobials they sell each year for use in animals. The legislation also requires the FDA to publish summaries of the information. In a statement released with the report, the agency said it is currently reviewing comments it received last year on a number of issues regarding the collection of antimicrobial drug sales data. In 2012 the agency launched a program designed to induce drug companies, veterinarians, and farmers to voluntarily reduce the use of antimicrobials to promote growth in farm animals.
FDA 2011 summary report on sales of animal antimicrobials
Feb 5 FDA statement about the 2011 report
FDA 2010 summary report
Related Apr 11, 2012, CIDRAP News story

H1N1 hospitalization, death more frequent in postpandemic season in Chinese adults
Among Chinese adults with confirmed pandemic H1N1 (pH1N1) influenza, proportionately more were hospitalized with their disease and more had severe disease and died in the 2010-11 (postpandemic) season than during the pandemic period (2009-10), according to a PLoS One study yesterday. The authors compared surveillance data for patients with lab-confirmed pH1N1 flu in the two seasons for hospitalization and age distribution. In addition, among hospitalized pH1N1 patients, they analyzed cases to determine risk factors for severe disease (defined as admission to the intensive care unit [ICU]) or death. They found the rate of hospitalization for pH1N1 to be higher in the 2010-11 than the 2009-10 season among patients older than 25 years (43.2% vs 24.5%, P < 0.0001). In addition, the proportion of fatal cases was higher in the postpandemic season (74.7% vs 60.1%, P < 0.01) in this age-group. Independent risk factors for severe illness were male sex (odds ratio [OD], 1.69; 95% confidence interval [CI], 1.09-2.63), presence of at least one chronic medical condition (OR, 2.50; 95% CI, 1.54-4.06), and 3 days or longer between illness onset and hospital admission (OR, 2.00; 95% CI, 1.03-3.04).
Feb 5 PLoS One article

Indiana warns of typhoid infection in Purdue food worker
Indiana health officials yesterday announced that a food handler at Purdue University has tested positive for typhoid fever and warned that anyone who ate at three food outlets in the campus's Marriott Hall from Jan 23 to Jan 25 may be at risk. Local, state, and Purdue health authorities are investigating the case and assessing the risk to the public, according to a statement from the Indiana State Department of Health (ISDH). The worker had recently traveled internationally, where he or she acquired the infection. The food outlets are the Boiler Bistro, John Purdue Room, and Lavazza coffee shop. Eating food or drinking beverages that have been handled by someone infected with Salmonella Typhi can post a risk. Another transmission risk is if sewage contaminated with the bacteria gets into water used for drinking or washing food. The ISDH advised people who may have been exposed to the sick worker to see a health provider immediately if they begin to experience a high fever, weakness, stomach pain, headache, diarrhea, or a flat rose-colored rash tat typically appears after 8 to 14 days, but sometimes later. About 400 cases of Salmonella Typhi are reported in the United States each year, with about 75% of the infections linked to international travel, according to the ISDH.
Feb 5 ISDH press release

Experts debate CDC guidance in fungal meningitis outbreak
A debate emerged yesterday in Antimicrobial Agents and Chemotherapy (AAC) about US Center for Disease Control and Prevention (CDC) recommendations for treating people exposed to contaminated injections in recent months. David A Stevens, MD, a fungal disease expert from Stanford University Medical School, said the CDC should have recommended prophylactic treatment with oral antifungals for all exposed patients, according to a press release from the American Society for Microbiology (ASM), which publishes AAC. He also aired concerns about the CDC's focus on only two drugs for treatment. Stevens wrote that, for patients who have been injected intrathecally or close to the intrathecal sac, fungal infection should be prevented with oral drugs that have known, uncommon, and usually inconsequential side effects. In the counterargument, four authors, including Tom Chiller, MD, deputy chief of the CDC's mycotic diseases branch, defended the CDC's recommendation against prophylactic antifungal drugs and described the decision model that an expert panel used in the deliberations. They argued that most of the cases resulted from epidural injection, not intrathecal ones as suggested by Stevens. Clinicians were faced with weighing the benefits of treating asymptomatic patients against the significant expenses of the drugs and monitoring efforts. The group wrote that the CDC chose to recommend careful clinical evaluation and imaging of high-risk patient, regardless of symptoms, to flag early signs of infection. In a Feb 4 update, the CDC said fungal infections linked to the contaminated injectable steroids have reached 696, 45 of them fatal
Feb 5 ACC commentary questioning CDC guidance
Feb 5 ACC commentary defending CDC guidance
Feb 5 ASM press release
Feb 4 CIDRAP News Scan on case count

Report on global public health policy launched by 3 international heavyweights
A study on policies needed to advance development of and access to medical and health technologies worldwide was released yesterday by three leading international health groups, the World Health Organization (WHO) announced. Titled, Promoting Access to Medical Technologies and Innovation: Intersections between Public Health, Intellectual Property and Trade, the report was prepared through a collaboration of the WHO, the World Intellectual Property Organization, and the World Trade Organization. Among the issues examined are how to provide incentives for medical innovations and how to ensure equitable access to the technologies for all, including the poor. Options for broadly applicable policy are discussed, as are complex legal questions such as differing patent rights and trade and intellectual property rules in different countries. The intended audience includes policymakers, legislators, government officials, delegates to international organizations, nongovernmental organizations, and researchers. Ruth Dreifuss, a former Swiss president and former WHO official who chaired the launch event, said, "Promoting both medical innovation and access to the fruits of that innovation is indispensable for progress towards improved and more equitable health outcomes. But to achieve this result demands greater practical cooperation and dialogue with the international system—the launch of this study represents an important step forward in that direction."
Feb 5 WHO press release
Summary of report

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