News Scan for Sep 09, 2014

ICU infections in kids
;
Heat-tolerant anthrax vaccine
;
Ohio measles over
;
Berry-linked hepatitis
;
Vectorborne illness control

Study: Healthcare-associated infections in critically Ill kids fall markedly

The rate of two important healthcare-associated infections (HAIs) in critically ill children decreased substantially from 2007 to 2012, an important factor in patient outcomes as well as in monetary savings, according to findings of a study yesterday in Pediatrics.

The authors of the cohort study evaluated changes in HAIs, specifically central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections (CAUTIs), by evaluating data reported to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network from 173 neonatal intensive care units (NICUs) and 64 pediatric intensive care units (PICUs) from Jan 1, 2007, to Sep 30, 2012.

Rates of CLABSIs in NICUs decreased steadily over the study period, from 4.9 to 1.5 per 1,000 central-line days (incidence rate ratio [IRR] per quarter, 0.96; 95% confidence interval [CI], 0.94 to 0.97) and in PICUs from 4.7 to 1.0 per 1,000 central-line days (IRR per quarter, 0.96; CI, 0.94 to 0.98). These declines translate to reductions of 4% per quarter and 61% over the study period in both NICUs and PICUs.

Rates of ventilator-associated pneumonias decreased steadily from 1.6 to 0.6 per 1,000 ventilator days (IRR per quarter, 0.97; CI, 0.92 to0.98]) in NICUs and from 1.9 to 0.7 per 1,000 ventilator days (IRR per quarter, 0.95; CI, .92 to 0.98] in PICUs. The declines reflect a decrease of 3% per quarter, or 50% over the study period, in NICUs and 5% per quarter, or 76% over the study period, in PICUs.

CAUTI rates did not change significantly.

Very low birth weight infants were more than two times more likely than normal weight infants to have CLABSIs and 3.5 times more likely to develop ventilator-associated pneumonia.

The authors estimate that the reduction in CLABSIs brought savings of roughly $61 million in NICUs and $70 million in PICUs during the 5-year study. National efforts to improve patient safety through decreasing HAIs have been effective, they say, and "must remain a prominent quality improvement goal to protect our most vulnerable patients."
Sep 8 Pediatrics abstract

 

Emergent BioSolutions aims to develop heat-tolerant anthrax vaccine

The US government has awarded Emergent BioSolutions a contract worth up to $29 million to develop a dry formulation of its adjuvanted anthrax vaccine, with the aim of eliminating the need for refrigeration during shipping and storage, the company announced yesterday.

The 5-year contract calls for further development of Emergent's next-generation anthrax vaccine candidate, called NuThrax, also known as AV7909, which consists of Anthrax Vaccine Adsorbed with the adjuvant CPG 7909, the company said in a press release.

The contract provides funding for manufacturing and nonclinical activities through the preparation of an investigational new drug application to the US Food and Drug Administration. It was awarded by the National Institute of Allergy and Infectious Diseases.

"The dry formulation of NuThrax is intended to increase stability of the vaccine candidate at ambient and higher temperatures, with the objective of eliminating the need for cold chain during shipping and storage," the company said.

The firm said it is currently conducting a randomized controlled phase 2 trial designed to evaluate the safety and immunogenicity of NuThrax for post-exposure prophylaxis of anthrax infection using two- and three-dose immunization schedules and two different dose levels.
Sep 8 Emergent press release

 

Ohio measles outbreak appears to be over

A measles outbreak in Ohio appears to be over after 377 cases in 6 months, according to an Associated Press (AP) report today.

The outbreak began in March among unvaccinated Amish people in Knox County who had traveled to the Philippines, where a measles epidemic was going on. Nine counties have been affected.

The latest illness-onset date in the outbreak was Jul 23, which means more than two 21-day incubation periods have passed, signaling the outbreak's end, the story said.

Nine people were hospitalized over the course of the outbreak, according to the Ohio Department of Health (ODH). Knox County accounted for 195 of the 377 cases.

For the nation as a whole, 592 measles cases have been reported this year through Aug 29, which is by far the most since measles was eliminated in 2000, according to the CDC.

The agency notes that measles is still common in many other countries, and travelers continue to bring the virus into the United States.
Sep 9 AP story
ODH measles outbreak information
CDC information on measles cases and outbreaks

 

European hepatitis A berry outbreak report reveals no single source

No single source has been identified in the 2013 hepatitis A virus (HAV) outbreak linked to mixed frozen berries that sickened nearly 1,500 Europeans, according to the final report issued by the European Food Safety Authority (EFSA) and published yesterday in the EFSA Journal.

The outbreak began in May of 2013 when HAV genotype IA developed in seven Germans who had traveled to ski resorts in northern Italy. Italy then began reporting cases, and about 90% of the total 1,444 cases over the course of the outbreak occurred in Italy.

Other countries with cases (331 total) included Denmark, Finland, France, Ireland, Norway, the Netherlands, Poland, Sweden, and the United Kingdom.

No known deaths occurred in the outbreak, although the report states that, because of limitations in HAV surveillance systems, it is impossible to rule out the possibility.

The final outbreak report says that exposure to contaminated berries may be underestimated because of the long period from exposure to symptom onset with HAV infection and the fact that berries are minor ingredients in numerous foods.

HAV infection is typically caused by ingestion of foods or water contaminated with fecal material. About 80% of case-patients reported eating mixed berries or berry-containing products such as cakes and pastries. A total of 43 contaminated lots or cases were identified, but no single source was found. Blackberries from Bulgaria and red currants from Poland were common ingredients in the traced lots.

The report states that contamination could have occurred in primary production of the berries or at the freezing stage.
Sep 8 EFSA Journal report

 

Southeast Asian countries announce vectorborne illness collaborations

Health ministers from several Southeast Asian countries adopted the Dhaka Declaration for battling vector-borne illnesses in Bangladesh today during the annual meeting of their region's World Health Organization (WHO) office. The declaration, signed by ministers from 11 different countries, sets out steps to control and eliminate the diseases from the region, according to a WHO press release.

The WHO estimates that about 1.4 billion people in the region are at risk for malaria, 871 million for lymphatic filariasis, and more than 147 million for visceral leishmaniasis. It said 52% of the world's population who are at risk for dengue infections live in the WHO's Southeast Asia region.

Adopting the declaration commits the ministers to multidisciplinary approaches to controlling and stamping out the diseases and means they recognize the need to strengthen their health systems to provide quicker treatment and outbreak response and to train vector control teams, the WHO said in the release.

In a related development, health ministers from five of the countries today at the same meeting signed a memorandum of understanding (MOU) to work together to eliminate visceral leishmaniasis from their countries, according to a separate WHO news release.

The countries are Bangladesh, Bhutan, India, Nepal, and Thailand. The disease is mainly a threat to Bangladesh, India, and Nepal, but sporadic cases have been reported in Bhutan and Thailand.

The disease is transmitted by sandflies and is debilitating and even fatal if left untreated. The WHO said more than 50% of the cases in the three main areas occur at border areas, which requires close collaboration. Collaborative steps will include agreed-on resource mobilization, information exchange, research, capacity building, and technical support.
Sep 9 WHO press release on Dhaka Declaration
Sep 9 WHO press release on leishmaniasis MOU

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