News Scan for Sep 25, 2015

US biosurveillance assessment
Plague case in New Mexico
MRSA and antibiotic stewardship

GAO finds National Biosurveillance Integration Center lacking

The National Biosurveillance Integration Center (NBIC) is falling short in its mission in several ways, such as lack of timely information to its partners, poor partner participation, and difficulty prioritizing some activities, and might even need to be discontinued, the US Government Accountability Office (GAO) said in a report yesterday.

The Department of Homeland Security (DHS) established the NBIC in 2004, and in 2007 the 9/11 Commission Act defined the center's role within DHS as identifying and analyzing data to detect biothreats and to issue alerts. Congress asked the GAO to assess how the NBIC carries out its mission, and the agency divided its assessment into the center's key roles as analyzer, coordinator, and innovator.

Analyzer. The GAO noted that the NBIC produces reports on biological events using open-source data but struggles to disseminate meaningful new information. It said 8 of 11 of its federal partners said the NBIC's products add little, because the partners can get the information from other federal partners quicker. The GAO added that data that could help to characterize a biological event may not exist or are not in a usable form. And only 5 of 19 federal partners said they share data with the NBIC.

Coordinator. The NBIC conducts regular calls with partners but faces limited partner involvement. For example, only 3 of 19 federal partners provided the NBIC with dedicated liaisons.

Innovator. The GAO said the NBIC has undertaken efforts to develop tools to address gaps in biosurveillance integration but has had difficulty prioritizing developmental efforts. Partners identified obstacles such as limited resources and the difficulty in prioritizing the center's innovation efforts because its partners' diverse needs.

The GAO identified various options that could address these challenges, "ranging from strengthening the center's ability to implement its current roles to repealing the NBIC's statute." It added that Congress should consider designating a different federal partner with biosurveillance expertise as the federal integrator.
Sep 24 GAO report


New Mexico plague case lifts national total to 15

New Mexico health officials recently reported the state's fourth plague case of the year, involving a 73-year-old woman from Santa Fe County, bringing to 15 the number of cases in the United States this year, an unusually high number.

According to a Sep 23 statement from the New Mexico Department of Health (NMDH), the woman had the less common septicemic plague, which is more difficult to recognize than the more common bubonic form. The department said septicemic plague is responsible for 20% to 25% of New Mexico's plague cases and is harder to detect, because patients don't have swollen lymph nodes as with the bubonic form.

Retta Ward, MPH, New Mexico's health secretary, said in the statement that the case is the state's fourth this year and that health providers should consider the illness when patients have a fever of unknown origin and are from plague-endemic parts of the state.

Several of the state's plague patients were likely exposed to plague-infected fleas from rodents that are brought into homes by dogs and cats that are allowed to roam and hunt and aren't treated with flea-control products, Paul Ettestad, DVM, the state's public health veterinarian said in the statement.

The US Centers for Disease Control and Prevention typically records about five plague cases each year. Of the 15 reported so far this year, 4 of them have been fatal, according to earlier reports.
Sep 23 NMDH statement
Sep 15 CIDRAP News scan "Michigan woman contracts first-ever Midwest plague illness"


Antibiotic stewardship program linked to sharp drop in MRSA

The introduction of a national antibiotic stewardship program in Scotland led to substantial reductions in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections, researchers reported in The Lancet Infectious Diseases yesterday.

The investigators' time-series analysis explored the ecological determinants of MRSA epidemiology of 1,289,929 hospital admissions and 455,508 adults registered in primary care in northeast Scotland. The team studied the effects of (1) stewardship to restrict the use of cephalosporins, co-amoxiclav, clindamycin, fluoroquinolones, and macrolide antibiotics; (2) a hand hygiene campaign; (3) hospital environment inspections; and (4) MRSA admission screening.

They noted that antibiotic use fell by 47% in hospitals and 27% in the community during the stewardship program. And they found that MRSA prevalence density decreased during antibiotic stewardship by 54% in hospitals and 37% in the community. When combined with infection prevention and control measures, MRSA prevalence density was reduced by 50% in hospitals and 47% in the community.

The authors conclude, "Alongside infection control measures, removal of key antibiotic selection pressures during a national antibiotic stewardship intervention predicted large and sustained reductions in hospital-associated and community-associated MRSA."
Sep 24 Lancet Infect Dis study

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