News Scan for Oct 19, 2016

News brief

CDC calls E coli outbreak tied to Adams Farm meat over after 11 cases

A multistate outbreak of Escherichia coli infections tied to Adams Farm beef, veal, and bison products appears to be over after 11 cases, which is 4 more than when the outbreak was first reported last month, the Centers for Disease Control and Prevention (CDC) said today.

Seven of the patients required hospitalization, and one had hemolytic uremic syndrome, a serious kidney complication. Illness-onset dates range from Jun 27 to Sep 10, with patients ranging in age from 1 year to 74, with a median of 32.

Cases have been confirmed in five states, which is one more than on Sep 24, when the CDC first announced the outbreak. Virginia reported its first case. Other states reporting cases are Massachusetts with 5, Connecticut and Pennsylvania with 2 each, and West Virginia with 1.

The outbreak investigation traced the likely source to Adams Farm Slaughterhouse in Athol, Mass. The company recalled various cuts of beef, veal, and bison on Sep 24. The products were shipped to farmers' markets, retail stores, and restaurants in Massachusetts, Connecticut, and eastern New York and may have been shipped elsewhere.

"This outbreak appears to be over," the CDC said in today's update. "However, the recalled beef, veal, and bison products may still be in freezers. Consumers who don't know about the outbreak could continue to eat recalled products and may get sick."
Oct 19 CDC update

 

$22.35 million needed to fight cholera in Yemen, more cholera reported in Haiti

The World Health Organization (WHO) said today it required more than $22 million U.S. dollars to fight an ongoing cholera epidemic in Yemen, with $16.6 million needed immediately to address the outbreak.

As of Oct. 17, there have been 340 cases of cholera and no deaths.  Cases come from the Taiz, Al-Hudaydah, Aden, Al Bayda, Lahj, and Sana’a governorates. Without a sustained intervention, the WHO said there could be as many as 76,000 cases in Yemen, where only 45% of health facilities are functional due to medical and staff shortages.

The WHO said there's an urgent need for chlorine tablets, an improved surveillance system, and support for public health laboratories.

In other cholera news, the Pan American Health Organization (PAHO) released its epidemiological update on cholera in the Americas, and said Hurricane Matthew caused wider spread of the disease in both Haiti and the Dominican Republic.

Haiti is seeing more cases at this point than last year, with a total of 28,559 suspected cases thus far in 2016. The country is also seeing a higher case-fatality rate (0.9%) in 2016 than it did in 2014 or 2015. The Dominican Republic is reporting twice the number of cholera cases this year as it did in 2014, with a total so far of 1,069 suspected cases.
Oct 19 WHO statement
Oct 19 PAHO update

 

New reports of avian flu in Taipei, India, and Germany

Three countries are reporting avian flu outbreaks today in a farm, park, and zoo.

In Taipei, the World Organization for Animal Health (OIE) reported a commercial farm destroyed 23,008 native chickens after 5,192 birds died from H5N2, highly pathogenic avian influenza. The mortality rate was 18.41% for this strain. The farm was located in the Zhutang Township.

A zoo in New Delhi is temporarily closed after nine birds died from H5N1 on Oct 14 and 15, according to the Associated Press (AP). The AP reports that autopsies conducted on two of the dead birds (ducks and pelicans) showed signs of H5N1 infection. The zoo is one of the largest in India, with more than 1,400 animals and 2.2 million visitors annually. At this point, zoo officials say there's no threat to human visitors.

Finally, Reuters reports that two pheasants in a Mannheim, Germany park died from low-pathogenic avian flu. While officials are testing more birds, six pheasants, 26 ducks, and two peacocks were culled as a precautionary measure.
Oct 19 OIE report
Oct 19 AP story
Oct 19 Reuters story

 

Europe reports high burden of healthcare-related infections

European patients develop an estimated 2.6 million cases of healthcare-associated infections each year, according to a study yesterday in PLoS Medicine led by researchers from the European Centre for Disease Prevention and Control (ECDC) and Germany's Robert Koch Institute.

The investigators estimated the burden of six common HAIs in 2011 through 2012: healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). For disease burden they calculated disability-adjusted life years (DALYs), a commonly used metric for measuring the impact of diseases on population health.

The team estimated that 2,609,911 new cases of HAI occur every year in Europe. The cumulative annual burden of the six HAIs was estimated at 501 DALYs per 100,000 population, or 2.5 million DALYs per year. They note that the cumulative burden of the six HAIs was higher than the total burden of all other 32 common communicable diseases tracked in Europe.

The authors wrote that, even though many of the reported HAIS can be prevented, "they still represent a significant burden among communicable diseases in Europe." They call for intensified prevention and control efforts in hospitals.
Oct 18 PLoS Med study
Oct 18 ECDC press release

 

UNICEF reaches deal on low-cost 5-strain vaccine for children

Six vaccine suppliers have agreed to cut the cost of a five-strain childhood vaccine in half, to 84 cents a dose, according to a press release today from UNICEF, the United Nations' children's organization.

The new pricing allows UNICEF to buy 450 million doses to send to 80 countries at a savings of $366 million for donors and governments, the agency said. Of those doses, 400 million will be allocated to nations supported by Gavi, the Vaccine Alliance and those transitioning to become so. The pentavalent vaccine protects against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b.

"Ninety percent of the world's children under five who die from vaccine-preventable diseases live in countries whose vaccine supply is no longer fully funded by donors," said Shanelle Hall, director of UNICEF's supply and procurement headquarters. "For the most vulnerable children in the world, pricing can make a difference between life and death," Hall added.

"Gavi estimates that 5.7 million deaths will be averted thanks to pentavalent vaccination in Gavi-supported countries between 2011 and 2020," said Gavi CEO Seth Berkley, MD.
Oct 19 UNICEF news release

Antimicrobial Resistance Scan for Oct 19, 2016

News brief

ASP in rehab facility reduces antibiotic use and resistance

The results of a small, single-center study suggest that implementing an antibiotic stewardship program (ASP) based on infectious disease (ID) consultation in a rehabilitation facility can reduce antibiotic use and antimicrobial resistance without affecting patient outcomes.

The quasi-experimental study, reported in Infection Control and Hospital Epidemiology, compared the periods before and after an ASP was implemented at a 150-bed rehabilitation facility in northern Italy specializing in spinal cord injuries (SCI). The authors note that patients cared for in SCI rehab hospitals are prone to infections dues to several factors—including bladder catheterization, invasive procedures, and pressure sores—and that antibiotic over-prescribing in these facilities is a recognized problem.

The ASP, which was implemented in July 2012, had two elements: Systematic bedside ID consultation with a dedicated ID consultant who visited patients and discussed antibiotic prescribing with their doctors, and regular structural interventions. The interventions included revisions of internal protocol for antibiotic prophylaxis and educational sessions on the appropriateness of antibiotic treatment.

During the study period (January 2011 to December 2014), overall antibiotic consumption at the facility decreased by 48%, dropping from 42 defined daily doses (DDD) per 100 patient days in 2011 to 22 DDD in 2014. Specifically, the use of carbapenems dropped by 97% and fluoroquinolone use dropped by 92%. The use of aminoglycosides, tetracycline, clindamycin, and macrolides also declined. The consumption of third-generation cephalosporins remained stable.

At the same time, the researchers found that the incidence of Clostridium difficile fell from 3.6 cases per 10,000 patient days in 2011 to 1.2 cases in 2014. In addition, they observed a significant decrease in drug-resistant bacteria. The prevalence of extensively drug-resistant (XDR) strains declined from 55% to 12% in Pseudomonas aeruginosa and from 96% to 73% in Acinetobacter baumanni; the prevalence of extended-spectrum beta-lactamase (ESBL) producing strains dropped from 42% to 17% in Escherichia coli and from 62% to 15% in Proteus mirabilis; carbapenem-resistant strains fell from 42% to 17% in Klebsiella pneumoniae; and methicillin-resistant strains of Staphylococcus aureus decreased from 77% to 40%.

The authors note that while their study is limited by the single-center design and long-term monitoring is needed, the results suggest that an ASP based on systematic ID consultation can be effective outside of acute-care hospitals.
Oct 17 Infect Control Hosp Epidemiol study 


HHS gives Johns Hopkins $16 million to improve antibiotic use in US healthcare

The US Department of Health and Human Services (HHS) on Tuesday awarded $16 million to Johns Hopkins University to help reduce unnecessary antibiotic use and fight antibiotic resistance in the healthcare system.

The contract awarded to the Johns Hopkins Armstrong Institute for Patient Safety and Quality will be spread out over 5 years and will fund the development of tools and educational modules to help healthcare providers make better decisions about antibiotic treatment. Johns Hopkins researchers will also be developing tools to help educate patients about antibiotics and when they are—and aren't—necessary.

"It's important for everyone, from health care providers to patients and families, to understand the importance of properly prescribing antibiotics," Johns Hopkins Univeristy assistant professor of pediatrics Pranita Tamma, MD, said in a news release. "We want to ensure each person involved in the care process is aware that antibiotics are essential for certain infections, but they can actually do more harm than good if they are improperly prescribed."
 Oct 18 Johns Hopkins Univeristy press release

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