Flu Scan for May 05, 2017

News brief

H3N2v sickens Texas resident who had contact with pigs; US flu ebbs

The US Centers for Disease Control and Prevention (CDC) reported the nation's first variant H3N2 (H3N2v) case of the year, a Texas resident who had contact with swine before illness began, according to a weekly flu update, which noted further decline in seasonal flu activity.

The CDC said the H3N2v case was detected through the Department of Defense's global flu surveillance program. The patient got sick a week after contact with swine at an agricultural event, a known risk factor for H3N2v illness. He or she was not hospitalized and has fully recovered.

H3N2v was first detected in humans in 2011, spiking to 309 US cases the following summer, many of them linked to exposure to swine exhibits. Cases have declined rapidly since then, with 18 cases reported in 2016.

In seasonal flu developments, flu markers continued to decline, but the disease is still having an impact, with 10 more pediatric deaths reported and flu still widespread in a few states in the northeastern part of the country.

Six of the pediatric deaths occurred between February and the end of April and three were reported from the 2015-2016 seasons. Six were from influenza B, one from H3N2, one from 2009 H1N1, and two from unsubtyped influenza A viruses. Due to a reclassification of an earlier pediatric flu death, the total for the season is now at 89, the CDC said.

All of the CDC's 10 regions are now below their baselines for clinic visits for flulike illness, and other indicators it uses to gauge flu activity are below baselines or epidemic thresholds. Influenza B last week was the most frequently detected strain, typical for late in the season.

The number of states that reported widespread flu last week was down to three: Connecticut, New Hampshire, and New York.
May 5 CDC FluView report

 

Mexico reports H7N3 recurrence, UK detects H5N8 again

Mexico yesterday reported a highly pathogenic H7N3 outbreak at a commercial poultry farm, its first since May 2016, and the United Kingdom reported another H5N8 outbreak, prompting another round of restrictions.

In Mexico, the H7N3 outbreak was found during active surveillance in chickens at a layer farm in Jalisco state in the central part of the country that didn't have any clinical signs, according to a notification yesterday from the World Organization for Animal Health (OIE). The event began on Apr 18. Mexican officials said the flock had been vaccinated against the disease 18 weeks earlier.

The 151,132 birds at the facility are being destroyed, and officials have quarantined the area and set up restriction and surveillance zones. The source of the outbreak hasn't been determined and an investigation is still underway. Mexico reported several H7N3 outbreaks in the same area in 2016.

Elsewhere, the United Kingdom's Department for Food, Environment, and Rural Affairs (DEFRA) said yesterday that H5N8 has been detected again, this time in backyard chickens near the city of Thornton in northwest England's Lancashire County. The detection prompted the placement of a 3-km protection zone and a 10-km surveillance zone around the farm. Officials said a ban on poultry gathering across the UK remains in place through May 15.
May 4 OIE report on H7N3 in Mexico
May 4 DEFRA report

In other avian flu developments, an OIE update from South Korea on H5N6 outbreaks on poultry farms said 273 events that occurred on poultry farms between Nov 23, 2016 and Dec 26, 2016 killed 29,922 birds and led to the culling of 20,190,073 more. The outbreaks were reported from a wide part of the country, mostly in its western half. Most occurred at duck farms, but several layer farms were also hit by the virus.
May 4 OIE report on H5N6 in South Korea

Measles outbreak in Minnesota, fueled by anti-vaxxers, grows to 44 cases

A Minneapolis-area measles outbreak that has been fueled by low vaccination rates in Somali-Americans grew by 3 cases today, to 44, the Minnesota Department of Health (MDH) reported today.

Anti-vaccine advocates have encouraged residents to avoid the measles-mumps-rubella (MMR) vaccine over baseless claims of a link to autism, the Washington Post reported today. The activists include Andrew Wakefield, an anti-vaccine leader, who visited the Somali community several times in 2010 and 2011, after which MMR vaccine rates plummeted.

Wakefield defends his role: "The Somalis had decided themselves that they were particularly concerned. I was responding to that."

He says of the measles outbreak, "I don't feel responsible at all."

But local Somali-American clinician Siman Nuurali countered, "It's remarkable to come in and talk to a population that's vulnerable and marginalized and . . . to take advantage of that. It's abhorrent."

Yesterday Kris Ehresmann, RN, MPH, infectious disease director for the MDH, said state officials are considering imposing mandatory isolation and quarantine orders on some people to help contain the outbreak, according to the Minneapolis Star Tribune. "We have some people who have not followed what we asked, and they have been blatant in exposing other people. They have potentially spread the disease in other locations," she said.

As part of a large immunization response, the MDH has widened its MMR recommendations, the department said in a news release yesterday. In addition to the usual guidelines—in which kids receive a shot around 1 year old then from 4 to 6 years old—officials said children living in affected counties and Somali-American children statewide should get the second MMR vaccine dose on an accelerated basis. That means they should receive it if they had the first dose at least 28 days previously.

"We would not be surprised if we saw additional cases in other parts of the state where there are clusters of unvaccinated people before this is over," Ehresmann said in the release.
May 5 MDH update
May 5 Washington Post story
May 4 Star Tribune article
Mar 4 MDH news release
May 4 MDH guidance for healthcare workers

 

Seven more cases reported in Liberia's unexplained illness cluster

Seven more cases have been reported in an unexplained illness cluster in Liberia in people who attended the funeral of a religious leader in Sinoe County, raising the total so far to 28, the African Press Agency (APA) News reported yesterday.

Francis Kateh, MD, Liberia's deputy health minister and chief medical officer, told reporters in Monrovia yesterday that the seven additional cases are from Greenville, the epicenter of the outbreak and where the funeral took place, according to the APA report.

He reiterated that tests have ruled out Ebola and Lassa fever, and he added that two pathologists are expected in Liberia today to conducts autopsies. So far, 12 deaths have been reported, and the two most recent ones were a man from Monrovia who had traveled to the funeral and his fiancé, who apparently had not. Kateh said the health ministry is searching for 60 people from Monrovia who attended the Greenville funeral to observe and isolate them.

Meanwhile, a World Health Organization (WHO) spokesman said at a press briefing in Geneva today that results of tests at labs in Europe and the United States are still pending, but so far the investigation suggests a point-source of infection, with the leading theory as food, drink, or water poisoning, Agence France-Presse (AFP) reported today. Tarik Jasarevic said the overall risk of spread is thought to be low.
May 4 APA story
May 5 AFP story

 

CDC says US adult vaccine coverage up but still wanting

The use of several key adult vaccines increased slightly in 2015—the year for which the most current data are available—but are still low, the US Centers for Disease Control and Prevention (CDC) reported today.

CDC researchers evaluated self-reported immunization statistics from the National Health Interview Survey for recommended adult vaccinations in 2015, and for flu vaccine during the 2014-15 flu season, according to the latest figures in Morbidity and Mortality Weekly Report (MMWR).

They noted that pneumococcal vaccine uptake increased by 2.8 percentage points over the previous year (to 23.0%), tetanus and diphtheria with acellular pertussis (Tdap) vaccine uptake was up 3.1 percentage points (to 23.1%), herpes zoster vaccine among adults aged 60 years and older increased 2.7 percentage points (to 30.6%), and hepatitis B vaccine use among healthcare workers rose by 4.1 percentage points (to 64.7%). Flu vaccine coverage improved by 1.6 percentage points, to 44.8%.

Increases of Tdap and herpes zoster vaccines were similar to those seen in 2014. Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30% or higher.

The authors concluded, "Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage."
May 5 MMWR report
Feb 5, 2016, CIDRAP News scan on 2014 numbers

 

Study finds multidrug resistance rates similar in small, large US hospitals

A study yesterday in Clinical Infectious Diseases reports no systematic differences in rates of antimicrobial resistance between large tertiary care hospitals and small community hospitals.

Using antibiotic susceptibility data obtained from The Surveillance Network Database-USA, which includes a network of clinical laboratories that serve approximately 300 hospitals across the United States, investigators compared multidrug-resistance (MDR) rates at large tertiary care hospitals (TCHs) and small community hospitals (SCHs) for five organisms: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Facilities were considered SCHs if they had fewer than 300 beds. Investigators identified 38 TCHs and 68 SCHs.

When the investigators compared MDR rates for inpatient and outpatient locations at both types of hospital for the entire study period, they found that the MDR rates were higher at SCHs for four of the organisms: E coli (26.1% vs. 24.9%), S aureus (52.7% vs. 45%), K pneumoniae (25.5% vs. 17.8%), and A baumanni (59.9% vs. 41.1%). Resistance rates in P aeruginosa were higher at TCHs (17.2% vs. 15.3%).

An examination of yearly MDR rates from 1999 to 2012, after adjustments were made for time and variability between hospitals, showed that MDR was higher in A baumannii only at small community hospitals in both patient locations, while E coli showed higher resistance at TCH inpatient locations, and S aureus was higher in SCH outpatient locations. No significant differences in resistance were found for other organisms between the two types of hospital.

The authors say they were surprised by the findings, since they hypothesized that TCHs would have higher MDR rates because they see more complex cases. But that might be balanced out by the fact they are also more likely to have antimicrobial stewardship and infection control programs than SCHs. Finding that MDR is no less of a problem at small community hospitals, they say, emphasizes the importance of ensuring those facilities have those programs as well.
May 4 Clin Infect Dis study

ASP Scan (Weekly) for May 05, 2017

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Study finds multidrug resistance rates similar in small, large US hospitals

A study yesterday in Clinical Infectious Diseases reports no systematic differences in rates of antimicrobial resistance between large tertiary care hospitals and small community hospitals.

Using antibiotic susceptibility data obtained from The Surveillance Network Database-USA, which includes a network of clinical laboratories that serve approximately 300 hospitals across the United States, investigators compared multidrug-resistance (MDR) rates at large tertiary care hospitals (TCHs) and small community hospitals (SCHs) for five organisms: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Facilities were considered SCHs if they had fewer than 300 beds. Investigators identified 38 TCHs and 68 SCHs.

When the investigators compared MDR rates for inpatient and outpatient locations at both types of hospital for the entire study period, they found that the MDR rates were higher at SCHs for four of the organisms: E coli (26.1% vs. 24.9%), S aureus (52.7% vs. 45%), K pneumoniae (25.5% vs. 17.8%), and A baumanni (59.9% vs. 41.1%). Resistance rates in P aeruginosa were higher at TCHs (17.2% vs. 15.3%).

An examination of yearly MDR rates from 1999 to 2012, after adjustments were made for time and variability between hospitals, showed that MDR was higher in A baumannii only at small community hospitals in both patient locations, while E coli showed higher resistance at TCH inpatient locations, and S aureus was higher in SCH outpatient locations. No significant differences in resistance were found for other organisms between the two types of hospital.

The authors say they were surprised by the findings, since they hypothesized that TCHs would have higher MDR rates because they see more complex cases. But that might be balanced out by the fact they are also more likely to have antimicrobial stewardship and infection control programs than SCHs. Finding that MDR is no less of a problem at small community hospitals, they say, emphasizes the importance of ensuring those facilities have those programs as well.
May 4 Clin Infect Dis study 

 

Scientists develop new method to produce penicillin

Originally published by CIDRAP News May 4

Scientists in the United Kingdom say they've developed a method to produce penicillin from baker's yeast. They report their findings today in Nature Communications.

In the study, scientists from Imperial College London describe how they used genes from the fungus Penicillium chrysogenum, which naturally produces penicillin, to re-engineer the cells of the baker's yeast Saccharomyces cerevisiae. This set off a biochemical reaction process that enabled the baker's yeast, in turn, to produce small amounts of the nonribosomal peptide penicillin. They then further modified the yeast to produce more penicillin.

When added to a petri dish containing Streptococcus bacteria, the yeast actively secreted penicillin that had the same bioactivity against Streptococcus as commercially obtained penicillin.

While producing more penicillin isn't necessarily a priority, the authors of the study say their research, though still in its early stages, demonstrates that baker's yeast could be a potential vehicle for producing and testing a whole range of new antibiotics. Baker's yeast is easy to genetically re-engineer and has previously been used to create molecules with industrial and therapeutic relevance, but this is the first time it has been genetically reprogrammed to produce antibiotics.      

"We believe yeast could be the new mini-factories of the future, helping us to experiment with new compounds in the nonribosomal peptide family to develop drugs that counter antimicrobial resistance," study co-author Ali Awan, PhD, said in an Imperial College news release.
May 4 Nat Commun study
May 4 Imperial College news release

 

VA study identifies factors associated with antimicrobial utilization

Originally published by CIDRAP News May 3

A new study of antimicrobial stewardship efforts at Veterans Administration (VA) hospitals published in the Journal of Hospital Medicine has identified factors associated with positive and negative effects on antimicrobial utilization.

The study comes out of a 2012 survey of antimicrobial stewardship practices at 130 acute care VA facilities administered by the VA National Antimicrobial Stewardship Task Force (ASTF). From the survey results, investigators derived 57 facility characteristics considered relevant to antimicrobial utilization, then whittled that number down to 34 variables. The variables were entered into a multivariable model that was used to determine associations between the variables and four antibiotic utilization measures: aggregate acute care antimicrobial use, antimicrobial use in patients with noninfectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and missed opportunities to avoid double anaerobic coverage with metronidazole.

Variables associated with at least three favorable changes (ie, reduced overall or noninfectious antimicrobial use, fewer missed opportunities to convert from parenteral to oral therapy or avoid double anaerobic coverage) included the presence of postgraduate physician/pharmacy training programs, the number of antimicrobial-specific order sets, frequency of systematic de-escalation review, the presence of pharmacists and/or infectious disease (ID) attending physicians on acute care ward teams, and formal ID training of the lead antibiotic stewardship program pharmacist. Variables associated with two unfavorable changes (increases in noninfectious antimicrobial use and missed opportunities to switch from parenteral to oral therapy) included number of hospital beds, the degree to which the facility engaged with the online resources of the VA stewardship task force, and the presence of antimicrobial stop orders.

"In summary, the VA has made efforts to advance the practice of antimicrobial stewardship system-wide, including a 2014 directive that all VA facilities have an ASP," the authors of the study write. "Our study identifies areas of stewardship that may correlate with, positively or negatively, antimicrobial utilization measures that will require further investigation."
May J Hosp Med study

 

Drug-resistant hospital infections tied to higher death rates

Originally published by CIDRAP News May 3

Hospital-associated infections caused by multidrug-resistant organisms (MDROs) can increase mortality, readmission rates, and emergency department (ED) visits compared with those caused by susceptible strains, Spanish investigators reported yesterday in Clinical Infectious Diseases.

The team studied 324 patients with MDRO infections and 686 with drug-susceptible infections. The risk of all-cause and 30-day mortality after infection was 70% and 77% higher, respectively, in MDRO patients. Probability of readmission was more than double that of patients with susceptible infections. ED visits were significantly higher with methicillin-resistant Staphylococcus aureus(MRSA) and Escherichia coli infections, in which case the risk was about triple and double the risk in patients with susceptible infections.

The authors noted the MDROs did not appear to influence length of hospital stay or the need for hospital admission, intensive care, surgery, or diagnostic tests.
May 2 Clin Infect Dis study

 

Study finds 6% resistance rate in hospital Enterobacteriaceae isolates

Originally published by CIDRAP News May 3

Scientists at a Malaysian teaching hospital found a 6% rate of carbapenem resistance among Enterobacteriaceae isolates obtained from patients and high rates of the resistance gene NDM-1, according to a study yesterday in Antimicrobial Resistance & Infection Control.

The team analyzed 8,306 Enterobacteriaceae isolates collected from August 2013 to December 2015 from patients at a 700-bed tertiary teaching hospital. Of those, 477 (5.7%) were carbapenem-resistant Enterobacteriaceae (CRE). About 86% of the CRE were K pneumoniae, and 49.3% were isolated from rectal swabs, with urine (15.9%) and blood samples (9.6%) accounting for most of the rest.

Of the 136 organisms that were genotyped, 112 (82.4%) were positive for the New Delhi metallo-beta-lactamase 1 (NDM-1) gene, which was first reported in 2009.
May 2 Antimicrob Resist Infect Control report

 

Pathogenic bacteria identified in Germany using DIY CRISPR kit

Originally published by CIDRAP News May 2

The European Centre for Disease Prevention and Control (ECDC) said that in March of this year, Germany reported the detection of pathogenic organisms in a do-it yourself Bacterial Gene Engineering CRISPR Kit. Some of the organisms were antibiotic-resistant.

"The kit is sold over the Internet, targeting non-professional microbiology hobbyists. The detection of the pathogenic microorganisms was made as part of the control implemented by local health and food safety authorities," the ECDC report said. The kit was labeled safe for at-home use.

The genome editing kit is manufactured in the United States, and the ECDC said it does not suspect to be in wide use in Germany or elsewhere in Europe.

"The risk of infection by the contaminating strains in the kit is low for the users of the kit, assuming that they are healthy," the ECDC concluded. "The contribution of the kit to the burden of antimicrobial resistance in the EU/EEA population and environment is marginal and the risk associated with the kits is considered very low."
Apr 29 ECDC report

 

Novel C diff antibiotic tops vancomycin in phase 2 trial

Originally published by CIDRAP News May 1

A phase 2 trial of the novel antibiotic ridinilazole in adults with Clostridium difficile infections showed that it performed better than vancomycin, one of three drugs used to routinely treat infections, and was well tolerated, with a similar adverse event profile.

An international group of researchers, including some from Summit Therapeutics, the drug's maker, published the findings on Apr 28 in The Lancet Infectious Diseases.

From June 2014 to Aug 2015 the investigators recruited 100 patients from 33 centers in the United States and Canada, randomly assigning half to the ridinilazole group and half to receive vancomycin. Their efficacy analysis is based on 69 patients: 36 ridinilazole recipients and 33 who got vancomycin. Sustained clinical response was seen in 66.7% (24) of ridinilazole subjects compared with 42.4% (14) of those who were treated with vancomycin. Recurrence was seen in 4 (14.3%) of 28 ridinilazole patients, compared with 8 (32.8%) of 23 vancomycin patients.

The researchers also found that ridinilazole performed better than vancomycin in patients older than 75 years, those with severe disease, and those who required other antibiotics, though the differences weren't always statistically significant.

The results support further development of the drug, the team concluded.

In a related commentary in the same issue, Simon Goldenberg, MD, with King's College London, wrote that the development of new drugs to treat C diff infections is vital, and ridinilazole appears to have many qualities that make it a good candidate for further development. He noted that the study was limited by the inclusion of patients who were slightly younger than the profile of C diff patients treated in everyday practice, with few who had previous infections. "Discounting these shortcomings, it is rare for a study of an antimicrobial to show statistical superiority over the standard of care," he wrote.
Apr 28 Lancet Infect Dis abstract
Apr 28 Lancet Infect Dis commentary

 

Study: Prescription length for strep throat is based on history, not science

Originally published by CIDRAP News May 1

A review published today in The Pediatric Infectious Disease Journal shows that the traditional 10-day course for antibiotics prescribed for strep throat has no basis in scientific evidence. Instead, the prescription length was determined 60 years ago, and is no more efficacious than a shorter course of treatment.

Streptococcal pharyngitis is a common diagnosis for a sore throat, and rarely can lead to serious complications, including rheumatic fever. Physicians traditionally prescribe a 10-day course of penicillin for the bacterial infection, but there are no studies that prove this prescription length is clinically valuable. Instead, it's a blanket recommendation that came out of the "penicillin boom" that followed World War II, a time when rheumatic fever was much more common in the United States.

Falling rates of rheumatic fever and the rise of non-penicillin antimicrobials should prompt clinicians to reconsider the need for 10 days of penicillin, the authors said. But, the subconscious power of the number "10" and a long clinical history will make changing prescribing patterns difficult.

"The 10-day rule appears to be an example of a more general phenomenon in clinical medicine, the fierce inertia of established usage," the authors concluded.
May 1 Pediatr Infect Dis J article

This week's top reads