Another MERS case reported in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) today confirmed another MERS case, the second in row after no cases had been reported for most of July.

A 36-year-old Saudi man from Buraydah is in critical condition after being diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). He is in critical condition and had direct contact with camels, a known risk factor for contracting the virus.

The new case raises Saudi Arabia's MERS-CoV total cases since 2012 to 1,681, which includes 684 deaths. Four people are still being treated for their illnesses.
Jul 27 MOH update

 

Public health groups warn of possible hit to prevention funds in latest Senate repeal bill

With the Senate expected to vote soon on a "skinny" repeal targeting some components of the Affordable Care Act, five public health groups today issued a statement warning about damage to the nation's health if the bill eliminates the Prevention and Public Health Fund (PPHF).

The groups include the American Public Health Association, Prevention Institute, Public Health Institute, Society of Public Health Education, and Trust for America's Health (TFAH).

In January, TFAH estimated that CDC would lose 12% of its annual operating budget if the ACA is repealed. It said states would lose about $3 billion over the next 5 years if the fund is erased, with reduced resources for handling disease outbreaks, opioid and heroin abuse, and chronic diseases such as obesity and diabetes.

The statement, posted on TFAH's Web site and signed from leaders of the five groups, said strong public health infrastructure makes the difference between health and illness, safety and injury, and life and death. "Slashing public health and prevention funding would increase preventable suffering and death, make the poorest and sickest communities fall even further behind, and leave our country far less prepared for and capable of responding to public health emergencies."
Jul 27 statement from public health groups on the PPHF
Jan 17 CIDRAP News scan "Analysis: CDC could lose $5 billion if ACA is repealed"

 

WHO: Progress seen against hepatitis, but more testing, treatment needed

The World Health Organization (WHO) today released new data on global progress toward hepatitis elimination, a review of efforts in 28 countries that revealed momentum is gaining. The group detailed its findings in an 83-page report released on the eve of the World Hepatitis Day.

According to the report, nearly all countries have formed national hepatitis elimination committees that have put together plans that include targets, and more than half have earmarked dedicated funding for hepatitis response. The report findings are geared toward increasing action toward meeting 2030 Sustainable Development Goals, which were endorsed by the World Health Assembly in 2016.

In a press release, the WHO said it is concerned that progress needed to speed up. Gottfried Hirnschall, MD, MPH, who directs the WHO's HIV and global hepatitis program, said "at best one in ten people who are living with hepatitis know they are infected and can access treatment. This is unacceptable." He added that countries need to boost access to testing and care.

WHO numbers from 2015 show 325 million people were infected with hepatitis, 257 with hepatitis B and 71 million with hepatitis C. That same year the virus led to 1.34 million deaths, similar to deaths from tuberculosis.

In a new treatment development, the WHO this week added a new generic treatment to its list of prequalified hepatitis C medicines—sofosbuvir, which as a generic costs between $260 and $280 a year, a fraction of the drug's original cost.

As part of its hepatitis efforts today, the WHO launched new communication and educational tools to improve injection safety and infection prevention, given that contaminated equipment in health settings is responsible for large numbers of hepatitis B and C infections.
Jul 27 WHO press release
Jul 27 WHO report

 

Global flu vaccine coverage has plateaued, despite recommendations

Despite recommendations by every major international health organization, influenza vaccination coverage has plateaued in recent years, according to a study yesterday in Vaccine.

The study looked at vaccine coverage over 12 years 2004 through 2015. Despite the World Health Assembly making the recommendation that member countries achieve 75% vaccine coverage in 2003 and despite the 2009 H1N1 flu pandemic, flu vaccine uptake has stalled in most countries, and has gone down in Europe.

The survey found that, of the 89 countries that recommended influenza vaccination in 2016, only 23 countries (26%) achieved the "hurdle" rate, defined as the number of doses required to reach about 15.9% of the population. In 2008, the hurdle rate was established as 159 doses per 1,000 population.

"The lack of progress has a sizeable potential economic cost. The annual direct medical costs alone are estimated at between $14 billion and $24 billion in the US, and between about €6 billion and €28 billion in the EU, based on direct costs from France, Germany, and the USA," the authors concluded. They added that no World Health Organization member countries are prepared for an influenza pandemic.
Jul 26 Vaccine study 

Stewardship / Resistance Scan for Jul 27, 2017

News brief

Vaccine candidate for recurrent MDR UTIs fast-tracked by FDA

Sequoia Sciences announced yesterday that it has received fast-track designation from the US Food and Drug Administration (FDA) for its investigational vaccine designed to treat recurrent urinary tract infections (UTIs) caused by multidrug-resistant (MDR) bacteria. Fast-track designation expedites the development and review of the vaccine through the US regulatory process.

Sequoia's vaccine is designed to produce an immune response preventing bacteria from colonizing the urinary tract, and it recently completed its first clinical trial in women. Among the 67 women enrolled in the study, 30 of whom had a 2-year history of recurrent UTI, the vaccine was well-tolerated and generated a strong immune response, the company said in a news release.

Based on these results, Sequoia has begun additional studies, including evaluating the vaccine in patients requiring antibiotics of last resort. In granting fast-track status, the FDA acknowledges that recurrent UTI caused by MDR bacteria is a serious condition for which there is an unmet medical need, Sequoia said.

"If approved, the vaccine could change the standard of care for recurrent UTI," said Gary Eldridge, president and CEO, Sequoia Sciences. "Since UTI[s] are a primary source of sepsis, decreasing recurrent UTI may ultimately drive down rates of hospitalization, sepsis, and associated in-hospital mortality."

Currently, patients who have recurrent UTI frequently take daily antibiotics for 1 to 4 months or even longer, which can lead to drug resistance, according to the release. Each year, about 3 million patients in the United States and 10 million in North America, Europe, and Japan experience recurrent UTI, about half of which is caused by antibiotic-resistant bacteria.
Jul 26 Sequoia Sciences news release

 

Group develops roadmap for MDR gonorrhea

Yesterday an international group of experts published a research and development roadmap for the discovery of new drugs for MDR gonorrhea, part of efforts by the Global Antibiotic Research and Development Partnership (GARDP), which was launched by the World Health Organization and Drugs for Neglected Disease initiative last year.

The roadmap, published as a commentary in PLoS Medicine, lays out a 7-year plan for health officials and includes four main components and a target product profile (TPP) for new medicines.

The number of gonorrhea cases has risen in many areas across the globe, an increasing proportion of which are MDR. The choice of treatment options for gonorrhea is very limited, and resistance has even been reported to extended-spectrum cephalosporins, the mainstay of current first-line therapy. Also, only three new chemical entities are in different stages of clinical development for treatment of gonorrhea, the experts report.

The plan's key components are: (1) accelerate development of a new molecule to treat the disease, (2) evaluate the potential of existing antibiotics and combinations, (3) explore co-packaging and development of fixed-dose combinations, and (4) support the development of simplified treatment guidelines and foster conservation.

The TPP includes "ideal" and "acceptable" criteria for such factors as indication, tolerability, cost, stability, and dosing schedule for new gonorrhea drugs.

The authors write, "Over the next 7 years, this research and development proposal includes the following: exploring the introduction of a new clinical entity against gonorrhea; the identification of existing, suitable partner drugs; the recovery of previously abandoned, out-of-favor, and withdrawn antibiotics; and the development of simplified treatment guidelines for the empiric management of sexually transmitted infections."
Jul 26 PLoS Med commentary
GARDP TPP

 

Analysis finds follow-up blood cultures unnecessary for bacteremia

An analysis of 383 bacteremia cases by University of Texas scientists has determined that follow-up blood cultures for gram-negative bacteremia are unnecessary and contribute to increased healthcare costs, longer hospital stays, unnecessary consultations, and inappropriate use of antibiotics.

The researchers, reporting in Clinical Infectious Diseases yesterday, analyzed data on 383 bacteremia patients who had at least one follow-up blood culture (FUBC). They gleaned information on presumed source of disease, antibiotic status at the time of FUBC, antibiotic susceptibility, presence of fever, comorbidities, need for intensive care, and mortality.

They found that antibiotic use did not affect the rate of positivity of FUBC, unless bacteria were not sensitive to the empiric antibiotic. Fever on the day of FUBC was associated with higher rates of positive FUBC for gram-positive cocci but not gram-negative bacilli (GNB). Mortality and care in the intensive care unit were also not associated with a positive FUBC.

The authors conclude, "FUBC added little value in the management of GNB bacteremia. Unrestrained use of blood cultures has serious implications for patients, including increased healthcare costs, longer hospital stays, unnecessary consultations, and inappropriate use of antibiotics."
Jul 26 Clin Infect Dis abstract

 

Scottish data platform helps inform Infection control, stewardship

A new paper in the Journal of Antimicrobial Chemotherapy describes efforts in Scotland to use patient data to better understand the epidemiology of infectious disease and inform and evaluate antimicrobial stewardship programs.

The objective of the Infection Intelligence Platform (IIP), which is led by the Scottish Antimicrobial Prescribing Group (SAPG) and supported by National Health Services Scotland (NHS), is to create a national infection informatics resource for infection control and stewardship clinicians. The program is focused on three objectives: Developing a technical platform to link the various NHS patient datasets to enhance surveillance capability; establishing a governance process that ensures the data is secure and accessible; and using the data to generate new evidence to guide clinical practice.

The authors report that in the build-out and test phase of the IIP, they have improved data security, created "simplified views" of the complex datasets, and embedded statistical programs to enhance capability. These developments have enabled researchers to conduct studies using the datasets. These studies have measured the intended and unintended effects of antimicrobial stewardship and infection management intervention and examined infection risk factors and clinical outcomes.

Findings from the studies have been disseminated to clinicians through the IIP website, regular newsletters, and presentations at international meetings, and the authors say the evidence is already shaping clinical practice.

"We are part way along our IIP journey and have begun to increase our responsiveness to address important clinical questions that could be answered through a data linkage approach," the authors write. "We hope our shared experience will inform and encourage others to embark upon this journey and catalyse opportunities for global collaboration."
Jul 10 J Antimicrob Chemother paper

This week's top reads