News Scan for Sep 08, 2017

ESBL-E in pregnant women
Antimicrobial resistance in Southeast Asia
Malaria infection trial launch

Study: ESBL-E present in 17% of pregnant, postpartum women in Africa

A systematic review by South African experts yesterday of 10 studies estimates the prevalence of colonization with extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) at 17% in pregnant or postpartum African women, higher than women in middle- to high-income settings.

The results represent a risk for colonization of neonates with ESBL-E.

ESBL-E, an enzyme produced by bacteria, confers resistance to several antibiotics, including penicillins, cephalosporins and monobactams. Among pregnant and postpartum women, ESBL-E is commonly associated with resistant urinary tract and bloodstream infections.

The study, published in the International Journal of Infectious Diseases, included seven studies on pregnant women and three on postpartum women conducted throughout Africa. The researchers found ESBL-E isolates were more prevalent in community settings than in hospitals (22% vs 14%). The most frequently reported ESBL-encoding gene was CTX-M, which has cefotaxime hydrolyzing capabilities.

The authors explained the difference between community and hospital prevalence by suggesting wider misuse of antibiotics in community settings and poor water sanitation conditions.

"More robust studies are needed to understand how frequently pregnant and/or post-partum women get colonized or infected with ESBL-E in Africa, the related risk factors in both community and hospital settings to inform future interventions to reduce their rates," they concluded.
Sep 7 Int J Infect Dis


Articles examine AMR in Southeast Asia

The British Medical Journal (BMJ) has published a collection of articles on antimicrobial resistance (AMR) in Southeast Asia.

The collection is a series of 15 articles that highlight how AMR has become not just a medical issue but also a political, social, and economic problem in the World Health Organization's South East Asia region, which includes Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, North Korea, Sri Lanka, Thailand, and Timor-Leste. The region, home to approximately 1.8 billion people, is considered to have a high risk for the emergence and spread of AMR, due to inadequate housing and sanitation, poor infection prevention and control in healthcare settings, and widespread and unregulated antibiotic use.

Among the papers included in the collection are a risk assessment for AMR in the region, a review of situational analyses of antimicrobial use and stewardship conducted in all 11 countries, and an in-depth look at AMR initiatives in India, Indonesia, and Thailand. The collection also includes articles on antimicrobial use and interventions in food animal production, antibiotic residues found in the environment, and the impact of drug resistance on treatment for malaria, tuberculosis (TB), and HIV. The region has half the global incident cases of TB and one-tenth of the estimated burden of malaria and HIV.

The region's member states have pledged to develop national action plans to combat AMR, using a One Health approach aimed at antibiotic use in agriculture, livestock, and human health.
Sep 5 BMJ special collection


Groups announce launch of large controlled malaria infection study

In the largest-ever controlled malaria infection study, PATH's Malaria Vaccine Initiative and the Walter Reed Army Institute of Research (WRAIR) today announced the launch of a clinical trial to test modifications to the vaccine regimen of Glaxo Smith Kline's RTS,S/AS01 malaria vaccine candidate.

The trial includes 160 US adult volunteers who have begun receiving their vaccinations, which involve various regimens using two different formulations. According to a PATH press release, the participants will be exposed to malaria parasites through mosquito bites under controlled laboratory conditions. The controlled human malaria infections will take place at WRAIR 3 months after the volunteers received their final vaccine dose.

PATH said the experimental infections allow researchers to evaluate the safety and effectiveness of the vaccine in a highly controlled lab setting, paving the way for field studies in regions where malaria is endemic. Infected volunteers will be treated with antimalarial drugs.

LTC James Moon, MD, from WRAIR who is the study's principal investigator, said a highly effective vaccine combined with other interventions would help eliminate and eventually eradicate malaria. "Such a vaccine would make a major contribution to global public health, and in turn, benefit national security."

RTS,S was originally developed to prevent malaria in young African children, but scientists are exploring if it can be adapted for broader use. It is the furthest malaria vaccine in clinical development and will be administered as a four-dose regimen in a World Health Organization pilot program in 2018 in parts of Ghana, Kenya, and Malawi.
Sep 8 PATH press release

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