News Scan for Sep 18, 2017

News brief

Italy's chikungunya outbreak spreads to Rome; more cases noted in Americas

Italy has now confirmed 14 cases of locally acquired chikungunya, 6 of them in Rome, the World Health Organization (WHO) said in a Sep 15 statement.

The other 8 cases are in the coastal region of Lazio in Anzio district, about 30 miles south of Rome. Italian health officials on Sep 8 reported 3 locally acquired cases in Anzio, the first in the country since 2015. Dates of illness onset range from Aug 5 to Sep 7.

Officials have ramped up mosquito control efforts and halted blood transfusions in the affected region. Italy's Ministry of Health is communicating risks to the public and underscoring the need to protect against bites of the Aedes albopictus mosquito that transmits the disease.
Sep 15 WHO statement

In the Americas, meanwhile, the Pan American Health Organization (PAHO), in its weekly update late last week, reported 305 new cases as a handful of countries reported small increases.

The new cases lift the 2017 total in the region to 145,473, PAHO said in its Sep 15 update. The agency reported 617 new cases the week before.

Venezuela reported the largest increase, 143 new cases, to bring its total this year to 241. El Salvador, Guatemala, Nicaragua, Bolivia, Peru, and the United States all recorded small upticks. The US increase was only 8 cases, bringing its 2017 total to 46 infections, all of them imported cases.

Since the Americas outbreak began in 2013 on the Caribbean island of St. Martin, the Americas region has reported 2,532,184 cases.
Sep 15 PAHO update

 

US states, territories report 6 more babies born with Zika defects

In one of its latest updates on the impact of Zika virus, the US Centers for Disease Control and Prevention (CDC) said two more babies have been born in the United States with birth defects linked to the virus, raising the total to 95. The number of Zika-related pregnancy losses held steady at 8, according to the CDC's Sep 14 update.

Elsewhere, 4 more babies in the US territories have been born with Zika-related birth defects, pushing the total to 132. Seven pregnancy losses related to the virus have been reported in the territories, the same as in the CDC's previous update.

So far, 1,862 pregnant women with evidence of Zika infection have completed their pregnancies in US states with or without delivering a baby with birth defects. Meanwhile, in the US territories, 3,258 women infected with Zika virus have completed their pregnancies.
Sep 14 CDC update

 

H5N8 outbreaks continue in Italy and South Africa

More avian flu outbreaks fueled by highly pathogenic H5N8 were reported by animal health officials in Italy and South Africa, according to the latest notifications from the World Organization for Animal Health (OIE).

In Italy, the virus struck a goose farm in Veneto district in the north central part of the country. The outbreak began on Sep 11, killing 92 of 1,425 susceptible birds. The remaining birds were destroyed to curb the spread of the virus. Though H5N8 activity tailed off in most of Europe over the summer months, Italy continues to report a small but steady stream of outbreaks, especially involving turkey farms in the north.

Elsewhere, South Africa reported three more farm-related outbreaks and five more detections in other settings. The farm outbreaks all occurred in Western Cape Province, with start dates from Aug 15 to Aug 21. One of the locations is a commercial farm in Cape Town, the second-largest city in South Africa. One of the other outbreaks involved geese and chickens at a backyard holding. Among the three events, the virus killed 72 of 4,051 birds, while the others were slated for culling.

South Africa also reported five detections involving a variety of birds in other settings, all of them in Western Cape Province. The outbreaks—four in the city of Swartland and one in Bergrivier—started from Aug 26 to Sep 1, affecting show chickens, turkeys, and ducks, as well as hobby geese and chickens and a house sparrow found dead. Taken together, the virus killed 214 of 508 birds.

The country reported its first H5N8 outbreak in June, becoming the third African nation to report the virus.
Sep 15 OIE report on H5N8 in Italy
Sep 15 OIE report on H5N8 at South African farms
Sep 15 OIE report on H5N8 in other South African settings

 

Study shows co-circulating flu strains on Chinese pig farms

A new study published in Clinical Infectious Diseases determined multiple strains of 2009 H1N1, swine-lineage H1N1, and swine-lineage H3N2 co-circulated and likely reassorted among people and animals on six Chinese swine farms monitored for 1 year.

Researchers from Duke University and the Beijing Institute of Microbiology and Epidemiology used a One Health approach, which takes into account human, animal, and environmental health, to survey flu strains on 299 swine workers and 100 controls, 9,000 pigs, and 6 pig farm environments from 2015 to 2016. Study subject samples were collected monthly and tested for influenza A viruses (IAV).

Between March 2015 and February 2016, 4,884 samples were screened for IAVs. Flu strains were detected in 11.6% of environmental samples, 7.1% of swine oral secretions, and 4.8% of fecal samples. Five of the 32 humans who reported influenza-like illness during the study period had nasal swabs test positive for IAV.

According to the authors, "Sequencing results showed that swine-lineage H1N1 and H3N2, and A(H1N1)pdm09 –like viruses were detected in pig oral secretion and environmental swabs."

China is home to some of the largest swine farms in the world, and the country has been implicated as the origin of the 1957 and 1968 flu epidemics. The authors concluded that enhanced biosecurity is needed on swine farms.
Sep 16 Clin Infect Dis study  

 

Microbes contribute to glacial melt

Multiplying microbes are increasing the rate of glacier melt on an Alaskan ice field, according to new data from a controlled field experiment recently published in Nature Geoscience. The snow-dwelling microbes increase the amount of light reflected on the ice's surface, leading to increased melting.

The study focused on microbes living on red snow algae. The presence of algae was positively related to an increasing amount of liquid water availability on the ice field. "The temporal correspondence of red snow, melt predictors, and melt rate are consistent with red-snow algae acting as both a cause and an effect of snowmelt," the authors write.

To offer a model of how red snow algae contributes to glacier melt, the authors documented how nitrogen–phosphorous–potassium fertilizer increased alga cell counts nearly fourfold, and that manipulating alga abundance explained a third of the observed variability in snowmelt.

The microbes "contribution to climate warming is likely to grow with increased melt and nutrient input," the authors concluded.
Sep 18 Nat Geosci study

Stewardship / Resistance Scan for Sep 18, 2017

News brief

Study finds subclone is prominent in resistant E coli infections in kids

Researchers at the University of Washington report in Clinical Infectious Diseases that a subclone of the emerging global pathogen Escherichia coli sequence type (ST) 131 is not as prevalent in children as adults but is nearly as dominant in drug-resistant E coli infections in children.

E coli ST131-H30 has been recognized as a clone of significant public health importance, comprising 10% to 20% of all extra-intestinal E coli infections among US adults. But data about its epidemiology in children are lacking. To quantify the burden and identify clinical and demographic correlates of infection with E coli ST131-H30 in children, the researchers prospectively collected all extended-spectrum cephalosporin-resistant (ESC-R) E coli isolates from urine or other sterile sites identified at four US children's hospitals from 2009 to 2013, along with demographic and clinical data. For each resistant isolate, researchers collected three extended-spectrum cephalosporin-susceptible (ESC-S) isolates.

A total of 339 ESC-R isolates from 278 patients and 1,008 ESC-S isolates from 1,008 patients were available for analyses. The estimated prevalence of H30 among all clinical E coli isolates at all hospitals was 5.3%. However, H30 was the most common subclone identified among the ESC-R isolates in the study, accounting for 29.9% of all ESC-R isolates and 43.3% of all extended-spectrum beta-lactamase (ESBL)–producing isolates—a proportion close to what has been observed in US adults (about 50%).

The researchers also found that patient age was associated with infection due to H30, although the nature of the association contrasted between ESC-R and ESC-S infections. In patients with ESC-R infections, H30 was associated with younger age (0 to 5 years); in patients with ESC-S infections, H30 was associated with older age (6 to 21 years) and underlying health conditions.

The authors of the study suggest the low overall prevalence of H30 in children could be the result of low fluoroquinolone use in pediatrics. They conclude, "More densely sampled studies are needed to elucidate the reservoirs and transmission dynamics of this difficult-to-treat pathogen in a pediatric population."
Sep 15 Clin Infect Dis abstract


New antibiotic shows promise against community-acquired pneumonia

Initial results from a phase 3 clinical trial show that the antibiotic lefamulin compares favorably to standard therapy in patients with moderate-to-severe community-acquired bacterial pneumonia (CABP), according to a news release today from Nabriva Therapeutics, the drug's maker.

In the lefamulin evaluation against pneumonia (LEAP 1) trial, the first of two phase 3 trials for the drug, intravenous to oral lefamulin met the Food and Drug Administration (FDA) primary end point of non-inferiority (NI, 12.5% margin) compared with moxifloxacin with or without adjunctive linezolid, according to Nabriva, which is based in Dublin. Early clinical response (ECR) rates assessed 72 to 120 hours following initiation of therapy were 87.3% for lefamulin and 90.2% for moxifloxacin with or without linezolid.

The drug also met the primary end points for non-inferiority established by the European Medicines Agency (NI, 10% margin). In addition, ECR by pathogen was similar to overall response rates and was comparable between treatment arms.

The trial enrolled 551 CABP patients, with 276 and 275 randomly assigned to the lefamulin arm and the moxifloxacin with or without linezolid arm, respectively. Individuals aged 65 or older represented 47.8% of the patients in the lefamulin arm, compared with 39.3 % of the patients in the moxifloxacin arm. Linezolid was added to moxifloxacin if an investigator suspected that a patient had been infected with methicillin-resistant Staphylococcus aureus prior to randomization.

A similar rate of treatment-emergent adverse events (TEAEs) was observed in both arms—38.1% in the lefamulin patients and 37.7% in the moxifloxacin with or without linezolid patients. TEAEs occurring in more than 2% of patients included hypokalemia, nausea, insomnia, infusion-site pain, infusion-site phlebitis, alanine aminotransminase increase, and hypertension. While no cases of Clostridium difficile were reported in either treatment group, diarrhea was observed in 7.7% of patients in the moxifloxacin group, compared with 0.7% of the lefamulin group.

"These Phase 3 data provide strong evidence of the potential of lefamulin to treat adults with CABP and provide an alternative to a current gold standard treatment regimen," Nabriva Therapeutics CEO Colin Broom, MBBS, said in the release. "Due to lefamulin's flexible dosing and targeted spectrum of activity against the pathogens most commonly associated with CABP, including multidrug-resistant strains, we believe that lefamulin is well suited to be a first-line empiric monotherapy."
Sep 18 Nabriva Therapeutics press release

 

UK: Women in preterm labor to be offered anti-Streptococcus antibiotics

Women who begin labor before 37 weeks of pregnancy should be offered antibiotics to prevent a group B Streptococcus (GBS) infections in newborns, according to guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) updated last week.

GBS is the most frequent cause of severe early-onset infection in newborns, occurs naturally in the lower vaginal tract of women, and can be passed on to the babies, RCOG said in a news release. The vast majority of infants will suffer no ill effects, but a small percentage will develop an infection and fall seriously ill.

Incidence of early-onset GBS appears to be rising in the UK and around 500 babies developed the condition in 2015, RCOG said. With prompt treatment, 17 of 20 diagnosed babies will fully recover, but 2 in 20 will recover with some disability, and 1 in 20 will die. Women are at higher risk of passing GBS to their baby if they go into preterm labor, and the risk of dying from GBS can be 10 times higher in preterm babies compared with those born at full term.

For these reasons, the RCOG guidelines now recommend all women who go into preterm labor, regardless of whether their waters have broken, receive intravenous antibiotics during labor. The guidance, which has now been updated three times, the most recent in 2012, also advises that women who were known GBS carriers in a previous pregnancy can be offered a test at 35 to 37 week to see whether they are still a carrier.

The guidance does not recommend universal bacteriological screening for GBS, in line with recommendations by the UK National Screening Committee. The experts who produced the RCOG guidelines found no clear evidence to show routine testing would do more good than harm.
Sep 13 RCOG guidance
Sep 13 RCOG
news release

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