News Scan for Sep 29, 2017

News brief

WHO announces 3 candidate vaccine viruses for pandemic preparedness

The World Health Organization (WHO) advisory committee that reviewed the most recent influenza developments and recommended strains for the Southern Hemisphere's 2018 flu season also looked at the newest genetic findings with zoonotic influenza viruses and recommended three new candidate vaccine viruses (CVVs).

The action is part of ongoing work by the world's influenza labs to have updated CVVs on hand in case a vaccine needs to be made to curb a pandemic threat to humans.

The group proposed two new CVVs against variant H1 (H1v), given that tests suggests that current CVVs aren't a close match with two H1N2v viruses detected this year in the United States, both of which caused mild disease in kids who had direct contact with pigs. The WHO noted that one of the recent H1N2v viruses was related to a North American swine lineage, while the other had a seasonal humanlike hemagglutinin (HA) gene segment and is closely related to HA genes circulating in US swine.

Also, tests on recent H3N2v samples from the United States, which have a humanlike HA gene from 2010 seasonal H3 flu, weren't a close match against the nearest current CVV, with some of the tests hinting at even less protection in children. So vaccine advisors recommended a new CVV based on a 2017 H3N2v sample from Ohio.
Sep 28 WHO candidate pandemic vaccine virus recommendations

 

BARDA awards $45 million for prime-boost Ebola vaccine

Johnson & Johnson announced today that it will pursue further development of its investigational prime-boost Ebola vaccine with support from a new award from the Biomedical Advanced Research and Development Authority (BARDA), part of the office of the Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services.

In its press release, the company said the funding signals one of BARDA's first Project BioShield awards for candidate Ebola vaccines and drugs.

The 5-year $44.7 million agreement has options for additional funding to support development and possible licensure. The vaccine had received BARDA funding in 2015 and 2016 to optimize manufacturing, and the new agreement will strengthen support for the program. Johnson & Johnson has collaborated with the National Institutes of Health on the vaccine, and had also received support from the European Commission.

The novel regimen involves a priming dose of the adenovirus-vectored Ad26.ZEBOV vaccine developed by Johnson & Johnson and a booster dose of MVA-BN-Filo from Bavarian Nordic.

Eleven vaccine phase 1, 2, and 3 trials are under way in Europe, the United States, and Africa. In September 2016 the company filed for emergency use and assessment listing with the WHO, which is still reviewing the application.

Johan Van Hoof, MD, global head of infectious diseases at Janssen Vaccines & Prevention, said in the company press release, "Thankfully, the Ebola crisis in West Africa is over, but we and other vaccine manufacturers remain determined to ensure that Ebola vaccines are successfully developed and made available to the world."
Sep 29 Johnson & Johnson press release

 

More Cyclospora cases reported to the CDC

The US Centers for Disease Control and Prevention (CDC) today reported 23 more Cyclospora cases, raising the multistate total to 1,054, with many of the cases linked to infections in people who didn't travel and pointing to a suspected foodborne illness outbreak.

Of the new cases, 14 patients didn't have a history of recent travel outside the United States, raising the foodborne illness outbreak portion of the total to 592 from 36 states, with Texas the hardest hit. The latest illness onsets were on Sep 13.

So far no food vehicle has been identified, but the CDC noted in its update that previous outbreaks have involved imported fresh produce such as basil, cilantro, mesclun lettuce, raspberries, and snow peas.

Cyclospora infection is caused by the Cyclospora cayetanensis parasite. Symptoms can include watery diarrhea, appetite loss, cramping, bloating, and fatigue.
Sep 29 CDC update

 

New typhoid vaccine immunogenic, protective in human challenge trial

A new typhoid vaccine that is already being used in India and is so far the only vaccine of its kind that can be used in infants was safe, highly immunogenic, and moderately protective in a phase 2b human challenge study that took place in the United Kingdom.

A team based at the Oxford Biomedical Research Center reported their findings for the Vi-conjugate typhoid vaccine (Typbar-TCV) yesterday in an early online edition of The Lancet. The findings come just weeks before World Health Organization (WHO) vaccine advisors are slated to consider use of the vaccines, with possible financing by Gavi, the Vaccine Alliance.

Typhoid, caused by Salmonella enterica serovar Typhi, typically occurs in regions where water quality and sanitation are lacking, especially in South Asia and sub-Saharan Africa. Antibiotics are used to treat the condition, but resistance to the drugs is increasing. Children younger than 2 years are especially vulnerable, and although there is a vaccine, it's not licensed for worldwide use in that age-group.

The human challenge trial involved 112 adults who were randomly assigned to receive a single dose of the new vaccine, the current vaccine, or a control meningococcal vaccine. A month after vaccination, they were given an oral dose of the bacteria. Researchers monitored them for 2 weeks, and participants who had symptoms received antibiotic treatment. At the end of the 2 weeks all participants got antibiotics.

Of the control group, 77% were diagnosed as having typhoid, compared with 35% for the new vaccine, and 35% of the current vaccine. Efficacy of the new typhoid vaccine was estimated to be 54.6%, compared with 52.3% for the existing vaccine.

Researchers also found that the disease was less severe in the group that received the new vaccine compared with the other groups and that using different diagnostic criteria suggested an even bigger efficacy benefit for the new vaccine.

Even though the study population isn't representative of the vaccine's target populations, the findings suggest the vaccine could halve infection rates and be an important new tool for controlling typhoid, the authors wrote.

In a related commentary, Nicholas Feasey, MBBS, with the Liverpool School of Tropical Medicine and Myron Levine, MD, DTPH, with the University of Maryland, wrote that the public health community has eagerly awaited the results of the human challenge trial, and that in India, the new vaccine has been shown to elicit robust serum antibody responses in infants as young as 6 months.

Despite the findings in India, until now there has been no evidence of actual efficacy, they wrote. "Importantly, the authors provide the first data documenting that Typbar-TCV is protective."
Sep 28 Lancet abstract
Sep 28 Lancet commentary
Sep 28 Lancet press release

 

Madagascar reports 2nd plague outbreak of year

Madagascar has reported 105 plague cases in recent weeks—51 pneumonic, 53 bubonic, and 1 septicemic— and 12 deaths, the WHO confirmed today.

The first reported case of pneumonic plague involved a 31-year-old man from Tamatave, who developed malaria-like symptoms on Aug 23 while visiting Ankazobe District. Four days later he developed respiratory symptoms while sharing a long public taxi ride. He later died, and his body was prepared for funeral without safety steps. Thirty-one people who came in contact with him became ill, and four of them died.

As of yesterday, the outbreak involved at least 51 suspected, probable, and confirmed cases of pneumonic plague, which is caused by Yersinia pestis, including 12 deaths. In addition, 53 people have contracted bubonic plague throughout the country, which is typically less serious. And one case of septicemic plague has been reported but is not linked to the outbreak.

Madagascar's Ministry of Health has activated crisis units in the affected regions, and all patients have been provided access to treatment at no cost, the WHO said. Active case finding and contact tracing are ongoing, and all patients who have pneumonic plague are being isolated and treated, and all contacts are receiving preventive antibiotics.

In January the WHO reported 62 cases of pneumonic and bubonic plague in the country. Before that, the country had a small outbreak in 2015.
Sep 29 WHO statement
Jan 10
CIDRAP News scan on earlier outbreak

 

New polio case identified in Pakistan

Officials reported one new case of wild-type poliovirus reported in Pakistan this week, according to the weekly update from the Global Polio Eradication Initiative (GPEI). The case brings the total number of wild poliovirus cases in Pakistan this year to five.

The case occurred in the Lakki Marwat district of Khyber Pakhtoon province. The patient first experienced paralysis on Aug 21. No other details were available, including the patient's age and vaccination status.

Pakistan, along with Afghanistan and Nigeria, is one of three countries where wild poliovirus is still endemic. Last week, Syria and the Democratic Republic of the Congo reported new cases of vaccine-derived polio.
Sep 27 GPEI update

Stewardship / Resistance Scan for Sep 29, 2017

News brief

CDC awards $10 million for healthcare-associated infection research

The US Centers for Disease Control and Prevention (CDC) has awarded $10 million to five organizations for research into the spread and prevention of healthcare-associated infections (HAIs), especially those that are antibiotic resistant.

The five recipients are the University of Utah, RTI International, the University of Iowa, Washington State University, and the Center for Disease Dynamics, Economics & Policy. Their projects include developing tools and methods to understand the transmission of HAIs and antibiotic-resistant infections in healthcare facilities, assessing hospital-based strategies to prevent HAI transmission, and evaluating outbreak alert algorithms.

The investments are part of the CDC's Antibiotic Resistance Solutions Initiative, which supports activities to detect, prevent, and respond to resistant infections in healthcare, food, and the community.

In its most recent survey of HAI prevalence, the CDC estimated that nearly 722,000 HAIs occurred in US acute care hospitals in 2011, and 75,000 patients with HAIs died during their hospitalization. The leading HAIs included surgical-site infections, pneumonia, and gastrointestinal illness.
Sep 27 CDC information page

UN, FAO join forces to combat antimicrobial resistance in supply chains

European Union (EU) Commissioner of Health and Food Safety Vytenis Andriukaitis, MD, and United Nations Food and Agriculture Organization (FAO) Director-General Jose Graziano da Silva, PhD, today agreed to bolster collaboration between the two organizations to address food waste, food safety, and antimicrobial resistance (AMR) in supply chains, according an FAO news story today.

In a letter of intent signed today, the FAO and the EU pledge to bolster cooperation on tackling the spread of AMR on farms and in food systems.

Calling AMR a growing global concern, Graziano da Silva said: "Unfortunately, the use of antibiotics, including their use to promote growth, is already widespread." He said the FAO believes that antibiotics and other antimicrobials should be used only to cure diseases and, in certain circumstances, to prevent epidemics, but not to promote animal growth.

Areas of cooperation include the following, according to the story: (1) increasing the exchange of information and evidence related to antimicrobial use in food production, as well as best AMR management practices; (2) joint advocacy and education efforts to promote the responsible use of antimicrobials and improve farm-level hygiene; (3) supporting nations in drafting legislation surrounding antimicrobial usage; and (4) conducting joint training and capacity building aimed to improve tracking the use antibiotic in food systems and mapping the presence of AMR.
Sep 29 FAO
news story

ASP Scan (Weekly) for Sep 29, 2017

News brief

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

CDC awards $10 million for healthcare-associated infection research

The US Centers for Disease Control and Prevention (CDC) has awarded $10 million to five organizations for research into the spread and prevention of healthcare-associated infections (HAIs), especially those that are antibiotic resistant.

The five recipients are the University of Utah, RTI International, the University of Iowa, Washington State University, and the Center for Disease Dynamics, Economics & Policy. Their projects include developing tools and methods to understand the transmission of HAIs and antibiotic-resistant infections in healthcare facilities, assessing hospital-based strategies to prevent HAI transmission, and evaluating outbreak alert algorithms.

The investments are part of the CDC's Antibiotic Resistance Solutions Initiative, which supports activities to detect, prevent, and respond to resistant infections in healthcare, food, and the community.

In its most recent survey of HAI prevalence, the CDC estimated that nearly 722,000 HAIs occurred in US acute care hospitals in 2011, and 75,000 patients with HAIs died during their hospitalization. The leading HAIs included surgical-site infections, pneumonia, and gastrointestinal illness.
Sep 27 CDC information page 

 

UN, FAO join forces to combat antimicrobial resistance in supply chains

European Union (EU) Commissioner of Health and Food Safety Vytenis Andriukaitis, MD, and United Nations Food and Agriculture Organization (FAO) Director-General Jose Graziano da Silva, PhD, today agreed to bolster collaboration between the two organizations to address food waste, food safety, and antimicrobial resistance (AMR) in supply chains, according an FAO news story today.

In a letter of intent signed today, the FAO and the EU pledge to bolster cooperation on tackling the spread of AMR on farms and in food systems.

Calling AMR a growing global concern, Graziano da Silva said: "Unfortunately, the use of antibiotics, including their use to promote growth, is already widespread." He said the FAO believes that antibiotics and other antimicrobials should be used only to cure diseases and, in certain circumstances, to prevent epidemics, but not to promote animal growth.

Areas of cooperation include the following, according to the story: (1) increasing the exchange of information and evidence related to antimicrobial use in food production, as well as best AMR management practices; (2) joint advocacy and education efforts to promote the responsible use of antimicrobials and improve farm-level hygiene; (3) supporting nations in drafting legislation surrounding antimicrobial usage; and (4) conducting joint training and capacity building aimed to improve tracking the use antibiotic in food systems and mapping the presence of AMR.
Sep 29 FAO 
news story

 

New report grades US restaurant chains on antibiotic use in meat supply

Originally published by CIDRAP News Sep 27

More than half of the nation's top 25 chain restaurants are taking steps to reduce the use of medically important antibiotics in their meat and poultry supply, according to a report today from a collection of consumer, environmental, and public health organizations.

The third annual Chain Reaction report, which assesses and grades fast food and fast casual restaurant chains on the progress they've made in eliminating the routine use of antibiotics in the meat they purchase, found that 14 of the 25 largest chains received passing grades on their efforts, up from 9 in 2016. Chipotle and Panera received "A" grades for their efforts. Eleven chains received an "F" for not taking any discernable action to reduce the use of antibiotics in their food supply.

The chains that received passing grades have adopted a range of antibiotic use policies. Some have pledged to buy only meat raised without any antibiotics ever, while other policies are limited to antibiotics that are also used in human medicine. Some chains will purchase meat only from suppliers that don't routinely use medically important antibiotics in their animals. And while Chipotle and Panera have fully implemented these policies, other chains have set timelines for full compliance with their commitments. The report grades the chains on the content of their policies, implementation, and transparency.

But most restaurant policies target antibiotic use only in chicken, the report notes, with few companies establishing similar policies for beef, pork, and turkey. Only Chipotle, Panera, and Subway (which received a "B+" grade) have taken steps to prohibit or reduce antibiotic use across nearly all of their supply chains.

“When it comes to chicken nuggets, we've seen incredible change in a few short years—but burgers and bacon are another story," Lena Brook, food policy advocate at the Natural Resources Defense Council (NRDC), said in a press release issued by Consumers Union. The two groups co-produced the report with the Food Animal Concerns Trust, Friends of the Earth, U.S. PIRG Education Fund, and the Center for Food Safety.

And while the report lauds the role that restaurant chains are playing in pushing the poultry industry away from routine antibiotic use, it also argues that the federal government needs to take more action to combat antibiotic misuse in the livestock industry. In particular, it argues that efforts by the Food and Drug Administration to end the use of antibiotics for growth promotion, and to collect data on the impact of those efforts, have not gone far enough.

Based on data from 2011, an estimated 70% of medically important antibiotics sold in the United States are for use in livestock and poultry production.
Sep 27 Chain Reaction III report
Sep 27 Consumers Union press release

 

Vietnamese study finds antibiotics don't benefit pediatric diarrhea patients

Originally published by CIDRAP News Sep 27

Empirical antimicrobial therapy for pediatric diarrhea in a high-usage, high-resistance setting provided no clinical benefit, and it even prolonged hospital stays in some groups, researchers reported yesterday in Clinical Infectious Diseases.

The prospective, observational, multi-center cross-sectional study of pediatric patients hospitalized with diarrhea was conducted in Vietnam, where all-cause diarrhea affects 7% to 11% of all children under the age of 5 and accounts for as much as 12% of all-cause deaths in this age-group. Although CampylobacterSalmonella, and Shigella have been identified as the main diarrhea-causing bacteria, less is known about the epidemiology, resistance profiles, treatment, and associated outcomes of these bacteria in pediatric diarrhea patients. But empirical antibiotic treatment for diarrhea is common in Vietnam.

From May 2014 through April 2016, researchers recruited 3,166 children hospitalized at three hospitals in Ho Chi Minh City. More than one third of the children (34.6%) had acute bloody diarrhea, 56.1% had acute non-bloody diarrhea, and 25% were culture-positive for ShigellaSalmonella, or Campylobacter.

The use of antimicrobials among all patients was high, with 85.2% receiving empirical treatment following admission to hospital and before obtaining a bacterial culture result. Fluoroquinolones, which are recommended by the World Health Organization for treatment of pediatric diarrhea, were the most commonly used class of antimicrobial, accounting for 66.7% of all antimicrobials. Antimicrobial resistance (AMR) was highly prevalent on the isolated bacteria, mainly to fluoroquinolones and third-generation cephalosporins. 

The effect of antimicrobial treatment was assessed using two proxy disease outcome measures—clinical outcome at 3 days post-enrollment and duration of hospital stay. While more than 80% of patients improved or recovered at 3 days post-enrollment regardless of antimicrobial treatment, those given fluoroquinolones had a longer hospital stay compared with those not receiving an antimicrobial. In addition, antimicrobial treatment in those with non-bloody diarrhea was also associated with a longer hospital stay.

The authors say the findings highlight the need for adequately powered randomized controlled trials to be conducted to better assess the potential benefits and drawbacks of antimicrobial therapy for treatment of diarrhea. "These data will become essential for controlling antimicrobial usage during the present AMR crisis," they write. 
Sep 26 Clin Infect Dis study

 

Study finds a 21% incidence of MDR pathogens in Fournier's gangrene

Originally published by CIDRAP News Sep 27

More than one in five patients with Fournier's gangrene were found to be infected with multidrug-resistant organisms (MDROs), according to a small study yesterday in the Journal of Infection.

San Diego researchers analyzed data from 59 patients who had Fournier's gangrene in their large academic hospital from 2006 through 2015. Patients had an average age of 56 years (range, 18 to 91), with risk factors that included obesity, diabetes, and having a compromised immune system. Fournier's gangrene involves dead or dying tissue (necrosis) of the scrotum, penis, or perineum.

The scientists were able to identify a causative organism in all but 2 cases, and 12 of those (21%) had an MDRO. The most common MDROs were methicillin-resistant Staphylococcus aureus (MRSA), in 8, followed by extended-spectrum beta-lactamase–producing Escherichia coli, in 3. Among aerobic gram-negative rod (GNR) bacilli isolated in the study, 32% were fluoroquinolone-resistant.

Among all the patients with gangrene, 15% lost an organ or other body part, and another 15% died.

The authors conclude, "This report highlights the emergence of MDROs as an important cause of these infections including MRSA and drug-resistant GNRs. Antibiotics should be chosen with broad-spectrum, anti-MDRO activity given the high morbidity and mortality associated with these infections."
Sep 26 J Infect study

 

Study describes XDR Acinetobacter baumannii outbreak in neonates

Originally published by CIDRAP News Sep 26

An outbreak of bacteremia caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB) affected 41 infants at a neonatal intensive care unit (NICU) in central Turkey, with 58% mortality, researchers reported yesterday in the American Journal of Infection Control.

The clustering of bloodstream infections (BSIs) due to XDR-AB in the NICU at Erciyes University Hospital was first noticed in mid-2014. Once the outbreak was identified, patients with A baumannii infection were cohorted in isolation rooms or separate areas within the NICU, and contact isolation was performed for all case patients. It took 2 years to get the outbreak under control.

In a retrospective case-control study conducted from July 2014 to July 2015 that included 41 case patients and 108 control patients, investigators found that the risk factors (by univariate analysis) associated with BSI due to XDR-AB were mechanical ventilation, 14-day mortality, use of peritoneal dialysis, and use of umbilical catheter. Multivariate analysis identified umbilical catheter use as an independent risk factor (odds ratio 2.44). All 41 strains isolated from the case patients were found to be XDR and fully susceptible only to colistin, and pulsed-field gel electrophoresis indicated they belonged to a distinct clone (common pulsotype 2).

Because XDR-AB is endemic in the adult wing of the hospital, the investigators initially hypothesized inter-hospital transmission of the bacterium because of lapses in environmental cleaning and disinfection. But the major epidemic clone of A baumannii was not related to the strain circulating in the adult section. Investigators were also unable to identify an index case or an environmental source. They suggest the source of the outbreak could have been a neonate who was transferred to the NICU from an outpatient clinic.

Control of the outbreak was achieved by implementing long-term infection control measures in the unit, including maximal barrier precautions during insertion of catheters, compliance to hand washing protocols, and full adherence of healthcare workers to periodic education programs. A baumannii infection rates gradually decreased over the following 2 years, in parallel with the decline in umbilical catheter-related infection rates.
Sep 25 Am J Infect Control abstract

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