News Scan for Dec 28, 2017

US E coli outbreak
;
Antibiotic use in Chinese hospitals
;
MERS in Saudi Arabia
;
Hurricane recovery progress

CDC: Multistate E coli outbreak sickens 17, shows links to Canada's outbreak

Federal and state health officials are investigating a multistate Escherichia coli O157:H7 outbreak that has sickened 17 people in 13 states, and preliminary tests by the US Centers for Disease Control and Prevention (CDC) show that the outbreak strain is closely related to one in Canada that has been associated with romaine lettuce.

The CDC said illness onsets range from Nov 15 through Dec 8, according to a press release today sent to journalists. Affected states include California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington.

State and local authorities are interviewing sick people to see what they ate in the week before they became ill. Because a source of the US infections hasn't been identified, the CDC said it is unable to recommend if US residents should avoid a particular food. "This investigation is ongoing, and more information will be released as it becomes available," it said.

The Public Health Agency of Canada (PHAC) issued its first announcement about an E coli outbreak linked to romaine lettuce on Dec 11. In a Dec 21 update, it said it is so far investigating 40 cases from five provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. It urged the public to avoid eating romaine lettuce until more is known about the contamination.
Dec 22 CIDRAP News scan "Romaine-linked E coli outbreak sickens 10 more in eastern Canada"

 

Study finds steady increase in antibiotic use in Chinese hospitals

Despite efforts to improve antibiotic use, total antibiotic consumption in China's tertiary hospitals showed a significant upward trend from 2011 through 2015, according to a study yesterday in PLoS One.

In the study, investigators from Peking University retrospectively analyzed aggregated monthly surveillance data on antibiotic sales to 468 hospitals in 28 provinces in China over the 5-year period, which coincided with a 3-year national regulatory campaign (2011-2014) to control total antibiotic use in the country's secondary and tertiary hospitals. Antibiotic consumption was expressed in defined daily doses per 1,000 inhabitants per day (DID), and population weighted antibiotic consumption patterns in China were compared with European countries using indicators from the European Surveillance of Antimicrobial Consumption (ESAC).

Total antibiotic consumption, including all specific antibiotic classes except macrolides, significantly climbed over the study period, from an average of 7.97 DID in 2011 to 10.08 DID in 2015. The most frequently used antibiotics were cephalosporins, which accounted for 28.6% of total consumption, followed beta-lactam-beta-lactamase inhibitor combinations (20%), macrolides (17.4%), and fluoroquinolones (10.5%). Antibiotics in parenteral form accounted for nearly half of all antibiotics consumed.

Analysis of regional distribution of antibiotic consumption showed that eastern regions of the country used more antibiotics than western regions when using census population as a denominator. Comparison of antibiotic use in China with ESAC data from 2012 showed that there was higher consumption of third- and fourth-generation cephalosporins and fluoroquinolones in China than in 75% of the 29 European countries.

The authors of the study say more research is needed on the appropriateness of antibiotic prescriptions in Chinese hospitals to help reduce the risk of antibiotic resistance. China is estimated to be the second largest consumer of antibiotics in the world.
Dec 27 PLoS One study

 

MERS hospitalizes another in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) today reported that one new MERS-CoV case has been detected, which involves a 60-year-old Saudi man from Riyadh.

The man is hospitalized in stable condition with Middle East respiratory syndrome coronavirus (MERS-CoV) symptoms and is not a health worker. An investigation into the source of his infection so far reveals that he had primary exposure, meaning he isn't thought to have contracted the illness from another person.

The latest report lifts Saudi Arabia's total since the virus was first detected in humans in 2012 to 1,760, which includes 712 deaths. Five people are still being treated for their infections.
Dec 28 Saudi MOH statement

 

Baxter manufacturing facilities back online amid hurricane recovery

Baxter International said today that as part of ongoing Hurricane Maria recovery efforts, its last manufacturing site in Puerto Rico is now connected to the power grid.

Damage from the hurricane exacerbated an existing shortage of some intravenous (IV) saline and dextrose bags used for rehydration and to dilute medications. In early October, the US Food and Drug Administration (FDA) announced it was taking new steps to help the island's medical product manufacturing sector, along with its efforts to help the territory's residents. Pharmaceutical and biological products make up 30% of Puerto Rico's gross domestic product, and 10% of all drugs consumed by Americans are made there.

In the middle of November, FDA Commissioner Scott Gottlieb, MD, said the IV bags were on the list of about 90 products the FDA was monitoring since the storm hit, and to alleviate shortages it was temporarily allowing the importation of IV saline products from facilities outside the United States, encouraging the expansion of production at existing facilities, and speeding the review of new product applications designed to help address the shortages. He warned that though access to power is a key to help plants in Puerto Rico return to full production, even ones that have returned to the power grid still face interruptions as the grid is rebuilt.

Baxter, in its brief announcement on Twitter today, thanked Puerto Rican officials, as well as the FDA and the Department of Homeland Security.
Baxter Twitter feed
Nov 17 FDA update
Oct 9 CIDRAP News scan "Puerto Rico hurricane damage stretches supply of IV saline"

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