Report: Drug companies wary of repeated calls for emergency vaccines

A growing number of vaccine makers are expressing concerns about their ability to quickly develop new vaccine candidates against emerging disease threat, such as Zika and Ebola viruses, Stat reported today, based on interviews with pharmaceutical executives, government officials, and infectious disease experts.

Companies such as Glaxo Smith Kline (GSK), Sanofi Pasteur, Merck, and Johnson & Johnson have responded to urgent requests from governments and global health groups when new threats such as Zika arise. However, the companies have grappled with expensive disruptions in their regular operations, research and regulatory hurdles, lack of solid development support from governments, and a lack of a market for the products after the threats diminish.

For example, GSK told Stat that it has proposed dedicating one of its facilities to producing emergency vaccines, but funding commitments haven't come through.

Richard Hatchett, MD, chief executive officer of the Coalition for Epidemic Preparedness Innovations (CEPI), which launched in early 2017 to advance the pipeline for public health threats, said that without private-sector involvement, there will be no emergency response vaccines, and sacrifices taken by pharmaceutical companies during outbreak response are often underappreciated, as are the financial risks they take.
Jan 11 Stat story

 

MERS kills 3 more in Saudi Arabia

Yesterday the Saudi Arabian Ministry of Health (MOH) announced two new fatal cases of MERS-CoV, and reported the death of a previously recorded patient.

An 89-year-old Saudi woman from Khamis Mushait died after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). A 79-year-old Saudi man from Abha also died from the coronavirus. In both cases, the source of infection was listed as "primary," meaning it's unlikely either patient contracted the virus from another person.

The MOH also reported the death of an 80-year-old Saudi woman from Riyadh. She had a preexisting illness and was not a healthcare worker.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,771, including 719 deaths. Eight patients are still being treated, according to the MOH.
Jan 10 MOH report

 

Philippines exhumes body of two children in Dengvaxia investigation

Government officials from the Philippines said today they have exhumed the bodies of two children whose parents suspect became ill and then died after receiving Sanofi Pasteur's Dengvaxia vaccine, Reuters reported.

Officials are trying to determine if, after receiving Dengvaxia, the children died from subsequent severe dengue infections. Officials from the Public Attorney’s Office (PAO) said one of the children’s bodies showed signs of excessive bleeding, a noted symptom of fatal dengue infection.

The PAO said several parents have contacted them asking to exhume their children's bodies. So far, five pediatric deaths in the country show possible connections to the dengue vaccine.

The Philippines have stopped using Dengvaxia and sued manufacturer Sanofi Pasteur after the French pharmaceutical company said the vaccine should not be used in people who have not had a prior dengue infection. Those recipients have a risk of developing more severe infections after being vaccinated.
Jan 11 Reuters story

 

Brazil plans yellow fever vaccine campaign

In an attempt to prevent a wide scale yellow fever outbreak, Brazilian health officials announced earlier this week plans to inoculate 19.7 million Brazilians living in Sao Paulo, Rio de Janeiro, and Bahia states against the flavivirus.

Brazil said they would use fractional dosing to extend supplies of the yellow fever vaccine. Using fractioned doses offers immunity for up to 1 year. The campaign will begin shortly, and officials said it will last approximately 2 weeks.

"It is a precautionary measure, designed to offer vaccine coverage to people in areas where the virus has not yet circulated. The vaccines will be diluted, ensuring that quick coverage can be offered in a short period of time", said Brazilian Health Minister, Ricardo Barros, Folha de S.Paulo, a newspaper based in Brazil, reported.

Since July, there have been 11 confirmed yellow fever cases, including 4 deaths in Sao Paulo.
Jan 10 Folha story

 

Cholera vaccine drive targets 1 million in Zambia's capital

The World Health Organization (WHO) and Zambia's government have launched a cholera vaccine drive to immunize residents of Lusaka, the country's capital, according to a WHO statement yesterday.

The campaign will use 2 million doses of cholera vaccine from the Gavi-funded stockpile, enough to immunize 1 million people.

Zambia's outbreak began in early October and has so far sickened 2,682 people, with Lusaka accounting for 96% of cases. So far, 63 deaths have been reported, 58 of them in the capital. Though sporadic cholera cases are often reported in Zambia during its 5-month rainy season, the burden this season has exceeded the country's average.

Nathan Bakyaita, MD, the WHO's country representative, said, "Zambia is experiencing one of the worst outbreaks of cholera in years. With this campaign, we can stop cholera in its tracks and prevent an even more devastating epidemic."

The WHO said it is working with the country's public health workers to address the underlying causes of the outbreak, which include a lack of clean water, sanitation, and hygiene. Plans are in the works to vaccinate another 1 million people in known hot spots across Zambia later this year.
Jan 10 WHO Regional Office for Africa statement

Stewardship / Resistance Scan for Jan 11, 2018

News brief

Italian scientists report first MCR-4 isolates from human samples

Scientists from Italy today reported detecting the worrisome colistin-resistance gene MCR-4 in two isolates of Salmonella from people, only the second time the gene has been reported and the first time in humans, according to their report in Eurosurveillance.

Chinese researchers first reported the MCR-1 gene in Escherichia coli from pigs, pork products, and humans in 2015. Since then, the gene has been detected in bacteria from animals and humans in more than 30 countries, and MCR-2 and MCR-3 have been identified, as well. The MCR-4 gene was first identified last August in the same journal by a mostly different group of Italian researchers.

The genes are of particular concern because they are located on plasmids, which are small, highly mobile pieces of DNA that can spread resistance within and between different species of bacteria. They confer resistance to colistin, a last-resort antibiotic used to treat multidrug-resistant infections.

In today's report, the investigators said the MCR-4 genes were identified in two Salmonella Typhimurium isolates collected in October and November 2016 from separate Italian patients.

They conclude, "To our knowledge, this is the first report of mcr-4-positive bacterial isolates of human origin. The two Salmonella species belonged to the same serovar as the first mcr-4-positive Salmonella strain reported in a pig slaughtered in Italy."
Jan 11 Eurosurveill report
Aug 3, 2017, CIDRAP News story on first identification

 

CDC notes inappropriate UTI antibiotic prescribing in early pregnancy

Because of concern over birth defects, sulfonamides and nitrofurantoin are not recommended for treating urinary tract infections (UTIs) in the first trimester of pregnancy unless other options are deemed inappropriate. But more than 40% of pregnant women with UTIs receive those antibiotics early in pregnancy, experts with the Centers for Disease Control and Prevention reported today in Morbidity and Mortality Weekly Report (MMWR).

The researchers analyzed insurance data for pregnant women in 2014. Of 14,286 women diagnosed as having a UTI in the first trimester, 9,846 (68.9%) received antibiotics. The most-prescribed antibiotics were nitrofurantoin (34.7%), ciprofloxacin (10.5%), cephalexin (10.3%), and trimethoprim-sulfamethoxazole (7.6%).

Which means that, in spite of American College of Obstetricians and Gynecologists guidelines recommending against sulfonamides and nitrofurantoin unless absolutely necessary, 42.3% of women in their first trimester of pregnancy received them to treat UTIs.

The authors conclude, "Given the recommendations to avoid nitrofurantoin and trimethoprim-sulfamethoxazole in early pregnancy if possible, it is important that health care providers of various specialties be familiar with these recommendations and that they consider that they might be 'treating for two' when prescribing antibiotic treatments for urinary tract infections to pregnant women and women who might become pregnant in the near future."
Jan 12 MMWR study

 

Review highlights utility of nasal screening for MRSA pneumonia

A meta-analysis of 22 studies has found that nasal screening for methicillin-resistant Staphylococcus aureus (MRSA) had a high specificity and negative predictive value (NPV) for ruling out MRSA pneumonia and may be an important antibiotic stewardship tool, according to a study today in Clinical Infectious Diseases.

US researchers pooled the data from the studies, which covered 5,163 patients. Overall sensitivity and specificity for nasal screening for all MRSA pneumonia types was 70.9% and 90.3%, respectively. Positive predictive value (PPV) was 44.8%, while NPV was 96.5%. Sensitivity and specificity for community-acquired and healthcare-associated MRSA pneumonia was 85.0% and 92.1%, respectively, while PPV and NPV increased to 56.8% and 98.1%, respectively.

The authors conclude, "Utilization of MRSA nares screening is a valuable tool for [stewardship programs] to streamline empiric antibiotic therapy."
Jan 11 Clin Infect Dis study

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