News Scan for May 08, 2018

UK guidance on UTIs
;
Chagas disease in Americas
;
Cholera vaccination in Bangladesh
;
Flu vaccine and infant pneumonia

UK health officials issue draft guidance for UTI treatment

The United Kingdom's National Institute for Health and Care Excellence (NICE) today issued draft guidance for the treatment of urinary tract infections (UTIs).

The draft guidelines set out recommendations for preventing and managing lower UTIs, pyelonephritis, catheter-associated UTIs, and recurrent UTIs. While the recommendations vary by condition, they all aim to optimize antibiotic use in UTI treatment and reduce antibiotic resistance. They encourage clinicians to ask patients about the severity and regularity of symptoms, provide advice about managing symptoms with self-care, and obtain urine culture and susceptibility results before prescribing an antibiotic.

The guidelines also recommend that when antibiotics are indicated, clinicians should review the susceptibility test results to choose the most appropriate antibiotic, use narrow-spectrum antibiotics when possible, take into account the severity of symptoms and previous antibiotic use, advise patients on possible adverse effects, and reassess treatment if symptoms worsen rapidly.

"We recognise that the majority of UTIs will require antibiotic treatment, but we need to be smarter with our use of these medicines," Mark Baker MD, director of the Centre for Clinical Practice at NICE, said in a press release. "Our new guidance will help healthcare professionals to optimise their use of antibiotics."

Public consultation on the draft guidelines ends on Jun 5, and final publication is expected in early 2019.
May 8 NICE press release


Americas countries refocus goals in Chagas disease battle

Health officials from countries in the World Health Organization's (WHO's) Americas region met in Washington, DC, last week to weigh the status of the battle against Chagas disease, agreeing to focus on maintaining progress and preventing maternal-child transmission, according to a news release yesterday from the Pan American Health Organization (PAHO).

Chagas disease is a parasitic infection caused by Trypanosoma cruzi that is spread by "kissing bugs" (triatomine bugs) and has increasingly been found in the United States, especially in the Texas Rio Grande Valley. The disease can pass from mothers to their unborn babies, and chronic infections can cause potentially fatal cardiomyopathy.

According to PAHO, 17 of 21 affected countries in the Americas have interrupted Chagas disease transmission, and all are screening for the parasite in blood banks. However, Luis Gerardo Castellanos, MD, PhD, MPH, who leads the neglected, tropical, and vectorborne disease unit at WHO/PAHO said around 6 million people still live with the disease and are unaware of their status. "The migration of people from endemic areas to urban areas also means that we must take measures to detect and treat everyone affected, including those in cities," he added.

The main source of infections in countries that have curbed the disease is mother-to-child transmission, and PAHO said that around 9,000 babies are born each year with Chagas in the Americas. In 2017, it launched a framework to prevent congenital transmission of four diseases, one of them Chagas, by 2020.

PAHO recommends universal screening of pregnant women and newborns and, if needed, curative treatment. It also recommends that if a woman tests positive for Chagas, her other children should be tested and treated.

In April, independent experts from the WHO/PAHO recognized Honduras and Nicaragua as having eliminated Rhodnius prolixus, the main vector of the Chagas disease parasite.
May 7 PAHO news release

 

Second cholera vaccine drive launches in Bangladesh refugee camps

A second cholera vaccination campaign is under way in Cox's Bazar, Bangladesh, targeting nearly 1 million Rohingya people from Myanmar and the host communities in and around the refugee camps, the WHO Regional Office for South-East Asia said in a May 6 press release.

The new push follows an initial campaign in October and November in which 900,000 doses of oral cholera vaccine were administered.

Bardan Jung Rana, MD, MPH, the WHO representative to Bangladesh, said, "Considering the water and sanitation conditions in the overcrowded camps and the increased risk of disease outbreaks in the monsoon season, the health sector is taking all possible measures to prevent cholera and other water and vector borne diseases."

The week-long effort began on May 6 and involves 245 mobile vaccination teams. The vaccines have been made available through a coordinating group of members from the WHO, UNICEF, Doctors Without Borders, and the International Federation of the Red Cross. Gavi, the Vaccine Alliance, financed the vaccines and supplies.

Alongside vaccination, efforts have begun to improve access to clean water and sanitation and to improve hygiene.
May 6 WHO Regional Office for South-East Asia press release

 

Maternal flu vaccine may protect infants from severe pneumonia

A pooled analysis of trials in Nepal, Mali, and South Africa reveals a possible protective effect of maternal flu vaccination on the incidence of severe pneumonia in infants in two of the countries, according to a study in The Pediatric Infectious Disease Journal.

Researchers from the United States, Mali, and South Africa enrolled 10,002 mothers and 9,801 infants across the three trials. Follow-up was 6 months after birth in Nepal and Mali and 2 years in South Africa. They compared trivalent (three-strain) influenza vaccine (TIV) with either placebo or quadrivalent meningococcal conjugate vaccine.

The investigators found a 31% lower incidence of severe pneumonia in the TIV group in Nepal and a 43% lower incidence in South Africa but no difference between TIV and control groups in Mali. Overall, the vaccine was associated with a 20% lower rate of severe pneumonia.

The authors concluded, "Maternal influenza immunization may reduce severe pneumonia episodes among infants—particularly those too young to be completely vaccinated against Streptococcus pneumoniae and influenza."

In an accompanying commentary, Kathleen Neuzil, MD, MPH, director of the University of Maryland's Center for Vaccine Development, wrote, "Only 4 randomized controlled efficacy trials of influenza vaccine in pregnant women have been conducted—all 4 have been conducted in Africa and Southeast Asia and funded by the Bill and Melinda Gates Foundation. This is a remarkable public health effort that has generated much needed data to inform policy and financing decisions in low-resource countries."
May Pediatr Infect Dis J study
May Pediatr Infect Dis J commentary

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