More Ebola cases suspected in remote DRC health zones

The Democratic Republic of the Congo (DRC) yesterday noted four new suspected cases of Ebola virus, two each in Bikoro and Iboko health zones, yet the number of cases overall remained steady. Four previously suspected cases tested negative for the virus, so the current total now stands at 61 cases, including 38 confirmed, 14 probable, and 9 suspected.

The death toll remains at 28, and the number of cured patients holds at 24.

Bikoro and Iboko are both remote health zones in the DRC, accessible only by motorcycle in some parts. Officials from the DRC and the World Health Organization (WHO) have said it may take several more weeks to track all known contacts of Ebola cases in these areas.

Also yesterday, the WHO released information concerning a May 26 panel of experts who met to discuss clinical trial design for testing Ebola therapeutics in an outbreak setting. To meet standards of both safety and efficacy, the experts recommended "a three-arm, open-label, randomized trial to evaluate simultaneously two candidate therapeutics."
Jun 21 DRC update

Jun 21 WHO document

 

Advance notice of polio cases in Papua New Guinea, DRC

Both Papua New Guinea and the DRC announced advanced notice of new polio cases, according to the weekly update from the Global Polio Eradication Initiative (GPEI).

Last month officials in Papua New Guinea identified a patient with acute placid paralysis (AFP), which will now be classified as a circulating vaccine-derived poliovirus type 1 (cVDPV1) case, GPEI said.

In the DRC, a circulating vaccine-derived poliovirus type 2 case was recorded in Ituri province, in the northeast part of the country near the Ugandan border. The patient is a child who suffered onset of paralysis on May 5, and recently traveled to Haut Katanga. According to GPEI, genetic sequencing indicates the case is linked to the Haut Lomami/Tanganika/Haut Katanga outbreak.

So far this year officials have reported five vaccine-derived polio cases globally, four in the DRC.
Jun 22 GPEI report

 

Trump proposes single federal food safety agency

Under President Trump's executive government reorganization plan, "Delivering Government Solutions in the 21st Century," all federal food safety issues would be handled by a single agency housed in the US Department of Agriculture (USDA).

Citing several Government Accountability Office (GAO) reports and calling the current system "irrational," the reorganization plan would consolidate the USDA's Food Safety and Inspection Service (FSIS) and the Food and Drug Administration's (FDA's) food inspection functions into one group called the Federal Food Safety Agency.

"There are many examples of how illogical our fragmented and sometimes duplicative food safety system can be," the proposal says. "For example: while FSIS has regulatory responsibility for the safety of liquid eggs, FDA has regulatory responsibility for the safety of eggs while they are inside of their shells; FDA regulates cheese pizza, but if there is pepperoni on top, it falls under the jurisdiction of FSIS; FDA regulates closed-faced meat sandwiches, while FSIS regulates open-faced meat sandwiches."

Increased food safety, better communications, and money saving, are all listed as benefits to moving towards consolidation. The new agency would have an annual operation budget of approximately $2.3 billion.
Jun 22 White House document

 

Cyclospora outbreak linked to veggie trays sickens 66 more

In an update yesterday on a multistate Cyclospora outbreak linked to Del Monte vegetable trays, the US Centers for Disease Control and Prevention (CDC) said 66 more cases have been reported, raising the outbreak total to 144.

The number of affected states remained at four: Iowa, Michigan, Minnesota, and Wisconsin. The patients in Michigan are linked to vegetable trays bought in Wisconsin. So far, six people have been hospitalized and no deaths have been reported. The most recent illness onset is Jun 6.

Federal and state investigations are still under way, but so far the exact source isn't known. The vegetable trays were sold at convenience stores and markets and contained broccoli, cauliflower, carrots, and dill dip.

The Minnesota Department of Health is also investigating a separate Cyclospora outbreak tied to Minneapolis restaurant Sonora Grill that has sickened 17 people. Foodborne illness outbreaks from Cyclospora cayetanensis, a parasite, have been reported the past several summers and when a cause is identified, the culprit has been imported produce such as basil, cilantro, mesclun lettuce, raspberries, and snow peas.
Jun 21 CDC outbreak update
Jun 18 CIDRAP News scan "Veggie tray Cyclospora outbreak sickens people in 2 more states"

 

China, Russia, Denmark report more high-path avian flu outbreaks

China's agriculture ministry has reported a highly pathogenic H5N1 avian flu outbreak at a broiler chicken farm in Qinghai province in the country's northwest, according to a government statement translated and posted today by Avian Flu Diary (AFD), an infectious disease news blog.

The outbreak began on Jun 12, killing 1,050 birds. The remaining 565 poultry were destroyed to curb the spread of the virus. The country's last known H5N1 outbreak was reported in August 2017 affecting poultry in Inner Mongolia province.

In related news, Russian officials reported two more highly pathogenic H5 outbreaks in poultry, both in Saratov oblast in the west, according to a separate AFD post today. The country has reported several recent similar outbreaks in the same general area.

And finally, Denmark today reported another H5N6 detection in a wild bird, this time a white-tailed eagle found sick on Mar 27 in Zealand region in the south of the country, according to a notification from the World Organization for Animal Health (OIE).
Jun 22 AFD post on H5N1 in China
Jun 22 AFD post on avian flu in Russia
Jun 22 OIE report on H5N6 in Denmark

 

Study: California Aedes mosquitoes capable of spreading Zika

Researchers reporting in PLoS Neglected Tropical Diseases provide evidence that Aedes aegypti mosquitoes from California are capable of transmitting the Zika virus (ZIKV).

Though it's well known that Ae aegypti mosquitoes are vectors of the flavivirus, competency varies between geographical regions.

To survey mosquitoes in California, researchers allowed Californian Ae aegypti, Culex tarsalis, and Cx quinquefasciatus to feed on mice infected with three different strains of ZIKV collected from Puerto Rico and Brazil in 2015 and Malaysia in 1966.

Neither Culex species showed signs of Zika in saliva at days 14 and 21 after infection. But 85% to 90% of the Aedes mosquitoes had ZIKV RNA in their saliva. All strains of the virus were found in the Aedes, with the Malaysian strain producing the highest levels of viral RNA.

"This laboratory vector competence study confirmed that Ae. aegypti from Los Angeles, California, USA, can transmit Asian lineage ZIKV and that Cx. tarsalis and Cx. quinquefasciatus are inefficient ZIKV vectors," the authors concluded. "Given that Culex mosquitoes are poor ZIKV vectors and seek primarily non-human hosts, they are unlikely to facilitate a ZIKV outbreak. Thus, vector control efforts targeting ZIKV should remain focused on reducing urban Aedes populations."
Jun 21 PLoS Negl Trop Dis study

Stewardship / Resistance Scan for Jun 22, 2018

News brief

Senators introduce bill to bolster oversight of antibiotics in food animals

Today Democratic US Senators Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), Dianne Feinstein (Calif.), and Richard Blumenthal (Conn.) introduced the Strengthening Antibiotic Oversight Act to strengthen regulation of medically important antibiotics administered to food-producing animals.

If passed, the legislation would require the Food and Drug Administration (FDA), which oversees the drugs in food animals, to review the duration of use of approved indications for medically important antibiotics labeled for animal use and would give the agency authority to withdraw approvals for unjustified durations. The bill also directs the FDA to use funds collected through animal drug user fees to collect and report data on antibiotics delivered to farms, through sampling of veterinary feed directives and feed distribution reports.

Current FDA rules do not contain duration limits regulating how much of an antibiotic can be used in an animal for a specified amount of time for all medically important antibiotics, according to a news release on Sen. Warren's website.

"The FDA has taken a number of steps to address the issue of antibiotic resistance, but with two million Americans developing antibiotic-resistant infections every year, it's clear that more work needs to be done," said Sen. Warren."One way to approach this is to reduce the overuse of antibiotics in animals. I'm glad to partner with my colleagues on a bill to help the FDA collect better data and support more careful use of antibiotics."

Sen. Feinstein added, "Our bill will give the FDA greater oversight and ensure medically-important antibiotics are used sparingly."

Matt Wellington, antibiotics program director for U.S. PIRG, said in a release emailed to journalists, "About a third of the medically important antibiotics approved for use in food-producing animals through feed or water have label indications without duration limits. That means meat producers can use these drugs continuously, which would further increase drug-resistant bacteria.

"There are few instances in human medicine where such prolonged antibiotic use would be appropriate. We should apply the same standard to animal medicine and farming."
Jun 22 Sen. Warren news release

 

UK awards $16 million for AMR research in low-, middle-income countries

The UK's Medical Research Council (MRC) today announced $15.9 million in grants to four universities to study drivers of antimicrobial resistance (AMR) in low- and middle-income countries (LMICs) in Africa and Asia.

The AMR in a Global Context Consortia awards, totaling £12 million, are jointly funded by the cross-research council AMR initiative and the National Institute for Health Research's (NIHR's) Global Health Research Programme. Teams at the University of Bristol, the University of St. Andrews, the Liverpool School of Tropical Medicine, and the University of Glasgow won the awards.

The 3-year awards will connect UK researchers with scientists and policy makers in partner countries. They will use a range of research approaches—from clinical and microbiological studies to geography, modeling, and social sciences—to address various AMR issues in Kenya, Tanzania, Uganda, Malawi, and Thailand.

"The NIHR, working in partnership with the cross-research council AMR initiative, is pleased to be supporting four multidisciplinary consortia to identify the factors driving microbial resistance in LMICs and contribute to the development of context-specific interventions to tackle this global health challenge," said Prof. Chris Whitty, NIHR chief scientific adviser, in an MRC news release.
Jun 22 MRC press release

ASP Scan (Weekly) for Jun 22, 2018

News brief

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

Senators introduce bill to bolster oversight of antibiotics in food animals

Today Democratic US Senators Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), Dianne Feinstein (Calif.), and Richard Blumenthal (Conn.) introduced the Strengthening Antibiotic Oversight Act to strengthen regulation of medically important antibiotics administered to food-producing animals.

If passed, the legislation would require the Food and Drug Administration (FDA), which oversees the drugs in food animals, to review the duration of use of approved indications for medically important antibiotics labeled for animal use and would give the agency authority to withdraw approvals for unjustified durations. The bill also directs the FDA to use funds collected through animal drug user fees to collect and report data on antibiotics delivered to farms, through sampling of veterinary feed directives and feed distribution reports.

Current FDA rules do not contain duration limits regulating how much of an antibiotic can be used in an animal for a specified amount of time for all medically important antibiotics, according to a news release on Sen. Warren's website.

"The FDA has taken a number of steps to address the issue of antibiotic resistance, but with two million Americans developing antibiotic-resistant infections every year, it's clear that more work needs to be done," said Sen. Warren."One way to approach this is to reduce the overuse of antibiotics in animals. I'm glad to partner with my colleagues on a bill to help the FDA collect better data and support more careful use of antibiotics."

Sen. Feinstein added, "Our bill will give the FDA greater oversight and ensure medically-important antibiotics are used sparingly."

Matt Wellington, antibiotics program director for U.S. PIRG, said in a release emailed to journalists, "About a third of the medically important antibiotics approved for use in food-producing animals through feed or water have label indications without duration limits. That means meat producers can use these drugs continuously, which would further increase drug-resistant bacteria.

"There are few instances in human medicine where such prolonged antibiotic use would be appropriate. We should apply the same standard to animal medicine and farming."
Jun 22 Sen. Warren news release

 

UK awards $16 million for AMR research in low-, middle-income countries

The UK's Medical Research Council (MRC) today announced $15.9 million in grants to four universities to study drivers of antimicrobial resistance (AMR) in low- and middle-income countries (LMICs) in Africa and Asia.

The AMR in a Global Context Consortia awards, totaling £12 million, are jointly funded by the cross-research council AMR initiative and the National Institute for Health Research's (NIHR's) Global Health Research Programme. Teams at the University of Bristol, the University of St. Andrews, the Liverpool School of Tropical Medicine, and the University of Glasgow won the awards.

The 3-year awards will connect UK researchers with scientists and policy makers in partner countries. They will use a range of research approaches—from clinical and microbiological studies to geography, modeling, and social sciences—to address various AMR issues in Kenya, Tanzania, Uganda, Malawi, and Thailand.

"The NIHR, working in partnership with the cross-research council AMR initiative, is pleased to be supporting four multidisciplinary consortia to identify the factors driving microbial resistance in LMICs and contribute to the development of context-specific interventions to tackle this global health challenge," said Prof. Chris Whitty, NIHR chief scientific adviser, in an MRC news release.
Jun 22 MRC press release

 

Study shows how antibiotic regimen affects resistance in urinary E coli

Originally published by CIDRAP News Jun 19

A retrospective multicenter study showed a dose-response relationship between antimicrobial use and resistance in uropathogens in older adults, Belgian researchers reported yesterday in Antimicrobial Resistance and Infection Control.

In the study, microbiological results for individual patient samples, retrieved from 15 voluntary participating clinical laboratories in 2005, were linked with individual antimicrobial consumption and sociodemographic data. The purpose of the research was to study the influence of different variables of antimicrobial prescribing on the occurrence of resistance in Escherichia coli isolated from urine samples in Belgian adults over the age of 65.

The final data used in the study contained information on resistance status for 7,397 E coli isolates obtained from 5,650 patients. The results demonstrated that resistance in E coli was higher when more antibiotics (more than nine prescriptions) had been prescribed before isolation of the sample, especially in women (significant interaction P = 0.0016).

In addition, the effect of route administration interacted with the number of preceding prescriptions, provided that the number of preceding prescriptions is not extremely high. With up to nine prescriptions, when other variables held constant, the probability of resistance decreased by increase in the proportion of preceding parenteral antibiotic prescriptions (significant interaction P = 0.0067).

The authors say the findings on route of administration and antimicrobial resistance, which has previously received little attention, should be further explored.
Jun 18 Antimicrob Resist Infect Control study

 

Pizza Hut to stop serving chicken raised with medically important antibiotics

Originally published by CIDRAP News Jun 19

The nation's second-largest pizza chain today announced that it would stop serving chicken raised with medically important antibiotics by 2022.

In a statement on its website, Pizza Hut said that the commitment comprises all chicken sold by the company, including chicken wings. Pizza Hut, which stopped using chicken raised with antibiotics important to human medicine in its pizza last year, is the first national pizza chain to commit to an antibiotic policy for chicken wings.

Matt Wellington, antibiotics program director for U.S. PIRG, praised the decision. "Pizza Hut's announcement is another step toward preserving life-saving medicines for what they're meant for, treating illness," Wellington said in a press release.

The move means that all of the Yum! Brands restaurant chains, which also include KFC and Taco Bell, have now pledged to reduce the use of medically important antibiotics in their chicken supply. 
Jun 19 Pizza Hut statement
Jun 19 U.S. PIRG statement

 

Triclosan found to induce multidrug resistance in E coli

Originally published by CIDRAP News Jun 19

A team of scientists from the University of Queensland has found that an environmentally relevant concentration of the antimicrobial chemical triclosan induces heritable multidrug resistance in E coli.

In a study published recently in the journal Environment International, researchers from Queensland's Advanced Water Management Centre exposed wild-type E coli to varying amounts of triclosan, ranging from a sub-minimum inhibitory concentration (0.02 and 0.2 milligrams per liter (mg/L), which are environmentally relevant concentrations) to a near-lethal concentration of 2 mg/L. After 30 days of exposure, they measured resistance to eight types of antibiotics.

The tests revealed that after 30 days, exposure to 0.2 mg/L of triclosan induced resistance to several antibiotics. Further investigation found that the oxidative stress induced by triclosan caused mutations in several key genes—fabL, frdD, marR, acrR, and soxR. These mutations led to resistance by up-regulating genes encoding beta-lactamases and multidrug efflux pumps—two important resistance mechanisms—and down-regulating genes related to membrane permeability.

Study author Jianhua Guo, PhD, said the findings suggest the environmental impact of triclosan—a chemical commonly found in consumer products such as soap and toothpaste—should be investigated.

"This discovery provides strong evidence that the triclosan found in personal care products that we use daily is accelerating the spread of antibiotic resistance," Guo said in a University of Queensland press release. 

In September 2016, the FDA banned the use of triclosan and other antimicrobial ingredients in over-the-counter soaps, saying they were no more effective at killing germs than plain soap and water. 
Jun 11 Environ Int abstract
Jun 19 University of Queensland news release

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