News Scan for Aug 09, 2018

News brief

Reports detail early start to West Nile season in Europe

Some European countries this year experienced an early start to their West Nile virus (WNV) transmission season, which could be related to earlier warmer temperatures and higher rainfall levels that foster populations of Culex mosquitoes that carry the virus, according to two reports published today in the latest issue of Eurosurveillance.

In the first study, focused just on Italian surveillance, researchers said the first human case was reported in the endemic province of Rovigo, in Veneto region, in the middle of June. They note that the first cases are usually seen in July, with case numbers peaking in August and September. Also, they said human cases are higher than in previous years. As of Aug 1, 52 human WNV infections had been reported in two regions. The cases include 16 neuroinvasive illnesses, 14 involving West Nile fever, and 22 with asymptomatic infections.

In recent years, transmission patterns have been changing for other vectorborne diseases in Europe, and climate change has been implicated as a contributing factor, the group wrote. They said the One Health surveillance system in Italy is providing an early-warning service, which allowed blood and tissue donation safety measures to be stepped up before the first human cases were reported.

In the second report, a team led by the European Centre for Disease Prevention and Control (ECDC) detailed early West Nile virus activity in Italy along with Greece, Hungary, and Romania.

The investigators said the first cases of 2018 were reported from Greece in late June and early July, with May 31 as the earliest illness onset. In other European countries, the authors also saw a steeper rise in cases, with 168 cases reported in the first 6 weeks of the season compared with 8, 2, 62, and 66 in 2014 through 2017, respectively.

Climate data show that precipitation was above average in March, especially in West Nileaffected areas, followed by warmer-than-average temperatures with normal rainfall in April and warmer temperatures in May, with precipitation levels along the Adriatic coast high in May and June.

They authors concluded that the weather pattern reflects an early spring in southeastern Europe, which could favor an early rise in vector populations. The early season should trigger heightened vigilance for the disease for clinicians. They note that outbreaks depend on numerous factors, and an early start to the season doesn't necessarily mean large outbreaks will occur.
Aug 9 Eurosurveill report on early West Nile virus season in Italy
Aug 9 Eurosurveill report on
early West Nile activity in Europe

 

More H5 outbreaks reported in Russian, Taiwanese poultry

In the latest highly pathogenic H5 avian flu developments, Russia reported eight more outbreaks in backyard birds and Taiwan reported a pair of H5N2 events, according to the latest notifications from the World Organization for Animal Health (OIE).

In Russia, the outbreaks are part of ongoing activity, which European officials have reported as H5N8, that has been under way in the west of the country since June. The latest outbreaks all involved backyard poultry, with start dates that ranged from Jul 25 to Aug 5. Affected locations include Orlov and Nizhegorod oblasts and the Chuvash, Udmurt, and Mari El republics.

Taken together, the virus killed 68 of 598 susceptible birds, and the surviving poultry were culled as part of the outbreak response.

Taiwan's latest H5N2 outbreaks are part of virus activity that's been under way since early 2015. The two new events both affected commercial farms in Yunlin County, one that began on Jul 18 at a meat duck farm and one that began on Jul 27 at facility housing native chickens.

Between the two outbreaks, 3,811 poultry deaths were reported, and authorities destroyed the remaining 36,055 birds to curb the spread of the virus.
Aug 8 OIE report on H5 in Russia
Aug 8 OIE report on
H5N2 in Taiwan

 

Nigeria, Papua New Guinea take steps to control polio

Nigeria approved a $150 million loan from the World Bank yesterday to support efforts to scale up polio immunization, Reuters reported. Nigeria, along with Afghanistan and Pakistan, is one of the three countries in the world still battling endemic polio transmission.

Nigeria has not recorded a polio case this year, and could be declared polio-free if no new cases are found as of July of 2019.

The 20-year loan required no payments for the first 5 years. Twelve states in Nigeria, including northern states controlled by terrorist organization Boko Haram, are expected to use the bulk of funding for vaccination campaigns.

The goal is to achieve 80% oral vaccine coverage across the country.

In other polio news, the World Health Organization (WHO) said today that nearly 300,000 children were reached during the first of four supplementary polio vaccination campaigns in Papua New Guinea, which recently recorded its first cases of the virus in 18 years. The next round will be held in late August, September, and October, the agency said in a press release.

"I am very pleased that we have been able to protect almost 300,000 children from polio," said Sir Puka Temu, MD, minister for health & HIV/AIDS of Papua New Guinea in a WHO press release. "There was a high turnout in areas where there are significant numbers of mobile populations, which suggests that parents from other provinces brought their children for vaccination."

As of Aug 6, three polio cases have been detected in Papua New Guinea.
Aug 8 Reuters
story
Aug 9 WHO
press release

 

MERS study shows no sign of infection in Nigerian camel workers

A study today in Eurosurveillance examined serologicl evidence of MERS-CoV infection in people occupationally exposed to infected dromedary camels in a slaughterhouse in Kano, Nigeria, and found that none of the 311 humans tested had any evidence of antibodies to Middle East respiratory syndrome coronavirus (MERS-CoV).

The results are a bit confounding, as camel workers in the Middle East are at an elevated risk of contracting MERS. In addition, camels in this abattoir had been studied several times, and 11% of samples had MERS-CoV RNA in January of 2015. In 2016, when this study was conducted, 0 to 8.4% of camel samples showed RNA. All but 50 of the workers in this study reported direct camel contact, including drinking camel milk and urine, and did not wear personal protective gear.

"This [study's] seropositivity rate is significantly lower than that of the camel abattoir workers in Saudi Arabia (p = 0.0049, Fisher's exact test) and that of the camel barn workers at a race track in Qatar (p = 0.00580)," the authors said. 

Instead, this study echoes a Kenyan study, which showed no seroconversion among 760 people with household or occupational exposure to MERS-CoV–seropositive camels.

"MERS-CoV from West Africa, including Nigeria, were genetically and phenotypically distinct from those in East Africa and thus zoonotic potential of viruses from Nigeria may be different from those in Kenya. Overall, these data may suggest that the risk of MERS infection from exposure to infected camels may be lower in some African countries," the authors concluded.
Aug 9 Eurosurveillance
study

 

Saudi Arabia refutes MERS social media rumors

Saudi Arabia’s Ministry of Health (MOH) is refuting rampant social media and press rumors that the country is experiencing an uptick in MERS-CoV cases in Al Ahsa, according to a new post from Avian Flu Diary, an infectious disease tracking blog.

For 3 months, the MOH has not been providing daily updates on MERS, but last week released a PDF document of recent cases. 

Though there have been household clusters and transmission from camel contact, the MOH said there is no increase or "outbreak" of Middle East respiratory syndrome-related coronavirus in Al Ahsa, a region in eastern Saudi Arabia.

The Hajj annual pilgrimage is set to begin in 10 days, which usually brings more focus to Saudi Arabia and on the threat of MERS.
Aug 9 Avian Flu Diary post

Stewardship / Resistance Scan for Aug 09, 2018

News brief

Australian report highlights drug-resistant gonorrhea, CPE infections

Neisseria gonorrhea and carbapenamase-producing Enterobacteriaceae (CPE) remain the most commonly reported organisms with resistance to critical antibiotics in Australia, according to a report yesterday by the Australian Commission on Safety and Quality in Health Care (the Commission).

The 6-month report from the National Alert System for Critical Antimicrobial Resistance (CARAlert), covering October 2017 through March 2018, found that, of 653 strains of bacteria with some type of critical antimicrobial resistance detected, azithromycin non-susceptible N gonorrhea (46.6%) were the most frequently reported, followed by CPE (36.9%), either alone or in combination with ribosomal methyltransferases (2.1%). CPE were the most frequently detected drug-resistant organisms reported in hospital patients.

"The finding that CPE remains prevalent in Australian hospitals is concerning," John Turnidge, MBBS, FRACP, senior medical advisor for the Commission's antibiotic use and resistance surveillance system, said in a press release. "This group of bacteria has the ability to cause common infections, has limited treatment options, and can have a death rate as high as 50% for blood stream infections."

While the number of azithromycin non-susceptible N gonorrhea isolates fell by 26% from the previous reporting period, the number of CPE isolates rose by 20%, from 213 to 255. A 266% increase in multidrug-resistant Shigella species was also observed.

The report also highlights two detected N gonorrhea infections that were resistant to both ceftriaxone and azithromycin, and five additional strains with high-level azithromycin resistance. Australian health officials are concerned about the potential for an outbreak of these extensively drug-resistant strains.
July 2018 CARAlert summary report
Aug 8 Commission press release

 

FDA committee urges approval of antibiotic for pneumonia, skin infections

The Antimicrobials Drug Advisory Committee of the US Food and Drug Administration (FDA) yesterday voted in favor of approving intravenous (IV) and oral omadacycline for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) and community-acquired bacterial pneumonia (CABP).

Omadacycline is a modernized tetracycline designed to overcome tetracycline resistance and has demonstrated activity against gram-positive and gram-negative bacterial strains. The drug was granted Qualified Infectious Disease Product Designation and Fast Track status by the FDA for the target indications of ABSSSI, CABP, and urinary tract infections.

The committee's decision was based in part on data from three completed phase 3 trials, in which IV and oral formulations of omadacycline met all FDA-designated primary and secondary outcomes for treating ABSSSI and CABP, and was generally safe and well-tolerated. Nearly 2,000 patients received the drug in those trials.

"Omadacycline has the potential to help address the urgent and growing need for new antibiotics to treat serious community-acquired infections," Michael F. Bigham, chairman and CEO of Paratek Pharmaceuticals, of Boston, said in a company press release. "With once-daily dosing and bioequivalent IV and oral formulations, omadacycline may help facilitate early discharge from the hospital or, in other cases, allow for safe and effective treatment in the outpatient setting."

The FDA is expected to make a final decision on the drug in October.
Aug 8 Paratek Pharmaceuticals press release

 

ESBL gut colonization seen as risk factors for drug-resistant pneumonia

French researchers report a significant relationship between colonization of the digestive tract with extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE) and subsequent ventilator-associated pneumonia (VAP) related to ESBLE, according to a study yesterday in PLoS One.

In the retrospective study, conducted from 2008 through 2011 at the University Hospital of Lille in France, researchers examined the risk factors for ESBLE-related VAP among patients in the intensive care unit. Because the spread of ESBLE infections has led to an increase in the use of carbapenems, the team wanted to determine how to better identify at-risk patients, in order to reduce the spectrum of initial antibiotic treatment. They also looked at the impact of ESBLE on the outcomes of VAP patients.

Among 410 patients with confirmed VAP, 43 (10.5%) had ESBLE VAP, 76 (19%) had polymicrobial VAP, and 189 (46%) had VAP related to multidrug-resistant bacteria. Among the patients with ESBLE VAP, 79% were previously identified as ESBLE carriers. Multivariate analysis identified prior ESBLE colonization of the digestive tract as the only independent risk factor for ESBLE VAP (odds ratio, 23; P < 0.001). While the positive prediction value of ESBLE digestive colonization was low (43.6%), the negative prediction value was excellent in predicting ESBLE VAP (97.3%).

Analysis of outcomes showed no significant differences between patients with ESBLE VAP and those with VAP caused by other bacteria in duration of mechanical ventilation (28 vs. 23 days), length of ICU stays (31 vs. 29 days), or mortality (55.8% vs. 50%).

Although the authors caution that further prospective studies are need to confirm the results, they write, "Our results suggest that patients without ESBLE colonization should probably not receive carbapenems as part of their initial empirical treatment to cover ESBLE. Such a strategy of restricting the use of carbapenems would be helpful to prevent subsequent resistance."
Aug 8 PLoS One study

 

Canadian study finds no link between autism, early antibiotic exposure

A new study in the International Journal of Epidemiology has found no clinically significant association between early life antibiotics exposure and the risk of autism spectrum disorders (ASD).

To test the hypothesis that early life changes to gut microbiota composition—potentially induced by antibiotic exposure—may impair the gut-brain axis and increase the risk of ASD, researchers at the University of Manitoba conducted a population-based cohort study that included all births identified in the Manitoba Health Insurance Registry from April 1998 through March 2016. Early exposure to antibiotics was defined as having filled one or more antibiotic prescriptions during the first year of life, and the main outcome during follow-up was ASD diagnosis.

Of the 214,834 subjects in the cohort, 94,024 (43.8%) filled an antibiotic prescription during the first year of life, and 2,965 children received an ASD diagnosis. After adjusting for covariates, antibiotic exposure was found to be associated with a slightly reduced risk of ASD (adjusted hazard ratio [HR], 0.91), but the researchers concluded that this observed association was not clinically meaningful. Secondary analyses showed no association between ASD and the number of treatment courses or cumulative duration of antibiotic exposure.

In an analysis based on a sibling-controlled design, conducted to address possible confounding due to environmental, genetic, and other familial or social factors, early life antibiotic exposure was not associated with ASD (adjusted HR, 1.03).
Aug 7 Int J Epidemiol abstract                     

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