News Scan for Nov 29, 2018

News brief

WHO: Northern Hemisphere flu activity starting to rise

Flu activity in the Northern Hemisphere is starting to rise, though levels are still low, as flu returned to inter-seasonal levels in temperate parts of the Southern Hemisphere, the World Health Organization (WHO) said in its latest global flu update.

In North America, Canada is reporting an earlier than usual start to its flu season, though in the United States, flu markers are still below baselines, with slight increases reported. In both countries, 2009 H1N1 is the most commonly detected strain.

In Central America, flu activity increases were reported by Costa Rica, El Salvador, and Nicaragua.

Flu in European and Central Asian countries is also starting to slowly increase, with 2009 H1N1 and H3N2 strains co-circulating. In western Asia, increased flu activity has mainly been reported on the Arabian peninsula, including Bahrain, the occupied Palestinian Territory, Oman, and Qatar, while 2009 H1N1 levels remain elevated in Saudi Arabia.

Farther east, flu levels reached baseline in South Korea, and disease levels in Laos stayed high.

Globally, of samples that tested positive for flu during the first half of November, 88.4% were influenza A and 11.6% were influenza B. Of the subtyped influenza A strains, 85% were 2009 H1N1 and 15% were H3N2.
Nov 26 WHO global flu update

 

FDA identifies Central Coast counties as potential E coli romaine sources

The Food and Drug Administration (FDA) yesterday further fine-tuned the suspected source of Escherichia coli O157:H7 in romaine lettuce from the California's Central Coast by naming six specific counties, based on preliminary results from the traceback investigation.

Counties include Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, and Ventura, the FDA said, noting that more counties may be added based on new findings.

Consumers no longer need to avoid romaine that was harvested outside the Central Coast growing region. For example, it said romaine grown near Yuma, Ariz., Imperial and Riverside counties of California, Florida, and Mexico don't appear to be part of the outbreak, which has sickened 65 people in the United States and Canada. Hydroponically and greenhouse-grown romaine is also not related to the outbreak.

On Twitter yesterday, FDA Commissioner Scott Gottlieb, MD, said the FDA has had "boots on the ground" since last week collecting environmental, soil, and water samples for lab testing to see if E coli is present. "Should positive samples be identified, we will update the public promptly," he said.
Nov 28 FDA update
Scott Gottlieb Twitter thread

In related developments, many companies in the romaine supply chain started shipping again on Nov 26, a week after all items were pulled from the market due to the E coli outbreak, Food Safety News (FSN) reported today.

Romaine growers and distributors have met with the FDA and have agreed on adding product labels with the harvest date and growing location to assure consumers that romaine coming back into the market is not linked to the current outbreak.

Teressa Lopez, with the Arizona Leafy Greens Marketing Agreement, told FSN that many distributors began shipping on Nov 26 as soon as word came from the FDA, because they had their labels ready.
Nov 29 FSN story

 

Imported tahini linked to Salmonella cases in 3 states

The US Centers for Disease Control and Prevention (CDC) said yesterday that tahini imported from Israel has been connected to five Salmonella Concord infections in three states. On the same day, Achdut Ltd., based in Ariel, Israel, said it is recalling all packages and sizes of its tahini products that were produced between Apr 7 and May 21 of 2018, because they may be contaminated with Salmonella.

Sick patients were reported from New York (3), Hawaii (1), and Michigan (1). None were hospitalized, and no deaths have been reported. Illness onset dates range from Jun 16 to Oct 18. All five people who were interviewed said they ate tahini or hummus made with tahini; three of them consumed the products in Hawaii and New York. The other two patients consumed the food during travel to other countries.

Tests by the FDA identified Salmonella Concord in a tahini sample collected at the point of import, specifically Baron's brand. The recall covers the all of the company's tahini brand names: Achdut, Baron's, S&F, Pepperwood, Soom, and Achva.

The company said the source of the outbreak is cross-contamination and that it has eliminated the source and taken preventive steps.
Nov 28 CDC outbreak announcement
Nov 28 FDA recall notice

Stewardship / Resistance Scan for Nov 29, 2018

News brief

Review: No support for use of postoperative antibiotics after rhinoplasty

A systematic review and meta-analysis published today in JAMA Facial Plastic Surgery suggests there's no evidence to support routine use of postoperative antibiotics after rhinoplasty procedures.

The review and meta-analysis of five randomized clinical trials involving a pooled sample of 589 patients found that postoperative antibiotic therapy did not significantly alter the rate of infections after rhinoplasty procedures when compared with preoperative or perioperative antibiotics or with placebo or no treatment. The pooled risk ratio (RR) for infection when comparing postoperative antibiotics with any or all other antibiotic regimens in the trials—including preoperative, perioperative, or placebo or no treatment—was 0.92 (95% confidence interval [CI], 0.35 to 2.43, P = .86). When comparing postoperative antibiotics with placebo or no treatment, the pooled RR was 0.43 (95% CI, 0.18 to 1.04, P = .06).

"The differences in RRs of infection were not statistically significant when comparing postoperative with preoperative and perioperative antibiotics or with placebo," the authors of the review write.

According to the review, the use of antibiotics following rhinoplasty to avoid infection is widespread, occurring in more than 90% of procedures. Yet several studies have found that the rate of infection after rhinoplasty is low, and evidence on the effectiveness of antibiotic prophylaxis is mixed. This is the first meta-analysis on the topic.

The authors conclude that, despite the findings, surgeons should still take into account a variety of factors when evaluating infection risk, including the scope of the surgery, the length, and the use of grafts or foreign materials. "It shall remain important to be vigilant regarding infection risk, and the above recommendations are not a replacement for clinical judgement on a case-by-case basis," they write.
Nov 29 JAMA Facial Plast Surg study

 

French study finds rapid flu test in children may cut antibiotic use, costs

A study by French researchers published yesterday in Clinical Microbiology and Infection found that bedside use of a rapid flu diagnostic test in children with flu-like symptoms was tied to significantly reduced invasive tests, antibiotic treatment, and hospitalization.

In the prospective study, conducted in the pediatric emergency department of a French academic medical center, the researchers used a rapid influenza digital immunoassay (DIA) to detect influenza virus A and B antigens in nasopharyngeal aspirates from children with flulike symptoms. To evaluate the sensitivity, specificity, and negative and positive predictive values of the DIA, they tested the same samples with standard immunofluorescence and molecular assays.

Before using the DIA, clinicians filled out questionnaires listing the tests and treatments they would have prescribed for the children in the absence of rapid testing. The researchers then compared those answers with what was done after using the DIA. They also compared the actions taken after using the DIA with data obtained from the three previous winter seasons.

Among the 512 patients included in the study, the DIA results showed that 245 tested negative for flu and 269 tested positive. When compared with the standard tests, the sensitivity, specificity, and negative and positive and predictive values of the DIA were 95.9%, 95.2%, 95.6%, and 95.5%, respectively. When the researchers compared the actions performed during the study period with the three previous winter seasons, they observed that use of the DIA at bedside was associated with a reduction in antibiotic treatments of 70% (from 16.9% to 5.1%), prescription of blood puncture of 77.8% (21.2% to 6.6%), chest x-rays of 69% (33.3% to 10.3%), lumbar puncture of 77.8% (7% to 1.6%), and hospitalization of 25.0% (27.2% to 20.4%). Reduction of medical costs was estimated to be more than €69,000 ($78,476) per season.

"In addition to delivering a rapid aetiological diagnosis, this strategy is able to save the prescription of a considerable number of unnecessary tests, antimicrobial treatments, and hospital stay," the authors of the study write. They suggest further studies are needed to confirm the results.
Nov 28 Clin Microbiol Infect abstract

 

CDC announces funding for antimicrobial resistance projects

The US Centers for Disease Control and Prevention (CDC) announced this week that it has awarded more than $15 million in 2018 to 41 innovative projects to combat antimicrobial resistance.

Among the recipients of the CDC funds are Rush University, which is studying factors associated with Candida auris colonization in healthcare settings, and the Children's Hospital of Philadelphia, where researchers are working on a novel metric for benchmarking antibiotic use to inform outpatient stewardship efforts. Other projects include a Washington University in St. Louis study on the effects of antibiotics on infant microbiomes and Iowa State University research on multidrug-resistant Campylobacter in dogs.

The projects are being supported through the CDC's Antimicrobial Resistance Solutions Initiative, which fund efforts to improve the national infrastructure for detecting, containing, and preventing resistant infections in healthcare settings, food, and the community.
Nov 26 CDC Broad Agency Announcement

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