CDC ends probe into multistate Salmonella outbreak tied to tahini products

The Centers for Disease Control and Prevention (CDC) said today it has wrapped up its investigation into a Salmonella Concord outbreak tied to tahini imported from Israel after eight cases were confirmed in four states.

The case count is up from five cases in three states in late November 2018, when the CDC first announced the outbreak. Illness-onset dates range from Apr 21, 2018, to Jan 3, 2019. No hospitalizations or deaths were reported.

Massachusetts reported its first case, and Hawaii and Michigan also had one. New York's case load grew from three to five.

On Nov 27, 2018, Achdut Ltd, of Ari'el, Israel, recalled tahini products because of the outbreak. Recalled products were sold under the following brands: Achva, Achdut, Baron's, Pepperwood, Soom, and S&F. "Epidemiologic and laboratory evidence indicated that tahini products from Achdut Ltd. were the likely source of this outbreak," the CDC said.

Officials detected no signs of antibiotic resistance in the outbreak strains they analyzed.
Feb 27 CDC update
Nov 28, 2018, CIDRAP News scan

 

CEPI awards funding for portable RNA printer for vaccine production

Today the Coalition for Epidemic Preparedness Innovations (CEPI) announced a $34 million contract and new partnership with CureVac AG, a biopharmaceutical company developing mRNA-based vaccines, to create a transportable RNA printer that could be used to develop vaccines in outbreak scenarios.

"This innovative platform will provide a rapid supply of lipid-nanoparticle (LNP)-formulated mRNA vaccine candidates that can target known pathogens (including Lassa Fever, Yellow Fever, and Rabies) and prepare for rapid response to new and previously unknown pathogens (referred to by [the World Health Organization] as "Disease X")," CEPI said in a press release.

The device would be able to produce several grams of LNP-formulated mRNA—enough for more than 100,000 doses—within weeks of an outbreak, CEPI said. The technology could be encoded for multiple proteins and antigens, targeting different viruses.

The project is set to begin next month. CEPI is a partnership among public and private organizations that was launched in Davos, Switzerland, in 2017 to develop vaccines to stop future epidemics. It has committed to investing more than $350 million in 12 vaccine candidates and three vaccine platforms.
Feb 27 CEPI press release

 

Legislators reintroduce law to boost investment in universal flu vaccine

US lawmakers yesterday reintroduced legislation to support the development of a universal flu vaccine, calling for a total investment of $1 billion through fiscal year 2024.

Called the Flu Vaccine Act, the bill was reintroduced by Sen Edward Markey, D-Mass., and Rep Rosa DeLauro, D-Conn., according to a statement from Markey's office. The proposed law calls for $200 million for fiscal years 2020 through 2024 for the National Institutes of Health (NIH). Legislators have already secured a dedicated $100 million for fiscal year 2018 and $140 million for fiscal year 2019 for universal flu vaccine research at the NIH's National Institute of Allergy and Infectious Diseases (NIAID).

At a Congressional briefing yesterday, the Foundation for Vaccine Research updated lawmakers on the current flu season and progress on a universal flu vaccine.

In the statement, Markey said American scientists are heavy hitters in health and disease research, and it is up to the United States to take the lead in improving and enhancing the response to flu. "With increased research funding, hard-working health care providers, and brilliant scientific investigators, we are the [closest] we have ever been to ensuring a flu-free future. The bases are loaded, and the Flu Vaccine Act will help us knock this public health menace out of the park," he said.

Senate cosponsors are Tammy Baldwin, D-Wisc., Richard Blumenthal, D-Conn., Angus King, I-Maine, Tina Smith, D-Minn., Chris Van Hollen, D-Md., and Amy Klobuchar, D-Minn. These are virtually the same senators who introduced a similar bill about a year ago.

In 2012, the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, led a group that published an in-depth analysis of problems with current flu vaccines and steps needed to develop a next-generation version with the capacity to minimize the impact of seasonal flu as well as a future pandemic. One of the report/s recommendations was to declare flu vaccines a national priority and dedicate substantial investment and leadership on the scale of the Manhattan Project, a massive effort that brought about the first nuclear weapons during World War II.
Feb 26 Sen Markey statement
Feb 19, 2018, CIDRAP News story "Senate bill would jump-start universal flu vaccine efforts"
Oct 15, 2012, CIDRAP News story on flu vaccine report

 

High-path H5 outbreaks hit birds in Nigeria, Pakistan, and Taiwan

In the latest highly pathogenic avian influenza outbreak developments, Nigeria and Pakistan reported H5N8 detections and Taiwan reported more H5N2 events in poultry, according to the latest notifications from the World Organization for Animal Health (OIE).

Nigeria's H5N8 outbreak began on Jan 28 in backyard birds, which were 16-week-old pullets, in Bauchi state in the central part of the country. The virus killed 105 of 460 susceptible birds, and the rest were destroyed. The source of the virus hasn't been determined, but health officials suspect the purchase of adults birds from an unknown source. Nigeria has reported sporadic H5N8 outbreaks since the first of the year.

In Pakistan, the agriculture ministry reported two H5N8 outbreaks involving wild birds, both in Islamabad. One outbreak began on Jan 2 and the other started on Feb 7. Affected birds include mallards, Guinea fowl, wild swans, and house crows. Between two events, the virus killed 64 birds, and officials euthanized 5 additional infected birds. The detections are Pakistan's first since February 2018.

Elsewhere, Taiwan reported four more H5N2 outbreaks at poultry farms, three in Yunlin County and one in Changhua County. Native chickens and turkeys were affected. Taiwan has been battling H5N2 outbreaks since early 2015, and these latest ones began from Jan 26 to Feb 19. Of 65,496 susceptible birds across the four farms, the virus killed 4,260, and the remaining ones were destroyed to curb the spread of the virus.
Feb 27 OIE report on H5N8 in Nigeria
Feb 26 OIE report on H5N8 in Pakistan
Feb 27 OIE report on H5N2 in Taiwan

Stewardship / Resistance Scan for Feb 27, 2019

News brief

Study analyzes patterns of movement of CRE infections in Atlanta

Using regional surveillance data, researchers from the US Centers for Disease Control and Prevention, the Atlanta Veterans Affairs Medical Center, and Emory University have determined that patients with carbapenem-resistant Enterobacteriaceae (CRE) infections in the Atlanta metro area transfer between healthcare facilities in similar patterns as Medicare patients, with the exception of a handful of nursing homes.

In a study today in Clinical Infectious Diseases, the researchers used surveillance data from the Georgia Emerging Infections program to identify all positive CRE cultures from urine or a sterile body site collected in 2016 in Georgia's Health District 3, an eight-county portion of the Atlanta metro area.

To construct a patient transfer network, each CRE was attributed to an acute care hospital (ACH), long-term acute care hospital (LTACH), or skilled nursing facility (SNF) based on timing of culture and facility exposures in the previous year. Centrality metrics were calculated from 2016 Medicare data and then compared with CRE-transfer derived centrality metrics.

During 2016, 283 CRE incident cases with concurrent or prior-year facility stays were identified, and positive cultures were most often collected at ACHs (141, 50%) and SNFs (113, 40%) and less frequently at LTACHs (29, 10%). The patient-sharing network as identified by Medicare transfer data included 93 facilities, with CRE cases originating in 17 of 20 ACHs (85%), 7 of 8 LTACHs (88%), but only 35 of 65 SNFs (54%).

The analysis of connectedness showed that the movement of patients with CRE between healthcare facilities (both direct and indirect transfers) mirrored the flow of Medicare patients between facilities, but the association was strong and significant only for ACHs and LTACHs. In six of the SNFs, the movement of CRE patients was not correlated with the movement of Medicare patients.

The authors of the study conclude, "In summary, we found patients with CRE move throughout the Georgia Health District 3 region, where initial CRE culture positive specimens as indicators of infection originated at almost all of the ACHs and over half of SNFs. Furthermore, we identified a subset of nursing homes involved in the flow of CRE patients that could not easily be explained by Medicare defined centrality measures, suggesting other factors may better explain CRE patient movement in nursing homes."
Feb 27 Clin Infect Dis abstract

 

Penicillin skin testing linked to antimicrobial de-escalation, reduced costs

The results of a quasi-experimental study published today in Open Forum Infectious Diseases show that penicillin skin esting (PST) in a community health system led to antimicrobial de-escalation in 71% of patients who tested negative and reduced costs.

In the study, which was conducted at SouthCoast Health Savannah in Savannah, Georgia, an intervention group of 100 adult patients who completed PST for a self-reported penicillin allergy was compared to a matched control group of patients who had a listed penicillin allergy as well as infectious diseases consultation. The patients in the control group were matched to infection diagnosis codes of members of the intervention group and then randomly selected and matched 1:1. Antimicrobial therapy and duration was documented for each patient, along with changes in therapy in the PST group.

The primary outcome was non-carbapenem beta-lactam days of therapy (DOT), and the secondary outcome was the average cost of antimicrobial therapy for the intervention group before and after PST.

Of the 100 patients in the intervention group, 98 tested negative for a penicillin skin allergy, and 70 (71%) of those 98 patients had changes directly made to their antimicrobial regimens. The most common change after a negative test (34 of 70 patients) was from carbapenems to penicillins. For the primary outcome, beta-lactam DOT for the PST group were 666 out of 1,094 (60.88%, with 34.82% being a penicillin specifically). Beta-lactam DOT for the control group were 386 out of 984 (39.64%, with 6.4% being a penicillin specifically). Changes to the antimicrobial regimen after PST saved the average patient $353.03.

The authors say further study is required to evaluate the overall clinical and economic benefit of PST in community health systems with limited resources.
Feb 27 Open Forum Infect Dis abstract

This week's top reads