News Scan for Mar 18, 2019

News brief

US measles cases reach 268 as outbreaks grow in New York, New Jersey

The US Centers for Disease Control and Prevention (CDC) today said measles counts have now grown to 268 cases in 15 states—62 more cases than the agency reported in a Mar 4 update. For comparison, the CDC reported 372 cases for all of 2018.

Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington, have all recorded cases. So far, the CDC has identified six outbreaks that involve 3 or more cases, in New York City; Rockland County, New York; Washington state, Texas, Illinois, and California.

"These outbreaks are linked to travelers who brought measles back from other countries such as Israel and Ukraine, where large measles outbreaks are occurring," the CDC said. The United States had 17 outbreaks in 2018.

Over the weekend, both Sullivan County, New York, and Ocean County, New Jersey, reported measles cases for the first time this year. Local news outlets in both communities reported two cases in each locality.
Mar 18 CDC
update
Mar 18 Hudson Valley Post story
Mar 18 New Jersey 101.5 story

 

MERS-CoV infects 3 more in Saudi Arabia; camels at market test positive

Saudi Arabia over the past few days reported three new MERS-CoV cases in three difference cities, according to an update to the Ministry of Health's (MOH's) epidemiologic week 11 report.

On Mar 15, the MOH reported two of the cases, one of which involves a 41-year-old man from Abha whose exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is under investigation. The other patient is a 73-year-old man from Najran whose exposure to the virus is listed as primary, meaning he probably didn't contract MERS from another person. Both Abha and Najran are located in southwestern Saudi Arabia.

The third case—reported on Mar 16—involves a 50-year-old man from Al Kharj, located in central Saudi Arabia. The report didn't detail any exposure but noted that the man has recovered. None of the three men reported recent camel contact, a known risk factor.

Saudi Arabia has now reported 105 cases in 2019, including 57 linked to a large outbreak in Wadi ad-Dawasir that is mostly associated with healthcare exposure, though some illnesses were related to camel exposure.

In other MERS-CoV developments, Saudi Arabia's agriculture ministry yesterday reported that camels at a livestock market in Arar, located in the north, have tested positive for the virus, according to a notification from the World Organization for Animal Health (OIE). Of 10 susceptible camels, 2 tested positive. Last week the MOH reported a human case in Arar, in a 42-year-old man who had a history of contact with camels.
Mar 16 MOH report
Mar 17 OIE report on
MERS-CoV in Saudi Arabia

 

AAP gives no preference on flu vaccines, says no to vaccine exemptions

For the 2019-20 flu season, the American Academy of Pediatrics (AAP) said parents can feel free to choose either the injected or inhaled flu vaccine.

"All children six months and older should receive the flu vaccine, in whatever form their pediatrician recommends," said Bonnie Maldonado, MD, chair of the AAP Committee on Infectious Diseases, said in statement. "Every year, we are never sure if the vaccine strains are going to be perfectly matched up with incoming flu strains, but based on the information that we have now, we believe the nasal spray is an acceptable option."

Before this season, the APP recommended the injectable vaccine over the inhaled version, citing recent studies that showed the injected vaccine was more protective than the spray vaccine. During the 2016-17 and 2017-18 flu seasons, the APP did not recommend the spray at all. But reformulations of the inhaled vaccine have made it a strong option for children, the AAP said.

In other AAP news, during the AAP's annual leadership forum the group called for the elimination of religious exemptions to vaccination to be the top priority for the year, according to a news release.

Ending religion exemptions topped the list of 10 resolutions, which also included safeguarding children's health at the US-Mexico border and curbing to e-cigarette use among students.

"Given the measles outbreaks, prioritizing the elimination of religious vaccine exemptions is a timely undertaking," said AAP President Kyle E. Yasuda, MD.
Mar 14 AAP
statement
Mar 16 AAP
news release

 

Bangladesh probes another suspected Nipah cluster

Health officials in Bangladesh are investigating another suspected Nipah virus cluster, which if confirmed would be the second of the year, according to a local media report posted on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

The patients are a 28-year-old woman and her two children, ages 8 and 4, who are from Baliadangi upazila in Thakurgaon district, the same area where a fatal five-person family cluster was reported in early March. In the new suspected cluster, the three people became ill with fever, headache, and vomiting and were admitted to Rangpur Medical College Hospital on Mar 14.

The woman's husband said his wife and children got sick after eating jujube fruit on Mar 13. According to the media report, samples were collected for testing, and a medical team from the Institute of Epidemiology, Disease Control, and Research is slated to visit the hospital.

Nipah virus is harbored by bats, which can transmit the disease to people and other animals. Bat droppings containing the virus can contaminate fruit and raw date palm sap.
Mar 17 ProMED Mail post
Mar 4 CIDRAP News scan on
earlier Nipah cluster

 

H5N1 avian flu strikes poultry in Nepal as Denmark detects low-path H7

In the latest avian flu developments, Nepal reported two highly pathogenic H5N1 outbreaks in poultry, Denmark reported low-pathogenic H7 at a duck farm, according to separate reports from the OIE.

In Nepal, outbreaks occurred at two commercial layer farms, one in Narayani zone that began on Feb 14 and the other in neighboring Bagmati zone that began on Feb 28. Both zones are in the central part of the country. Between the two events, the virus killed 12,369 of 56,746 birds.

So far, the source of the virus isn't known. The OIE report said the outbreaks were marked by sudden deaths of many laying hens. Nepal's last H5N1 outbreak occurred in September 2018.

The low-pathogenic H7 outbreak in Denmark occurred at a mallard breeding farm in the city of Brenderup, located in the south. The H7 virus was detected on Mar 14 during surveillance, and the birds had no clinical signs. According to the OIE report, the outbreak is Denmark's first involving the strain.

All 3,300 susceptible birds were culled on Mar 15 to curb the spread of the virus.
Mar 17 OIE report on H5N1 in Nepal
Mar 15 OIE report on
low-path H7 in Denmark

Stewardship / Resistance Scan for Mar 18, 2019

News brief

US data show overall drop in antibiotic prescribing, but not for adults

US nationwide prescribing data show that oral antibiotic prescription rates dropped 5% from 2011 to 2016, and the ratio of broad- to narrow-spectrum antibiotics decreased 8% in that span, but prescribing rates in adults rose slightly, according to a new study in Clinical Infectious Diseases.

The investigators, from the Centers for Disease Control and Prevention, used prescription information from the IQVIA Xponent database over the 6-year study period. They used Poisson models to estimate prevalence ratios to compare 2011 and 2016 antibiotic prescription rates and linear models to evaluate temporal trends.

The researchers found that oral antibiotic prescription rates decreased 4.7%—from 877 prescriptions per 1,000 people in 2011 to 836 per 1,000 people in 2016. Prescription rates for pediatric patients (19 and younger) fell 13.0%, while adult rates actually increased a bit, by 1.7%. The ratio of broad- to narrow-spectrum antibiotics dropped from 1.62 to 1.49, or 8.0%, driven by reductions in macrolides and fluoroquinolones.

The proportion of prescriptions written by nurse practitioners and physician assistants increased by 95.0% and 58.5%, respectively, during the study period, and these professionals accounted for more than a fourth of all antibiotic prescriptions by study's end.

The authors conclude, "Although overall and broad-spectrum antibiotic prescriptions decreased during the study period, there are likely further opportunities to improve prescribing, especially to adults, and additional stewardship interventions are needed." They add that antimicrobial stewardship efforts need to include nurse practitioners and physician assistants.
Mar 16 Clin Infect Dis abstract

 

Support for shorter antibiotic course for Pseudomonas in bloodstream

Patients receiving short-course antibiotic therapy for uncomplicated Pseudomonas aeruginosa bloodstream infection (BSI) had similar odds of recurrent infection or death as those receiving longer courses, and spent fewer days in the hospital, researchers from Johns Hopkins University School of Medicine reported today in Clinical Infectious Diseases.

Overall, 361 patients treated in the Johns Hopkins Health System for P aeruginosa BSI from July 2016 through October 2018 were evaluated, and 249 met the eligibility criteria for the study. Sixty-nine patients (28%) received short-course therapy (median duration, 9 days) and 180 (72%) received long-course therapy (median, 16 days). Sixty-five percent of the cohort consisted of severely immunosuppressed patients. Antibiotics prescribed included piperacillin/tazobactam, cefepime, ciprofloxacin, meropenem, and ceftazidime.

In the propensity-score weighted cohort, the primary outcome of recurrent P aeruginosa infection or mortality within 30 days of completing therapy occurred in 10 (14%) of patients in the short-course group and 24 (13%) of patients in the long-course group (odd ratio, 1.06; 95% confidence interval [CI], 0.42 to 2.68, P = 0.91). On average, patients who received short-course therapy spent 4 fewer days in the hospitals compared with patients receiving longer courses (4.04 days; 95% CI, 1.25 to 6.83, P = 0.005).

The authors of the study say further interventional studies are needed to evaluate the reproducibility of the findings
Mar 18 Clin Infect Dis abstract

 

Antibiotic-releasing 'envelope' for cardiac devices tied to less infection

A study yesterday in the New England Journal of Medicine showed that an added antibacterial mesh envelope led to 40% fewer infections related to major cardiac implantable electronic devices (CIEDs) than did standard infection-prevention strategies alone.

The researchers used an absorbable TYRX envelope designed to hold a CIED—such as a pacemaker—when the device is implanted in the body. The envelope, made by Medtronic, consists of a multifilament knitted mesh coated with an absorbable polymer mixed with minocycline and rifampin, which releases the antibiotics into surrounding tissue for at least 7 days. The envelope is fully absorbed by the body in about 9 weeks, the authors said.

The scientists randomized 3,495 patients to the envelope group and 3,488 patients to the control (standard treatment) group. After 1 year, 6.0% of patients in the envelope group and 6.9% of patients in the control group had infections, for a hazard ratio (HR) of 0.87 (95% confidence interval [CI], 0.72 to 1.06; P < 0.001 for non-inferiority). The mean follow-up was 20.7 months, and major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group (HR, 0.63; 95% CI, 0.40 to 0.98).

The authors conclude, "Adjunctive use of an antibacterial envelope resulted in a 40% lower incidence of major CIED infection than standard-of-care infection-prevention strategies alone. Patients who received the envelope did not have more procedure-related or system-related complications than those who did not receive it."
Mar 17 N Engl J Med study

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