News Scan for Mar 26, 2019

Limits of rapid diagnostics
;
Measles in Michigan, NY
;
More Lassa in Nigeria

Vietnamese study shows limits of rapid diagnostics technology

A randomized controlled trial of rapid diagnostics technology in two hospitals in Vietnam found no improvement in antimicrobial therapy compared with traditional microbiologic methods, according to a study in the Journal of Infection.

The study aimed to determine whether matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF-MS), which can accurately identify cultured bacteria or fungi within minutes, increased the number of patients with confirmed infection on optimal antimicrobial therapy when compared with conventional microbiological identification. While MALDITOF-MS has been shown to improve clinical decision-making in high-income settings when combined with antimicrobial stewardship programs (ASPs), the benefits of the technology in relation to clinical end points have not been explored in low-income settings.

To compare the two diagnostic methods, researchers recruited patients with a pathogen cultured from a normally sterile sample and randomly assigned samples to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion of patients on optimal antimicrobial therapy within 24 hours of positive culture.

Among 1,005 randomized patients, pathogens were isolated from 628, with 326 in the MALDITOF-MS arm and 302 in the control arm. The proportion receiving optimal therapy within 24 hours was not significantly different between the two arms (135/326, 41.4% vs 120/302, 39.7%; adjusted odds ratio [aOR], 1.17; P = 0.40). There was also no difference in the secondary outcome, which was the proportion of patients on optimal therapy within 48 hours of positive culture (151/326, 46.3% vs 141/302, 46.7%; aOR, 1.05; P = 0.79). Nor did MALDITOF-MS have any impact on other outcomes explored, including time taken to provide optimal antibiotic therapy, total antibiotic therapy, patient outcomes, or time in intensive care.

The authors of the study say the findings indicate that technological advances in rapid diagnostics technology, in the absence of an ASP, do not always lead to improvements in clinically relevant outcomes.

"In conclusion, our study showed no improvement in antimicrobial prescribing or other patient or provider centred outcomes through MALDITOF-MS, though MALDITOF-MS did produce results rapidly in our setting," they write. "While MALDITOF-MS has many other compelling advantages, our findings suggest that it is unlikely to lead to improvements in prescribing on its own."
Mar 23 J Infect study

 

Michigan officials report 18 measles cases linked to Israeli traveler

At least 18 people in Oakland County, Michigan, have contracted measles in an outbreak that began Mar 13, according to an update yesterday from the Michigan Department of Health and Human Services and the Oakland County Health Division

The Detroit Free Press reportedthe cases stemmed from an ill Israeli traveler who visited Oakland County from Mar 6 through Mar 13. Michigan health officials have held several vaccine clinics in that county in the past 2 days, already reaching more than 970 people.

Several synagogues, kosher food markets, and health clinics are listed as possible sites of exposure. According to health officials, vaccination within 72 hours of exposure can help prevent the disease.

Meanwhile, health officials in New York's Rockland County have declared a state of emergency as a measles outbreak in the Orthodox Jewish community continues to grow. 

Beginning tomorrow, unvaccinated minors will be banned from public spaces until the emergency declaration ends in 30 days, ABC news reported.

Rockland County has recorded 153 cases of measles in an outbreak that began last September, and 82.1% of case-patients are unvaccinated, another 4.0% are undervaccinated, and the immunization status of 9.9% is unknown. As in the Michigan outbreak, Rockland County’s outbreak began with a foreign traveller visiting the community.
Mar 25 Oakland County Health Division
news release
Mar 25 Detroit Free Press
article
Mar 26 ABC News
story
Mar 26 Rockland County measles
update

 

Lassa fever outbreak in Nigeria nears 500 cases

The Lassa fever outbreak in Nigeria grew by 23 cases in the past week, according to the latest update from the Nigerian Centre for Disease Control (NCDC). The confirmations raise outbreak totals since Jan 1 to 495 confirmed cases, including 114 deaths.

The agency also noted 15 probable cases.

The new cases and deaths raised the case-fatality rate to 23% from 22.1%, but last week's totals are less than the previous week's, suggesting a possible return to the declining trend recorded throughout February and part of early March.

Of note, one of the new cases is in healthcare worker, the 16th infected in this outbreak.

Lassa fever is usually transmitted by infected rodents or food contaminated with rodent urine or feces, but human-to-human transmission has been noted in the Nigerian outbreak.
NCDC
situation report for week ending Mar 17

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