News Scan for Apr 23, 2019

Ebola total grows by 13
;
Diagnostic stewardship intervention
;
Polio in Pakistan
;
Third dose of MMR vaccine
;
MERS diagnostic delay

DRC Ebola surge pushes on, with 13 more cases

The Democratic Republic of the Congo (DRC) health ministry today reported another double-digit rise in Ebola cases, raising the overall total to 1,353 illnesses, according to its daily update.

The 13 cases are all from current epicenters: Katwa (5), Vuhovi (4), and 1 each in Butembo, Mabalako, Masereka, and Beni. Also, health officials are still investigating 68 suspected cases.

Six more people died from Ebola, including two in community settings in Butembo and Masereka and four in Ebola treatment centers in Butembo and Katwa. The outbreak has now claimed 880 lives.

The country's health minister Oly Ilunga Kalenga, MD, was in Butembo today to comfort response teams in the wake of an Easter weekend attack on outbreak responders that killed an epidemiologist working for the World Health Organization (WHO). He urged teams not to give up and to continue reaching out to the wounded population.

The health minister acknowledged new condemnations from community leaders that had until now been silent, and during his visit he was greeted by a delegation of customary chiefs who assured him they were engaged in educating the community and getting their cooperation with the response.
Apr 23 DRC update

 

Diagnostic stewardship intervention reduces inappropriate use of GI test

Implementing a "hard stop" in a hospital's electronic medical record system significantly reduced inappropriate use of a rapid diagnostic test for gastrointestinal pathogens and saved more than $160,000 over 15 months, researchers from the University of Nebraska Medical Center report today in Infection Control and Hospital Epidemiology.

In a quasi-experimental study conducted at an 830-bed tertiary care medical center, the researchers measured the impact of a diagnostic stewardship intervention on the use of the FilmArray Gastrointestinal Panel (GIPP), a rapid multiplex panel that can detect 22 common pathogens in patients who have diarrhea.

The hospital has used the GIPP since 2015 in lieu of traditional stool culture, but concerns about inappropriate use led to an antimicrobial stewardship program (ASP) intervention that included updated guidelines on appropriate use and an order validation alert in the electronic medical record. The alert appears when users attempt to order the GIPP more than once per admission or in patients hospitalized more than 72 hours, and an override requires clinicians to call the microbiology lab director.

A comparison of the preintervention period (January 2016 through March 2017) and the postintervention period (April 2017 though March 2018) showed that the rate of GIPP test ordering dropped from 7.48 per 1,000 patient-days to 5.24 per 1,000 patient-days. The Poisson model estimated a 30% reduction in GIPP ordering rates between the two periods (relative risk, 0.70; 95% confidence interval, 0.63 to 0.78, P < .001). Furthermore, the rate of inappropriate tests ordered declined from 21.5% to 4.9% (P < .001). When including encounters in which the GIPP was initiated but not completed, testing was reduced by 46%, for a potential savings of $168,000.

The authors of the study conclude, "Responsible test ordering of low-yield tests such as the GIPP leads to significant cost savings without affecting high-quality patient care. This study and our results highlight the value of diagnostic stewardship in ASP and collaboration with the microbiology laboratory."
Apr 23 Infect Control Hosp Epidemiol abstract


New polio cases recorded in Pakistan as policeman killed in Bannu

Today officials in Pakistan recorded two more polio cases, one in North Waziristan and the other in Bannu, as a policeman in Bannu protecting vaccination efforts was gunned down.

According to media reports, the attack on the policeman was linked to a personal grudge, and not a statement on vaccination efforts.

The two new cases raise Pakistan's polio case counts for 2019 to eight. The wild poliovirus infections occurred in a 2-year-old girl from North Waziristan, and a 22-month-old boy from Bannu. Health officials said the children's parents were responsible for the cases, implying they had refused vaccination.

Pakistan has currently suspended a vaccine campaign after several protests and demonstrations overwhelmed local hospitals and vaccinators.
Apr 23 Dawn
story
Apr 23 Pakistan Today
story

 

Third dose of MMR may be useful in mumps outbreaks, study finds

According to a study today in The Journal of Infectious Diseases, a third dose of the measles, mumps, and rubella (MMR) vaccine illicit a good immune response and was safe in healthy adult volunteers.

Waning protection from the two doses of MMR most people get in childhood is likely a culprit in adults' susceptibility to mumps. In this study, researchers in the Netherlands gave a third dose of the MMR vaccine (MMR-3) to 150 volunteers ages 18 to 25, who had no history of mumps and had received two MMR doses in childhood. Blood samples were collected at the time of MMR injection, and 1 month and 1 year after.

No serious adverse outcomes were reported, though 12% of participates reported localized pain at the injection site. Thirty-three percent of the participants reported one or more systemic adverse events, including the swelling of neck glands (16%) or joint and muscle pain (18%), the authors said.

The authors said 77.6% of the study group was estimated to be protected against mumps virus infection prior to vaccination, based on antibody titer levels, which increased to 85.7% and 85.8%, respectively, at 4 weeks and 1 year following vaccination.

"According to the defined cutoff levels that were determined based on pre-outbreak sera, approximately 20% of the young adults in our study was expected to be susceptible for mumps virus infection prior to MMR-3 receipt," the authors concluded. "Our data support that MMR-3 vaccination is a good and safe manner to control a mumps outbreak."
Apr 23 J Infect Dis
study

 

MERS diagnosis delay linked to patient, health-system delays

Both patient delays in seeking medical care and health-system delays contributed to the diagnostic delay of MERS-CoV (Middle East respiratory syndrome coronavirus). The findings are published in the Journal of Infection and Public Health.

The study was based on medical records of 266 MERS patients, reported by the WHO from January 2017 through May 2018. The patients were mostly men (71.8%), and 94% were from Saudi Arabia, with 30.5% directly exposed to camels.

The authors found the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile range [IQR], 3-8 days), 4 days (IQR, 2-7 days), and 2 days  (IQR, 1-2 days), with both patient and health-system delays positively correlated with a diagnostic delay.

Diagnostic delays contribute to nosocomial MERS outbreaks, the authors write.

"Early MERS-CoV diagnosis remains a major challenge and may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system," they concluded.
Apr 18 J Infect Public Health
study

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