CDC: 79 more illnesses in multistate outbreak linked to raw turkey

The US Centers for Disease Control and Prevention (CDC) today posted a final investigation update for a Salmonella Reading outbreak that it first announced in July 2018, which reflects 79 new cases since its last report in February, lifting total cases to 358 in 42 states.

The latest illness onset was Mar 31, and though the number of illnesses has declined, cases still continue to be reported, the CDC said. Investigations over the past months have found that the multidrug-resistant Salmonella strain is present in live turkeys and many types of raw turkey products. Several products, including raw ground turkey and raw turkey pet food, were recalled, but health officials have said they don't account for all of the illnesses, and a single common supplier has not been identified. Federal health officials have shared the information with turkey industry representatives.

Of the 302 people with available information, 133 (44%) were hospitalized and 1 death was reported. Of patients interviewed, 130 (65%) got sick after eating turkey products that were purchased raw, and 4 became ill after pets in their homes ate raw ground turkey pet food. Five worked in facilities that raise or process turkeys. In February, 47 people in Iowa got sick after eating turkey that wasn't prepared properly at an event, the agency said.

The CDC said it continues to monitor for more cases, interview sick people, and analyze Salmonella isolates for antibiotic resistance patterns. It added that it will provide future updates if there is an increase in new cases. The agency urges consumers to treat raw turkey properly, such as washing hands before and after handling the products and cooking the products thoroughly.
Apr 30 CDC final outbreak update

 

Philippines, Nigeria report growing measles outbreaks

The Philippines will launch a measles vaccination campaign when school starts the first week of June, to target millions of elementary age children, the nation's department of health announced today, according to GMA News.

Of 8.5 million elementary school children, only around 944,000 have been immunized from measles since February. In January, the country saw the beginning of a large-scale measles outbreak, with more than 31,000 cases recorded from Jan 1 to Apr 13.

Although 93% of children under age 5 years and 42% of those 12 and older, have been vaccinated in the last several months, national campaigns missed elementary school children because the campaign was launched at the end of the school year, then students went on break.

The Philippines, Ukraine, Israel, and other nations are experiencing measles outbreaks that have resulted in imported cases in the United States.

Also, the World Health Organization's (WHO's) African regional office said Nigeria is still facing a growing measles outbreak, concentrated in Borno state. Since Jan 1, a total of 20,127 cases and 50 deaths (case-fatality rate, 0.25%) have been recorded in the country. Borno state accounts for 48.4% of cases.

Borno, Katsina, and Yobe states have launched or will soon launch extensive vaccination campaigns, the WHO said.

"The measles outbreak in Nigeria is occurring at a time when there is a global rise in measles cases. The high incidence and recurrent outbreaks of measles are linked to sub-optimal immunization coverage," the WHO said.
Apr 30 GMA News
story
Apr 28 WHO African Regional
report

 

WHO: Second wave of flu seen in South Korea

According to the latest global flu update from the WHO, flu activity is decreasing in most regions in the Northern Hemisphere, but hot spots remain.

Countries in North America, Europe, North Africa, and most of West Asia are recording fewer flu cases, the WHO said. In those regions, H3N2, an influenza A strain, was predominant in the 2018-19 flu season. An exception in the WHO West Asian region is Saudi Arabia, which is still reporting high levels of influenza and respiratory illness.

In East Asia, influenza activity was reported in some countries, with influenza B viruses most frequently detected, followed by H3N2.

"In the Republic of Korea, influenza activity continued to increase with influenza B most frequently detected followed by influenza A(H3N2) viruses, after a first wave of influenza activity predominated by influenza A(H1N1)pdm09 virus," the WHO said.

Of global flu specimens tested in the first half of April, 83.9% were typed as influenza A and 16.1% as influenza B. Of the influenza A viruses, 32.8% were H1N1 and 67.2% were influenza H3N2.
Apr 29 WHO
update

 

Study: Coinfection with multiple flu viruses linked to cardiopathy, death

Coinfections with multiple influenza subtypes at the same time is linked to more severe outcomes, according to a study yesterday in The Journal of Infectious Diseases.

The study was based on specimens collected from 34,459 patients with respiratory infection from 2009 to 2018 in Rio Grande do Sul, Brazil, of which 8,011 were positive for influenza A or B viruses. Eighteen of the cases showed dual infections with two influenza strains, and one case showed a triple influenza strain infection.

The 19 coinfection cases were compared with 76 mono-infected controls. No difference was seen in flu vaccine uptake in either group. And although hospitalization rates were similar for both groups, co-infected individuals were more likely to be admitted to an intensive care unit (33.3% vs 13.6%).

"Conjunctivitis (21.0% vs. 7.3%) and low oxygen saturation (26.3% vs. 14.5%) were more frequent among coinfected than mono-infected patients," the authors concluded. "Cardiopathy was more common among coinfected than mono-infected patients (35.3% vs.13.3%, p=0.035). In total, 21.1% of the coinfected and only 5.3% of mono-infected patients deceased."
Apr 29 J Infect Dis study

 

HPV vaccine coverage rates lag behind 2020 goal

During the Pediatric Academic Societies (PAS) 2019 meeting last week and this week, researchers presented data showing that, despite increasing uptake trends, human papillomavirus (HPV) vaccination rates in the United States fall far below the Healthy People 2020 goal of 80% coverage.

Researchers used data from a cohort study of 7.5 million children and adolescents to compare vaccine rates in 2011 to 2016. Children were enrolled at age 9 and followed through their first dose of HPV vaccine, death, end of insurance coverage, or the end of the year when they turned 17.

HPV vaccine coverage among girls and boys by age 15 increased from 38% and 5%, respectively, in 2011, to 54% and 45%, respectively, in 2016. 

"The HPV vaccine uptake varied substantially across states and, by 2016, it was above 60% for 15-year-old girls and boys only in 13 and three states, respectively," according to a PAS press release.
Apr 27 PAS
press release

 

Attacks prompt pause in Pakistan polio vaccination

A dramatic spike in deadly attacks on Pakistan's polio workers and police officers who protect them has led the country to suspend a polio vaccination campaign that had a goal of immunizing 40 million children under age 5, according to media reports.

Pakistan is one of three countries in which wild poliovirus is still endemic, and the attacks and the halt in vaccination activities mark the latest setback in eradicating the disease. The country has reported six wild poliovirus type 1 (WPV 1) cases so far this year.

Two police officers accompanying polio teams were killed in separate attacks in different locations this month, and over the past several days, polio workers have been attacked in four different locations, with a 35-year-old woman shot and killed in one of the incidents, The Guardian, a UK newspaper, reported today.

According to the report, the violence was preceded by rumors and a viral video that circulated on Facebook of a man claiming that children were getting sick after the polio vaccinations, which prompted thousands of children to be taken unnecessarily to hospitals by worried parents.
Apr 30 Guardian story

Stewardship / Resistance Scan for Apr 30, 2019

News brief

Rapid susceptibility test promising for optimal antibiotics in bacteremia

South Korean scientists have demonstrated strong potential of a rapid antimicrobial susceptibility test called QMAC-dRAST for selecting optimal targeted antibiotics for patients who have bacteremia, according to a study today in the Journal of Antimicrobial Chemotherapy.

The test is made by QuantaMatrix Inc, a South Korean company, and the study was conducted by researchers from the National University College of Medicine in Seoul and QuantaMatrix. They compared QMAC-dRAST, which can produce results within 6 hours, with MALDI-TOF MS, a type of mass spectrometry that can yield results in less than an hour and has been successfully used for selecting empirical antibiotics for bloodstream infections.

The investigators assessed 359 patients who had positive blood cultures, and infectious disease (ID) physicians decided on antibiotic regimens with consensus at each time point of receiving results of Gram staining, MALDI-TOF MS, and antimicrobial susceptibility testing (AST) using QMAC-dRAST.

The ID physicians with MALDI-TOF MS results chose optimal targeted antibiotics in 255 cases (71.0%), with appropriate antibiotic selection in 303 (84.4%). The proportion of optimal targeted antibiotic selection and appropriate antibiotic selection was significantly lower for resistant strains than for susceptible strains (62.5% vs 79.2% and 68.2% vs 100%, respectively).

QMAC-dRAST results led to optimal antibiotic treatment in 95 (91.3%) of the 104 cases receiving non-optimal targeted antibiotics. Optimal targeted treatments based on QMAC-dRAST results were possible in 322 (98.2%) of the 328 cases with monobacterial infection and in 345 (96.1%) of the 359 cases with monobacterial and polymicrobial infection.

The authors conclude, "MALDI-TOF MS has a high chance of failure in guiding ID physicians to optimal antibiotics, especially against resistant organisms. With increasingly common resistant organisms, rapid AST is needed to identify optimal targeted antibiotics early in bacteraemia."
Apr 30 J Antimicrob Chemother abstract

 

CARB-X announces new funding rounds

CARB-X today announced four new rounds of funding for companies seeking to develop novel antibiotics and other products to address drug-resistant infections.

Each of the four funding rounds has a specific scope and different application period: Round 1 will be restricted to non-traditional approaches, round 2 to vaccines and biotherapeutics, round 3 to diagnostics, and round 4 to direct-acting small molecule antibiotics. CARB-X is planning a webinar on May 16 to discuss the funding rounds and the application process.

Since its inception in June 2016, CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) has awarded more than $110 million in funding to 42 projects that seek to address high-priority drug-resistant bacteria. In addition to financial support, CARB-X also provides scientific and business advice to help move the projects through the early development phases.

"Our goal is to select the best, most innovative projects that have the potential to prevent, diagnose and treat drug-resistant infections that are killing hundreds of thousands of people each year worldwide," CARB-X executive director Kevin Outterson, JD, said in a press release. "We plan to grow the portfolio through these funding rounds and expand the number of different approaches to increase the chances of delivering urgently-needed medicines and diagnostics to patients."
Apr 30 CARB-X press release

 

CRE bloodstream infections linked to worse outcomes in poorer countries

The results of a multinational study yesterday in The Lancet Infectious Diseases show that carbapenem resistance is associated with longer hospital stays and increased mortality in patients with bloodstream infections in low- and middle-income countries (LMICs).

The study, conducted at 16 tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam from August 2014 through June 2015, included 297 patients with carbapenem-resistant Enterebacteriaceae (CRE) and carbapenem-susceptible Enterobaceteriaceae (CSE) infections.

The researchers wanted to compare outcomes in the two groups because while CRE bloodstream infections have been associated with poorer outcomes, most studies have been conducted in high-income countries. Multistate-modeling was used to estimate excess length of hospital stay associated with carbapenem resistance, and proportional subdistribution hazards models were applied to estimate the effect of carbapenem resistance on in-hospital death and probability of discharge alive.

Crude mortality was 20% for patients with CSE bloodstream infection (35 of 174) and 35% for those with CRE bloodstream infection (43 of 123 patients). Carbapenem resistance was associated with increased length of hospital stay (3.7 days, 95% confidence interval [CI], 0.3 to 6.9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio [HR], 1.75; 95% CI, 1.04 to 2.94), and decreased probability of discharge alive (HR, 0.61; 95% CI, 0.45 to 0.83).

Multilocus sequence typing of patient isolates identified various clades of Escherichia coli and Klebsiella pneumoniae (the two most common species of Enterobacteriaceae detected), with marginal overlap between strains in the CRE and CSE clades. Polymerase chain reaction screening of 208 isolates revealed that blaNDM and blaOXA-48-like were the most commonly identified carbapenemase-encoding genes.

"This study contributes to an improved understanding of the scale of the emerging threat of carbapenem-resistance in LMICs," the authors of the study write. "In the future, affordable surveillance mechanism, interventions to prevent infection, and management strategies should be developed to reduce the burden of bloodstream infections caused by CRE in LMICs."

An accompanying commentary says the findings indicate global action against CRE is needed. "At a minimum, every country should have a national action plan tasked with measuring the prevalence of CRE and other resistant phenotypes, promoting the prudent use of antibiotics in health care and in animal husbandry, immunising their population, and investing in water sanitation," write Federico Perez, MD, and Robert Bonomo, MD, of the Louis Stokes Cleveland Veteran Affairs Medical Center and Case Western Reserve University.
Apr 29 Lancet Infect Dis abstract
Apr 29 Lancet Infect Dis comment

 

Hospital intervention reduces treatment for asymptomatic bacteremia

Raising the threshold for identifying uropathogens from inpatient urine cultures averted treatment for asymptomatic bacteriuria and candiduria (ASB/C) in nearly a third of patients at an acute care hospital, Canadian researchers reported yesterday in JAMA Internal Medicine.

In a research letter, clinicians from Sunnybrook Health Sciences Centre in Toronto describe a controlled interrupted time series study conducted after the hospital raised the threshold for identifying and reporting growth in urine cultures from 104 colony-forming units per milliliter (CFU/mL) to 105 CFU/mL. With this change, all urine cultures with low colony counts (defined as 104 to 105 CFU/mL) were issued with a report stating that these organisms usually represent ASB/C, which does not require antibiotic therapy.

In the study, the clinicians compared the rate of monthly treatment for ASB/C in the period before and after the threshold was raised; secondary outcomes included days of antibiotic therapy and a composite clinical outcome of hospital readmission, death, or transfer to clinical care within 14 days.

Over 2 years, there were 609 patients (30%) with a low colony count and 1,432 (70%) with a high colony count, of which 608 and 690 were included in the analysis, respectively. The results showed that the intervention was associated with a reduction in antibiotic prescribing for ASB/C in the low-colony-count group compared with the high-colony-count group (incidence rate ratio, 0.14; 95% CI, 0.03 to 0.64, P = .01). There were no significant clinical changes between the two groups.

The authors say raising the threshold to 105 CFU/mL was associated with sustained reduction of antibiotic prescribing for ASB/C on the order of 70 fewer treatment courses per year, which would avert an estimated 14 adverse drug events annually.
Apr 29 JAMA Internal Med abstract

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