ASP Scan (Weekly) for Aug 23, 2019

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Survey finds improved antibiotic stewardship programs in nursing homes

A national survey has found that antibiotic stewardship programs (ASPs) in US nursing homes have become more comprehensive since the Centers for Medicare and Medicaid (CMS) required the facilities to have them, researchers from Columbia University School of Nursing reported yesterday in the American Journal of Infection Control.

In the nationally representative survey, conducted in 2018, ASP comprehensiveness was defined by the number of policies, based on the Centers for Disease Control and Prevention's core stewardship elements, that nursing home staff reported having in place. Those reporting six or more policies were defined as "comprehensive," while those with four to five in place were defined as "moderately comprehensive," and those with three or fewer were labeled "not comprehensive."

The survey also asked about infection preventionist (IP) training and certification; on-site staffing of advanced practice registered nurses, physician assistants, and pharmacists; and involvement in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) initiatives.

Of 861 nursing homes that completed the survey, 33.2% had "comprehensive" ASP policies, 41.1% had "moderately comprehensive" ASP policies, and 25.6% had "not comprehensive" ASP policies. Overall, the rates of inclusion of specific policies ranged from 19.0% for restriction of specific antibiotics to 91.4% for data collection on antibiotic use, with 65.7% reporting use of antibiotic prescribing guidelines. Forty-six percent of nursing homes reported that their IP had no specific infection control training. Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy.

A 2013-2014 national survey found that only 51% of CMS-certified nursing homes collected antibiotic use data, and 46% had written guidelines for antibiotic initiation. In November 2017, CMS finalized a rule requiring nursing homes to have an ASP in order to receive Medicare and Medicaid payments.

"ASPs in NHs [nursing homes] are showing signs of increased comprehensiveness as indicated by the inclusion of more policies since the implementation of the CMS Final Rule," the authors of the study conclude. "Certain policies may be more easily adopted, whereas others may require more intensive efforts."
Aug 22 Am J Infect Control study

 

Biotech organization to lead new antimicrobial resistance coalition

The Biotechnology Innovation Organization (BIO) this week announced the launch of a new coalition to raise public awareness of antimicrobial resistance (AMR) and advocate for policies to stimulate new antibiotic development.

The "Working to Fight AMR" coalition will be led by BIO, a trade organization that represents biotechnology companies and related organizations, and will include scientists, public policy experts, and industry leaders. The group says that, in addition to educating the public, it will advocate for policies like the DISARM Act, which calls for higher Medicare reimbursement for new antibiotics that treat serious or life-threatening infections.

"Antimicrobial resistance already poses a grave threat to human health—and it is a looming public health emergency," Greg Frank, PhD, BIO's director of infectious disease policy, said in a press release. "Working to Fight AMR will advocate for policies to boost investment in this deeply neglected area."
Aug 21 Working to Fight AMR press release

 

Move to single-bed hospital rooms linked to less MRSA, VRA colonization

A Montreal hospital's move to single-patient rooms was associated with reduced colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), along with fewer VRE infections, Canadian researchers reported in JAMA Internal Medicine. But no change in MRSA infection or Clostridioides difficile infection (CDI) was found.

The time-series analysis compared institution-level rates of new multidrug-resistant organism colonization and healthcare-associated infections at Montreal's Royal Victoria Hospital before and after patients were moved to a newly constructed hospital on Apr 26, 2015. The original hospital, built in 1893, was a mix of three- and four-bed ward rooms and single rooms; the new building consisted entirely of single-bed rooms with individual toilets and showers and easy access to sinks for hand washing.

Compared with the 27 months before the hospital move, the analysis found during the 36 months after the move an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonization events; incidence rate ratio [IRR], 0.25; 95% confidence interval [CI], 0.19 to 0.34) and MRSA colonization (from 129 to 112 colonization events; IRR, 0.57; 95% CI, 0.33 to 0.96), as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12 to 0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51 to 1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34 to 2.29) did not decrease.

"The changes in VRE and MRSA colonization appeared to be temporally associated with the move with an immediate apparent difference and no subsequent return to historical levels," researchers from McGill University write. "This reduction occurred despite demographic changes that increased the high-risk tertiary care population, notably in hematology-oncology, complex surgery, and severe, end-stage respiratory diseases."

The researchers note that while their study could not account for other infection control and antimicrobial stewardship interventions that were going on simultaneously at the hospital, they believe the findings support the concept that moving to single-bed facilities could reduce the transmission of specific multidrug-resistant organisms.
Aug 19 JAMA Internal Med study

 

Pfizer Foundation to fund groups fighting infectious diseases, AMR

Originally published by CIDRAP News Aug 22

The Pfizer Foundation this week announced $2 million in grants to help non-governmental organizations, non-profits, and social enterprises in low- and middle-income countries address infectious disease challenges, including the growing threat of AMR.

According to a Pfizer Foundation press release, the 20 recipients of the 1-year Global Health Innovation Grants will each receive $100,000 to develop sustainable solutions to overcome infectious diseases, which cause an estimated 8.4 million deaths annually. The focus of the projects is on strengthening local healthcare systems and building capacity to fight infectious diseases in low-resource settings.

Among the grant recipients is Nepal's Group for Technical Assistance, which will develop and implement an e-learning platform and website to help health facilities across the country set up AMR programs.

"Mounting infectious disease outbreaks and the threat of large-scale antimicrobial resistance are increasingly becoming some of the most challenging global health needs of our time," said Pfizer Foundation president Caroline Roan. "We are dedicated to working with individuals and organizations in local communities as they rethink and scale innovative solutions to fight infectious diseases and from the ground up, providing effective solutions to those patients most in need."
Aug 20 Pfizer Foundation press release

 

African study finds multiple malaria populations, indicators of resistance

Originally published by CIDRAP News Aug 22

A large genomic study of malaria parasites in sub-Saharan Africa has identified several genetically distinct populations in different regions of the continent, along with genomic signatures that indicate selection by current antimalarial drugs. The findings appeared today in Science.

In the study, researchers with the Plasmodium Diversity Network Africa analyzed whole-genome sequences of 2,263 Plasmodium falciparum isolates from 15 African countries and identified genetically distinct subpopulations in West Africa, Central Africa, South Central Africa, East Africa, and Southeast Africa, plus a highly divergent population in Ethiopia. The researchers believe the emergence of these different parasite populations followed patterns of human migration on the continent, including migration brought on by colonization and slavery.

The analysis also found an extensive flow of genetic material across the region in all directions, including genes that confer resistance to antimalarial drugs. P falciparum isolates from two countries, Malawi and Ghana, shared changes in genomic region that could compromise the efficacy of artemisinin-based combination therapies (ACTs), which are the first-line treatment for uncomplicated P falciparum malaria.

"Whatever the historic factors affecting the flow of genes between the distinct P. falciparumpopulations, the multi-directional flow we've identified raises the prospect of continental spread of resistance to artemisinin-based combination therapies, which could arise from anywhere in Africa," study co-author Alfred Amambua-Ngwa, Phd, a professor at the Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, said in a press release from the Wellcome Sanger Institute, where the genomes were sequenced.

Amambua-Ngwa and his colleagues say the findings signal the need for broader molecular surveillance of malaria in sub-Saharan Africa to track the emergence and spread of ACT resistance.
Aug 22 Science study
Aug 22 Wellcome Sanger Institute press release

 

UK study details high inappropriate antibiotic prescribing in primary care

Originally published by CIDRAP News Aug 21

An analysis of the electronic health records of more than 1.6 million UK patients revealed that doctors don't always prescribe antibiotics according to guidelines, especially for upper respiratory tract infections (URTI) and otitis externa (outer ear passage infection), according to a study yesterday in the Journal of Antimicrobial Chemotherapy.

The main goal of the study was to look at how antibiotic prescribing deviated from national guidelines released in 2017. The research group focused on prescriptions after 2010 when Public Health England published its first guidelines for managing infections in primary care. The data they used cover about 8% of the UK population and were collected from January 2010 through June 2015.

The investigators found that the highest levels of prescribing not in accord with guidelines were for otitis externa (67.3%) and URTI (38.7%). Levels were relatively low for otitis media (3.4%), sinusitis (2.2%), lower respiratory tractions infections (LRTI) (1.5%), and urinary tract infection (UTI) in adults (2.3%), and UTI in children (0.7%).

Though not recommended for the conditions, amoxicillin was the most common drug prescribed for all respiratory tract infections except for URTI. Small variations in inappropriate prescribing was linked to the clustering effect at the practice level, and the group also found that patients with underlying health conditions were more likely to receive inappropriate antibiotics for URTI, LRTI, and UTI in adults.

The researchers concluded that future studies should examine how individuals' characteristics vary between practices and that future antibiotic stewardship activities should focus on urging primary care providers to cut back on amoxicillin use in favor of narrow-spectrum antibiotics.
Aug 20 J Antimicrob Chemother abstract

 

Combination drug for complicated UTIs shows promise in phase 3 trial

Originally published by CIDRAP News Aug 21

The results of a randomized non-inferiority trial conducted in India suggest a novel combination of two antibiotics and an antibiotic adjuvant could be a potential alternative to carbapenems for patients who have complicated urinary tract infections (cUTIs) caused by multidrug-resistant gram-negative pathogens.

In the phase 3 trial, published today in Open Forum Infectious Diseases, 230 adults at 17 sites with a diagnosis of cUTI, including acute pyelonephritis, were randomized 1:1 to receive either intravenous ceftriaxone, sulbactam, and disbodium EDTA (CSE) or intravenous meropenem. The addition sulbactam and disbodium EDTA (a known metal chelator) has been shown to expand the in vitro activity of ceftriaxone against beta-lactamase producing bacteria, and CSE has demonstrated efficacy in animal infection models. The primary objective of the trial was to show the noninferiority of CSE to meropenem in the microbiologic modified intent-to-treat (mMITT) population at the test-of-cure visit, with a non-inferiority margin of 10 percentage points.

The mMITT population consisted of 143 patients, with 74 receiving CSE and 69 receiving meropenem. Ceftriaxone non-susceptible pathogens were identified in 140 patients (97.9%), extended-spectrum beta-lactamase-producing pathogens in 119 (83.2%), and multidrug-resistant pathogens in 100 (69.9%).

Noninferiority of CRE to meropenem was demonstrated for both of the US Food and Drug Administration–defined co-primary end points. Seventy-one of 74 patients (95.9%) in the CSE group showed symptomatic resolution at test-of-cure, compared with 62 of 69 patients (89.9%) in the meropenem group (treatment difference, 6 percentage points; 95% confidence interval [CI], -2.6 to 16), and 70 of 74 patients (94.6%) in the CSE group showed both symptomatic resolution and microbiologic eradication at test-of-cure, compared with 60 of 69 (87.0%) patients (treatment difference, 7.6 percentage points; 95% CI, -2 to 18.4). Non-inferiority was also demonstrated for the European Medicine Agency primary end point (microbiologic eradication at test-of-cure). The safety profile of CSE was consistent with that of ceftriaxone alone.

"The results support the use of CSE as a potential alternative to carbapenems in the treatment of patients with cUTI or acute pyelonephritis, including infections caused by extended-spectrum beta-lactamase-producing gram-negative bacteria," the authors of the study conclude.

The study was supported by CSE developer Venus Remedies Limited, and three of the six authors are employees of the company.
Aug 21 Open Forum Infect Dis abstract

 

Study supports shorter parenteral antibiotics for infants with bacteremic UTIs

Originally published by CIDRAP News Aug 20

A study of infants who had bacteremic UTIs indicates that short-course parenteral antibiotic therapy may be considered as a treatment option, a team of US researchers reported today in Pediatrics.

In the multicenter retrospective cohort study, conducted at 11 geographically diverse US children's hospitals, researchers with the Febrile Young Infant Research Collaborative examined the association between parenteral antibiotic duration and clinical outcomes in infants younger than 60 days who had a UTI with concomitant bacteremia. UTIs are a common bacterial infection in young infants, and approximately 8% to 10% have bacteremic UTIs. Yet no evidence-based treatment guidelines exist in this population, and infants with bacteremic UTIs frequently receive prolonged courses of parenteral antibiotics, which can lead to complications, prolonged hospitalization, and increased costs.

The primary outcome of the analysis was UTI recurrence resulting in an emergency department visit or hospitalization within 30 days of discharge. Secondary outcomes included length of hospitalization and 30-day all-cause hospital reutilization.

Among the 115 infants treated for bacteremic UTIs from 2011 through 2016, 58 received short-course parenteral antibiotic therapy (defined as 7 days or less) and 57 received long-course antibiotics (7 days or more). Six infants had a recurrent UTI, and no significant difference was found in the rates of recurrent UTI between the two treatment groups (adjusted risk difference, 3%; 95% confidence interval [CI], –5.8 to 12.7). Fifteen infants had 30-day all-cause reutilization, with no significant difference found in the rates of reutilization between the two groups (adjusted risk difference, 3%; 95% CI, –14.6 to 20.4). The adjusted mean hospital duration was significantly longer in the long-course group compared with the short-course group (adjusted mean difference, 6 days; 95% CI, 4.0 to 8.8).

The authors of the study conclude, "Our data indicates that ≤7 days of parenteral antibiotic therapy may be safe in this population. Researchers in future prospective studies should seek to establish the bioavailability and optimal dosing of oral antibiotics in young infants and assess if there are particular subpopulations of infants with bacteremic UTI who may benefit from longer courses of parenteral antibiotic therapy."
Aug 20 Pediatrics study

 

CARB-X awards funds for developing vaccine against resistant Klebsiella

Originally published by CIDRAP News Aug 20

CARB-X today said it is awarding Vaxxilon AG of Reinach, Switzerland, up to $1.4 million—and possibly more—to develop a multivalent vaccine to prevent infections caused by carbapenem-resistant Klebsiella pneumoniae, an invasive and deadly gram-negative bacterium.

Arne von Bonin, PhD, chief scientific officer and head of immunology at Vaxxilon, said in a CARB-X news release, "CARB-X's award will support the development of VXN-319, a semi-synthetic conjugate vaccine targeting multiple strains of Klebsiella pneumoniae, one of the top priority critical pathogens identified by the World Health Organization."

Vaxxilon said it expects the vaccine would protect against more than 80% of carbapenem-resistant strains of K pneumoniae. To create VXN-319, Vaxxilon scientists synthesized the carbohydrates that resemble the coating that surrounds each bacterial cell. They then combined the synthetic carbohydrates with other components to create a conjugate vaccine similar to those that have been approved to prevent infections from bacteria such as Streptococcus pneumoniae and Haemophilus influenzae type B.

"Vaccines are vital tools in the fight against disease and drug-resistant bacteria, with the potential to prevent infections and reduce the spread of life-threatening bacteria," said Kevin Outterson, JD, CARB-X executive director and professor of law at Boston University. "Vaxxilon's vaccine, if approved for use in patients, could prevent deadly infections and save the lives of thousands of patients."

Vaxxilon could receive $3.1 million in additional funding if certain project milestones are met, according to CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator). Since its inception in 2016, CARB-X has announced awards for 46 projects in seven countries exceeding $134 million total.
Aug 20 CARB-X news release

 

Carbapenem susceptibility test results widely variable, study finds

Originally published by CIDRAP News Aug 19

A study by Italian investigators in Clinical Microbiology and Infection has found that commercial methods for testing carbapenem susceptibility produced widely variable results in a sample of carbapenemase-producing Escherichia coli, with none satisfying the criteria for acceptable antimicrobial susceptibility testing (AST) performance.

In the study, the researchers tested a total of 54 non-replicate K pneumoniae carbapenemase (KPC)-producing E coli isolates from two Italian hospitals for susceptibility to imipenem, meropenem, and ertapenem. They used the broth microdilution method (BMD) as a reference and several commercial testing systems (Vitek2, MicroScan, Etest, MIC Test Strip). Susceptibility to imipenem and meropenem was also tested by Sensititre and disk diffusion (Bio-Rad).

Results were interpreted according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) clinical breakpoints. Essential agreement (EA), category agreement (CA), and error rates were calculated as described by the International Organization for Standardization (ISO) guidelines and also considering the new EUCAST definitions.

Reference BMD results showed that, of the 54 KPC-positive E. coli isolates, 5.6%, 7.4%, and 0% were susceptible to the standard dosing regimen, 55.6%, 72.2%, and 0% were susceptible to increased exposure, and 38.9%, 20.4%, and 100.0% were resistant to imipenem, meropenem and ertapenem, respectively. CA lower than 90% was observed with all systems for imipenem and meropenem, using both the ISO and the modified EUCAST criteria. With ertapenem, CA greater than 90% was observed with all methods except Vitek2. Overall, for commercial methods returning minimum inhibitory concentration (MIC) values and for all molecules, the EA with the reference method was relatively low, with no method being acceptable according to the ISO criteria.

"This study suggests that, whatever semiautomated AST systems are used for testing KPC-producing E. coli, laboratories should always confirm carbapenems MICs with reference BMD in order to carry out an appropriate antimicrobial therapy," the authors of the study conclude.
Aug 16 Clin Microbiol Infect study

 

New Australian AMR hub launched

Originally published by CIDRAP News Aug 19         

The Australian Research Council (ARC) yesterday announced nearly $3.4 million in funding for a new AMR research center.

The ARC Research Hub to Combat Antimicrobial Resistance, which will focus on sexually transmitted microorganisms, aims to develop new technology to fight drug-resistant pathogens and guide investments in new antibiotics and diagnostics. The hub will bring together Australian universities, pharmaceutical and diagnostics companies, and healthcare partners and be led by Rebecca Guy, PhD, a professor of epidemiology the University of New South Wales.

"We plan to develop new molecular diagnostic technology and improve the processes for identifying potential new antibiotics," Guy said in a university press release. "The hub aims to connect the many complex facets of antimicrobial resistance, to provide a highly integrated diagnostic and pharmaceutical solution to the problem of antimicrobial resistance."

The ARC is contributing almost $5 million Australian ($3.4 million US) to the project. An additional $3.8 million Australian ($2.6 million US) is being provided by Australian-based biotech company SpeeDx and other industry partners. 
Aug 18 ARC press release
Aug 19 University of New South Wales press release

Stewardship / Resistance Scan for Aug 23, 2019

News brief

Survey finds improved antibiotic stewardship programs in nursing homes

A national survey has found that antibiotic stewardship programs (ASPs) in US nursing homes have become more comprehensive since the Centers for Medicare and Medicaid (CMS) required the facilities to have them, researchers from Columbia University School of Nursing reported yesterday in the American Journal of Infection Control.

In the nationally representative survey, conducted in 2018, ASP comprehensiveness was defined by the number of policies, based on the Centers for Disease Control and Prevention's core stewardship elements, that nursing home staff reported having in place. Those reporting six or more policies were defined as "comprehensive," while those with four to five in place were defined as "moderately comprehensive," and those with three or fewer were labeled "not comprehensive."

The survey also asked about infection preventionist (IP) training and certification; on-site staffing of advanced practice registered nurses, physician assistants, and pharmacists; and involvement in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) initiatives.

Of 861 nursing homes that completed the survey, 33.2% had "comprehensive" ASP policies, 41.1% had "moderately comprehensive" ASP policies, and 25.6% had "not comprehensive" ASP policies. Overall, the rates of inclusion of specific policies ranged from 19.0% for restriction of specific antibiotics to 91.4% for data collection on antibiotic use, with 65.7% reporting use of antibiotic prescribing guidelines. Forty-six percent of nursing homes reported that their IP had no specific infection control training. Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy.

A 2013-2014 national survey found that only 51% of CMS-certified nursing homes collected antibiotic use data, and 46% had written guidelines for antibiotic initiation. In November 2017, CMS finalized a rule requiring nursing homes to have an ASP in order to receive Medicare and Medicaid payments.

"ASPs in NHs [nursing homes] are showing signs of increased comprehensiveness as indicated by the inclusion of more policies since the implementation of the CMS Final Rule," the authors of the study conclude. "Certain policies may be more easily adopted, whereas others may require more intensive efforts."
Aug 22 Am J Infect Control study

 

Biotech organization to lead new antimicrobial resistance coalition

The Biotechnology Innovation Organization (BIO) this week announced the launch of a new coalition to raise public awareness of antimicrobial resistance (AMR) and advocate for policies to stimulate new antibiotic development.

The "Working to Fight AMR" coalition will be led by BIO, a trade organization that represents biotechnology companies and related organizations, and will include scientists, public policy experts, and industry leaders. The group says that, in addition to educating the public, it will advocate for policies like the DISARM Act, which calls for higher Medicare reimbursement for new antibiotics that treat serious or life-threatening infections.

"Antimicrobial resistance already poses a grave threat to human health—and it is a looming public health emergency," Greg Frank, PhD, BIO's director of infectious disease policy, said in a press release. "Working to Fight AMR will advocate for policies to boost investment in this deeply neglected area."
Aug 21 Working to Fight AMR press release

 

Move to single-bed hospital rooms linked to less MRSA, VRA colonization

A Montreal hospital's move to single-patient rooms was associated with reduced colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), along with fewer VRE infections, Canadian researchers reported in JAMA Internal Medicine. But no change in MRSA infection or Clostridioides difficile infection (CDI) was found.

The time-series analysis compared institution-level rates of new multidrug-resistant organism colonization and healthcare-associated infections at Montreal's Royal Victoria Hospital before and after patients were moved to a newly constructed hospital on Apr 26, 2015. The original hospital, built in 1893, was a mix of three- and four-bed ward rooms and single rooms; the new building consisted entirely of single-bed rooms with individual toilets and showers and easy access to sinks for hand washing.

Compared with the 27 months before the hospital move, the analysis found during the 36 months after the move an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonization events; incidence rate ratio [IRR], 0.25; 95% confidence interval [CI], 0.19 to 0.34) and MRSA colonization (from 129 to 112 colonization events; IRR, 0.57; 95% CI, 0.33 to 0.96), as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12 to 0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51 to 1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34 to 2.29) did not decrease.

"The changes in VRE and MRSA colonization appeared to be temporally associated with the move with an immediate apparent difference and no subsequent return to historical levels," researchers from McGill University write. "This reduction occurred despite demographic changes that increased the high-risk tertiary care population, notably in hematology-oncology, complex surgery, and severe, end-stage respiratory diseases."

The researchers note that while their study could not account for other infection control and antimicrobial stewardship interventions that were going on simultaneously at the hospital, they believe the findings support the concept that moving to single-bed facilities could reduce the transmission of specific multidrug-resistant organisms.
Aug 19 JAMA Internal Med study

News Scan for Aug 23, 2019

News brief

Three new polio cases noted as WHO details Myanmar outbreak

Afghanistan has one more wild poliovirus (WPV) case, and Angola and Ghana each have one more vaccine-derived polio case, according to the latest weekly update today from the Global Polio Eradication Initiate (GPEI).

The three new cases come during the same week Nigeria reached the 3-year mark of no WPV transmission.

"Because Nigeria is the last polio-endemic country in Africa, this milestone opens the door for the potential WPV-free certification of the entire WHO [World Health Organization] AFRO region after the Africa Regional Certification Commission (ARCC) evaluation as early as mid-2020," the GPEI said.

In Afghanistan, the new case came from Uruzgan province, and the patient experienced an onset of paralysis on Jul 16. This is the 13th wild poliovirus case recorded in Afghanistan in 2019; in 2018, the country reported 21 cases.

Angola's new case is its sixth case in 2019. The patient experienced an onset of paralysis on Jul 12. Ghana's case was from the  Chereponi district, Northern province, and the isolates are linked to the Jigawa circulating vaccine-derived polio outbreak in Nigeria.

In other polio news, the WHO offered new details on four cases of circulating vaccine-derived polio type 1 (cVDPV1) in Myanmar. The cases represent the country's first outbreak of cVDPV1 since 2007. The patients experienced an onset of symptoms from May 23 to Jul 23, and neighboring countries have been notified of the outbreak.
Aug 23 GPEI report
Aug 22 WHO report

 

Human-to-human H3N2 flu spread with low susceptibility to baloxavir noted

A study today in Emerging Infectious Diseases describes how a Japanese infant with no baloxavir exposure contracted an H3N2 strain of influenza with reduced susceptibility to baloxavir.

Baloxavir, or Xofluza, is an antiviral approved for use in Japan in children and adults over the age of 12, as well as in younger children who weigh more than 10 kilograms (22 pounds).

The infant was identified in a family cluster of influenza in February 2019. Though the infant was treated with oseltamivir, his or her 10 year-old sibling was treated with baloxavir. Genetic sequencing from samples collected from the siblings showed identical strains of H3N2, indicating human-to-human transmission.

The researchers said that, during the 2018-19 influenza season in Japan, they detected 32 mutant influenza A(H3N2) viruses the conferred reduced susceptibility to baloxavir, 4 of which were isolated from children under the age of 12 without prior baloxavir exposure.

"Baloxavir susceptibility of influenza viruses, especially among infected children <12 years of age, should be closely monitored for public health planning purposes and for making clinical," the authors concluded.
Aug 23 Emerg Infect Dis study

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