News Scan for Dec 27, 2019

News brief

Three MERS cases confirmed in Qatar's capital

Qatar has reported three more MERS cases to the World Health Organization (WHO), the WHO said yesterday. The three cases are related, and all case-patients are from Doha.

The first case-patient is a 67-year-old woman who developed symptoms of Middle East respiratory syndrome coronavirus (MERS-CoV) infection at the end of November, and died on Dec 12. The source of her illness is still under investigation.

"The patient had neither a history of contact with dromedary camels nor recent travel. Follow up and screening of seven household contacts and 40 healthcare worker contacts is ongoing and two asymptomatic secondary cases have been identified so far," the WHO said.

The woman's son, age 50, and a 32-year-old case contact have also been diagnosed as having MERS-CoV. Both patients were asymptomatic and identified during contact tracing. The WHO said a total of 47 identified contacts of the patient have been monitored daily for the appearance of respiratory or gastrointestinal symptoms for a period of 2 weeks following their last exposure to the patient.

From 2012 through Nov 30, 2019, a total of 2,494 laboratory-confirmed MERS-CoV cases and 858 associated deaths have been reported to the WHO, the vast majority in Saudi Arabia.
Dec 26 WHO report

Six countries report more polio cases; WHO extends polio emergency

In the latest global polio developments, Afghanistan and Pakistan reported more wild poliovirus type 1 (WPV1) cases, and four African nations reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, according to totals reflected on the Global Polio Eradication Initiative (GPEI) tables, which include data reported as of Dec 24.

The GPEI didn't publish its full report with paralysis onsets, noting that the weekly updates will resume on Jan 9.

ProMED Mail, the online reporting system of the International Society for Infectious Diseases (ISID) compiled a report on the recent cases compared to the previous weekly polio totals. It said for WPV1 cases, Afghanistan has two more, one each from Fara and Kandahar provinces, raising its total for the year to 26. Pakistan has 10 more cases from Balochistan, Khyber-Pakhtunkhwa, Punjab, Sindh, and Islamabad provinces, pushing its number for 2019 to 111.

Meanwhile, four African countries reported five new cVDPV2 cases, including two from Angola and one each from Central African Republic, Chad, and Ethiopia.
GPEI WPV1 cases as of Dec 24
GPEI vaccine-derived polio cases as of Dec 24
Dec 26 ProMED Mail post

In other polio developments, the World Health Organization’s (WHO) polio emergency committee met for the 23^rd time on Dec 11, and after hearing from experts and representatives from polio-affected countries unanimously agreed that the risk of international spread remains a public health emergency of international concern (PHEIC).

The WHO said in a Dec 20 statement on the deliberations that the committee voiced grave concerns about the significant rise in WPV1 cases this year, along with widespread transmission, vaccine refusal, and detection of vaccine-derived cases in Pakistan and challenging security and inaccessibility problems in Afghanistan.

Regarding vaccine-derived polio, the group said multiple outbreaks in four of the WHO regions are very concerning, noting that since its last meeting, seven new countries have reported outbreaks. WHO emergency committees typically meet every 3 months or sooner if needed.
Dec 20 WHO statement

WHO details yellow fever outbreak in Mali

The WHO yesterday released more details about a yellow fever outbreak in Mali that has so far resulted in three confirmed cases, plus nine suspected and three probable infections.

The initial case-patient is a 15-year-old girl from Koulikoro region who had not traveled outside of her district and had not been vaccinated. The other confirmed infections are in two men ages 17 and 25 from Ivory Coast who are living in Bouguimi district in Mali's Sikasso region. Two of the people with confirmed infections died.

The suspected and probable cases are all from Bouguimi district, and there are three deaths among the suspected infections.

The WHO said mass yellow fever campaigns have been underway in Mali since 2008, but coverage is still below herd immunity thresholds and there are pockets of low immunity, with high population movements within and outside of the country possibly diluting population immunity.

The district where the first patient is from is near Bamako, Mali's capital and home to 2 million people. The district where the two other patients lived is near the Ivory Coast border. The WHO said the risk of yellow fever spread within Mali due to disease activity is high, the risk of regional spread is moderate, and the threat of global spread is low.
Dec 26 WHO statement
Dec 9 CIDRAP news scan "Health officials confirm 3 yellow fever cases in Mali, Ivory Coast"

ASP Scan (Weekly) for Dec 27, 2019

News brief

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

Spending bills boost funding for some antibiotic resistance measures

Originally published by CIDRAP News Dec 26

A federal spending bill passed by Congress and signed by President Trump late last week includes millions in additional funds for agencies addressing antibiotic resistance. But funding remained flat for some efforts.

The Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) appropriations bill—one of two Fiscal Year (FY) 2020 spending bills passed by Congress and signed by the President—includes a $50 million increase for antibiotic resistance research at the National Institute of Allergy and Infectious Diseases and a $2 million increase for the Center for Disease Control and Prevention's (CDC's) Antibiotic Resistance Solutions Initiative, which invests in national infrastructure to detect, respond, contain, and prevent drug-resistant infections.

"This legislation funds initiatives that are very important to our nation's health and safety," Society for Healthcare Epidemiology of America (SHEA) president Hilary Babcock, MD, MPH, said in a SHEA press release. "We thank Congress for supporting our commitment to addressing antibiotic resistance in a comprehensive and meaningful way."

The legislation also provides $21 million in funding for FY 2020 for the National Healthcare Safety Network, a tool used by hospitals to track and report data on antibiotic use, antibiotic resistance, and healthcare-associated infections. But as the Infectious Diseases Society of America (IDSA) notes, that funding level remains the same as in FY 2019.

IDSA also expressed concern that no additional funding was provided for the Biomedical Advanced Research and Development Authority, which helps fund development of new antibiotics, and the CDC's Advanced Molecular Detection program, which is helping modernize the public health system's ability to identify new and emerging antibiotic resistance threats.

"With drug-resistant infections causing an estimated 2.8 million illnesses and as many as 35,000 deaths in this country each year, building our capacities to protect the infection-fighting medicines we have, and to ensure the development of urgently needed new medicines must be a significant priority," IDSA said in a statement.
Dec 19 SHEA press release
Dec 19 IDSA statement

Study links childhood allergies to use of multiple antibiotic classes in infancy

Originally published by CIDRAP News Dec 26

Exposure to multiple classes of antibiotics in infancy is associated with increased risk of developing an allergy in childhood, researchers reported last week in a research letter in JAMA Pediatrics.

The retrospective cohort study, conducted by researchers with the Uniformed Services University of the Health Sciences, examined data on 798,426 Department of Defense Tricare beneficiaries who had a birth medical record in the Military Health System database between October 2001 and September 2013 and received a prescription for an antibiotic (penicillin, penicillin with a beta-lactamase inhibitor, cephalosporin, macrolide, or sulfonamide) within the first 6 months of life. The main outcome of the study was the presence of any allergic disease.

Among the children in the cohort, there were 162,605 filled antibiotic prescriptions, with 109,341 children receiving one class of antibiotics and 24,375 receiving more than one class. Over a median of 4.6 years, all antibiotic classes were associated with significant increased risk for developing an allergic disease. Adjusted hazard ratios (aHRs) were highest for penicillin (aHR, 1.30; 95% confidence interval [CI], 1.28 to 1.31) and lowest for sulfonamides (aHR, 1.06; 95% CI, 1.03 to 1.10).

Even after adjustment for the total days of antibiotic supplied, children prescribed an additional class of antibiotic during infancy had increased risk for each subtype of allergic disease: any food allergy (aHR, 1.08; 95% CI, 1.05 to 1.11), anaphylaxis (aHR, 1.08; 95% CI, 1.02 to 1.15), asthma (aHR, 1.47; 95% CI, 1.45 to 1.49), atopic dermatitis, (aHR, 1.13; 95% CI, 1.11 to 1.15), allergic rhinitis (aHR, 1.33; 95% CI, 1.32 to 1.34), allergic conjunctivitis (aHR, 1.18; 95% CI, 1.15 to 1.22), and contact dermatitis (aHR, 1.11; 95% CI, 1.10 to 1.12).

The authors of the study suggest the association between exposure to multiple classes of antibiotics and increased risk of developing childhood allergies may be linked to greater disruption of the gut microbiome.
Dec 20 JAMA Pediatr study