Study finds frequent use of key antibiotics in 4 low-resource nations

A study of community-level antibiotic use in patients in four low- and middle-income countries (LMICs) found frequent use of broad-spectrum antibiotics considered at risk of becoming ineffective owing to rising antibiotic resistance, an international team of researchers reported today in Clinical Microbiology and Infection.

As part of an effort to optimize antibiotic use in LMICs, the Neglected Infectious Diseases DIAGnosis (NIDIAG)-Fever study investigated the causes of infections in patients with persistent fever who were admitted to hospitals in Cambodia, the Democratic Republic of the Congo (DRC), Sudan, and Nepal.

The researchers described the prevalence and choice of antibiotics before and at study inclusion, applying the World Health Organization's (WHO's) Access/Watch/Reserve (AWaRe) classification, which was introduced in 2017 to provide an indirect indication of the appropriateness of antibiotic use at national and global levels. They also looked at the route of administration and analyzed factors associated with prior antibiotic use.

Of 1,939 people included in the study, 428 (22.1%) reported prior use of one or more antibiotics, ranging from 6.3% in Cambodia (24 of 382) to 35.5% in Nepal (207/583). Of 545 antibiotics, the most frequently used were Watch antibiotics, which accounted for 64.4% (351/545) of antibiotics used, ranging from 23.6% in the DRC to 82.1% in Nepal. Parenteral administration ranged from 5.9% to 69.6% between study sites. Antibiotic use was most frequent among patients aged 5 to 17 years (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.19 to 1.71) and men (RR, 1.29; 95% CI, 1.09 to 1.53).

No association was found between antibiotic use and specific symptoms. Of 555 antibiotics started before study inclusion, 49.5% (275) were discontinued at study inclusion.

"These findings emphasize the need to monitor and optimize community- or primary healthcare-level antibiotic use in LMICs," the authors wrote.
Nov 11 Clin Microbiol Infect abstract


Romaine lettuce possible source for third recent US E coli outbreak

In the third multistate Escherichia coli O157:H7 outbreak reported this fall—this one affecting 12 people—Tanimura & Antle, of Salinas, California, is recalling its packaged single-head romaine lettuce that was packaged Oct 15 and 16, the Centers for Disease Control and Prevention (CDC) said yesterday.

Among the 12 E coli infections across six states, 5 patients have been hospitalized. Illinois has 4 cases, and Michigan, California, and Pennsylvania each have 2. Illness-onset dates range from Sep 2 to Oct 14.

A routine inspection by the Michigan Department of Rural and Agriculture Development found the same strain of E coli in the romaine that was identified among ill people associated with the outbreak, but further investigation needs to be done to show a conclusive link. Of the 11 ill people who have been interviewed, all say they ate leafy greens, including romaine lettuce (5), spinach (5), iceberg lettuce (3), and red leaf lettuce (3).

For now, the CDC recommends not to eat, sell, or serve any of Tanimura & Antle's recalled, packaged single-head romaine lettuce, which has the UPC number 0-27918-20314-9 and the produce traceability initiative sticker 571280289SRS1 and 571280290SRS1.
Nov 10 CDC outbreak report
Nov 6 Food and Drug Administration recall notice


Flu at low global levels, with sporadic or low activity in some countries

In its latest global flu update, the WHO said levels are still much lower than expected for this time of year, though some regions and countries are reporting sporadic or low-level activity.

The report covers roughly the last half of October and includes the caveat that flu activity and reporting might be influenced by COVID-19 measures and surveillance. In Europe, sporadic flu detections were reported, including in two French patients who were hospitalized after returning from West Africa.

In Africa, flu activity rose in Ivory Coast, with detections reported in Niger and Kenya.

Elsewhere, in Asia, China's flulike illness activity increased in the south to levels higher than reported for this time during the previous three seasons. In Southeast Asia, flu declined in Cambodia, but detections—mainly H3N2—continued in Laos. Elsewhere in Asia, Bangladesh and India reported low levels of activity.

In the Americas, Caribbean and Central American countries reported sporadic flu cases. In the United States, flu levels remained below the national baseline for all groups, except for children 0 to 4 years old.

Globally, of about 94,000 respiratory specimens tested at WHO-affiliated labs, only 140 were positive for flu. Influenza A made up 57.1% of the viruses, and of subtyped influenza A samples, 94.6% were H3N2.
Nov 9 WHO global flu update


Three nations note H5N8 avian flu outbreaks; Netherlands finds H5N1 reassortant

In the latest highly pathogenic avian flu developments, three European countries reported more detections in wild birds, including a United Kingdom report of a second outbreak in poultry and a Netherlands detection of an H5N1 reassortant, according to official reports and notifications from the World Organization for Animal Health (OIE).

The UK's Department for Environment, Food, and Rural Affairs (DEFRA) said today that H5N8, with a pathogenicity still to be determined, has been detected in broiler chickens at a farm near Leominster in Herefordshire. It also reported new highly pathogenic H5N8 detections in wild geese in Gloucestershire and swans in Devon and undetermined-pathogenicity H5N8 in a wild goose in Dorset.

The Netherlands reported four outbreaks in wild birds involving a highly pathogenic H5N1 reassortant that contains a hemagglutinin nearly identical to recent H5N8 isolates in wild birds, with the other genes from low-pathogenic avian influenza. The country also reported 19 more H5N8 outbreaks in wild birds, mostly from North Holland and Friesland provinces.

Meanwhile, in separate reports, Germany reported 42 more H5N8 outbreaks in wild birds from Schleswig-Holstein and Mecklenburg-Vorpommern states and 1 more H5N5 outbreak from Mecklenburg-Vorpommern state. It also reported an H5N8 outbreak in backyard birds in Schleswig-Holstein state.

Elsewhere, Japan reported a second H5N8 outbreak in poultry in Kagawa prefecture. The event at a layer farm began on Nov 7, killing 24 of 48,000 birds. The rest were culled to curb the spread of the virus.
Nov 11 DEFRA report
Nov 7 OIE report on H5N1 in Dutch wild birds
Nov 7 OIE report on H5N8 in Dutch wild birds
Nov 7 OIE reports on H5N8 in Schleswig-Holstein and Mecklenburg-Vorpommern states
Nov 7 OIE report on H5N5 in Mecklenburg-Vorpommern state
Nov 7 OIE report on H5N8 in Schleswig-Holstein backyard birds
Nov 9 OIE report on H5N8 in Japan

COVID-19 Scan for Nov 11, 2020

News brief

Older people more likely to embrace COVID prevention steps, study finds

A PLOS One study yesterday showed that behavioral responses to the pandemic differ by age and change over time, with older people more likely to practice pandemic-mitigating behaviors—hygiene, quarantining, and physical distancing—and all age-groups demonstrating greater likelihood of engaging in risky behavior over time.  

Researchers analyzed survey data from 5,128 US adults during four "waves" of the pandemic from Mar 10 to May 26, using nationally representative responses from the Understanding Coronavirus in America Tracking Survey. Respondents reported their participation in the past 7 days in six preventive personal activities—mask wearing, avoiding crowds, etc—and four risky social behaviors—non-household member contacts, eating in restaurants, etc.

At the beginning of the pandemic, people of all ages reported a similar likelihood of engaging in preventive personal behaviors, but people 65 and older quickly adopted preventive behaviors during wave 2—Apr 1 to Apr 28. Older participants showed the most change in preventive behaviors from March to May, perhaps because of an awareness of their increased disease risk.

By wave 4—from Apr 29 to May 26—people 65 and older were significantly less likely to engage in risky activities, reporting a 38.7% rate of contacts with non-household members, versus 54.0% for those aged 18 to 34. As the pandemic progressed, all age-groups showed a decrease in preventive practices, with older people maintaining higher rates of adherence than younger individuals.

Greater adoption of pandemic-mitigating behaviors was seen for women, racial/ethnic minorities, and those with higher socioeconomic status. Higher state case rates, a greater perceived risk of infection and dying, and a more left-leaning political orientation were also associated with increased adoption of preventive behaviors.

"It is encouraging to observe older people taking more preventive personal behaviors as the pandemic progressed, which may have alleviated their risk of infection," the authors wrote. "However, at the same time, it is concerning that people started loosening observance of recommendations to avoid risky behaviors, particularly older people who could have more adverse consequences from meeting with family and friends."
Nov 10 PLOS One study


Poll: 28% of parents say pandemic made them less likely to vaccinate for flu

A survey of US parents found that the COVID-19 pandemic has not made them more likely to have their children vaccinated against seasonal flu. Most—60%—reported that the pandemic had changed their intentions to vaccinate, with changes significantly influenced by previous flu vaccination history. Parents who did not vaccinate their child for the flu last year reported that the pandemic made them less likely to vaccinate in 2020-21.

The Pediatrics study recruited 1,893 US parents or guardians of children ages 5 months to 5 years of age for an online survey exploring their flu vaccination history for their child, intention to vaccinate for the 2020-21 season, and whether this changed as a result of the pandemic. Responses were measured on a scale from 1 (much less likely to get the flu shot for their child) to 5 (much more likely).

Overall, 28% of parents (532) reported that they are less likely to have their child vaccinated for flu this year as a result of the pandemic.

Changes in vaccine intentions differed significantly between parents who vaccinated their children in 2019-20 and those who did not. Parents whose children did not receive the flu vaccine last year reported that the pandemic made them less likely to have their child receive the current year vaccine (34%; 95% confidence interval [CI], 30% to 37%). Among those whose children did receive the 2019-20 vaccine, this figure was just 24% (95% CI, 22% to 27%).

Only 21% (95% CI, 18% to 24%) of parents whose children did not receive the 2019-20 vaccine reported that the COVID-19 pandemic made them more likely to have their child receive the 2020-21 vaccine, compared with 39% (95% CI, 36% to 41%) of parents whose children were vaccinated in 2019-20.

"The COVID-19 pandemic alone does not appear sufficient to encourage the uptake of pediatric seasonal influenza vaccination," the authors note. "Instead, the COVID-19 pandemic may exacerbate polarity in vaccination uptake."
Nov 11 Pediatrics study

This week's top reads

Our underwriters