Stewardship / Resistance Scan for Dec 26, 2019

News brief

Spending bills boost funding for some antibiotic resistance measures

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

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

News Scan for Dec 26, 2019

News brief

Flu continues to rise in several Northern Hemisphere countries

Flu levels continued to rise in North America, Europe, the Middle East, and parts of Asia, with some countries reporting higher than normal influenza B activity, the World Health Organization (WHO) said on Dec 20 in its latest global flu update.

In Canada, influenza B accounts for half of all flu detections, followed by 2009 H1N1. Europe is reporting mixed patterns, with many countries reporting mainly the H3N2 strain, but the eastern region and Portugal seeing dominant influenza B activity.

Influenza B circulation increased in central Asia.

Meanwhile, some countries in the Middle East reported rising flu levels, mainly from 2009 H1N1, but with a small proportion of influenza B viruses, as well.

China is starting to experience increased flu activity, with H3N2 most commonly detected. Illness levels are also on the rise in South Korea—mainly from 2009 H1N1—and Japan.

Globally, of samples tested from late November through the first part of December, 74.9% were influenza A, and of the subtyped influenza A viruses, 69.8% were H3N2.
Dec 20 WHO global flu update

Tests find high-path H5N6 avian flu in earlier Nigerian poultry outbreak

Further testing of H5N6 avian influenza samples from birds infected in a June outbreak in Nigeria found that the virus was highly pathogenic, rather than low pathogenic, as originally reported. The event, first reported in November, marked the first H5N6 detection in Africa.

In a Dec 23 updated notification, the World Organization for Animal Health (OIE) said intravenous pathogenicity index lab analysis confirmed the H5N6 samples as highly pathogenic. The virus was found during active surveillance at a market in Sokoto province in the northwest of the country, where it sickened 150 of 2,449 birds.
Dec 23 OIE report on H5N6 in Nigeria
Dec 2 CIDRAP News scan "H5N6 avian flu reported for first time in Africa"

Study finds screen-and-vaccinate dengue policy cost-effective

A screen-and-vaccinate policy related to tetravalent dengue immunization is likely to be cost-effective in most transmission settings, researchers reported in the Dec 23 edition of Vaccine.

The dengue vaccine, which is relatively new and has been adopted by some countries, carries a risk of severe dengue illness and hospitalization in those who were seronegative before receiving it. As such, the WHO recommends a screen-and-vaccinate policy, but questions persist about the public health impact and cost effectiveness of the step.

For the study, a research team from Sanofi, the vaccine's maker, and Brandeis University used a previously reported transmission model based on results from three dengue vaccine efficacy trials. They also used data from an assessment of three dengue rapid tests, which all had high specificity and with sensitivities that ranged from 50% to 90%. The team analyzed the impact of the screen-and-vaccinate strategy in nine transmission settings, and examined the cost-effectiveness in 10 endemic countries.

When compared to a no-screening approach, the team found that the screen-and-vaccinate strategy was more effective in reducing the numbers of severe illnesses and hospitalizations and was cost-effective in all settings, except for areas of very low dengue transmission. They also found that the overall population impact was likely to be higher with several rounds of screening, with an up to 48% reduction in dengue hospitalization over 10 years with 5 rounds.
Dec 23 Vaccine abstract

In other dengue developments, two more local dengue cases have been reported in Florida's Miami Dade County, according to a Dec 23 Florida Department of Health update. The new illnesses bring the county's number of local cases for the year to 14.
Dec 23 Florida Health statement

Study: Barring non-medical exemptions increases vaccination rates

A study published earlier this week in PLOS Medicine showed a 2016 ban on non-medical vaccine exemptions in California increased vaccine uptake.

This is the first official study of the effects of the California law, and was conducted by researchers at the University of California-San Francisco. Researchers used county surveillance data to estimate how many children would have received the measles, mumps, rubella (MMR) vaccine if the law had not been enacted, and then compared that number to the number of children who received the vaccine.

MMR coverage across the state increased 3.3 % after the law was passed, and nonmedical exemptions decreased by 2.4 %. Medical exemptions increased 0.4 %. On a county level, vaccine uptake varied greatly, ranging from a 6% decrease to a 26% increase.

"The largest increases in vaccine coverage were observed in the most 'high-risk' counties, meaning those with the lowest prepolicy vaccine coverage. Our findings suggest that government policies removing nonmedical exemptions can be effective at increasing vaccination coverage," the authors concluded.
Dec 23 PLOS Med study