Stewardship / Resistance Scan for Feb 14, 2019

News brief

Survey finds low postgrad stewardship training in pharmacists, nurses

British investigators conducted an international survey and found that postgraduate training and support in antibiotic prescribing remain low among nurses and pharmacists, and, although antibiotic policies and committees are established in most institutions, surveillance of antibiotic use is not, according to a new report in Antimicrobial Resistance & Infection Control.

The authors polled 505 professionals who had taken a Massive Online Open Course (MOOC) on antibiotic stewardship. Their aim was to assess their organizations' resources for antimicrobial stewardship. Of the respondents, 36% were physicians, 26% pharmacists, 18% nurses, and 20% other professions.

Post-graduate training in infection management and stewardship was reported by 56% of physicians, 43% of nurses, and 35% of pharmacists. The researchers also found that 65% of primary care centers had antibiotic policies, compared with 83% of teaching hospitals and 79% of regional hospitals.

Fifty-eight percent of teaching hospitals and 62% of regional hospitals reported a surveillance mechanism for antibiotic consumption. Respondents identified antimicrobial resistance, patient needs, policy, peer influence, and specialty-level culture and practices as important determinants for stewardship decision-making.
Feb 12 Antimicrob Resist Infect Control study

Use of antibiotics to promote growth in food animals down, OIE report says

The use of antimicrobials for growth promotion in food animals worldwide is down, and more nations are reporting specific data on the use of the drugs in livestock, according to the World Organization for Animal Health's (OIE's) third annual report on antimicrobial agents in animals, published today.

A total of 110 countries of 155 surveyed (71%) did not use any antimicrobial drugs for growth promotion as of 2017, which is up from 86 of 146 (59%) reported in the second annual report, published in 2017. Of the 45 countries that used antimicrobials to promote growth, according to today's report, 18 (40%) had a regulatory framework that either provided a list of antimicrobials that can be used as growth promoters or provided a list of those that should not be used as growth promoters.

In addition, today's report noted that 118 nations of 155 (76%) reported quantitative data for one or more years from 2015 to 2017, up slightly from 107 of 146 countries (73%) in the 2017 report. In the OIE's first such report, published in 2016, the rate was 89 of 130 nations (68%).

The authors of the report conclude, "The OIE remains strongly committed to supporting our Members in developing robust measurement and transparent reporting mechanisms for antimicrobial use, but the challenges for many of our Members must not be under-estimated."
Feb 14 OIE report

News Scan for Feb 14, 2019

News brief

New health area, Bunia, reports Ebola in DRC as outbreak hits 829 cases

Bunia, in the Democratic Republic of the Congo (DRC) is the 19th health district to confirm an Ebola case, the DRC's ministry of health said today in its daily update.

The case in Bunia is in a 6-month-old baby whose mother died from the virus. The mother was from Katwa, and her corpse was intercepted in Komanda, where the baby is currently being treated in an Ebola treatment center.

The baby is among 6 new cases reported today, which also include 3 in Katwa, and 2 in Butembo. The cases raise the outbreak total to 829, of which 786 cases are confirmed and 61 are probable. A total of 201 cases are still under investigation, which is up from 177 yesterday.

Four new fatalities recorded today raise the death toll in the outbreak to 521. Among the new deaths are 3 community deaths in Katwa and Butembo, the current disease hot spots.

The ministry of health said 79,146 people have been vaccinated against the virus with Merck's rVSV-ZEBOV vaccine, including 20,547 in Beni, 19,971 in Katwa, and 9,214 in Butembo.
Feb 14 DRC update

Oman reports 4 new MERS infections, Saudi Arabia 1

Several Arabic media outlets are reporting that the Omani ministry of health has confirmed 4 more MERS cases in Oman, while Saudi Arabia also noted a new, fatal case.

The Omani cases are part of an ongoing outbreak and bring the total to 10 recent cases of MERS-CoV (Middle East respiratory syndrome coronavirus) in that country, which had not seen the a MERS case since March 2018.

According to Avian Flu Diary, an infectious disease tracking blog, the Omani ministry of health said the 10 cases have resulted in 4 deaths in different provinces. If confirmed, that would mean the outbreak is no longer contained to a single family farm, as reported by the World Health Organization on Feb 11.

The Saudi Arabian Ministry of Health (MOH), meanwhile, today recorded another new MERS-CoV case for epidemiologic week 7 in Wadi ad-Dawasir.

The infection lifts the country's MERS-CoV cases since the first of the year to 61, which includes 38 from Wadi ad-Dawasir, the site of a possible hospital-based outbreak.

The patient is a 60-year-old man who died after acquiring MERS in a healthcare setting. He did not have camel contact, a known risk factor, the Saudi MOH said.
Feb 14 Avian Flu Diary post

Study: 1 to 4 meningitis B outbreaks on US college campuses annually

According to a study yesterday in Emerging Infectious Diseases, from 2013 to 2017 officials confirmed one to four meningococcal serogroup B outbreaks on American college campuses annually, which suggests that wider use of the MenB vaccine could be used in outbreak and non-outbreak settings.

Since 2005, most American college students have been vaccinated with the quadrivalent meningococcal conjugate vaccine covering serogroups A, C, W, and Y (MenACWY), but serotype B has now become the most prevalent on college campuses. In 2013, MenB became available for outbreak response, and, by 2015, MenB vaccines were available for wider use, though not routinely administered.

From January 2013 to May 2018, there were 10 university-based meningococcal disease outbreaks caused by serogroup B reported in seven states, which resulted in 39 cases and 2 deaths (5% case-fatality rate).

"Only 1 case occurred in a student who previously received MenB vaccine; this student had been vaccinated with 1 dose of MenB vaccine 6 days before disease onset," the study authors, from the Centers for Disease Control and Prevention, said. "The remaining cases occurred in persons believed to be unvaccinated with MenB vaccine."

In all but two outbreaks, mass vaccination campaigns with MenB were put in place across campus, and the vaccine was also offered at campus health centers, by appointment, and during seasonal flu vaccinations. Still, MenB vaccination coverage in response to university-based outbreaks was highly variable, ranging from an estimated 14% to 98% for the first dose (median, 67%), the study authors said.

"Coverage with >1 dose of MenB vaccine among persons 17 years of age was estimated to be 14.5% in 2017 (13), and a recent survey demonstrated that only 2% of universities require MenB vaccination for student," the authors concluded. "Achieving high MenB vaccination coverage is necessary to help protect persons during outbreaks of meningococcal disease caused by serogroup B."
Feb 13 Emerg Infect Dis study