Stewardship / Resistance Scan for Feb 23, 2017

News brief

Scientists report first case of artemisinin-resistant malaria in Africa

The first known case of malaria resistant to the essential drug artemisinin was reported yesterday in the New England Journal of Medicine.

An international team of experts said that a 43-year-old man was diagnosed as having malaria caused by the Plasmodium falciparum parasite in January 2013. He had returned to China after a 20-month stay in Equatorial Guinea the previous month, where he had been treated for the disease six times.

The researchers performed whole-genome sequencing to determine that the P falciparum was of African origin and had not been recently imported from elsewhere. Equatorial Guinea has a perennially high rate of malaria, and artemisinin combination therapy (ACT) is commonly used for treating patients, the authors note.

"The spread of artemisinin resistance in Africa would be a major setback in the fight against malaria, as ACT is the only effective and widely used antimalarial treatment at the moment," said study author Arnab Pain, PhD, according to a news release from Saudi Arabia's King Abdullah University of Science & Technology (KAUST).
Feb 22 N Engl J Med study
Feb 22 KAUST news release


Skin lotion with antibiotics derived from skin bacteria shows promise

Scientists have identified two new antibiotics produced from beneficial skin bacteria and added them to skin lotion to treat Staphylococcus aureus infections, according to a study yesterday in Science Translational Medicine.

Researchers from the University of California San Diego (UCSD) School of Medicine screened thousands of colonies of bacteria found on the skin of volunteers to find out how many demonstrated antimicrobial properties. They found that some strains of beneficial bacteria produce two types of antimicrobial peptides (AMPs), and colonization of pigskin or mice with these two AMPs reduced S aureus replication, even that of methicillin-resistant S aureus, a common resistant pathogen.

The lab-isolated AMPs were more effective at eliminating S aureus than their naturally occurring counterparts and produced the best results when administered in combination. In addition, the AMPs did not reduce healthy bacteria found on the skin, such as Propionibacterium acnes, S epidermidis, and Corynebacterium minutissimum.

The researchers then conducted a small trial on five patients who had atopic dermatitis, which is exacerbated by S aureus. The phase 1trial involving personalized lotions containing the AMPs was intended to test for safety and efficacy only, but all five patients had a significant decrease in S aureus on their skin, the authors reported.

The technique has already been approved by the US Food and Drug Administration, the authors wrote, and a phase 2 trial is being launched, according to a UCSD press release.
Feb 22 Sci Transl Med study
Feb 22 UCSD press release

Our underwriters

News Scan for Feb 23, 2017

News brief

H5N8 strikes Spanish poultry; Egypt reports H5N1 outbreaks

Spain reported its first highly pathogenic H5N8 avian flu outbreaks in poultry, following two earlier detections in wild birds, and Egypt noted poultry outbreaks involving both the H5N8 and H5N1 strains, according to the latest reports from the World Organization for Animal Health (OIE) and the United Nations Food and Agriculture Organization (FAO).

The outbreak in Spain began on Feb 18 at a farm in Catalonia, located in the northeast, with the deaths of ducks in one of the facility's six sheds. The virus killed 723 of 17,800 birds on the farm, and the rest were destroyed as a control measure. One of the earlier detections in wild birds also occurred in Catalonia.

In Egypt, officials linked H5N8 to four more outbreaks in poultry, three in backyard birds and one at a farm. The events began from Jan 17 to Feb 15, and all were located in the northeastern corner of the country. All told, the virus killed 183 of 3,294 birds, with the rest culled to curb the spread of the virus. Egypt first reported H5N8 in a wild bird at the end of November, which was followed by an outbreak in backyard birds at the end of December.

In other avian flu developments, Poland reported nine more H5N8 outbreaks affecting 15 wild birds, most of them swans, found dead between Feb 12 and Feb 20 across six provinces.
Feb 23 OIE report on H5N8 in Spain
Feb 22 OIE report on H5N8 in Egypt
Feb 22 OIE report on H5N8 in Poland

In developments involving other strains, Egypt's agriculture ministry recently reported 12 highly pathogenic H5N1 outbreaks in domestic poultry, according to FAO notifications flagged by FluTrackers, an infectious disease news message board. The events had start dates ranging from Feb 4 to Feb 9, affecting 194 chickens, ducks, and other unspecified birds. H5N1 is endemic in Egyptian poultry and was responsible for an unprecedented surge in human infections in the winter of 2014-15.
Feb 22 FluTrackers thread


Animal evidence builds for Zika-related testicular atrophy, fertility problems

Researchers who experimentally infected male with Zika virus found more evidence of testicular shrinkage, according to findings from a team based at Yale University published yesterday in Science Advances.

One group of mice was subcutaneously injected with a nonlethal dose of the virus, while the controls were mock-infected. When researchers looked at Zika in various cell types, they found that Zika continued to replicate in Leydig cells, which supply testosterone to the blood, even after the virus had cleared from the blood. They also found high levels of viral RNA and antigen in the epididymis, where sperm is stored, and in surrounding epithelial cells.

At 21 days after infection, the testes of the Zika-infected mice were smaller than those of the controls, suggesting progressive testicular atrophy. Researchers also said Zika infection caused a drop in testosterone, which could also reduce male fertility.

They concluded that the findings have implications for understanding sexual transmission of the virus and the potential long-term reproductive effects on men. So far at least two other research groups published animal studies that raised the possibility of Zika-related fertility problems in men, one in October by a team from Washington University School of Medicine and the other in November by a group from China.
Feb 22 Sci Adv abstract


WHO says polio still global emergency as CDC details situation in Nigeria

The World Health Organization (WHO) emergency committee tasked with evaluating polio developments met for the 12th time on Feb 7 to discuss the international spread of the virus, and agreed that recent cases warrant a continued  a public health emergency of international concern, as defined by the International Health Regulations.

In a Feb 13 statement on the teleconference posted today, the WHO said the committee was satisfied with steady progress on vaccination campaigns in Pakistan and Afghanistan, saying that the level of environmental surveillance in those two countries was at unprecedented levels.

The committee also said it was reassured by the rapid response of the polio eradication program in Nigeria, where four cases of wild polio virus were detected in August and September of 2016. In 2015, Nigeria was taken off the list of countries with endemic polio circulation, then added back last year.

The cases were in Borno state, the northern region under control of terrorist group Boko Haram. According to a report today in Morbidity and Mortality Weekly Report (MMWR) by the US Centers for Disease Control and Prevention (CDC), the cases were in unvaccinated children ages 21 to 24 months, and genetic analysis showed that the strain of virus had been circulating in Borno since 2013. In response to the cases, five rounds of targeted vaccination campaigns in children under the age of 5 in the Lake Chad region were conducted, with approximately 30 million children vaccinated. But about 40% of Borno is still unreachable, the report said.

Both the CDC scientists and the WHO panelists expressed concern over unvaccinated internally displaced persons surrounding the Lake Chad region, and the WHO experts said Equatorial Guinea remained vulnerable, based on low surveillance and sub-optimal vaccination campaigns.

Most concerning were two new outbreaks of vaccine-derived polio reported in Nigeria and Pakistan, the WHO said. "Both of these outbreaks highlighted the presence of vulnerable under immunized populations in countries with endemic transmission," the statement said.

The committee will reconvene in 3 months.
Feb 13 WHO statement
Feb 24 MMWR report


CDC: Pilot norovirus outbreak reporting system slashes lag times

A norovirus outbreak reporting system implemented by the CDC in five states in 2012 reduced the median reporting interval from 22 days to 2 days for epidemiologic data, and from 21 days to 3 days for laboratory data, according to another study today in MMWR.

The CDC launched Norovirus Sentinel Testing and Tracking (NoroSTAT) in collaboration with state health departments in Minnesota, Ohio, Oregon, Tennessee, and Wisconsin. Using NoroSTAT, state officials report epidemiologic and laboratory data on norovirus outbreaks within 7 business days to the CDC via two platforms: NORS, a Web-based tool for reporting all waterborne, foodborne, and enteric disease outbreaks, and CaliciNet, a nationwide electronic lab surveillance system that collects genetic sequences of norovirus strains.

The five states reduced their reporting lags to NORS from a median of 22 to 2 days and to CaliciNet from a median of 21 to 3 days. This in spite of the fact that outbreak reporting rates to NORS climbed slightly during the study period, from 17.3 to 21.0 per 1 million person-years. Nonparticipating states had no change in reporting lag to NORS, with a median of 26 days' lag over the study period. CaliciNet outbreaks that were linkable to NORS outbreaks increased from 86% to 95% for NoroSTAT states and from 29% to 33% for the other states.

The authors conclude, "Substantial improvements in norovirus outbreak reporting, measured by the volume, timeliness, and completeness of epidemiologic and laboratory reports have been observed since the introduction of NoroSTAT in participating states, likely because of stringent reporting requirements and enhanced communication between epidemiologists and laboratorians in both state health departments and at CDC."
Feb 24 MMWR study

This week's top reads