Stewardship / Resistance Scan for Jan 15, 2019

News brief

Pig farm study notes ties between resistome, antimicrobials, biosecurity

A study of pig farms in nine European countries suggests antimicrobial use during the fattening phase is associated with antimicrobial resistance, researchers from the European Union Ecology from Farm to Fork Of microbial drug Resistance and Transmission (EFFORT) project reported yesterday in the Journal of Antimicrobial Chemotherapy.

The analysis, conducted from June 2014 to Dec 2015, looked at fecal samples from 176 conventional pig farms in Belgium, Bulgaria, Denmark, France, Germany, Italy, the Netherlands, Poland, and Spain. The investigators also surveyed farms about practices such as antimicrobial use. Resistomes—the profile of resistance genes in microorganisms and microbial populations—were determined using shotgun metagenomics and the Resfinder reference database.

For the positive association the researchers found between fattening and antibiotic use, the pattern was especially evident for widely used macrolides and tetracyclines, with antimicrobial resistance genes corresponding to their respective antimicrobial classes. However, they didn't see the same link for beta lactams, and they saw only a few colisitin resistance genes, despite the drug class's high use in younger pigs.

Increased biosecurity was related to higher abundance of resistance genes, mainly those that encode macrolide resistance. Adjusted models suggested that biosecurity effects were independent of antimicrobial use.

The authors said the study was the first of its kind and adds accuracy to earlier observations of the associations between antimicrobial use and antimicrobial resistance.
Jan 14 J Antimicrob Chemother abstract

Study finds diarrheal pathogens, resistance genes in Bolivian river

A team of Bolivian and Swedish researchers has found evidence of diarrheal pathogens and antibiotic-resistant bacteria in samples from an urban waterway in Bolivia, according to a study yesterday in PLOS One.

In the study, the researchers aimed to analyze the occurrence and bacterial load of diarrheal pathogens in water, soil, and vegetable samples from the Choqueyapu River—which receives wastewater from urban, medical, and industrial sources—and other affluent rivers in the La Paz River basin. They collected samples from four different points from April 2013 to March 2014 and conducted quantitative real-time polymerase chain reaction (qPCR) to detect the presence of genes indicating enterobacterial contamination. They also tested for the presence of diarrheagenic Escherichia coli, Klebsiella pneumoniae, Salmonella enterica, Shigella spp, and for antibiotic resistance genes.

The most abundant genes found in the water, soil, and vegetable samples were gapA, which indicates the presence of enterobacteria, and eltB, an indicator of enterotoxigenic E coli carrying the heat labile toxin. Pathogen levels in the samples were significantly positively associated with high water conductivity—which can signify high levels of metals, pollutants, and bacteria in the water—and low water temperature.

In addition, 101 bacterial isolates obtained from the samples were found to be resistant to multiple antibiotics, and qPCR identified the extended-spectrum beta-lactamase (ESBL) gene blaCTX-M, along with several other resistance genes and a high number of plasmids. Whole-genome sequencing identified three of the isolates as E coli and one as Enterobacter cloacae. The E coli isolates belonged to three emerging, globally disseminated, multidrug-resistant lineages.

"In conclusion, this study evidences the risk of transmission of diarrheal diseases directly or indirectly from the Choqueyapu River and its basin due to the presence of diarrheal pathogens in river water, vegetables and agricultural soils," the authors of the study wrote. "Bacterial isolates carrying ESBL genes and conjugative resistant plasmids obtained from the basin indicate that the risk is not only associated with the transmission of infectious bacteria, but also with the possibility of transmission of antibiotic resistant bacteria and the resistance genes they carry from the environment to the community."
Jan 14 PLOS One study

News Scan for Jan 15, 2019

News brief

Second new MERS case reported in Jeddah

Today Saudi Arabia's ministry of health (MOH) reported a new MERS-CoV case in the city of Jeddah. The notice came in an epidemiologic week 3 notification.

A 52-year-old man is hospitalized for his MERS-CoV (Middle East respiratory syndrome coronavirus) infection. He is listed as a household contact of another case—quite possibly a 75-year-old man from the same city who was hospitalized last week. Neither man had any contact with camels.

The new case likely lifts on the global total since 2012 to 2,286 cases, at least 806 of them fatal. It is the fifth Saudi MERS case of 2019.
Jan 15 MOH update

FDA approves Sanofi Tdap vaccine for repeat vaccination

Sanofi announced yesterday that the US Food and Drug Administration (FDA) has approved expanded use of its Adacel tetanus, diphtheria, and acellular pertussis (Tdap) vaccine for repeat vaccination, making it the first to be cleared for that purpose.

The approval for repeat vaccination applies to people ages 10 through 64, 8 or more years after first vaccination. In its statement yesterday, the company said that Adacel is the only Tdap vaccine available in a syringe made without rubber latex, which may reduce the risk for people who have latex allergies.

David Greenberg, MD, Sanofi's regional medical head for North America, said in the statement that despite strong vaccination programs for young adolescents, a single Tdap immunization doesn't offer lifetime protection against pertussis because of waning immunity. "The licensure of Adacel as the first Tdap vaccine in the U.S. for repeat vaccination is an important step for eligible patients and offers flexibility for health care providers to help manage their immunization schedules," he added.

The Centers for Disease Control and Prevention currently recommends a single dose of Tdap for adolescents and adults, as well as for pregnant women during every pregnancy. Three of four adults, however, have not received the Tdap vaccine.
Jan 14 Sanofi press release

Analysts tracking signs of North Korea bioweapons advances

North Korea's capacity to pursue biological weapons is increasing rapidly, and the global threat could be greater than the country's nuclear program, the New York Times reported today, based on a recent report from the Middlebury Institute of International Studies at Monterey and interviews with experts.

Sources aren't certain how sophisticated North Korea's bioweapons program is, but former Pentagon intelligence official Anthony Cordesman told the Times that it has made great strides in technical areas needed to produce biological agents.

South Korean military assessments have identified at least 10 sites in North Korea that could be involved in developing and making several biological agents, but US intelligence officials have not publicly endorse the findings, and the Trump administration has apparently not specifically addressed the topic in recent nuclear talks.

According to the Times, scientists from North Korea have received advanced microbiological training in Asia and Europe. Also, defectors have described testing of agents on political prisoners, and some have tested positive for smallpox antibodies, hinting that they were either exposed or immunized.

An internet search team analysis has found web searchers from North Korea seeking information about advanced gene and biologic research, and the Middlebury report flagged at least 100 research papers with implications for military purposes, written by scientists from North Korea other countries, that may violate international sanctions.

Current and former federal officials told the Times that federal spending on biodefense preparedness has tapered off in recent years, raising concerns that the United States isn't prepared for a deliberate or natural event involving a biologic agent.

The Times report echoes concerns raised by sources in the intelligence community that were detailed in a 2017 Washington Post story, which spotlighted worrying signs of a North Korean bioweapon buildup.
Jan 15 NY Times story
Dec 11, 2017, CIDRAP News scan

WHO lists 10 threats to global health, aims to improve health for billions

Yesterday the World Health Organization (WHO) officially launched a new 5-year strategic plan, which focuses on 10 global health threats the world faces in 2019 and beyond. Among the 10 are 6 infectious disease threats: pandemic flu, antimicrobial resistance, Ebola and other high-threat pathogens, vaccine hesitancy, dengue, and HIV.

The WHO said the overall goal of the 5-year plan is a triple-billion target, ensuring that 1 billion more people benefit from access to universal health coverage, 1 billion more people are protected from health emergencies, and 1 billion more people enjoy better health and well-being.

Influenza was the highest-listed infectious disease threat on the organization's list. "The world will face another influenza pandemic—the only thing we don't know is when it will hit and how severe it will be," the WHO said. After influenza, the WHO said antimicrobial resistance is a major focus, citing resistance to tuberculosis as one of the most pressing issues in public health.

The ongoing Ebola outbreak in the Democratic Republic of the Congo and other high-threat pathogens, such as MERS, have prompted the WHO to call 2019 the "Year of action on preparedness for health emergencies." The WHO also noted the global rise of measles and the ongoing transmission of polio as outcomes of growing vaccine hesitancy around the world.
Jan 14 WHO article