Stewardship / Resistance Scan for Jan 24, 2019

News brief

CDC warns of raw milk exposure to drug-resistant Brucella after 3rdcase

A New York resident who drank raw milk from a Pennsylvania dairy has contracted the nation's third known case of brucellosis caused by the antibiotic-resistant Brucella RB51 strain, the Centers for Disease Control and Prevention (CDC) said yesterday in a Health Alert Network (HAN) notice. The previous two illnesses occurred in 2017.

"The New York State Department of Health and Pennsylvania Department of Health are investigating Brucella RB51 exposures that may be connected to consuming raw (unpasteurized) milk from Miller's Biodiversity Farm in Quarryville, Pennsylvania," the CDC said. Officials say people in 19 states across the country have consumed raw milk products from the farm and may have been exposed to the bacterium.

The New York resident was diagnosed as having brucellosis in November after drinking raw milk from the farm, and milk samples from the dairy tested positive for Brucella RB51. Anyone who drank raw milk or consumed other raw milk products from the dairy since 2016 may have been exposed, the CDC said.

Brucella strain RB51 is a live-attenuated cattle vaccine strain, which can be shed in milk and can cause infections in humans who drink the milk without pasteurization. The strain is resistant to rifampin and penicillin, so the CDC recommends both doxycycline and trimethoprim-sulfamethoxazole as first-line treatment. Blood culture is recommended for diagnosis.

Symptoms of brucellosis can include fever, sweats, general malaise, loss of appetite, headache, fatigue, muscle and joint pain, and potentially more serious complications like endocarditis and neurologic symptoms. Pregnant women are at risk of miscarriage.

The CDC reported the first two confirmed US RB51 cases in a Texas woman in September 2017 and in a New Jersey woman in November of that year.
Jan 23 CDC HAN advisory
Sep 15, 2017, CIDRAP News story "CDC issues alert over raw milk and Brucella infection"
Sep 21, 2017, CIDRAP News story "CDC issues raw milk Brucella warning for 4 states"


FDA clears first test for Mycoplasma genitalium

The US Food and Drug Administration (FDA) today cleared a new test for diagnosing the common sexually transmitted infection (STI), Mycoplasma genitalium, a step that could aid antibiotic stewardship efforts.

The test—Aptima, manufactured by Hologic Inc, of Marlborough, Mass.—is the first on the market to target M genitalium, which the Centers for Disease Control and Prevention (CDC) called an emerging public health threat in 2015.

According to Hologic, more than 15% of Americans in certain high-risk groups may be infected with the bacterium, and as many as 50% of women and 42% of men may have antibiotic-resistant infections. Also, some patients may be asymptomatic or have symptoms similar to those caused by chlamydia, so accurate diagnostic testing is crucial. If left untreated, M genitalium infections can result in infertility in women and an increased risk for HIV transmission.

"Although Mycoplasma genitalium is typically more common than gonorrhea, there is very little public awareness of this rising sexually transmitted infection, which can cause serious and potentially devastating health problems," said Damon Getman, PhD, the senior principal research scientist and director of research at Hologic, in a company press release.

The FDA said the STI test will help clinicians choose the correct antibiotic to target the bacterium, potentially limiting the misuse of antibiotics that results in antimicrobial resistance.

"In the past, it has been hard to diagnose this organism," said FDA Commissioner Scott Gottlieb, MD in a statement. "By being able to detect it more reliably, doctors may be able to more carefully tailor treatment and use medicines most likely to be effective. In cases where M. gen. is detected, doctors can consider forgoing use of antibiotics that are known to be ineffective against M. gen. and choose a treatment more likely to be appropriate."
Jan 23 Hologic press release
Jan 23 FDA


KFC makes good on pledge to eliminate medically important antibiotics

Fast food chain KFC announced today that it has fulfilled its pledge that 100% of the chicken purchased by the company would be raised without medically important antibiotics by the end of 2018.

KFC said that it has worked closely with more than 2,000 US poultry producers to meet its promise, which was announced in April 2017. KFC is one of several fast food chains to commit to reducing or eliminating chicken raised with medically important antibiotics in recent years, a move that has been driven by consumer demand and growing public health concern about antibiotic resistance.

"Recognizing the rising public health concerns about the increased threat of resistance to human antibiotics, KFC has advanced this initiative while keeping both customers—and the health of flocks from which they source—top of mind," the company said in a press release.

Matthew Wellington, antibiotics program director for US PIRG (Public Interest Research Group), which was among a coalition of groups that had urged KFC to enact better antibiotic policies, said the announcement illustrates the important role that food companies play in efforts to reduce antibiotic use in food-producing animals.

"KFC making good on its promise to cut the use of medically important antibiotics in its chicken supply shows that food companies can use their purchasing power to make a positive impact," he told CIDRAP News. "It's good news for consumers and will help preserve these life-saving medicines for future generations."
Jan 24 KFC press release

News Scan for Jan 24, 2019

News brief

Study: Flu vaccine offers 68% protection in Canada, 72% against H1N1

Today in Eurosurveillance, researchers published the first estimates of vaccine effectiveness (VE) for the 2018-19 seasonal flu vaccine administered in Canada, showing that overall VE was 68% in a season driven by influenza A(H1N1) viruses and 72% against the predominant strain.

The study was based on 1,518 eligible specimens collected by the Canadian Sentinel Practitioner Surveillance system from Nov 4, 2018, through Jan 12, 2019. Among those specimens, 661 (44%) tested positive for influenza, including 656 (99.2%) specimens typed as influenza A, 4 (0.6%) as influenza B, and 1 (0.2%) as an influenza A/B co-infection.

For all flu types, VE was 68%. For the H1N1 strain alone, it was 72% (95% confidence interval [CI], 60% to 81%). According to the study, adjusted VE estimates against H1N1 were 91% (95% CI, 67% to 98%) in children ages 1 to 8 years, 71% (95% CI, −60% to 95%) in 9- to 19-year-olds, 68% (95% CI, 51% to 80%) in adults ages 20 to 64, and 65% (95% CI, −1% to 88%) in adults 65 and older. The estimates for 9- to 19-year-olds and those 65 and older, however, were not statistically significant.

All influenza vaccines manufactured for Canada for the current flu season were egg-based, and more than 95% were the inactivated vaccine.

"Our 2018/19 VE estimate of 72% (95% CI: 60 to 81) against influenza A(H1N1)pdm09 viruses is comparable to a preliminary report from Australia using the same vaccine component for their 2018 season (78%)," the authors concluded.
Jan 24 Eurosurveillance study


FDA approval expands Fluzone quadrivalent indication for youngest kids

Sanofi Pasteur announced yesterday that the US Food and Drug Administration (FDA) has approved an expanded age indication for the use of the 0.5-milliliter (mL) dose of Fluzone quadrivalent flu vaccine for children ages 6 through 35 months.

In a statement, David Greenberg, MD, the company's regional medical head for North America, said the expanded indication will streamline immunization efforts for pediatricians by allowing the same 0.5-mL dose for the youngest children as for other children. The company said doctors will have both the 0.25-mL dose and the 0.5-mL dose available for the expanded age indication for the upcoming 2019-20 season.

Sanofi said the FDA's approval was based on a phase 4 safety and immunogenicity study in nearly 2,000 children that suggested one or two 0.5 mL doses of children ages 6 through 35 months had a safety profile that was similar to the smaller dose, with no new safety concerns and with a robust immune response.
Jan 23 Sanofi press release


CDC: Three in 2017 sickened with listeriosis after eating caramel apples

Today's Morbidity and Mortality Weekly Reports (MMWR) includes information on a cluster of listeriosis patients sickened after eating caramel apples in the fall of 2017.

The apples were sold in clamshell packs at grocery store chains throughout the country, and the cases occurred in Illinois, Iowa, and Michigan. All case-patients were men from 55 to 71. All three were hospitalized for listeriosis, but none died.

Investigators did not find the outbreak strain of Listeria monocytogenes on any caramel apples collected during the outbreak investigation nor during testing of apple production environments. Nevertheless, the authors said the epidemiologic evidence indicated that caramel apples were the cause of the outbreak.

Grocery store recipes collected from the patients showed all three had eaten the same caramel apples in the weeks prior to symptom onset.

"All outbreak-associated ill persons consumed a specific brand of a relatively uncommon food product in the month before their illness onset, and all were infected with indistinguishable L. monocytogenes strains," said the authors, who are from the Centers for Disease Control and Prevention and state health departments. "Caramel apples were previously implicated in a large multistate outbreak of listeriosis during 2014-2015, caused by contamination of whole apples."
Jan 24 MMWR study


Avian flu outbreaks reported in India, Taiwan, Dominican Republic

In the latest avian flu developments, India reported more highly pathogenic H5N1 detections in poultry and in wild birds, Taiwan reported more highly pathogenic H5N2 outbreaks at poultry farms, and the Dominican Republic reported an outbreak involving low-pathogenic H5N2, according to separate notifications from the World Organization for Animal Health (OIE).

In India, the agriculture ministry reported two more H5N1 outbreaks in backyard poultry, both in Bihar state. One began on Dec 15, and the other started on Jan 3. Combined, the outbreaks killed 57 of 4,046 susceptible birds, which were culled to curb the spread of the virus. So far, the source of the virus hasn't been determined. In late December, the country reported a similar outbreak at a different location in Bihar state, the first appearance of H5N1 in India since June 2018.

Also, India reported four more H5N1 events in wild birds, three involving house crows found dead in Bihar state and one in an Indian pond heron found dead in Orissa state. In total, 39 bird deaths were reported. Earlier this month, the country reported finding the virus in house crows in both Bihar and Orissa states.

Taiwan's new H5N2 outbreaks are part of poultry detections that have been occurring since 2015. The latest events struck commercial poultry farms in Changhua and Yunlin counties, with start dates on Dec 6 and Jan 9, respectively. The report didn't note any poultry deaths but said 11,719 birds were destroyed at the two locations.
Jan 24 OIE report on H5N1 in Indian poultry
Jan 24 OIE report on H5N1 in India wild birds
Jan 23 OIE report on H5N2 in Taiwan

Meanwhile, animal health officials in the Dominican Republic said low-pathogenic H5N2 was found in an outbreak involving backyard birds that began on Nov 2 in the city of Puerto Plata. Affected birds included hens, ducks, turkeys, and guinea fowl.

The virus killed 745 of 1,126 susceptible birds, and authorities destroyed the survivors as part of the outbreak response. The country's last outbreak involving the outbreak strain occurred in May 2018.
Jan 24 OIE report on low-path H5N2 in the Dominican Republic

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