Stewardship / Resistance Scan for Jun 05, 2018

News brief

Global Burden of Disease Study to include antimicrobial resistance data

University of Washington and University of Oxford experts yesterday announced the inclusion of mortality and morbidity data related to drug-resistant infections into the annual Global Burden of Disease Study, part of a new antimicrobial resistance (AMR) project "to provide rigorous quantitative evidence of the burden of AMR, to increase awareness of AMR, to support better surveillance of AMR, and to foster the rational use of antimicrobials around the world," according to a commentary in BMC Medicine.

"There are many challenges to estimating the burden of AMR," the authors write. "Primarily, there is limited and unreliable current and historical information on the geographical distribution, prevalence, and incidence of AMR and its health burden, making the burden of AMR difficult to measure and limiting our ability to devise geographically explicit strategies for its control."

The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study at the University of Washington's Institute for Health Metrics and Evaluation is the largest known repository of epidemiology data and can help researchers estimate the impact of a condition or health disparity like AMR on various populations. The GBD provides comparable estimates of mortality and disability resulting from 328 disease and injury causes and from 84 risk factors.

"Including AMR in the GBD will ensure that the resulting estimates comply with the rigorous, evidence-based framework that characterizes the GBD effort," the authors conclude, adding that the effort will provide "essential health intelligence to guide interventions and policies, as well as a benchmark for measuring the impact of interventions on future burden."

The effort is funded by the UK Department of Health and Social Care, the Fleming Fund, the Wellcome Trust, and the Bill and Melinda Gates Foundation.
Jun 4 BMC Med commentary

Review of One Health training finds lapses, makes recommendations

A systematic review of 45 One Health educational programs in the United States found that few have set core competencies or have consistent standards for applying them, along with other gaps, but offered recommendations for training future practitioners.

Since 2002, many institutions and universities have developed programs related to the One Health approach, which centers around the connections between human health and that of animals and the environment. Authors from the One Health Institute at the University of California (UC), Davis, and the National Academies' One Health Action Collaborative published their findings yesterday in National Academies of Medicine (NAM) Perspectives.

Lead author Eri Togami, DVM, MPH, a fellow at the UC Davis' One Health Institute, said in a press release from the school that the group believes three main skill sets are important to give future public health professionals the tools to solve complex challenges: robust health science knowledge; an understanding of local and global issues related to human, animal, and environmental health; and professional skills such as communication. "We recognize there is a large variety of educational programs for different purposes. Having these three pillars will help aspiring One Health professionals go through high quality training," she said.

Of 45 programs, 27 (60%) did not explicitly state core competencies, and only 14 (31%) listed them publicly online. Epidemiology, as well as environmental health and ecology, were covered by 75% of programs, but underrepresented disciplines included plant biology, law, and antimicrobial resistance. Also, less than half of the programs focused on communication skills required to collaborate with team member, the public, policymakers, and people in different cultural settings.

On the positive side, most programs emphasized practical, applied training for students, including internships, capstone projects, and nonacademic work settings. The report's four main recommendations include clearly stating core competencies, educating future students across a range of disciplines, emphasizing hands-on training, and emphasizing communication.

Jonna Mazet, DVM, PhD, the study's senior author, said in the press release, "I am encouraged to see the country's top educational institutions taking up this charge and creating so many new programs. Our hope is to provide some guidance to help them achieve their goals and ultimately improve the health of our planet."
Jun 4 NAM Perspectives study
Jun 4 UC Davis press release

News Scan for Jun 05, 2018

News brief

DRC reports six new Ebola cases in known contacts

The Democratic Republic of Congo (DRC) reported six more suspected cases of Ebola, including five in Bikoro and one in Wangata in its latest outbreak update. All of the new cases are known contacts of previously recorded cases.

The new cases bring the total number of suspected or confirmed Ebola cases to 56 (37 confirmed, 13 probable, and 6 suspected), including 25 deaths. No new deaths have been reported since late last week. Also, testing conducted on Jun 2 ruled out three previously suspected cases, the ministry of health said.

The DRC also said a total of 1,199 people have been vaccinated with Merck's unlicensed VSV-EBOV vaccine, including 577 in Mbandaka, 299 in Bikoro and 323 in Iboko.

Earlier today, Peter Salama, MD, the World Health Organization's deputy director-general of emergency response, tweeted that the WHO was working with the DRC's ministry of health and Doctors without Borders (MSF) to administer five therapeutics approved for compassionate use under WHO's MEURI (Monitored Emergency Use of Unregistered and Investigational Interventions) by DRC authorities. Salama said four were "currently available in-country and in place for access if Ebola patients need them today."

This is the first time during early stages of an Ebola outbreak a global evidence-based framework is in place to guide the review and prioritization of investigational drugs, Salama said. The therapies include ZMapp and mAb 114, both monoclonal antibody treatments.
Jun 4 DRC update
May 17 WHO Ebola treatment page
Peter Salama Twitter feed

More suspected monkeypox cases reported in Cameroon

Health officials in Cameroon announced 9 more suspected monkeypox cases, bringing the total number of cases to 16 (15 suspected, 1 confirmed), the World Health Organization (WHO) said in an update today.

Patients range from 1 month to 58 years of age, with a median age of 13. Nine patients are male. So far there have been no deaths, but all cases have involved a fever and body rash.

The outbreak began on Apr 30. The incubation period for monkeypox can be up to 10 days, with lesions lasting 2 to 5 weeks. The disease, a relative of smallpox, can be fatal but is much milder than smallpox, which has been eradicated.

Monkeypox, caused by an orthopoxvirus, is most likely transmitted through the consumption of contaminated bushmeat, a common practice in Western and central Africa.

"The detection of monkeypox in Cameroon underscores the need to maintain high level of vigilance and raise awareness of the disease among the local population," the WHO said. "Communication and education for people on how to prevent infection by avoiding contact with wild animals particularly rodents and primates are important."
Jun 5 WHO update

Chinese poultry workers have higher levels of avian flu antibodies in blood

A 3-year study of avian flu viruses such as H7N9, H9N2, H5N1, and H5N6 in poultry workers, swine workers, and members of the public in China's Jiangsu province who didn't have contact with the animals found low levels of exposure overall, but poultry workers had a higher risk than the other two groups, Chinese researchers reported the findings yesterday in Emerging Infectious Diseases.

They focused on live-poultry markets in the city of Wuxi, where they also obtained swab samples from chickens, ducks, and geese to assess the diversity and genetic variation of avian flu viruses at the locations.

The survey began in July 2013, and the team made follow-up visits at 1, 2, and 3 years, enrolling about 2,000 new participants each year to address the challenge of tracking often-temporary animal workers. The control group was made up of residents from community service centers who had not been exposed to poultry, pigs, or animal manure as part of their everyday activities. For the animal sampling, they visited nine markets each month and collected about 54 cloacal samples, plus additional environmental samples, at each visit.

Seroprevalence varied by group and over time, with overall levels of H7N9, H9N2, and H5N1 significantly higher in poultry workers than in swine workers and controls. Of 964 poultry workers, 9 showed evidence of H7N9 exposure, 18 for H9N2, and 18 for H5N1 over the study period. Seroprevalence in swine workers and controls was similar. No poultry workers were seropositive for H7N9 in 2016 or for H5N1 in 2014 and 2015. The team saw a significant increase in H5N1 seroprevalence in poultry workers in 2016 compared with 2015. None of the participants of any of the three groups were seropositive for H5N6 in the 3 study years.

When the researchers looked at incidence of seroconversion in poultry workers, 2 seroconverted for H7N9, 12 for H9N2, and 7 for H5N1. Of the other two groups, 1 control seroconverted for H7N9, and 3 swine workers and 4 controls seroconverted for H9N2. Poultry workers were more likely than controls to be infected with H9N2 and H5N1, but the rates weren't significantly different for H7N9.

Poultry sampling found high diversity of avian flu viruses, with H9N2 as the dominant subtype, making up 31.5% of the viruses. All H5 subtypes had genetic features that suggested high pathogenicity in poultry. There weren't any H5 outbreaks in Wuxi during the study period, but there were some events in several nearby cities in Jiangsu province.

The team concluded that surveillance for new flu viruses at live-poultry markets, especially at large facilities, and monitoring poultry and poultry workers is critical.
Jun 4 Emerg Infect Dis study