Stewardship / Resistance Scan for Nov 19, 2018

News brief

Antibiotic use declining in UK livestock

A new report from the Responsible Use of Medicines in Agriculture Alliance (RUMA) says the UK livestock industry is making progress in efforts to meet antibiotic use targets, but a group of leading British clinicians warns that progress could be threatened if the government doesn't commit to changes in the way antibiotics are used in food-producing animals.

According to RUMA's "One Year On" report, the industry overall is making headway in its efforts to reduce antibiotic use. Sales of antibiotics to the livestock industry fell by 40% from 2013 through 2017, including a 52% decrease in sales of the most critical antibiotics for human health, and antibiotic use in food-producing animals is among lowest in the European Union. But progress in reaching 2020 targets varies among different animal sectors.

The report shows that the pig sector in the United Kingdom is on track to meet the 2020 target for reducing antibiotic use, the poultry meat sector is already under the targets set for both chickens and turkeys, the laying hen sector is below its target, and the gamebird sector hit its target 2 years early and is now considering new targets. But the cattle and sheep industries have had issues with data collection that have made it difficult to assess progress, and progress in the fish sector (farmed trout and salmon) has been mixed.

The targets were established in 2017 by RUMA's Targets Task Force, a group that included a specialist veterinary surgeon and a leading farmer for each of the sectors covered.

"Some species have met their targets already but now, with a measure of what's happening in their sector, they know they can go further and are working on new goals," RUMA secretary general Chris Lloyd said in a press release. "For others at or around their optimal level of use, progress is about animal health, continual refinements to what they do and working to overcome new diseases threats as they emerge."

Meanwhile, the Guardian reports that the leaders of the UK's main medical associations have signed a joint letter to the secretaries of state for health and the environment calling on the British government to commit to a ban on the use of antibiotics to prevent diseases in groups of animals. In October, members of the European Parliament voted to limit the use of antibiotics to prevent disease to individual animals (rather than entire herds or flocks), and only in cases where a veterinarian believes there is a high risk of infection.

But that legislation will not become law until 2022, and with the United Kingdom scheduled to leave the European Union in 2019, that means the British government won't be bound by it. The letter asks the government to commit unequivocally to banning preventive antibiotic group treatments.

"If the government allows group prevention to continue, the UK will have some of Europe’s weakest regulatory standards," the letter states. "This could seriously undermine progress being made in reducing UK farm antibiotic use."
Nov 16 RUMA report
Nov 16 RUMA press release
Nov 16 Guardian story

PAHO issues guidance for antibiotic stewardship in Latin America

The Pan American Health Organization (PAHO) has published a new set of recommendations to help governments and healthcare providers in Latin America and the Caribbean set up antimicrobial stewardship programs (ASPs).

The manual, published in conjunction with the Global Health Consortium at Florida International University, aims to provide practical guidelines on implementing ASPs for national health authorities in the region and recommendations for hospital managers and healthcare workers on cost-effective interventions to reduce inappropriate antibiotic use. The recommendations focus on stewardship in acute care and ambulatory settings

"Antibiotics are responsible for having saved millions of lives all over the world, but we are currently experiencing unprecedented rates of resistance to some of the most common treatments,” Marcos Espinal, MD, MPH, director of the Communicable Diseases and Environmental Determinants of Health unit at PAHO, said in a press release. "It is vital that efforts are stepped up to preserve these achievements, reduce the impact of resistance and ensure continued treatment and prevention of infectious disease."

ASPs are a critical part of the World Health Organization (WHO) Global Action Plan on Antimicrobial Resistance and the PAHO Regional Action Plan, but hospitals in the region have been slow to adopt them. According to a 2012 survey, only 46% of hospitals in Latin America and the Caribbean have an ASP in place, compared to 58% in the rest of the world (and 66% and 67% in Europe and North America, respectively.)

Observational studies estimate that the misuse of antibiotics by healthcare providers in Latin America and the Caribbean is around 50%, but there have been no regional studies on antibiotic use in hospitals. The authors of the manual say that standardized systems and indicators are needed at different health care levels in the region to promote benchmarking, guide policy-making, and implement effective strategies to change antibiotic behavior.
Nov 16 PAHO press release
Nov 16 PAHO manual

FDA approves new antibiotic for travelers' diarrhea

The US Food and Drug Administration (FDA) approved a new antibiotic for adults with uncomplicated travelers' diarrhea caused by non-invasive strains of Escherichia coli.

Aemcolo (rifamycin), developed by Cosmo Pharmaceuticals, is an orally administered, minimally absorbed antibiotic that releases its active ingredient in the colon. It was approved based on results from two randomized, controlled phase 3 clinical trials of adult patients with travelers' diarrhea, which showed that Aemcolo significantly reduced symptoms compared to a placebo and was well-tolerated, with headache and constipation being the most common adverse events.

Aemcolo was not shown to be effective in patients with diarrhea complicated by fever and/or bloody stool or diarrhea caused by pathogens other than non-invasive strains of E coli. It should not be used by patients with a known sensitivity to rifamycin.

Travelers' diarrhea affects an estimated 10% to 40% of travelers worldwide each year and is commonly caused by bacteria found in food or water. The highest-risk destinations are in Asia, the Middle East, Africa, Mexico, and Central and South America.

Aemcolo was granted priority review under the FDA's Qualified Infectious Disease Product designation, given to antibacterial and antifungal drug products that treat serious or life-threatening infections. It will be available in pharmacies in the first quarter of 2019.
Nov 19 Cosmo Pharmaceuticals press release
Nov 16 FDA press release

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News Scan for Nov 19, 2018

News brief

MERS infects one more in Saudi Arabia

Saudi Arabia yesterday reported a new MERS-CoV case for epidemiologic week 47, which involves a 52-year-old man from Riyadh.

The ministry of health said the man didn't have a history of recent contact with camels and wasn't known to have been exposed to another known MERS-CoV (Middle East respiratory syndrome coronavirus) case. He is currently hospitalized.

Earlier this month, Saudi Arabia reported two other MERS case-patients, one who apparently had no contact with camels or another sick patient and another who was exposed as a household contact.

The new cases lift the global number of MERS-CoV illnesses reported since 2012 to 2,267, at least 803 of them fatal.
Nov 18 Saudi MOH update

Poll: 'Echo chamber' may be obstacle for children's flu vaccination

Parents who decide not to vaccinate their children against flu may be exposed to a limited range of information, contributing to an "echo chamber" that seems to reinforce negative opinions, according to a new poll from the C.S. Mott Children's Hospital at the University of Michigan.

The nationally representative web-based poll, administered in October 2018, included responses from 1,977 parents who have at least one child ages 1 to 18 years old.

According to the findings, nearly one-third of parents said they were not planning to get their child vaccinated against flu this season, even though the US Centers for Disease Control and Prevention recommends that everyone age 6 months and older be vaccinated against flu every year.

Four in 10 parents said they based their flu-vaccine decisions on information from sources other than their child’s healthcare provider, and those in that group were less likely to have their child vaccinated. Common sources of information for those who opted out included family, close friends, and other parents. That group reported seven times as many sources of information that made them question or decline the vaccine, and researchers said the volume of negative information may make it less likely that they will change their minds.

In contrast, the most common source for parents who wanted the flu vaccine was their child's healthcare provider, nurses, and medical staff. However, one in five parents said the child's provider did not make a vaccine recommendation.

Sarah Clark, MPH, poll codirector, said in a University of Michigan press release that child health providers are critical for building the rationale for annual flu vaccination and to answer parents’ questions about safety and effectiveness. "Without clear guidance from the provider, parents may be left with misinformation, such as the suggestion that flu vaccine causes the flu," she said.

According to Clark, several possible recommendations could explain the echo chamber. For example, some parents may seek out specific people and information sources that support their position on vaccines, so that what they learn is in line with their already formed opinions. She said it's important to acknowledge that children's providers aren't the sole or primary influence. "For these families, we need to explore other mechanisms to convey accurate information and allow parents to hear a more balanced viewpoint," Clark added.
Nov 19 University of Michigan press release
Nov 19 Mott Poll report

Texas notes four cases of infant botulism tied to honey pacifiers

The Texas Department of State Health Services (DSHS) issued a health alert concerning four recent cases of infant botulism tied to honey pacifiers.

According to the Food and Drug Administration (FDA), the pacifiers were purchased in Mexico, but are widely available online. All four cases have been reported since August.In recent years, Texas has reported seven to eight cases annually.

Honey is not recommended for consumption for babies under 1 year of age because it can contain spores of Clostridium botulinum, which acts as a neurotoxin in infants.

"Investigators noted that these honey pacifiers and other food-containing pacifiers are available for sale at retailers as well as online, and that parents may not be aware of their potential danger," the DSHS said on their website. "Infants (children less than 12 months of age) should not be given honey, or pacifiers containing honey or other food products, because of the risk of contracting infant botulism."
Nov 16 DSHS health alert
Nov 16 FDA press release

One more death reported in NJ peds facility’s adenovirus outbreak

One more patient has died in an adenovirus type 7 outbreak at a pediatric health facility in New Jersey, raising the fatality count to 11, according to an update yesterday from the New Jersey Department of Health (NJDH).

The outbreak at Wanaque Center for Nursing and Rehabilitation has sickened 35 people, including 34 residents and 1 staff member.

In another development, the health center, which cares for medically fragile pediatric patients, has finished separating patients without symptoms in the respiratory unit from those who are sick with adenovirus, which includes grouping residents by lab testing status and symptoms, the NJDH said in a Nov 17 statement. Because of a drop in patients, the center now has space to separate the patients and was able to meet the Nov 21 deadline for completing the action.

The NJDH said it is requiring Wanaque Center for Nursing and Rehabilitation to hire a certified infection control practitioner and a physician or a physician practice with board certification in infectious diseases.

Meanwhile, the case count in an adenovirus outbreak at a separate children health center, Voorhees Pediatric Facility, involving the less serious type 3 strain remains at 8, with no deaths, the NJDH said.
Nov 18 NJDH update
Nov 17 NJDH statement