Stewardship / Resistance Scan for Oct 22, 2019

News brief

WHO issues toolkit for stewardship programs in low-resource countries

The World Health Organization (WHO) yesterday published a roadmap for implementing antimicrobial stewardship programs in healthcare facilities in low- and middle-income countries (LMICs).

The WHO toolkit provides guidance on the core elements and structures that need to be in place at the national and facility level in low-resource countries to establish and support antimicrobial stewardship, along with detailed recommendations on how to plan, perform, and assess stewardship interventions. It also provides an overview of the core competencies that an antimicrobial stewardship team needs to facilitate more responsible antibiotic prescribing, and the education and training required to develop those competencies.

The aim of the toolkit, according to Hanan Balkhy, MD, the WHO's assistant director-general for antimicrobial resistance (AMR), is to offer practical guidance to LMICs to support objective 4 of the Global Action Plan on AMR—optimizing the use of antimicrobial medicines.

"It is my sincerest hope that this toolkit will be helpful to countries in implementing their national action plans on AMR, in particular in optimizing their use of antibiotics," Balkhy writes in the foreword. "Time is running out, but we still have a window of opportunity to turn the tide on AMR and ensure continued effective treatment of bacterial infections for future generations. Let us act now."
Oct 21 WHO toolkit for stewardship in LMICs

G20 health ministers reaffirm commitment to urgent action on AMR

In a statement issued after their recent meeting in Japan, health officials from 19 countries and the European Union have reaffirmed their commitment to take urgent action to address AMR.

The Okayama Declaration, released following the Oct 19-20 meeting of G20 Health Ministers in Okayama, Japan, contains several commitments to address major health issues, which have been a focus of the group since 2017. In addition to AMR, the document reaffirms commitments to universal health coverage, active and healthy aging, and strengthening health systems against infectious disease outbreaks and other global health threats.

On AMR, the ministers say they will strengthen efforts to fund, implement, monitor, and update national and regional AMR action plans; enhance implementation of measures to provide clean water, sanitation, vaccination, and hygiene to improve infection control; promote antimicrobial stewardship and appropriate access to antimicrobials and diagnostics; encourage countries to strengthen AMR surveillance; and encourage investment in research and development of new antibiotics, diagnostics, and vaccines.

The document also acknowledges the need for a coordinated approach to addressing AMR and universal health coverage in order to achieve the 2030 Agenda for Sustainable Development.
Oct 20 Okayama Declaration

FDA details progress made in veterinary antimicrobial stewardship

Yesterday the US Food and Drug Administration (FDA) made public performance measures for tracking the progress of the Center of Veterinary Medicine's (CVM's) Five-Year Plan for Supporting Antimicrobial Stewardship in Veterinary Settings, the FDA said in an update. The information is contained in FDA-TRACK, which monitors progress on FDA projects.

The CVM 5-year plan contains three goals:

Align antimicrobial drug product use with the principles of antimicrobial stewardship
Foster stewardship of antimicrobials in veterinary settings
Enhance monitoring of AMR and antimicrobial use in animals

The new performance measures pertain to the first goal and include implementing Guidance for Industry #213, which brings 292 medically important antimicrobials under veterinary oversight, defining the duration of use for 70% of medically important antimicrobial drugs used in food animals, assessing antimicrobial risk, and updating the list of medically important antimicrobials.

Performance measures for the other two goals will be made available in the coming year, the FDA said.
Oct 21 FDA update
FDA-TRACK progress report

News Scan for Oct 22, 2019

News brief

Study launched to track infectious diseases in Caribbean, Central America

The US Centers for Disease Control and Prevention (CDC) announced the launch of a new study to detect and better understand acute febrile illnesses (AFIs) in Belize, Guatemala, and the Dominican Republic.

During the study, people who report to a healthcare facility within the surveillance network with symptoms of an AFI will be asked to allow information describing them and their test results to be entered into a surveillance system.

According to the CDC, AFIs are characterized by a rapid onset of fever accompanied by a range of symptoms such as headache and diarrhea. AFIs often cause a public health crisis, as seen with recent outbreaks of Zika, dengue, and chikungunya viruses throughout the region.

"The development of a comprehensive surveillance system that improves the timeliness and effectiveness of detecting and responding to infectious disease threats is critical to reducing the impact and spread of disease within and across borders and ultimately improving health outcomes among vulnerable populations in the Central America and Caribbean region and globally," said Emily Zielinski-Gutierrez, MD, director of the CDC-Central America Regional Office.

Both Guatemala and the Dominican Republic are seeing a major outbreak of dengue right now, including 35,000 cases in Guatemala, and 12,000 cases in the Dominican Republic.
Oct 21 CDC press release

Zambia reports its first vaccine-derived polio case

Zambia's health ministry recently notified the World Health Organization (WHO) of a circulating vaccine-derived poliovirus type 2 (cVDPV2) case, marking the country's first local polio case since 1995 and its first cVDPV2 detection.

Including Zambia, 10 African nations have reported vaccine-derived polio cases this year.

In a weekly outbreaks and health emergencies report, the WHO's African regional office said the patient is a 2-year-old boy from the Luapula province on the border with the Democratic Republic of the Congo (DRC) who had a Jul 16 paralysis onset. A few days later, he was taken for medical care to Haut Katanga province in the DRC, where his stool sample tested positive for cVDPV2.

Of 34 stool samples collected from healthy contacts near the boy's home in Zambia, two were positive for cVDPV2. Genetic sequencing revealed that they were related to the case-patient. So far, no links have been found to an ongoing cVDPV2 outbreak in the DRC, where 37 cases have been confirmed this year.

The WHO said Zambia's routine coverage of oral poliovirus vaccine (OPV3) has been above national targets in the affected area for the past 2 years, but inactivated polio vaccine (IPV) coverage has been much lower.

The country's health ministry has activated a public health emergency operations center and put an incident management system in place to respond to the outbreak. Enhanced surveillance is underway, as well as an immunization survey.

The WHO said the evolving cVDPV2 situation in Africa is concerning, and the confirmation of a case near the border with DRC suggests the potential for cross-border spread. It added that high levels of routine polio vaccination are needed to minimize the risk of any poliovirus circulation.
Oct 21 WHO African regional office report

Ethiopia, Lebanon report measles outbreaks

Both Ethiopia and Lebanon are in the midst of growing measles outbreaks, according to new updates from the World Health Organization (WHO).

According to the latest weekly update from the WHO's African regional office, Ethiopia reported 24 new measles cases in the past week, raising the total number of suspected cases since Jan 1 to 8,514, including 57 deaths (case fatality ratio 0.67%). The measles outbreak in that country began in December 2018 and has occurred in four regions —Oromio, Afar, Amhara and Somali. Officials said the outbreak likely peaked during the first week of March, when 642 cases were reported.

Children under 5 represent 50.4% of cases, and 82.6% of cases were either not vaccinated or had an unknown vaccination status.

In Lebanon the WHO said measles has sickened 1,171 people since November 2018 across all of eight of the country's governorates. Children under 5 represent 63% of cases.

"In Lebanon, between 2000 to 2018, the WHO-UNICEF coverage estimations for second dose of measles-containing-vaccine ranged from 15-75 percent with a median coverage of 63 percent," the WHO said. Coverage needs to be around 95% to confer herd immunity against measles.
Oct 20 WHO African regional office update
Oct 22 WHO Lebanon update

Study shows Tamiflu effective against 1918 flu strain

A new study in mBio shows oseltamivir phosphate, the neuraminidase inhibitor marketed as Tamiflu, was effective against the H1N1 strain that caused the 1918 flu pandemic when used in infected macaques. The findings suggest the antiviral could be useful in future flu pandemics, but warns resistance would be likely.

The 1918 flu pandemic was the world’s deadliest, causing 50 million fatalities globally. To conduct the study, researchers treated two groups of four animals daily for 5 consecutive days with 150 mg oseltamivir phosphate starting either 1 day before or 1 day after infection with the 1918 strain of H1N1.

The drug was effective and limited severe illness when initiated prior to infection and partially successful when administered within 1 day postinfection, the authors said. But evidence of drug resistance was also noted among animals treated with oseltamivir.

"Our demonstration of oseltamivir-resistant virus in upper respiratory tract secretions suggests that spread of drug-resistant virus, even from successfully treated individuals, is likely to be a problem where sustained transmission of virus occurs, such as in a pandemic," the authors concluded. They added a combination treatment with oseltamivir and baloxavir might reduce antiviral resistance in a pandemic setting.
Oct 22 mBio study

France reports second local Zika case

French health officials yesterday reported a second local Zika infection, which involves a person living near the neighborhood of the first local case-patient.

A statement yesterday from the Paca Regional Health Agency, which covers Provence-Alpes and Cote d'Azur region in the country's southeast corner, said the second case was found during an Oct 10 survey near the first patient's neighborhood. It added that the two patients contracted Zika virus following bites from tiger mosquitoes, also known as Aedes albopictus, one of the types capable of carrying the virus.

The agency said health officials are continuing their investigations and that vector control actions have been taken in the neighborhood where the two patients live. It also noted that the patients have recovered from their infections.

The first patient, whose illness was first reported in the middle of October, is from the city of Hyeres and had Zika symptoms during the first half of August. The European Center for Disease Prevention and Control (ECDC) said in an Oct 16 risk assessment that the local Zika case in France poses a very low transmission risk but that sporadic cases or clusters of local cases are possible, especially in Europe's Mediterranean areas. Aedes albopictus mosquitoes are widely established in southern Europe, but decreasing temperatures in autumn months are not favorable for sustained transmission.
Oct 21 regional health agency media statement
Oct 17 CIDRAP News scan "ECDC: Local Zika case in France poses very low transmission risk