Stewardship / Resistance Scan for Oct 23, 2017

News brief

Salmonella strain in US pigs linked to resistant group from Europe

A new study published in Clinical infectious Diseases suggests that a Salmonella strain circulating in pigs in the US Midwest is part of an emerging clade from Europe that is resistant to multiple antibiotics and may pose a public health risk.

The strain, Salmonella 4,[5],12:i:-, causes many foodborne disease outbreaks mostly tied to pigs and pork products and is expanding in the United States, according to the report by researchers from Minnesota and the United Kingdom.

The team used whole-genome sequencing to assess the relatedness of 659 S 4,[5],12:i:- isolates and 325 S Typhimurium isolates from various sources and locations in the United States and Europe. They also searched for resistance genes and other virulence factors and, for 50 livestock isolates and 22 human isolates, determined the antimicrobial resistance phenotypes.

The researchers found that the S 4,[5],12:i:- isolates fell into two main clades, regardless of their host or place of origin. Eighty-four percent of the US isolates recovered from 2014 through 2016, including nearly all those from pigs in the Midwest, were part of an emerging clade. This clade carried multiple genetic markers for antimicrobial resistance, including resistance to ampicillin, streptomycin, sulphonamides, and tetracyclines.

In addition, phenotypic (actual) resistance to enrofloxacin and ceftiofur was found in 11 of the 50 tested livestock isolates and 9 of the 22 human isolates. This was accompanied by plasmid-mediated resistance genes.

The authors conclude that S 4,[5],12:i:- strains circulating in Midwestern swine herds "are likely part of an emerging multidrug resistant clade first reported in Europe, and can carry plasmid-mediated resistance genes that may be transmitted horizontally to other bacteria and thus could represent a public-health concern."
Oct 23 Clin Infect Dis abstract


CDC awards $9 million more for research to slow antibiotic resistance

The US Centers for Disease Control and Prevention (CDC) today announced $9 million in awards to support research into new ways to combat antibiotic resistance and to identify knowledge gaps related to the problem. The support will go to 25 centers, including several major universities and other institutions, such as the Children's Hospital of Philadelphia and the J. Craig Venter Institute.

In its announcement, the CDC said the awards are part of its Antibiotic Resistance Solutions Initiative, intended to grow innovative approaches to fighting antibiotic resistance. In fiscal years 2016 and 2017 the initiative awarded more than $24 million.

The CDC said in a press release e-mailed to journalists that the latest round of awards is targeted to discovering and testing new strategies to protect patients from resistance threats in healthcare settings, investigate the threat from the human microbiome, and probe the impact of antibiotic resistance elements—genetic material that can move between and combine with bacteria—from environmental sources such as surface water and soil.

Newly funded projects are detailed in a list on the CDC's website.
Oct 23 CDC announcement

News Scan for Oct 23, 2017

News brief

Mugabe appointment to WHO goodwill post triggers firestorm, quick reversal

In a stunning development that played out over the weekend, news surfaced that WHO Director General Tedros Adhanom Ghebreyesus appointed 93-year-old Zimbabwe President Robert Mugabe as goodwill ambassador for noncommunicable diseases, prompting international outrage followed by a quick withdrawal of the appointment. Mugabe has been accused of human rights abuses and neglecting Zimbabwe's collapsing health system.

Tedros—who had held posts as Ethiopia's foreign minister and health minister—took over as WHO director-general on Jul 1, becoming the first African to hold the post and the first to be elected by member countries rather than the executive board. Earlier this month, he announced his senior management team, prompting praise for its diversity.

Global health officials and other observers have eagerly been watching for signs that he would steady and strengthen the WHO, especially in the wake of criticism, for example, over its slow response to West Africa's Ebola outbreak. The WHO continues to juggle multiple health and humanitarian emergencies, all of which draw heavily on support from donor countries.

In a statement yesterday rescinding Mugabe's appointment, Tedros didn't say why he had appointed him, but said he listened carefully to all who expressed their concerns. "I have also consulted with the Government of Zimbabwe and we have concluded that this decision is in the best interests of the World Health Organization."

Some global health leaders praised Tedros for reversing course, while many worry about his judgement and leadership, as well as how the misstep will affect global support for the WHO.

Global health experts quoted in a Stat story today said one possible explanation of the appointment is that Tedros was trying to repay those who supported him in the race for WHO director-general, which has prompted calls from a United Nations watchdog for a full inquiry.
Oct 22 Tedros statement
Oct 23 Stat
Oct 3 WHO
senior leadership team announcement


Madagascar's plague outbreak reaches nearly 1,300 cases

Madagascar's number of confirmed, probable, and suspected plague cases climbed to 1,297, according to the World Health Organization's (WHO's) latest situation report, an increase of 448 since its previous update. Of the total, 846 (65.2%) are pneumonic plague infections.

The number of deaths rose to 102, up 35 since the last report. The case-fatality rate remained at 7.9%.

Fourteen of the country's 22 regions have reported pneumonic plague cases, but the hardest hit area is still Antananarivo Renivohitra District, a large urban area surrounding the country's capital.

Nine plague treatment centers have been established in Madagascar with support from the WHO and several other health partners, up from four in the agency's last update. Six are in Antananarivo. Doctors Without Borders (MSF) announced on Oct 19 that it was working with local authorities to battle an outbreak of the disease in Tamatave, one of the country's biggest port cities.
Oct 20 WHO situation update
Oct 19 MSF press release


FDA clears GSK shingles vaccine

Following the unanimous recommendation from its advisory committee, the US Food and Drug Administration has approved GlaxoSmithKline's (GSK) shingles vaccine (Shingrix) for preventing herpes zoster in adults age 50 and older, GSK announced on Oct 20.

The recombinant subunit adjuvanted vaccine is given intramuscularly in two doses, and in phase 3 trials has shown over 90% efficacy across all age groups, with benefits sustained over a 4-year follow-up period, GSK said in a press release. The performance is expected to be an improvement over that of the currently licensed shingles vaccine, Zostavax, which reduces the risk of shingles by 51% in adults age 60 and older, according to the US Centers for Disease Control and Prevention.

Thomas Breuer, senior vice president and chief medical officer at GSK Vaccines, said in the release, "The risk and severity of shingles increases with age as the immune system loses the ability to mount a strong and effective response to infection. Shingrix was developed specifically to overcome the age-related decline in immunity."

The company said the CDC Advisory Committee on Immunization Practices (ACIP) is expected to vote on a recommendation about use of the vaccine at its Oct 25 meeting. Following the FDA's approval and pending a recommendation from ACIP, the vaccine will be available shortly.

On Oct 13, Canada approved Shingrix for adults 50 and older, and regulatory consideration is also underway in the European Union, Australia, and Japan.

The FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC), which provides nonbinding advice to the FDA,  voted Sep 13 to recommend the vaccine for approval.
Oct 20 GSK press release
shingles vaccine page
Sep 15 CIDRAP News scan "
FDA panel approves GSK shingles vaccine"


Bulgaria, Germany, Russia report avian flu outbreaks

Three European locations reported new highly pathogenic avian influenza outbreaks, an H5 strain in Bulgaria and H5N8 Germany and Russia, according to separate reports from the World Organization for Animal Health (OIE).

In Bulgaria, outbreaks involving a still undetermined H5 strain struck a commercial poultry farm in Dobric province in the east and backyard birds in Haskovo province in the south-central part of the country. The events began on Oct 17 and Oct 19, respectively. Between the outbreaks, the virus killed 502 of 10,613 susceptible birds, and the remaining ones were culled to curb its spread. The avian flu detection is Bulgaria's first since April.

Elsewhere, Germany today said tests on a wild mallard found dead on Oct 18 in Lower Saxony province in the northwest revealed H5N8.

Russia's H5N8 outbreak, its first since August, began Oct 20 and affected village birds in Rostov Oblast in the far southwest of the country. The virus killed 27 of 1,919 birds, and the remaining ones were to be stamped out, along with other response steps.

H5N8 took a heavy toll on European poultry last winter and spring, and virus detections continued over the summer and fall in a few countries, with Italy hardest hit.
Oct 22 OIE report on H5 in Bulgaria
Oct 23 OIE report on
H5N8 in Germany
Oct 23 OIE report on
H5N8 in Russia


Johns Hopkins releases pandemic countermeasure risk communication exercise

The Johns Hopkins Center for Health Security today released a self-guided exercise to help public health officials target their risk communications regarding the deployment and use of medical countermeasures in a pandemic.

The scenario involves an outbreak of the fictional "SPARS coronavirus," first detected in a US city in the year 2025. Over 3 years, the virus spreads to every state and more than 40 countries, with a fatality rate that depends on local health capacity. An existing drug is repurposed to treat the disease, as federal officials work with the pharmaceutical industry to develop a vaccine.

A national vaccination campaign is part of the exercise, which also includes a strain on the health system from patients seeking treatment for serious complications.

The exercise walks participants through risk communications, rumor control, interagency message coordination and consistency, issue management, proactive and reactive media relations, cultural competency, and ethical concerns. It is available in a 76-page publication on the center's website.
Oct 23 Johns Hopkins press release
pandemic scenario book

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