Stewardship / Resistance Scan for Sep 05, 2019

News brief

Trump administration sued over expanded use of antibiotics on citrus trees

The Center for Biological Diversity today sued the Environmental Protection Agency (EPA) and the Food and Drug Administration (FDA) for refusing to provide documents related to the EPA's decision to allow expanded use of medically important antibiotics on citrus trees.

The organization filed a Freedom of Information Act (FOIA) request for the documents in March. The lawsuit says the delay in providing those records is a violation of FOIA, and is asking the court to order the agencies to provide the documents.

In December 2018, the EPA approved expanded use of the antibiotic oxytetracycline in Florida and other citrus-growing states to combat citrus greening disease, a bacterial infection that has devastated the citrus industry. It's currently reviewing a request for expanded use of streptomycin.

Under expanded use, citrus growers could use 388,000 pounds of oxytetracycline and 650,000 pounds of streptomycin—amounts far greater than those used to treat human bacterial infections. The Center for Biological Diversity and other concerned groups, including the Centers for Disease Control and Prevention (CDC), have warned that spraying massive amounts of antibiotics on citrus trees could spur antibiotic resistance in soil bacteria, and resistant pathogens in the soil could ultimately impact human health.

Earlier in the year, the center obtained a 2017 CDC report to the EPA that concluded that using antibiotics as pesticides has the potential to select for antibiotic-resistant bacteria in the environment, including bacteria that pose a risk to human health. The organization is currently seeking all communications among the EPA, FDA, and CDC regarding the use of oxytetracycline and streptomycin as pesticides.

"The Trump administration is recklessly endangering public health by allowing these human medicines to be sprayed on crops," Center for Biological Diversity senior scientist Nathan Donley, PhD, said in a press release from the organization. "The EPA is trying to conceal conversations revealing the risks these careless actions pose to public health and wildlife."
Sep 5 Center for Biological Diversity press release
Aug 29 CIDRAP News story "Lawmakers urge EPA to rethink use of antibiotics on citrus trees"

Telehealth-based stewardship program shows promise in 2 small hospitals

Implementation of a telehealth-based antimicrobial stewardship program (ASP) at two Pennsylvania community hospitals was associated with a nearly 25% reduction in broad-spectrum antibiotic use, researchers reported today in Clinical Infectious Diseases.

The telehealth-based ASP implemented in two community hospitals in the Heritage Valley Health System involves hospital pharmacists without previous stewardship training who were trained to provide audit and feedback to providers. During weekly hour-long telehealth meetings, the pharmacists and infectious disease (ID) physicians from another health system (Allegheny Health Network) review patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft-tissue infections. The ID physicians then make ASP intervention recommendations that are relayed to provider teams by the pharmacists.

To study the impact of the program, researchers from both health systems tracked antibiotic use and local ID consults at the two hospitals over a12-month baseline period and the 6-month intervention period, and estimated the antibiotic cost savings. Their analysis found that during the intervention period (March 2018 through August 2018), 1,419 recommendations were made, of which 1,262 (88.9%) were accepted. Broad-spectrum antibiotic use decreased by 24.4% from the baseline period (342.1 vs 258.7 days of therapy per 1,000 patient-days). ID consults increased by 40.2% (15.4 vs 21.5 consults per 1,000 patient-days), and the estimated annualized cost savings on antibiotic expenditures was $142,629.

"In conclusion, we describe a practical model by which an intense ASP may be implemented in a community hospital setting via telehealth," the authors of the study write. "It represents a unique and viable strategy by which community hospitals not affiliated with a large system may gain access to robust stewardship support, and a mechanism by which larger institutions with such infrastructure may assist unaffiliated hospitals with expansion of ASP efforts."
Sep 5 Clin Infect Dis abstract

News Scan for Sep 05, 2019

News brief

Facebook announces new steps to combat vaccine misinformation

Facebook yesterday announced the launch of new features to battle vaccine misinformation on Facebook and Instagram, a move that was applauded by the World Health Organization (WHO).

When users search for vaccine-related content, visit vaccine-related Facebook groups or pages, or tap on a vaccine-related hashtag, an educational pop-up window will appear, CNN reported yesterday. If users are in the United States, the pop-up window will direct them to credible information from the Centers for Disease Control and Prevention (CDC), and if outside the United States, the pop-up window will direct them to information from the WHO.

The move is a follow-up to initial actions to combat vaccine misinformation that Facebook announced in March. Those steps included, for example, reducing the news and search rankings of groups and pages that spread misinformation and a policy to reject ads that include misinformation.

In a statement yesterday, the WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said the group welcomed Facebook's commitment, noting that it will direct millions of users to the WHO's accurate and reliable vaccine information in several languages to ensure that vital health messages reach people who need them most.

"The World Health Organization welcomes the commitment by Facebook to ensure that users find facts about vaccines across Instagram, Facebook Search, Groups, Pages and forums where people seek out information and advice."

Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them the most.

The WHO and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies, Tedros said. "Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases."
Sep 4 CNN report
Sep 4 WHO statement
Sep 4 Facebook update

Study: Flu in hospitalized infants higher than thought

Lab-confirmed flu hospitalizations in infants may be at least two times higher than earlier estimates, according to a new study of babies in four hospitals in four different countries across two flu seasons. An international team of researchers published their findings on Sep 3 in The Lancet Child and Adolescent Health.

For the prospective observational study, they looked at flu detections in acutely ill babies ages 1 year and younger who were hospitalized within 10 days of illness onset. The study included data from four hospitals over two flu seasons (2015-2016 and 2016-2017) in Albania, Jordan, and Nicaragua, and over a 34-week period (2015-2016) in the Philippines.

The team examined flu frequency based on real-time reverse transcriptase polymerase chain reaction (rRT-PCR) and serology.

Of 3,634 sick infants who were enrolled, 1,943 with complete acute-convalescent test result pairs were included in the final analysis. Of those, 5% (94) were positive by both tests, 3% (58) were positive by just rRT-PCR, 5% (102) were positive by only serology.

Of the 254 babies with flu, 33% only had nonrespiratory clinical discharge diagnoses, such as sepsis, febrile seizures, and dehydration. The authors wrote that focusing only on respiratory diagnoses and rRT-PCR confirmed flu may underdetect flu by a factor of 2.6 (95% confidence interval, 2.0 to 3.6).

They concluded that if the incidence of lab-confirmed flu is at least twice higher than previous estimates, the global burden of severe flu substantially increases, as does the value of maternal and infant flu vaccination programs.
Sep 3 Lancet Child Adolesc Health abstract

US travelers' Zika knowledge varies by gender, destination, survey finds

A new survey of US travelers shows inconsistent knowledge about the virus, with women and people traveling to Zika-endemic countries more likely to know about Zika transmission and risk factors than men and than those traveling to countries without active Zika transmission. The results of the survey were published this week in BMC Public Health.

Researchers conducted the Web-based survey of 1,043 US residents who had a history of traveling outside the United States in June 2017, 1 year after the virus caused major outbreaks in most of South America and in parts of the Caribbean and Central America.

"Those traveling to a Zika endemic country had 48% greater odds of having high Zika knowledge compared to those not traveling to a Zika endemic country (OR [odds ratio]: 1.48, 95% CI [confidence interval]: 1.14–1.93). Additionally, women had higher odds of having high Zika knowledge compared to men (OR: 1.44, 95% CI: 1.08–1.92)," the authors said.

When asked how to prevent Zika transmission, participants traveling to a Zika-endemic country with high knowledge of the virus were five to six times more likely to adopt sexual transmission preventive actions, such as condom use and abstinence, and more likely to use mosquito repellent and wear long-sleeved clothing.

"Our findings show that among travelers there are gaps in knowledge about the risks and transmission of Zika virus and that travelers with low knowledge are much less likely to engage in the appropriate prevention methods when traveling to a Zika endemic country," the authors concluded.
Sep 3 BMC Public Health study