Stewardship / Resistance Scan for Sep 23, 2019

News brief

HHS, CDC celebrate commitments to fight antimicrobial resistance

Officials from the US Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) said today during the United Nations General Assembly (UNGA) in New York that they've received nearly 350 commitments from corporations, non-profit organizations, and health officials in 33 countries to take specific actions against antimicrobial resistance (AMR).

The commitments are in response to the AMR Challenge, an initiative launched last year at the UNGA by HHS and the CDC. The challenge, which emphasizes a One Health approach to addressing AMR, asked public- and private-sector organizations and leaders around the world to make a commitment in one of five areas: improving antibiotic use in humans and animals; reducing antibiotics and resistant bacteria in the environment; developing new antibiotics, vaccines, and diagnostics; enhancing data collection and sharing; and improving infection prevention and control.

In a press release, the CDC said nearly half of the commitments focus on improving antibiotic use in humans and animals, and nearly 45% focus on improving infection prevention and control. More than 55 pharmaceutical and biotech groups committed to developing or providing access to products that will prevent and treat resistant infections, and 47 organizations made commitments related to safe drinking water, sanitation, and hygiene. Seventy-six of the commitments came from countries outside the United States.

"The year-long initiative we launched last year around this time, the AMR Challenge, marks a historic step and sets a promising precedent," HHS Secretary Alex Azar said in prepared remarks. "The success of the Challenge over the past year demonstrates what is possible, in the relatively short term, when we have real commitment to the fight against this pressing public health threat."
Sep 23 CDC press release
Sep 23 AMR Challenge commitments
Sep 26, 2018, CIDRAP News story "HHS, CDC issue AMR 'challenge' to public, private sectors"

Letter from 'high-profile messenger' helps cut antibiotics in England

A new study by Public Health England has found that a letter from England's Chief Medical Officer (CMO) to primary care physicians with high antibiotic prescribing rates reduced prescribing by more than 3%. The findings appeared in the Journal of Antimicrobial Chemotherapy.

The CMO sent the letter on antibiotic prescribing rates to general practitioners (GPs) in 1,439 practices in England that were ranked in the top 20% of prescribers in April 2017. A version of the letter, which stated that "the great majority of practices in England prescribed fewer antibiotics per head than yours," has been sent to high prescribing GPs in England annually during each winter flu season since 2014, when a randomized clinical trial found the intervention reduced prescribing by 3.3% in an intervention group. To evaluate whether the letter continues to be effective, researchers from PHE Behavioural Insights measured the average rate of antibiotics dispensed by the GPs from April 2017 to September 2017, compared to a control group of GPs that didn't receive the letter.

Using regression discontinuity design to evaluate the intervention, the researchers estimated that the practices that received the letter changed their prescribing rates by approximately -3.69% (95% confidence interval [CI], -2.29 to -5.10), with the biggest reduction seen among prescribers in the top 11% to 20% and a lesser effect observed in the top 10% of prescribers. Based on this reduction, an estimated 124,952 fewer antibiotics were dispensed during the intervention period.

"Our results suggest that the social norm feedback intervention can be successfully implemented multiple times," the researchers write.

The intervention has also been adopted by CMOs in Australia, Northern Ireland, and Canada, and France is planning to follow suit.
Sep 20 J Antimicrob Chemother study

News Scan for Sep 23, 2019

News brief

CDC review: Norovirus most common foodborne pathogen in 2017

The Centers for Disease Control and Prevention (CDC) late last week released a summary of foodborne illnesses in 2017 based on an annual analysis of data from the Foodborne Disease Outbreak Surveillance System, and norovirus was the most common pathogen reported, responsible for 46% of illnesses. Salmonella and Shiga toxin–producing Escherichia coli were also linked to a substantial number of outbreaks.

In 2017, the CDC tracked 841 foodborne outbreaks, which included 14,481 illnesses, 827 hospitalizations, 20 deaths, and 14 food product recalls. A single etiologic agent was confirmed in 395 outbreaks (47%), which are defined as two or more related cases.

Tainted seafood and poultry were tied with causing the most outbreaks, with mollusks (41 outbreaks), fish (37), and chicken (23) the specific food items most often implicated. The most outbreak-associated illnesses were from turkey (609 illnesses), fruits (521), and chicken (487), the CDC said.

California had the most outbreaks (107), followed by Ohio (69), and Washington state (67).

As in past years, restaurants with sit-down dining were the most commonly reported locations for food preparation associated with outbreaks (366).
Sep 20 CDC report

New cases lift US measles total to 1,241, as Brazil faces growing outbreak

With two more cases confirmed in the last week, the United States has seen 1,241 measles cases in 2019—the most since 1992 and since measles was declared eliminated in 2000. The 1,241 total, however, remains the same as the previous week's, because two previously recorded cases were determined to not have been measles, the CDC said.

"As of September 19, 2019, 131 of the people who got measles this year were hospitalized, and 65 reported having complications, including pneumonia and encephalitis," the CDC said. No deaths have been recorded.

Thirty-one states have confirmed measles cases, and more than 75% of this year's cases have been recorded in New York State. Only the outbreak in New York's Rockland County is considered ongoing, as health officials this month declared outbreaks in New York City, El Paso, and Wyoming County, New York to be over.

In other measles news, Xinhua, Chin's state-run news agency, reported that Brazil has doubled the number of measles, mumps, and rubella vaccine doses ordered this year in an effort to stop a large ongoing outbreak. Xinhua said the vaccine order grew from 30.6 million doses in 2018 to 60.2 million in 2019.

Brazil's ministry of health will launch a vaccination campaign targeted at 39 million unvaccinated Brazilians. So far this year, Brazil has recorded 4,476, measles cases, with more than 3,000 of those confirmed in the past 3 months.
Sep 23 CDC update
Sep 21 Xinhua story