BSAC launches global plan to accredit antimicrobial stewardship efforts

Yesterday, the British Society for Antimicrobial Chemotherapy (BSAC) launched the Global Antimicrobial Stewardship Accreditation Scheme (GAMSAS), which aims to support healthcare organizations globally by recognizing good practices to combat antimicrobial resistance, identifying areas for improvement, and supporting education and training.

BSAC said GAMSAS plans to establish centers of excellence around the world to support the spread of effective antimicrobial stewardship (AMS) programs, according to a BSAC news release.

BSAC President David Jenkins MBBS, said, "AMS is a collection of evidence-based tools that helps keep antimicrobial resistance at bay. AMS ensures best treatment for infected patients now and keeps antibiotics working for future patients. Accreditation is another evidence-based discipline that measures and drives up quality of healthcare.

"The BSAC GAMSAS is the first global scheme to combine these two methodologies to focus on antimicrobial prescribing," BSAC said in the release.
Sep 1 BSAC news release
GAMSAS website

Study finds antibiotic use high in kids' ICUs, with a third deemed improper

A point-prevalence study in 10 medical centers across the United States reveals that almost 60% of pediatric intensive care unit (PICU) patients receive antibiotics, and researchers estimate that a third of antibiotic orders in PICUs are inappropriate, according to a study yesterday in Clinical Infectious Diseases.

The group of scientists, led by researchers with the Children's Hospital of Philadelphia, conducted the study over 4 days in 2019. They call it the largest such study to date focused on PICU patients.

The researchers note that, of 1,462 PICU patients, 843 (58%) had at least one order for antibiotics. They reviewed 1,277 antibiotic orders and note that 260 orders (21%) were empiric therapy for suspected bacterial infections without sepsis or septic shock and 164 (13%) were for non-operative prophylaxis, followed by empiric therapy for sepsis or septic shock (155 orders; 12%), community acquired pneumonia (CAP; 118; 9%), and post-operative prophylaxis (94; 8%).

Of 985 orders assessed for appropriate prescribing, the investigators classified 331 (34%) as inappropriate. The most common of those were empiric therapy for suspected bacterial infection without sepsis or septic shock (78 orders; 24%), sepsis or septic shock (55; 17%), CAP (51; 15%), ventilator-associated infections (47; 14%), and post-operative prophylaxis (44; 14%). The proportion of antibiotics classified as inappropriate varied across PICUs, from 19% to 43%.

The authors conclude, "Tailoring empiric antibiotic choices, de-escalating antibiotics when no bacterial infection has been identified, limiting the duration of post-operative antibiotics, and ensuring antibiotic durations are aligned with national guidelines represent actionable stewardship targets in this population."
Sep 1 Clin Infect Dis abstract

CDC director endorses updated COVID booster recommendation

Soon after vaccine advisors to the Centers for Disease Control and Prevention (CDC) yesterday voted to recommend updated COVID boosters that target the original virus plus the Omicron BA.4 and BA.5 subvariants, CDC Director Rochelle Walensky, MD, MPH, endorsed the Advisory Committee on Immunization Practices (ACIP) recommendation, paving the way for immunization to begin.

In a statement, she said the recommendation followed a comprehensive scientific evaluation and a robust discussion.

"The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant," she said. "They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants. This recommendation followed a comprehensive scientific evaluation and robust scientific discussion."

The CDC recommends the new Pfizer/BioNTech booster for those ages 12 and older and the new Moderna booster for those ages 18 and up. For both groups, the CDC recommends receiving the booster at least 2 months after receiving the primary vaccine series or the last booster dose. Walensky said, "If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it."

In related developments, the White House is preparing to ask Congress for $22.4 billion to fund the COVID-19 response and $3.9 billion for the monkeypox response, The Hill reported today, citing administration sources. The COVID funding is for short-term needs such as testing, research and development of next-generation vaccines and drugs and support for global efforts.

Yesterday during the CDC vaccine advisory panel discussions, a CDC official signaled that existing funding will cover the rollout of the updated boosters with a supply of 171 million doses. The funding request for COVID-19 is similar to the $22.5 billion emergency funding that the Biden administration requested in the spring but did not receive.
Sep 1 CDC statement
Sep 1 CIDRAP news story
Sep 2 Hill story

Preschoolers' parent confidence in COVID vaccines wanes as safety shown

Today in Morbidity and Mortality Weekly Report (MMWR), survey results show that parental confidence in COVID-19 vaccines dipped after authorization for preschoolers, and surveillance reveals that most adverse events after mRNA vaccination in this age-group were mild or moderate.

A team led by researchers from the University of Arizona and the CDC studied the intent of 393 parents of children aged 4 months to 4 years to vaccinate their children against COVID-19 from July 2021 to May 2022. The Pfizer/BioNTech and Moderna mRNA vaccines were authorized for this age-group on Jun 17, 2022. The survey was part of an ongoing study in Arizona, Florida, Texas, and Utah.

At baseline, 64.4% of parents said they were likely to vaccinate their children, while 19.3% were uncertain and 9.9% were unlikely. Three months later, parents were 16% less likely to vaccinate their children (adjusted odds ratio [aOR], 0.84) and 39% and 35% less likely to think the vaccines were effective (aOR, 0.61) and safe (aOR, 0.65), respectively. Both intent to vaccinate and perception of safety rose somewhat 6 months after baseline, but the findings weren't significant after adjustment.

"Enhanced efforts to address parental confidence in childhood vaccination and increase vaccination coverage among children aged <5 years are needed, including reinforcing the effectiveness and safety of vaccination against COVID-19," the researchers wrote.

In another study, CDC researchers monitored local and systemic adverse events reported to v-safe and the Vaccine Adverse Event Reporting System (VAERS) after Pfizer or Moderna vaccination in children aged 6 months to 5 years from Jun 18 to Aug 21, 2022.

Among 1,040,230 vaccinees, most adverse events were mild or moderate. VAERS received 1,017 adverse-event reports, 98.1% of them nonserious, and there were no reports of myocarditis (inflammation of the heart muscle).

"Health care providers and parents of young children should be aware that local and systemic reactions are expected after vaccination with Pfizer-BioNTech or Moderna vaccine and that serious adverse events are rare," the authors wrote.
Sep 2 MMWR parental intent study and mRNA vaccine study

CDC reports more E coli with links to romaine on Wendy's sandwiches

The CDC yesterday reported 13 more illnesses in an Escherichia coli O157:H7 outbreak that may be tied to romaine lettuce served on Wendy's sandwiches, with two more affected states—Kentucky and New York.

The new developments push the outbreak total to 97 people in 6 states. So far, 43 people have been hospitalized, and 10 had hemolytic uremic syndrome (HUS), a potentially fatal kidney complication. The latest illness onset was Aug 15.

State and local health officials are still interviewing sick people about the foods they ate before they became ill. Of 67 people with detailed food histories, 54 (81%) ate at Wendy's the week before in restaurants located in Indiana, Michigan, Ohio, and Pennsylvania. They had eaten a variety of menu items, including sandwiches and burgers.

Investigators are still examining other ingredients as a potential source of the outbreak. Wendy's uses a different source of romaine for its sandwiches than it does for its salads, and as a precaution it has removed the romaine it uses for sandwiches.
Sep 1 CDC outbreak update

Midwestern states see return of high-path avian flu in poultry

Four Midwestern states—Indiana, Minnesota, North Dakota, and Wisconsin—reported more avian flu outbreaks in poultry flocks, part of a small but steady stream of events over the summer.

The Indiana State Board of Animal Health (BOAH) said birds in a hobby flock in Elkhart County tested presumptive positive for H5 avian influenza. The facility has 261 chickens, ducks, and geese, which were depopulated. The outbreak is the state's first since Jun 8.

Meanwhile, the Minnesota Board of Animal Health (MBAH) has reported two new outbreaks at turkey farms in Meeker County, the state's first since May. The two central Minnesota locations housed 174,849 birds. Also, the MBAH reported an outbreak involving 20 backyard birds in Hennepin County, which is in the Twin Cities.

Shauna Voss, DVM, senior veterinarian with the MBAH, said, "While the timing of this detection is a bit sooner than we anticipated, we have been preparing for a resurgence of the avian influenza we dealt with this spring."

Also, North Dakota reported an outbreak in a backyard flock of 20 birds in Cass County, its first since Jun 6, according to an update from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

Today, the Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) reported an outbreak in a backyard flock in Washington County, the first since May.

In related US developments, APHIS reported three more outbreaks from three recently affected California counties. Two involve commercial farms, including a broiler breeder in Fresno County housing 22,900 birds and a turkey farm in Tuolumne County that has 30,800 birds. Also, APHIS reported an outbreak in Sacramento County involving a flock of 10 backyard birds.

So far, outbreaks in the United States involving the highly pathogenic H5N1 strain have led to the loss of 40.8 million birds across 39 states.
Aug 30 Indiana BOAH update
Aug 31 MBAH press release and avian flu updates
Sep 2 Wisconsin DATCP statement
USDA APHIS poultry outbreak updates

Europe has also reported H5N1 outbreaks in poultry over the summer months, with Portugal the latest to report another event involving commercial poultry. According to a notification from the World Organization for Animal Health (WOAH), the virus struck a fattening duck farm that has 47,868 birds in Evora, about 85 miles east of Lisbon.
Sep 2 WOAH report on H5N1 in Portugal