News Scan for Jun 30, 2014

News brief

Saudi Arabia launching MERS case-control study at last

Saudi Arabia has begun work on a case-control study to try to pinpoint how people contract MERS-CoV, something that critics of the government's response have been demanding for many months, according to a Reuters report today.

Also, the Saudi Ministry of Health (MOH) reported one new MERS-CoV (Middle East respiratory syndrome coronavirus) case today, involving a 15-year-old Saudi boy in Jeddah. He has symptoms but is isolated at home.

The case raises the MOH's MERS count to 712 cases, while the death toll remains at 292.

Tariq Madani, head of the scientific advisory board for the MOH Command and Control Centre for MERS, told Reuters that 10 cases and 40 controls have been enrolled so far in the case-control study, which will compare the histories of patients and healthy people.

The study will focus on primary cases, meaning patients who had no known contact with other MERS patients, healthcare facilities, or people with unexplained respiratory illnesses that might have been MERS, Madani said.

The study team includes several scientists who helped develop the World Health Organization's 22-page guidance for MERS case-control studies, he added.

Madani said the study is the centerpiece of a 25-study MERS-CoV research agenda, which includes studies of human-animal interactions, hospital outbreaks, and treatment strategies. Sixteen studies are under way, with 120 scientists participating, he added.

He said the study is part of a "180-degree" policy change on MERS, following the government's change of health minsters in April. "This should have been done long ago, but unfortunately it wasn't," he told Reuters. "So it was the top-priority research project we started with."
Jun 30 Reuters story
Jun 30 MOH statement

CDC: E coli outbreak tied to clover sprouts grows to 18 cases

An outbreak of Escherichia coli O121 infections linked to raw clover sprouts has grown to 18 cases in five states, the Centers for Disease Control and Prevention (CDC) said in a Jun 27 update, with the addition of 1 new case, in Washington state.

Illness-onset dates range from May 1 to May 20, and patients' ages range from 11 to 45 years, with a median age of 27. Fourteen of the patients (78%) are female.

Among the 16 people with available information, 7 (44%) have been hospitalized. No case-patients have developed hemolytic uremic syndrome, a potentially fatal kidney complication, and no deaths have been reported.

The numbers of cases per state are: Idaho, 3; Michigan, 1; Montana, 2; Utah, 1; and Washington, 11. The CDC's previous update was on Jun 10.

The CDC said, "Epidemiology and traceback investigations conducted by local, state, and federal officials indicated that contaminated raw clover sprouts produced by Evergreen Fresh Sprouts, LLC of Idaho are the likely source of this outbreak," but added that the company had not recalled its clover sprouts.

Representatives of the CDC and Food and Drug Administration on Jun 26 met with the owner of Evergreen Fresh Sprouts, who said the company planned to stop using the sprout seed lot linked to the outbreak.
Jun 27 CDC update

PAHO says cholera cases dropping in Haiti, Dominican Republic

The pace of cholera cases in Haiti and the Dominican Republic so far this year is well below last year's level, according to the Pan American Health Organization (PAHO).

Cases in Haiti this year have averaged 291 per week, with 1 death, compared with 993 cases and 8 deaths per week in the same period in 2013, PAHO reported in a Jun 27 update. In the neighboring Dominican Republic, cases this year have averaged 31 per month, with a total of 4 deaths, versus 130 cases per month and a total of 13 deaths in the same period last year.

The two countries, which share the island of Hispaniola, have been battling cholera since October 2010. The figures for this year show a continuing decline since 2011. The downward trend in cases is nationwide in both countries.

In the first 23 weeks of this year, Haiti recorded 6,689 cholera cases, with 31 deaths, PAHO reported. Two of the nation's 10 departments, Nippes and Nord Est, have not recorded any new cases since week 19.

The cumulative total of cases in Haiti since the epidemic began has reached 703,510, including 8,562 deaths and 393,012 hospitalizations. The Dominican Republic has had a total of 31,628 suspected cases and 471 deaths.

PAHO also said that Mexico on Jun 13 reported three cases of cholera in people who had eaten street foods before they got sick on Jun 4. The three individuals are all members of one family living in Hidalgo state. No additional cases have been reported.
Jun 27 PAHO update

Drug Resistance Scan for Jun 30, 2014

News brief

Health and ag ministers issue joint antibiotic resistance statement

Health and agriculture ministers from more than 20 countries issued a joint statement calling for stepped-up political efforts to battle antibiotic resistance, the World Health Organization (WHO) Regional Office for Europe said today. The call for action came out of a meeting at The Hague on Jun 25 and Jun 26.

The joint statement highlights the links between antibiotic use in animals and the threat of antimicrobial resistance (AR) in humans, along with the need to fight all sources of the problem. The group's statement strongly supports the development of a global action plan, which was called for by the World Health Assembly in May.

Dr Zsuzsanna Jakab, the WHO's regional director for Europe, said in the statement that AR can spread not just from human to human, but also through the food chain and the environment. "Thus, tackling it requires multifaceted approaches. Intersectoral and interdisciplinary collaboration and information sharing are crucial."

The joint statement said reducing AR demands a One Health approach that cuts across many sectors, including health, agriculture, and aquaculture. The group also called for a United Nations high-level meeting in 2016 to enable follow-up on the global action plan.

It also detailed several issues that came up at the meeting, including improving public awareness at all levels and improving the quality and voicing particular concerns about the rise in drug-resistant bacteria. The statement also listed priorities, led by the need to develop and set national and global standards for preventing infections and curbing the antimicrobial use in human and veterinary settings.
Jun 30 WHO statement
Joint statement text

FDA notes progress on judicious drug use in food animals

The US Food and Drug Administration (FDA) today issued the first of its planned semiannual progress reports on promoting the judicious use of antimicrobials in food animals, saying drug companies are on board.

The FDA said all 26 drug manufacturers affected by the agency's plan to combat drug overuse in animals as a means of curtailing antimicrobial resistance (AR), called Guidance for Industry (GFI) #213, "have now agreed to fully engage in the strategy by phasing out the use of medically important antimicrobials in food-producing animals for food production purposes and phasing in the oversight of a veterinarian for the remaining therapeutic uses of such drugs."

And, although drug companies have until December 2016 to complete recommended changes to their antimicrobials, some have already begun to implement them, the FDA said.

Of 283 products that fall under GFI #213, 31 have been withdrawn from the market completely and will no longer be available in the United States, while partial label changes have been completed for 2 and are pending for 1, the report states.

In an FDAVoice blog post today, David G. White, PhD, chief science officer and research director in the FDA's Office of Foods and Veterinary Medicine, wrote, "While these changes are significant steps forward, the strategy is still in its early stages. The changes are just one part of FDA’s overall strategy for monitoring and reducing antimicrobial resistance."
Jun 30 FDA report
Jun 30 FDAVoice blog post
Full text of GFI #213

AMA toughens stance on animal antibiotics

The American Medical Association (AMA) is pressing federal officials to take steps to ban antibiotic use in food animals for growth promotion to help slow the development of antibiotic-resistant bacteria, according to a report today from Food Safety News (FSN).

The group adopted a resolution at its annual meeting earlier this month in Chicago that urges its members to support regulatory and legislative measure to require animal antibiotic prescriptions to be overseen by a veterinarian and for the FDA to expand its surveillance and data collection regarding agriculture antibiotic uses.

The new AMA policy is seen as a more stringent step that replaces the group's previous stance, which opposed antimicrobials at nontherapeutic levels in agriculture and pushed for them to be stopped or phased out, according to FSN.

In a statement today, Keep Antibiotics Working, a Chicago-based coalition of health, consumer, and advocacy groups, applauded the AMA for taking a tough stance on reducing antibiotic use in food animals.

Dave Wallinga, MD, a physician on the group's steering committee, said in the statement, "Timely implementation of this policy will help stave off a future where antibiotics no longer work. Such a future would mean greater suffering and death for children, cancer patients, transplant recipients, and other patients who need them."
Jun 30 FSN report
Jun 30 Keep Antibiotics Working statement

Study: Timing of antibiotic use may predict resistant pneumonia

Time since the last exposure to antibiotics is the most important factor in predicting AR in pneumococcal disease, according to a study in Clinical Infectious Diseases.

Researchers with the Toronto Invasive Bacterial Diseases Network analyzed data on patients in that city from 2002 through 2011, using broth microdilution to measure antimicrobial susceptibility. They collected data on 4,062 episodes of AR in pneumococcal disease, 1,193 (29%), of which involved antibiotic treatment in the previous 3 months.

They found that the time elapsed since the most recent antibiotic course was inversely relatedly to resistance and varied by antibiotic class. The investigators also found that the risk of resistance after exposure declined fastest for fluoroquinolones and penicillins and reached baseline in 2 to 3 months with those drug classes.

The decline in resistance was slowest for macrolides, particularly for azithromycin. The researchers found no significant link between duration of therapy and resistance for any antibiotic class.
Jun 27 Clin Infect Dis study