COVID-19 Scan for Oct 23, 2020

News brief

Lower COVID-19 viral loads found in asymptomatic children

In the first large study looking at SARS-CoV-2 viral loads (VL) in asymptomatic children, researchers found that VL were 3 to 4 logs lower compared with symptomatic children, which was consistent with the difference in median cycle threshold (Ct) values—10.3 cycles—between the two groups.

This finding, published yesterday in the Journal of Clinical Microbiology, held true across age (0 to 17 years old), race and ethnicity, sex, and institution, although the researchers found that both the magnitude of Ct difference and the VL lessened with older subgroups. SARS-CoV-2 is the virus that causes COVID-19.

Polymerase chain reaction (PCR) tests were used for initial COVID-19 detection, and in a press release from Ann & Robert H. Lurie Children's Hospital in Chicago, senior author Nira Pollock, MD, PhD, says, "Many of the asymptomatic kids in our study likely would have tested negative using the rapid tests based on our understanding of the limits of detection of those tests. Our findings should raise caution about using low sensitivity tests for asymptomatic screening programs in pediatric populations."

Across nine health institutions in the United States and Canada, the researchers looked at 339 asymptomatic and 478 symptomatic children from March to July. For the purpose of the study, symptomatic children had at least two symptoms.

The median adjusted Ct value was 8.6 cycles in asymptomatic children and -1.7 cycles in symptomatic children. Median VL was 2.0 X 103 in asymptomatic children and 1.3 X 107 in symptomatic children. Lead author Larry Kociolek, MD, says in the release, "Even the groups of asymptomatic kids with highest viral load in our study still had lower viral loads than the children with symptoms."

Asymptomatic children with diabetes who had recent contact with someone who had COVID-19 were most likely to be in the top 25% of asymptomatic VL, and those with more recent asymptomatic infections also had higher VL. Immunocompromised children did not seem to significantly differ.

The researchers say their study raises questions about peak VL in asymptomatic children, how quickly VL may rise and decline after initial infection, and how the findings affect transmission.
Oct 22 J Clin Microbiol study
Oct 22 Lurie Children's Hospital press release

 

A summer flight to Ireland led to a 59-person COVID outbreak

Despite implementing safety precautions, one summer flight into Ireland led to a 59-person outbreak in six of the country's eight health regions. Tests eventually confirmed that 13 (26.5%) of the original 49 passengers were positive for SARS-CoV-2, with the other 46 infected via contact with infected passengers.

In the Eurosurveillance study, researchers looked at four separate passenger groups, analyzing travel itineraries and their interactions with each other, including how close they sat together on the plane. Genome sequencing indicated a single source of COVID-19 spread the disease among the passengers, who came from elsewhere in Europe and two other, unspecified, continents.

The researchers found that the plausible attack rate was 17.8%, with 8 people contracting COVID-19 during the 7.5-hour flight, 3 incubating or infected after the flight, and 1 a tertiary contact of a flight case. At a minimum, the researchers determined, the virus attack rate was 9.8% if 4 of the passengers—those from the more isolated groups—contracted COVID-19 in-flight. They calculated the maximum attack rate to be 25%.

The airline practiced physical distancing and restricted crew and passenger interaction, and of the 13 known people who tested positive, 9 wore masks, 3 had unknown mask statuses, and 1 child did not wear a mask. The outbreak probe closed 28 days after the last symptom onset. Four people had to be hospitalized, with 1 needing intensive care. No deaths were reported.

To prevent future outbreaks linked to flights, the researchers recommend accessing flight manifests quickly, tracking not only flight information but transit information, and ensuring current contact information, as 11 passengers could not be reached.
Oct 23 Eurosurveillance study

ASP Scan (Weekly) for Oct 23, 2020

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Report shows significant drop in European veterinary antibiotic sales

Originally published by CIDRAP News Oct 22

Sales of veterinary antibiotics in European countries fell by more than one-third from 2011 through 2018, according to a report yesterday from the European Medicines Agency (EMA).

The latest European Surveillance of Veterinary Antimicrobial Consumption (ESVAC), which includes data from 25 European Union (EU) and European Economic Area countries, shows that overall sales of veterinary antibiotics declined by 34.6%, with notable declines in sales of antibiotics considered critically important for human medicine. Sales of third- and fourth-generation cephalosporins fell by 24%, polymyxins by 70%, fluoroquinolones declined by 4%, and other quinolones decreased by 74%.

Eighteen of the 25 countries providing data saw sales declines of greater than 5%, while 5 countries saw increases of more than 5%.

"The steady decrease in sales of veterinary antibiotics over ten years shows that Europe is on the right track to fight antimicrobial resistance," Ivo Claassen, head of EMA's Veterinary Medicines Division, said in a press release. "EU guidance and national campaigns promoting prudent use of antibiotics in animals are having a positive effect."

Among the potential explanations for the sales declines are the implementation of responsible-use campaigns, restrictions on veterinary antibiotic use, increased awareness of the threat of antimicrobial resistance, and the implementation of targets for reductions in veterinary antibiotic sales.

The authors of the report note that differences in reported sales and sales patterns between countries are likely to be partly due to differences in the occurrence of bacterial disease, the composition of the animal population, and production systems, and that direct comparisons should not be made between countries without considering these differences. But the reduced sales of veterinary antibiotics in some countries indicate the potential for a reduction in other countries as well, they said.
Oct 21 ESVAC report
Oct 21 EMA press release

 

Drug makers share discontinued antibiotic research data

Originally published by CIDRAP News Oct 22

The Pew Charitable Trusts announced yesterday that Merck and Kyorin Pharmaceutical Co. of Japan have shared antibiotic research data from a discontinued joint research program with Pew's open-access Shared Platform for Antibiotic Research and Knowledge (SPARK).

The preclinical, previously unpublished data come from research the two companies conducted on a potentially novel way to attack gram-negative bacteria that involves targeting two types of enzymes—DNA gyrase and topoisomerase IV.

Pew launched SPARK in 2018 to spur basic research into new antibiotics for gram-negative bacteria. The database provides access to chemical and biological data from published and unpublished studies and discontinued research programs, with a focus on molecules that take new approaches to overcoming the defenses of gram-negative bacteria. SPARK is open to scientists from industry, academia, government, and nonprofit research groups, with the hope that they can learn from past research and gain insights that will advance antibiotic discovery efforts.

"As we face the COVID-19 pandemic—with millions of patients vulnerable to secondary infections due to weakened immune systems—the need for new antibiotics that can treat multidrug-resistant Gram-negative bacterial infections has never been greater," Kathy Talkington, MPaff, director of Pew's antibiotic resistance project, said in a press release. "Our hope is that the data from Merck’s research will help catalyze discovery of new antibiotics for Gram-negative pathogens."
Oct 21 Pew Charitable Trusts press release

 

Cellics receives $3.94 million from CARB-X for sepsis treatment

Originally published by CIDRAP News Oct 21

Today CARB-X announced it is funding $3.94 million to Cellics Therapeutics, based in San Diego, to further its nanomedicine treatment for sepsis.

"Our macrophage nanosponge technology leverages the natural receptors on human macrophage membranes to neutralize bacterial pore-forming toxins, endotoxins, and inflammatory cytokines that underlie sepsis," said Steve Chen, MD, president and chief medical officer at Cellics, in a CARB-X press release.

The project, which is called CTI-111, uses cell membrane technology created by Cellics founder Liangfang Zhang, PhD, and the plan is to use the treatment in combination with other medicines such as antibiotics. The project may receive up to $15 million more in funding from CARB-X if specific milestones are met.

Sepsis occurs in 1.7 million US adults and contributes to nearly 270,000 deaths per year, according to the US Centers for Disease Control and Prevention. CARB-X, which stands for Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, is a nonprofit partnership that invests in early research and development to combat drug-resistant bacteria. Since its launch in 2016, CARB-X has announced 71 awards worth $256.64 million.
Oct 21 CARB-X press release

 

Effort launched to broaden access to new drug-resistant TB treatments

Originally published by CIDRAP News Oct 21

The TB Alliance today announced a new initiative to scale up novel treatments for tuberculosis (TB), including drug-resistant forms, in the most affected countries in Southeast and Central Asia, the group said today in a press release.

Known as LIFT-TB (Leveraging Innovation for Faster Treatment of Tuberculosis), the project's goal is to broaden adoption and scale up of improved treatment regimens and increase treatment completion rates for drug-resistant TB.

Sandeep Juneja, PhD, senior vice president for market access at the TB Alliance, said the group has recently seen great momentum in the fight against some of the most drug-resistant forms of TB. "Now, we're excited to help make an impact by ensuring that novel TB treatment regimens become widely available to those who need them the most."

The 5-year program is supported by $11 million from the TB Alliance and the government of South Korea and will target seven countries: Indonesia, Myanmar, The Philippines, Vietnam, Kyrgyzstan, Ukraine, and Uzbekistan. Along with the main goals, the initiative will also cover the initial stages of a study of the 6-month, all-oral, three-drug (bedaquiline, pretomanid, and linezolid, or BPaL) regimen, which will take place in the participating countries.
Oct 21 TB Alliance press release

 

VA study finds increased antibiotic use during early months of COVID-19

Originally published by CIDRAP News Oct 20

Data from inpatient Veterans Administration (VA) hospitals show a significant increase in antibiotic use from January to May, largely negating a downward trend over the previous 5 years, researchers reported today in Infection Control and Hospital Epidemiology.

To provide a broad overview of changes in antibiotic use at VA facilities during the COVID-19 pandemic, researchers examined data from acute inpatient care units at 84 VA facilities from 2015 through 2020, using only data from Jan 1 to May 31 of each year. They measured the impact in days of therapy (DOT) per 1,000 days-present (DP), but also examined the changes in the total antibiotic DOT to account for decreases in healthcare use during the pandemic.

From 2015 through 2019, antibiotic use decreased each year for Jan 1 to May 31 from 638 to 602 DOT/1,000 PD, a mean decrease of 9.1 DOT/1,000 PD per year. Consistent year-to-year declines were observed for broad-spectrum agents for community-onset infections, broad-spectrum agents for hospital-onset infections, and agents used for antibiotic-resistant gram-positive infections.

In contrast, the same period in 2020 saw antibiotic use increase from 602 to 628 DOT/1,000 PD, with increases observed for broad-spectrum agents used for community-onset and hospital-onset infections. The largest increase in the rate of use was for antibiotics typically prescribed for empiric therapy for community-acquired pneumonia (CAP). Total antibiotic DOT decreased from 721,761 in 2019 to 643,455 in 2020, likely because of a decline in DP (a 14.5% decline from 2019 to 2020) linked to fewer elective procedures and fewer emergency department visits.

A subset analysis that excluded VA facilities in states that were hit hard early in the pandemic showed similar results.

The authors say that while overall institutional antibiotic use fell, the increased density of antibiotic use (as measured by the use per patient per day) may adversely affect patient outcomes and institutional antibiotic resistance patterns.
Oct 20 Infect Control Hosp Epidemiol abstract

 

Clinical decision support tied to improved antibiotic use for pneumonia

Originally published by CIDRAP News Oct 20

A single-center study found that a clinical decision support (CDS) tool supplemented by antimicrobial stewardship program (ASP) audit and feedback led to robust improvements in antibiotic use for pneumonia patients, University of Utah researchers reported yesterday in Open Forum Infectious Diseases.

The study, conducted at the University of Utah Hospital, was a pre-post intervention analysis of inpatients with pneumonia that evaluated a CAP pathway built around a CDS advisory that aimed to help providers identify appropriate antibiotic therapy for CAP patients on admission, promote early transition from intravenous (IV) to oral therapy, and shorten overall durations of antibiotic therapy.

The study compared three 6-month phases of intervention—education alone, education and a CDS-driven CAP pathway coupled with active ASP and provider feedback, and a CDS-driven CAP pathway without stewardship—with the 12 months preceding the interventions. The primary outcomes were length of intravenous (IV) antibiotic therapy and total antibiotic therapy. Secondary outcomes included clinical, process, and cost outcomes.

A total of 400 CAP patients were included in the baseline period and 623 in the intervention phases. When compared to the baseline period, length of IV antibiotic therapy and total antibiotic therapy was unchanged in phase 1, while phase 2 of the intervention was associated with significantly lower length of IV and total antibiotic therapy, higher procalcitonin lab use, and a 20% cost reduction. Phase 3 was also associated with shorter IV antibiotic therapy and increased procalcitonin testing, and a non-significant reduction of 16% in costs.

There was no change in inpatient mortality or 30-day readmissions between any of the phases.

The authors attribute the success of phase 2 to its being the most intensive, with the ASP conducting prospective audit and feedback of all CAP patients in addition to using the CAP pathway.

"The early initiation of a CDS-driven CAP pathway supplemented by ASP review appears to improve healthcare value through decreased IV antibiotic length of therapy, decreased total length of therapy and decreased costs with similar clinical outcomes," the authors wrote.
Oct 19 Open Forum Infect Dis abstract

News Scan for Oct 23, 2020

News brief

Ten countries add more cases to their polio totals

Ten countries reported a total of 87 new polio cases over the past week, including Afghanistan and Pakistan seven African nations, and Yemen, according to the latest update from the Global Polio Eradication Initiative (GPEI).

Afghanistan reported 1 more wild poliovirus type 1 (WPV1) case involving a patient from Kandahar province, raising its total for the year to 53. It also reported 14 more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases in nine provinces, for a total of 91 cases for the year. Pakistan reported 2 more WPV1 cases, both in Balochistan province, boosting its 2020 total to 79.

All of the new African cases involved cVDPV2. Burkina Faso reported 21 more from 12 difference provinces, putting its total for the year at 38, all linked to outbreaks in Nigeria's Jigawa state and Togo's Savanes region. Sudan had 16 more cases in 9 different locations, lifting its 2020 total to 39. Ivory Coast confirmed 15 new cases in 13 provinces, making 48 cases for 2020.

These countries also reported more cVDPV2 cases:

  • Ethiopia had 4 new cases in three provinces, bringing this year's total to 35.
  • Mali reported 6 more cases in three provinces, for a total of 11 so far.
  • Nigeria recorded 1 more case, in Delta state, increasing its total to 3 so far this year.
  • Somalia confirmed 5 new cases in 5 provinces, making 9 so far this year.

In another Middle East development, Yemen reported 2 more circulating vaccine-derived poliovirus type 1 (cVDPV1) cases, both in Saadah district, lifting its total for the year to 16.
Oct 22 GPEI update

 

H5N8 avian flu infects wild swans in the Netherlands

Dutch veterinary officials reported a highly pathogenic H5N8 avian flu detections in two wild swans found dead in a wetland area near a village in Utrecht province in the central part of the country, according to a notification today from the World Organization for Animal Health (OIE).

The outbreak began on Oct 17 and involved mute swans. So far the source of the virus isn’t known.

In a related development, the UK Department for Environment, Food, and Rural Affairs (DEFRA) yesterday weighed in on the Netherlands' outbreak, noting that it occurred in the wake of recent H5N8 outbreaks in poultry and waterfowl in Russia and its neighbor Kazakhstan. It said mute swans don't migrate over long distances, so the infections in the Netherlands probably signal that the birds were exposed to the virus by migratory waterfowl.

DEFRA said the Netherlands has many more migratory birds this time of year than the United Kingdom has, but colder weather may encourage birds to move the British Isles. DEFRA officials raised the overall threat to UK wild birds to medium, though the risk to UK poultry still remains low. The agency urged poultry keepers to maintain or enhance their biosecurity measures.
Oct 23 OIE report on H5N8 in the Netherlands
Oct 22 DEFRA report

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