News Scan for Jan 15, 2020

News brief

CDC: E coli outbreak linked to romaine appears over after 167 cases

The Centers for Disease Control and Prevention (CDC) said today a multistate outbreak of Escherichia coli O157:H7 infections tied to contaminated romaine lettuce grown in Salinas, California, appears to be over.

"CDC is no longer advising that people avoid romaine lettuce from the Salinas Valley growing region in California," the CDC said, noting the lettuce in question is no longer for sale.

During the outbreak, at least 167 people in 27 states were sickened, including 85 hospitalizations. No deaths were reported, but 15 people developed hemolytic uremic syndrome, a type of kidney failure.

Illnesses started on dates ranging from Sep 20, 2019, to Dec 21, 2019. Wisconsin reported the most cases (35), followed by Pennsylvania (21) and Illinois (15).

According to the CDC, whole-genome sequencing showed that this outbreak was caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.

In December the CDC and the US Food and Drug Administration (FDA) tracked three separate outbreaks linked to romaine lettuce caused by three different strains of E coli O157:H7. In a statement today from the FDA, the administration said the common growers of lettuce in Salinas Valley are still being investigated.

"Our investigation is ongoing, and we are doing everything possible to find the source or sources of contamination. The investigation into how this contamination occurred is important, so romaine growers can implement measures that will prevent future contamination and illnesses," the FDA said.
Jan 15 CDC update
Jan 15 FDA statement

Fewer Americans say vaccines important; more tie them to autism

A new survey from Gallup shows only 84% of Americans view vaccinating children as extremely important—down from 94% in 2001. Even more troublingly, only 45% of polled Americans say vaccines do not cause autism.

The Gallup survey was conducted from Dec 2 to Dec 15, 2019, only a few months after the United States narrowly avoided losing its measles elimination status after a record-breaking year with outbreaks in New York, New Jersey, and Washington state, among other places.

"The decline in Americans' belief in the importance of vaccinating children between 2001 and 2015 occurred among almost all subgroups of the U.S. public. Since then, attitudes have been fairly flat by gender, age, education and party ID," Gallup said in a press release yesterday. "The only group that has maintained its 2001 level of support for vaccines is highly educated Americans, those with postgraduate degrees."

Ninety percent of Americans with postgraduate degrees in 2019 believe vaccinating is extremely important, a percentage unchanged since 2001.

In 2001, only 39% of Americans polled said they heard a great deal or a fair amount about the possible disadvantages of vaccines. In 2019, that percentage rose to 79%. Currently, 11% of US adults think vaccines are more dangerous than the diseases they prevent, Gallup said.

The link between autism and vaccines, which has been thoroughly debunked by scores of major studies over the last 20 years, is still a concern for many Americans: 46% of Americans polled, down from 52% in 2015, say they are unsure if vaccines cause autism. Ten percent said they do cause autism, compared with 6% in 2015.

The poll's margin of error is plus or minus 4 percentage points at the 95% confidence level.
Jan 14 Gallup poll

Unidentified infection in Kentucky college student prompts investigation

The Kentucky Department for Public Health (KDPH) announced yesterday that it, the Barbourville Appalachian Regional Healthcare (ARH) hospital are working with local health officials and the CDC to investigate a potential infectious disease case.

The KDPH sais the patient's close contacts have been identified and are being monitored.

Angela Dearinger, MD, MPH, said in a statement that the wider community isn't at risk and that the hospital followed appropriate protocols to prevent exposure to others.

The KDPH said it believes the threat to the public is extremely low and it will share more information as details are confirmed. It added that the hospital remains open, along with its emergency department. Officials urge anyone experiencing viral illness symptoms, including fever, nausea, body aches, or lethargy to seek healthcare immediately.

Union College, based in Barbourville, said in a message from school president Marcia Hawkins, PhD, on its Facebook page yesterday that one of its students is in isolation at ARH. It said the student is undergoing tests to identify a virus, but so far officials know that the student did not contract Ebola, as was speculated on Facebook. The report also said the student had not traveled out of the country during the holiday break.
Jan 14 KDPH statement
Jan 14 Union College Facebook post

Study finds asthma not tied to worse outcomes in kids with flu

A study of more than 1,700 children with medically attended flu across 10 flu seasons shows that asthma is not a risk factor for serious illness, according to findings published yesterday in Influenza and Other Respiratory Viruses.

Experts at the Marshfield Clinic Research Institute in Wisconsin analyzed data on children who received medical care at the Marshfield system from 2007-08 through 2017-18, excluding the 2009-10 pandemic season. Of the 1,764 children with lab-confirmed influenza, 287 (16.3%) had confirmed asthma, as well.

A serious flu-related outcome occurred in 104 children (5.9%). The odds of a serious outcome did not differ between those with asthma and those without, and the effect of vaccination on serious outcomes did not differ by asthma status, either, which supports previously reported national data.

The authors conclude, "Additional studies are needed to better understand the role of influenza vaccination in preventing these serious outcomes among children with asthma. In particular, children with severe or poorly controlled asthma merit further investigation to understand the effects of influenza illness and vaccination."
Jan 14 Influenza Other Respir Viruses study

Stewardship / Resistance Scan for Jan 15, 2020

News brief

Antibiotics obtained easily without prescription in China, study finds

Medical students posing as patients were able to obtain antibiotics without a prescription in 84% of Chinese retail pharmacies, Chinese researchers reported today in Antimicrobial Resistance and Infection Control.

For the cross-sectional survey, pairs of undergraduate medical students were sent to pharmacies in 13 provinces representing all three regions of China. The students were instructed to tell pharmacists they had a sore throat and a headache, then request antibiotics, following a three-step protocol in which the request became increasingly specific when antibiotics were not offered. They then recorded whether they were offered antibiotics, and at which step, along with the characteristics of the pharmacy and other details of their experience.

Overall, the students visited 1,106 pharmacies and obtained antibiotics without a prescription in 925 (83.6%; 95% confidence interval [CI], 81.5% to 85.8%). In 279 (25.2%) of the pharmacies, antibiotics were obtained at step 1, in which the students described their symptoms. More than half of the pharmacies (576, 52.1%) gave out antibiotics at step 2, when the students asked for antibiotics, and 70 (6.3%) gave out antibiotics when students specifically asked for penicillin or cephalosporins.

There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township, or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19).

Noting that previous studies have documented the ease of obtaining antibiotics from Chinese retail pharmacies, the authors of the study say these results are further evidence that little progress has been made toward the Chinese government's goal of prescription-only antibiotics by 2020. One study published in October 2019 found that 70% of patients reporting upper respiratory tract symptoms received antibiotics in Chinese pharmacies across six provinces.

"The very easy access to antibiotics in retail pharmacies in China needs to be addressed as a matter of urgency," the authors conclude. "This should be part of the wider anti-microbial stewardship effort."
Jan 15 Antimicrob Resist Infect Control study
Oct 7, 2019, CIDRAP News story on previous study

Study finds high rates of antimicrobial use in animals, people in Vietnam

Total antimicrobial usage in humans and animals in Vietnam reaches an estimated 3,842 tons a year, with usage in pigs far outpacing usage in people, according to a separate study yesterday in Antimicrobial Resistance and Infection Control.

The investigators used 2015 data to come up with their estimates. Of the 3,842 tons of antimicrobials used that year, 2,741 tons (71.7%) were used in animals and 1,086 tons (28.3%) in humans. The greatest use was in pigs (41.7% of the total), people (28.3%), aquaculture (21.9%), and chickens (4.8%).

Per kilogram of body weight, the results were similar: 261.7 milligrams (mg) of antimicrobials per kilogram (kg) in humans and 247.3 mg/kg in animals. That compares with 122.0 mg/kg in people and 151.1 mg/kg in Europe, the authors noted. They add that their data can help refine policies and interventions aimed at reducing antibiotic use in Vietnam.
Jan 14 Antimicrob Resist Infect Control study