News Scan for Aug 16, 2018

News brief

New DRC Ebola cases recorded, including 1 in healthcare worker

The Democratic Republic of the Congo (DRC) Ministry of Health (MOH) released a new update late yesterday afternoon on the growing Ebola outbreak in the eastern region of the country, noting seven new confirmed cases, one of whom is a healthcare worker at Mangina Reference Health Center.

The outbreak total now stands at 73 cases, of which 46 are confirmed and 27 are probable. Forty-three deaths have been reported, and health officials are investigating 40 suspected cases.

All seven new cases are from Mabalako and involve probable and known contacts of previously confirmed cases.

Yesterday, the MOH confirmed that ring vaccination began in the affected health zone of Ituri province. Earlier this week, Ituri confirmed six cases of Ebola, including one death.

The medical humanitarian organization Doctors Without Borders (MSF) announced the opening of an Ebola treatment center on Tuesday in Mangina, the epicenter of the outbreak in North Kivu. A total of 37 patients are currently hospitalized in this facility, with 31 of those cases confirmed and six suspected.

"Among our patients, we have several colleagues from the Congolese health system," said Gwenola Seroux, MSF emergency programs coordinator, in a press release. "They were the first to respond, and some were exposed to the virus."
Aug 15 DRC update
Aug 16 MSF press release

CDC: No major measles outbreaks reported this summer

Despite alarming stories from CNN and Fox News, the Centers for Disease Control and Prevention (CDC) confirmed there are no far-reaching measles outbreaks this summer.

In recent weeks media outlets have reported that 21 states were involved in a 107-person measles outbreak, as if it was a single, far-reaching outbreak happening across the country.

"We believe this news organization misinterpreted the first paragraph of our Measles Cases and Outbreaks site. Since this article was published, several other outlets have published articles as well and that may be causing some confusion," said Kristen Nordlund, a media representative from the CDC, in an interview.

Nordlund explained that each month, CDC updates its Measles Cases and Outbreaks website with the total number of measles cases that have occurred in the United States and the names of states that have reported the cases. To protect patient confidentiality, the CDC does not list the number of cases that occurred in each state.

"The 107 cases reported to CDC have been since January 2018 across 21 states, but they are not one unified outbreak," Nordlund said. Last year, a total of 188 cases were confirmed across the United States.

The World Health Organization defines an outbreak of measles as three or more confirmed cases in a population of approximately 100,000 people.

"As always, the best protection against measles is MMR [measles, mumps, and rubella] vaccine," Nordlund said, also noting that some news organizations, including CNN, have corrected their erroneous reports.
CDC measles page

BioNTech and Pfizer sign deal to develop mRNA flu vaccines

BioNTech, a biotechnology company based in Germany, announced today that it has entered a multiyear research collaboration with Pfizer to develop mRNA-based flu vaccines.

According to a statement from BioNTech, the two companies will jointly conduct research and development to advance the vaccines, with Pfizer assuming responsibility for clinical development and commercialization of the mRNA vaccines, following the completion of BioNTech's first human clinical study.

The terms of the deal provide a $120 million initial payment to BioNTech, with the potential for $305 million in additional development, regulatory, and commercial milestone payments. It also includes royalty payments if the vaccine is commercialized.

BioNTech's focus has been on targeted immunotherapies for treating cancer and infectious diseases.

Kathryn Jansen, senior vice president and head of Pfizer's vaccine development unit, said in the statement that innovative vaccine approaches are urgently needed to improve protection against flu and respond more quickly and strongly to pandemic threats. "mRNA vaccines offer a novel approach to code for any protein or multiple proteins, and the potential to manufacture higher potency flu vaccines more rapidly and at a lower cost than contemporary flu vaccines," she said.
Aug 16 BioNTech press release

Stewardship / Resistance Scan for Aug 16, 2018

News brief

VA study finds MRSA colonization significantly increases infection risk

A longitudinal study of inpatients at Department of Veterans Affairs (VA) acute care hospitals has found that methicillin-resistant Staphylococcus aureus (MRSA) colonization significantly increases the risk of MRSA infection, with a substantial number of infections occurring after discharge from the hospital, VA researchers report in Clinical Infectious Diseases.

The retrospective study looked at a cohort of 985,626 inpatient admissions to VA acute care hospitals from 2008 through 2015, focusing only on patients who had surveillance testing for colonization status performed on admission. A patient whose admission MRSA screen and all subsequent screens were negative was categorized as not colonized. A patient who had a positive MRSA screen was classified as an importer, and a patient who had a negative MRSA screen on admission, but a subsequent positive screen, was defined as an acquirer.

For each of the three groups, the researchers calculated the proportion of MRSA infections that occurred prior to discharge and at 30, 90, 180, and 365 days after discharge, then determined the relationship between MRSA colonization status and infection.

Overall, 903,190 patients (91.6%) were found not to be colonized with MRSA during their hospitalization, 72,388 (7.3%) were importers, and 10,048 (1.0%) were acquirers. The MRSA infection rate across the predischarge and 180-day postdischarge time period was 5.5% in importers and 7.0% in acquirers, rising to 11.4% in importers and 11.7% in acquirers who were admitted directly to the intensive care unit. In the multivariable regression analysis, the predischarge hazard ratio for MRSA infection was 29.6 for importers and 28.8 for acquirers compared to those not colonized. When measured at 180 days postdischarge, 63.9% of all pre- and postdischarge infections among importers occurred during the postdischarge period. For acquirers, this value was 61.2%.

"In conclusion, acquisition of MRSA during hospitalization markedly increases the risk to a patient of subsequent infection that may not become manifest until after discharge," the authors wrote. "These factors should be taken into account when optimizing infection control strategies for MRSA."
Aug 11 Clin Infect Dis study

Study indicates high prevalence of mupirocin-resistant S aureus in Africa

A systematic review and meta-analysis yesterday in Antimicrobial Resistance & Infection Control suggests there is a high rate mupirocin-resistant S aureus in Africa.

Mupirocin nasal ointment, alone or in combination with chlorhexidine, is considered the main decolonization strategy for S aureus carriage, which is an important risk factor for subsequent infection among patients with surgical site infections and atopic dermatitis. The emergence of mupirocin-resistant (mupR) S aureus threatens this decolonization strategy. While mupR S aureus has been reported in several countries, there is no data summarizing screening, prevalence, characterization, and geographic spread in Africa.

Using five electronic databases, researchers from South Africa and Nigeria identified 43 eligible studies. Only 12 of 54 African countries (22%) reported data on screening for mupR S aureus. The pooled prevalence of mupR S aureus in Africa, based on 11 human studies conducted in South Africa, Ghana, Libya, Egypt, and Nigeria, was 14%. The proportion of S aureus isolates with the mupA gene, which confers high-level mupirocin resistance (HmupR), ranged between 0.5 and 8%. Isolates that expressed HmupR and low-level resistance (LmupR) ranged between 0.5 and 38% and 4 and 47%, respectively. The frequency of mupR-MRSA isolates ranged between 5 and 50%.

The authors of the study say the findings show the paucity of data on the continent and support the need for mupR S aureus surveillance data to provide information on it epidemiology and clinical significance. In addition, they note the need for data on administration and use of mupirocin in the community and hospital setting in Africa.
Aug 15 Antimicrob Resist Infect Control study