News Scan for Dec 30, 2019

News brief

Four more Ebola cases confirmed in DRC outbreak

Over the weekend and through today, officials in the Democratic Republic of the Congo (DRC) confirmed four more Ebola cases, according to the World Health Organization’s (WHO) Ebola dashboard.

The outbreak total is now 3,376, including 2,232 deaths. As reported late last week, the viral disease has returned to Kalunguta, and the DRC's Ebola technical committee (CMRE) said yesterday in an update that another new case had been confirmed in that area. Late last week two young sisters were the first patients in 63 days to be diagnosed as having Ebola in Kalunguta.

The other recently reported cases came from Butembo and Mabalako, the CMRE said.

Vaccination efforts continue throughout the region. As of Dec 26, 3,582 people had been vaccinated with Johnson & Johnson's vaccine, all in the health areas from Karisimbi to Goma, the CMRE said.

Since Aug 8, 2018, a total of 259,856 people have been vaccinated with Merck's e rVSV-ZEBOV vaccine.
WHO Ebola dashboard
Dec 29 CMRE update
Dec 28 CMRE update
Dec 27 CMRE update


Study finds 1 dose of HPV vaccine may protect as well as 2 or 3

One dose of human papillomavirus (HPV) vaccine may afford similar protection as two or three doses, according to an analysis of data collected from the National Health and Nutritional Examination Survey (NHNES) between 2009 and 2016. A research team based at the University of Texas School of Public Health reported their findings on Dec 27 in JAMA Network Open.

Current recommendations suggest two or three doses, but uptake levels are less than ideal. Researchers are trying to learn more about the vaccine's potential for cutting the cancer burden, even when people don't receive all of the recommended doses.

The study included 1,620 women ages 18 to 26 whose data included information about HPV vaccination status. Of those, 1,004 were vaccinated, and 616 had received at least one dose, 126 received two doses, and 384 received three doses.

Compared with unvaccinated women, infection with HPV was significantly less among women who got one, two, or three doses. The team found no significant difference between one dose and two doses, or one dose and three doses.

Though the study suggests women who received one dose have similar protection to those who received multiple doses, the authors point out that the cross-sectional study design prevented them from comparing vaccination timing and potential exposure, and they warned that vaccine recall bias prohibits any definitive efficacy conclusions.

In a press release, senior author Ashish A. Deshmukh, PhD, MPH, said, "If ongoing clinical trials provide evidence regarding sustained benefits of a one-dose regimen, then implications of single-dose strategy could be substantial for reducing the burden of these cancers globally." Deshmukh is an assistant professor at the University of Texas School of Public Health.
Dec 27 JAMA Netw Open research letter
Dec 27 University of Texas press release


Samoa ends measles emergency

With measles outbreak cases declining, Samoa's government on Dec 28 announced that it lifted a 6-week state of emergency that had ordered steps such as closing schools and limiting public gatherings, according to a Reuters report. Deaths and infections started slowing in the middle of December, following a vaccine drive that had a goal of lifting the immunization rate to 95%.

In the government's latest Twitter update on totals, dated Dec 28, it said 5,667 cases have been reported since the outbreak began, including 12 in the last 24 hours. So far, 81 deaths have been recorded. It also noted that as of Dec 28, 95% of the population had been vaccinated—a level thought to provide herd immunity against the disease.

A report yesterday from the BBC said prominent anti-vaccine activist Edwin Tamasese was arrested in Samoa earlier this month and charged with incitement against a government order. The report said he had posted misinformation about the vaccine on Facebook and promoted the use of unproven remedies to treat the disease.
Dec 28 Reuters story
Dec 28 Samoan government tweet
Dec 29 BBC story


Survey: Most Americans think flu vaccines safe, effective

An internet survey conducted during the 2017-18 flu season showed that 86.3% of US adults thought the vaccine was safe and 73.0% thought it was effective, with slightly less confidence among younger adults, according to a new study in Vaccine.

2020 will mark a decade since the Advisory Committee on Immunization Practices recommended every America 6 months and older receive an annual flu shot. But despite the recommendation and the favorable attitudes found in this study, less than 45% of American adults report getting vaccinated each year.

In 2016-17, flu vaccine coverage estimates for adults over 65 were 65.3%, higher than adults ages 18 to 49 (33.6%), and those aged 50 to 64 (45.4%). To understand attitudes toward vaccination, the authors of the study analyzed 4,597 survey results from 2017 and 2018, with 54.0% of respondents aged 19 to 49, 25.9% aged 50 to 64, and 20.0% 65 years and older. Older participants had more favorable attitudes toward the flu vaccine.

"Adults aged 19–49 years (82.7%) reported significantly lower confidence in its safety compared with those aged 50–64 years (89.5%) or ≥65 years (91.3%)," the authors wrote. "Likewise, although adults overall still reported believing the influenza vaccine is effective (73.0%), markedly fewer adults aged 19–49 years (68.3%) did so compared with those aged 50–64 years (74.1%) or ≥65 years (83.4%)."

Further study is needed to understand why flu vaccine uptake is low, the authors concluded.
Dec 27 Vaccine study

Stewardship / Resistance Scan for Dec 30, 2019

News brief

New clindamycin-resistant C difficile strain identified in VA patients

A surveillance study of patients in a Veterans Administration (VA) long-term care facility and its affiliated acute care hospital detected the clonal outbreak of a newly recognized Clostridioides difficile strain, researchers reported yesterday in Emerging Infectious Diseases.

The strain, which was detected in 15 patients at the Louis Stokes VA Hospital in Cleveland, was identified as restriction endonuclease analysis (REA) group DQ, ribotype (RT)591, and is closely related to the epidemic BI/RT027 strain associated with numerous healthcare facility outbreaks and an increasing number of illnesses and deaths. Whole-genome sequencing and multi-locus sequence typing (MLST) showed that the strains share several genetic and phenotypic characteristics and reside in the same clade (MLST 2), but form a separate cluster.

Antimicrobials susceptibility testing of the DQ/RT591 isolates revealed high-level resistance to clindamycin and azithromycin. The seven C difficile infections caused by DQ/RT591 were healthcare associated, and all patients in whom DQ/RT591 was confirmed had received antibiotics within 90 days before testing. DQ/RT591 did not appear to carry the same level of severity that BI/RT027 has exhibited.

"Because REA DQ/RT591 is closely related to BI/RT027, further monitoring is required to determine whether this strain carries increased risk for illness and death or has the capability of widespread dissemination," the authors of the study write.
Dec 29 Emerg Infect Dis study


Study: Empiric fluoroquinolones effective against bloodstream infections

A study conducted at a hospital in South Carolina has found that, in the absence of antibiotic resistance risk factors, empirical fluoroquinolones were as effective as broad-spectrum beta-lactams for treating gram-negative bloodstream infections (GN-BSIs), researchers reported late last week in the Journal of Global Antimicrobial Resistance.

In the retrospective, 1:2 matched cohort study, researchers from the University of South Carolina examined clinical outcomes in adults without risk factors for antibiotic resistance who were hospitalized with GN-BSIs and treated empirically with either fluoroquinolones (74 patients) or broad-spectrum beta-lactams (148 patients). The primary outcomes studied were early treatment failure at 72 to 96 hours, 28-day mortality, and hospital length of stay.

Early treatment failure rates were comparable in the fluoroquinolone and broad-spectrum beta-lactam groups (27% vs 30%, respectively; odds ratio, 0.82; 95% confidence interval [CI], 0.43 to 1.54; P = .53), as were 28-day mortality rates (8.9% vs 9.7%, respectively; hazard ratio [HR], 0.74; 95% CI, 0.26 to 1.90; P = 0.54). The median hospital length of stay was 6.1 days in the fluoroquinolone group and 7.1 days in the broad-spectrum beta-lactam group (HR, 0.73; 95% CI, 0.54 to 0.99; P = 0.04).

Transition from intravenous to oral therapy also occurred earlier in the fluoroquinolone group (3.0 vs 4.9 days, P < 0.001). The researchers suggest the earlier transition to oral therapy for fluoroquinolone patients may be the reason for the shorter hospital stays.
Dec 27 J Glob Antimicrob Resist abstract

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