Ebola infects 1 more person in the DRC

The Democratic Republic of Congo (DRC) reported one new confirmed Ebola case over the last 3 days, edging the overall outbreak total to 3,427, according to numbers reflected on the World Health Organization's (WHO's) online Ebola dashboard. The WHO in a recent report said recent trends have been encouraging, with the number of cases in the most recent epidemiologic week the fewest since the outbreak response began.

Four more probable cases have been added, raising that number to 123. The DRC's Ebola technical committee (CMRE) said in its Jan 31 daily update that three of the probable cases are from Butembo and one is from Mandima. So far, 2,246 deaths have been reported. Health officials are still investigating 451 suspected cases.

In its report for Feb 2, the CMRE said the newly confirmed case is from Beni, which is the current hot spot. In that report, the group said attacks have disrupted health control activities at two control points in the Biakato Mines area near Mandima.

In a speech today at the WHO's executive board meeting in Geneva today, Tedros Adhanom Ghebreyesus, PhD, said the small number is an encouraging trend, "But until we get to zero, there is always the risk that the outbreak could flare up again." He said security incidents in November undermined earlier progress, and he said he worries about ongoing security threats and noted that on Jan 30 more civilians were killed by armed rebels in Beni.

Tedros said the WHO currently has about 630 staff in the DRC to support the Ebola response. "But even as we focus on ending this outbreak, we must also think beyond Ebola to strengthening DRC's weak health system," he said.
WHO online Ebola dashboard
Jan 31 CMRE update
Feb 2 CMRE update


Saudi Arabia reports first MERS-CoV case of February

Today Saudi Arabia's Ministry of Health (MOH) reported one more MERS-CoV case in Jeddah, the first case noted this month.

The MOH said the patient is a 28-year-old man, whose exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as primary, meaning it's unlikely he contracted the virus from another known patient. He is not a healthcare worker, and he had camel contact—a known risk factor for MERS.

Saudi Arabia reported 15 cases in January, including a probable healthcare-related cluster of 6 cases in Abha.

The WHO said in its latest monthly update that, since 2012, it has received reports of 2,499 MERS-CoV cases, at least 861 of them fatal. The vast majority have been in Saudi Arabia.
Feb 3 MOH report


Study: Quadrivalent flu vaccines offer similar protection against flu B

A new study published in Clinical Infectious Diseases tracked flu vaccine efficacy against influenza B strains in both the trivalent (three-strain) and quadrivalent (four-strain) vaccines and found no significant differences between the two.

Beginning in 2013 in the United States, quadrivalent inactive influenza vaccines (IIV4) containing two B viruses became an option in addition to trivalent vaccines (IIV3), which contained one B strain. To conduct this study, researchers compared the odds of influenza B infection across four flu seasons (2013-14 to 2016-17) where both IIV3 and IIV4 vaccines were used, and by the two B lineages among vaccinated versus unvaccinated participants.

The overall effectiveness against any influenza B was 53% (95% confidence interval [CI], 45% to 59%) for IIV4 versus 45% (95% CI, 34% to 54%) for IIV3, the authors said. "IIV4 was more effective than IIV3 against the B lineage not included in IIV3, but comparative effectiveness against illness related to any influenza B favored neither vaccine valency," they wrote.
Feb 1 Clin Infect Dis study
Feb 3 Tedros WHO executive board speech


FDA approves Seqirus's H5N1 pandemic flu vaccine

Vaccine manufacturer Seqirus, of Holly Springs, North Carolina, announced today that the US Food and Drug Administration (FDA) has approved Audenz, its adjuvanted cell-based H5N1 pandemic flu vaccine.

The FDA approved the vaccine for people aged 6 months and older in the event of an H5N1 flu pandemic, the company said in a news release. The vaccine uses the company's MF59 adjuvant, which is designed to enhance the body's immune response. It is produced using cell-based antigen manufacturing, which is designed for rapid production and can be stockpiled for first responders in the event of an H5N1 pandemic.

"Pandemic influenza viruses can be deadly and spread rapidly, making production of safe, effective vaccines essential in saving lives," said Rick Bright, PhD, director of the Biomedical Advanced Research and Development Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services.

Russell Basser, MD, senior vice president of research and development at Seqirus, said, "This pandemic influenza vaccine exemplifies our commitment to developing innovative technologies that can help provide rapid response during a pandemic emergency."
Feb 3 Seqirus news release


H5N1 strikes Chinese poultry farm

Animal health officials in China have reported a highly pathogenic H5N1 avian flu outbreak in China, affecting a farm in the city of Shaoyang in Hunan province, the Straits Times, an English-language newspaper based in Singapore,  reported today, citing a statement from the country's agriculture ministry.

About 18,000 poultry were culled to curb the spread of the virus.
Feb 3 Straits Times story

In other avian flu developments, two countries reported more highly pathogenic H5N8 detections. Poland reported one more outbreak, which began on Jan 24 and affects a farm in Warminsko-Mazurskie province in the northeast, according to a notification today from the World Organization for Animal Health (OIE).

Elsewhere, Israel reported that tests on a sick eagle found on Jan 27 in the Jordan valley yielded H5N8. The bird was wearing a transmitter. It was brought to a wildlife hospital and put in quarantine. The detection was the country's first involving the strain since April 2019.
Feb 3 OIE report on H5N8 in Poland
Feb 1 OIE report on H5N8 in Israel



Stewardship / Resistance Scan for Feb 03, 2020

News brief

FDA asks manufacturers to withdraw bacitracin from the market

The US Food and Drug Administration (FDA) has requested that manufacturers of bacitracin for injection voluntarily withdraw their products from the market.

In a statement issued late last week, the FDA said that while bacitracin for injection is approved to treat infants who have pneumonia or empyema caused by Staphylococci bacteria, healthcare providers no longer use it for these conditions because there are other effective, FDA-approved treatments that don't have the same serious risks, which include kidney toxicity and anaphylactic reactions. The move follows an April 2019 meeting of the FDA's Antimicrobial Drugs Advisory Committee that ended with an almost unanimous vote that the drug's risks outweigh its benefits.

"Based on FDA's review of currently available data, FDA believes that the potential problems associated with bacitracin for injection are sufficiently serious to remove the drug from the market," the agency said.

Topical or ophthalmic drugs containing bacitracin are not affected by the voluntary withdrawal request.
Jan 31 FDA statement


CRE outbreak continues in Lithuanian hospitals

The European Centre for Disease Prevention and Control (ECDC) today issued a rapid risk assessment on an ongoing hospital outbreak of Klebsiella pneumoniae carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (KPC-CRE) in Lithuania.

The ECDC reports that 223 KPC-CRE cases were detected from Feb 1, 2019, to Jan 7, with 208 cases (93.3%) occurring in a single hospital (hospital 1) and five other hospitals affected. The vast majority of the isolates collected from cases were K pneumoniae (199 cases, 89%), followed by Escherichia coli (21 cases, 9%). Whole-genome sequencing (WGS) revealed that one major K pneumoniae strain—sequence type (ST) 392—was responsible for the outbreak in hospital 1 and was detected in the other five hospitals.

WGS also revealed that the ST392 outbreak strain carried a plasmid containing the blaKPC-2 carbapenemase gene, which was also found in different K pneumoniae sequence types and in E coli and Citrobacter spp isolates, "thus indicating plasmid-mediated spread of carbapenem resistance in addition to clonal expansion of one single CRE strain," the ECDC said.

Additional resistance to the last-resort antibiotic colistin was detected in half of the 52 KPC-CRE isolates for which colistin susceptibility was performed.

The number of CRE cases reported in the outbreak represents a significant increase for Lithuania, which reported only 5 and 12 cases in 2017 and 2018, respectively. The ECDC warns that the risk of continued spread in the Lithuanian healthcare system is likely to be high, since several patients with the outbreak strain have been transferred from hospital 1 to other hospitals. The risk of transmission for people outside the healthcare system is considered low.
Feb 3 ECDC rapid risk assessment


Stewardship program tied to drop in MRSA rates

After implementation of an antibiotic stewardship program involving an infectious disease consultant at four Japanese hospitals, a new study found that decreasing trends for methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant Pseudomonas aeruginosa (DRPA) accelerated after the program was established, with the drop in MRSA rates increasing by 50% to 150%.

The study appeared Jan 31 in the International Journal of Infectious Diseases.

The stewardship program was implemented at one hospital from 2010 through 2013, and the other three from 2014 through 2017. They collected susceptibility data several years before and during the intervention and compared MRSA and DRPA rates with other hospitals throughout Japan.

Both MRSA and DRPA exhibited decreasing trends (P < 0.01 for all four hospitals and all bacterial cultures) throughout the study period, but the decrease was heightened after the intervention was initiated. The sharper decrease occurred for all DRPA regardless of the antibiotic class assessed (eg, carbapenems), and for MRSA the decline was 50% to 150% steeper among the four hospitals.
Jan 31 Int J Infect Dis study

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