Five new cases of Ebola in DRC

The World Health Organization's (WHO's) online Ebola dashboard reflects 5 new cases of the viral disease over the weekend, including 3 cases reported today. The outbreak total now stands at 3,398, including 2,235 fatalities.

Officials are still investigating 410 suspected cases.

The DRC's Ebola technical committee (CMRE) said in a report yesterday that two new cases over the weekend were in Beni and Musienene. The case in Musienene marks the reappearance of the virus in that village, which had gone several weeks without Ebola detection.

The CMRE also said 264,682 people have been vaccinated as of Jan 12 with Merck's rVSV-ZEBOV, and 5,684 with Johnson & Johnson's Ebola vaccine.
WHO Ebola dashboard
Jan 12 CMRE


Minnesota confirms CWD on Pine County deer farm, linked to other farm

The Minnesota Board of Animal Health (MBAH) late last week confirmed chronic wasting disease (CWD) on a deer farm in Pine County—the first case in the county—and the case is linked to CWD investigations into a Douglas County farm that began last month.

"We identified the Pine County herd as high priority early in our investigation because our records showed it provided deer to the Douglas County herd," said MBAH Assistant Director Linda Glaser, DVM, in a Jan 10 news release. "At this point in the investigation CWD has not been detected in any of the other herds connected to Douglas County."

CWD is a deadly neurologic prion disease that affects cervids such as deer, elk, and moose. Though the disease has not yet jumped to humans, some experts fear it could mimic bovine spongiform encephalopathy ("mad cow" disease). Pine County is in east-central Minnesota, whereas Douglas County is in west-central Minnesota.

MBAH officials reported CWD detection on the Douglas County farm on Dec 10, in an 8-year-old doe. The only other deer on the farm was euthanized to prevent further CWD spread, and the site cannot house deer or elk for 5 years. The finding prompted the Minnesota Department of Natural Resources on Dec 23 to announced a 30-day mandatory emergency temporary ban on the movement of farmed white-tail deer within the state.

Officials investigated the Pine County farm because it had provided animals to the other farm in the past, including the doe that tested positive last month. The CWD-positive Pine County deer is also a doe. The farm's owners will now cull the remaining animals on the farm and test them for the disease. It likewise cannot stock cervids for 5 years.
Jan 10 MBAH news release
Dec 10, 2019, MBAH news release on Douglas County farm
Dec 26, 2019, CIDRAP News story "CWD detection prompts Minnesota ban on farmed deer movement"


Mandatory vaccination tied to higher measles, pertussis vaccine uptake

A study published today in Pediatrics shows that mandating vaccination in some European countries was associated with an increase in immunization rates against measles and pertussis by 2 to 4 percentage points.

Researchers used data from the WHO and 29 European countries to establish country-level vaccination policies and the annual incidence of these two infectious diseases. They found that mandatory vaccination was associated 3.71 (95% confidence interval [CI]: 1.68 to 5.74) percentage point higher prevalence of measles vaccination and a 2.14 (95% CI: 0.13 to 4.15) percentage point higher prevalence of pertussis vaccination when compared with countries that did not have mandatory vaccination.

Only 7 of 29 European countries mandated vaccination.

"In 6 of the 7 countries that had mandatory vaccination policies in place, if parents failed to meet the requirements of their country's regulations and requirements, they faced a financial penalty," the authors wrote.

Every €500 ($557 US) increase in the maximum possible penalty was associated with an increase of 0.8 percentage points for measles vaccination coverage (95% CI, 0.50 to 1.15; P ≤ .0001) and an increase of 1.1 percentage points for pertussis vaccination coverage (95% CI, 0.95 to 1.30; P ≤ .0001).

In an accompanying commentary, Sean T. O'Leary, MD, MPH, of the Children's Hospital Colorado, and Yvonne A. Maldonado, MD, of Stanford University, write that the study has implications for US vaccine policy. Unlike Europe, the US has no countrywide mandatory vaccine policies or financial penalties.

"Perhaps, vaccine mandates and fines are 1 answer, but is it possible for us also to identify effective ways to address the growing distrust of evidence-based interventions, such as vaccination?" the two wrote. "We must strive to develop an effective national approach to prevent the resurgence of highly preventable infectious diseases, using tested, multipronged approaches that still seem to be lacking."
Jan 13 Pediatrics study
Jan 13 Pediatrics commentary


Hungary, Slovakia, and Taiwan report avian flu in poultry

In a sign of expanding highly pathogenic H5N8 avian flu activity in European poultry, Hungary and Slovakia have reported their first outbreaks of the winter, according to notifications from the World Organization for Animal Health (OIE).

Hungary's outbreak occurred in 13-week-old fattening turkeys at a farm in Komarom-Esztergom County in the northwest. The event began on Jan 9, killing 4,500 of 53,500 birds. The remaining turkeys were slated for culling. The source of the virus is listed as unknown but could be indirect contact with wild birds. The outbreak is Hungary's first from H5N8 since 2017.

Meanwhile, Slovakia reported an outbreak in backyard birds in Nitra region in the west. The outbreak also started on Jan 9, killing 3 of 22 birds. The surviving birds were culled as part of response measures. The country also reported its last H5N8 outbreak in 2017.
Jan 13 OIE report on H5N8 in Hungary
Jan 10 OIE report on H5N8 in Slovakia

Elsewhere, Taiwan reported more outbreaks involving different strains, one caused by highly pathogenic H5N2 and three from highly pathogenic H5N5, which was first detected in the country in September 2019. The H5N2 outbreak began on Dec 28 at a farm housing native chickens in Yunlin County, killing 2,432 of 23,411 birds. The outbreak is part of ongoing H5N2 activity in Taiwan that has been under way since 2015.

The three H5N5 outbreaks were detected in native chickens in two slaughterhouses in Taipei City and at a poultry farm in Yunlin County. The outbreak start dates range from Dec 27 to Dec 31, 2019, with the virus killing 1,000 of 10,895 birds. The rest were slaughtered to curb the spread of the virus.
Jan 13 OIE report on H5N2 in Taiwan
Jan 13 OIE report on H5N5 in Taiwan

Stewardship / Resistance Scan for Jan 13, 2020

News brief

CARB-X awards $3.2 million for monoclonal antibody against superbugs

CARB-X today said it has awarded Trellis Bioscience of Redwood City, California, up to $3.2 million to develop an innovative monoclonal antibody designed to disrupt the protective biofilm that makes bacteria resistant to antibiotics.

The monoclonal antibody, called TRL1068, disrupts the bacterial biofilm by extracting a key protein, thereby rendering the bacteria more susceptible to attack by the immune system and to antibiotics. TRL1068 has been shown to enhance antibiotic activity in highly drug-resistant strains of gram-positive and gram-negative bacteria, the company said in a news release.

Erin Duffy, PhD, chief of research and development for CARB-X, which is based at Boston University, said in the release, "The Trellis project is in early development but if successful and approved for use in patients, its promise for tackling challenging, biofilm-mediated infections including joint implants could be transformational for the success of many modern medical procedures."

Stefan Ryser, PhD, CEO of Trellis, said TRL 1068 is a potential game-changer in treating a broad range of antibiotic-resistant bacteria. "CARB-X funding will support the manufacture of the drug for clinical development and, in a potential second tranche of funding, support an initial trial in patients with an infected implant, a type of infection that is particularly hard to treat due to biofilm formation on the surface of the implant."

Trellis could be awarded up to an additional $3.8 million if it meets certain project milestones.

Since it began in 2016, CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator), a public-private partnership, has announced 55 awards of more than $182.5 million total. It plans to invest $500 million for promising approaches to combat antibiotic resistance by the end of next year.
Jan 13 CARB-X news release


Lack of ID consult tied to higher death rates, inappropriate antibiotics

University of Minnesota researchers have discovered that having no infectious disease (ID) consultation is associated with more than a quadruple risk of death at 3 months, and a sixfold increased risk of death in the hospital among patients with bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA), Candida fungi, and Pseudomonas bacteria, according to their study in Open Forum Infectious Diseases.

ID consultation was also tied to a much higher rate of receiving appropriate antibiotics or antifungals.

The retrospective cohort study included 229 bloodstream infections in 2016 through 2018 (99 from MRSA, 69 Candida, and 61 Pseudomonas). All told, 181 patients had an ID consultation and 48 did not.

Overall 3-month mortality was 36%, but it was 4.5-fold higher in those who received no ID consult. Likewise, the risk of dying while still in the hospital was 5.9 times higher in those who had no ID consult. The investigators also determined that patients who received ID consultation were 9 times more likely to receive appropriate antibiotics or antifungals, 6 times more likely to have central lines removed, and 4 times more likely to have echocardiography to evaluate for endocarditis.

The authors conclude, "Automatic ID consultation may have the potential to improve patient survival; prospective evaluation of such an intervention is warranted."
Jan 11 Open Forum Infect Dis abstract


C difficile carriage tied to living near livestock farms

A single-center study published in JAMA Network Open found that living near a livestock farm is tied to a higher rate of Clostridioides difficile carriage at hospital admission, among other risk factors such as having been treated in a hematology-oncology unit and recent hospitalization in general.

Scientists examined data on 3,043 adults consecutively treated at Medical College of Wisconsin in Milwaukee from May 1, 2017, through Jun 30, 2018. All patients underwent C difficile screening using a nucleic acid amplification test at hospital admission. In addition to assessing typical C difficile risk factors, the investigators also noted the distance from patients' residence to the nearest livestock farm, meat processing plant, raw materials services, and sewage facilities.

Among the cohort, 318 (10.4%) tested positive for C difficile. Patients admitted to hematology-oncology units were 35% more likely to be colonized with C difficile, and the risk quadrupled among these patients if they had co-morbidities. The researchers also found that having been hospitalized in the preceding months raised the likelihood of colonization by 70%. Both these risk factors have been identified before.

The authors also found, however, that regardless of previous healthcare exposure, the probability of C difficile colonization more than doubled for those living 1 mile from a livestock farm compared with those living 50 miles from a livestock farm. They wrote, "Although we found an inverse association between C difficile colonization and the distance from a patient's residence to livestock farms, we did not find similar associations with water treatment plants, meat processing plants, or farm raw material plants."

They conclude, "Knowledge of the epidemiology of C difficile in the community surrounding the hospital is important, as it has potential implications for the incidence of hospital-onset C difficile infection."
Jan 10 JAMA Netw Open study

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