News Scan for Jan 22, 2020

News brief

No new Ebola in DRC; recent cases linked to known transmission chains

According to the latest situation report published by the World Health Organization (WHO) yesterday, the 15 most recent Ebola cases reported from Jan 13 to 19 in the Democratic Republic of the Congo (DRC) all came from a known transmission chain and were all recorded in Beni (9 cases) and Mabalako (6 cases).

In other positive developments, the WHO said new case-patients are getting medical treatment more promptly compared with other times during the outbreak.

"Of the 37 people confirmed with Ebola virus disease in the past 21 days, 29 (78%) were isolated within the first two days after the onset of symptoms, meaning they have better chances of survival and are less likely to infect contacts in the community," the WHO said.

The WHO said, however, that the origins of a cluster of five cases in Kalunguta, a cluster of four cases in Mambasa, and a single case in Katwa all reported in the first week in January are still unknown.

No new cases were recorded today on the WHO's online Ebola dashboard, so the outbreak still stands at 3,416 cases, including 2,238 deaths. A total of 394 suspected cases are still under investigation.

The DRC's Ebola technical committee (CMRE) said that yesterday's two cases were in Beni.
Jan 21 WHO situation report
WHO Ebola dashboard
Jan 21 CMRE update

Another MERS case in Abha, Saudi Arabia, suggests possible cluster

Saudi Arabia's Ministry of Health (MOH) today reported another new MERS-CoV case in a healthcare worker from Abha. Yesterday the MOH said a 38-year-old female healthcare worker in the same city had also been infected, which suggests Abha may be the site of a healthcare-associated cluster.

The new case-patient is a 27-year-old female healthcare worker diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). The MOH said the source of her infection is secondary, meaning she probably contracted the virus from another person.

The country reported its last case in Ahba in the middle of December, that of a 66-year-old man. The new cases raises Saudi Arabia's MERS-CoV total for January to six cases.

The WHO said in its latest monthly update that 2,499 cases have been lab-confirmed since the virus emerged in people in 2012, including 861 fatalities. The vast majority of the cases have been in Saudi Arabia.
Jan 22 MOH report

Researchers estimate high cost of local US measles outbreaks

A study today in Clinical Infectious Diseases from researchers at the Centers for Disease Control and Prevention used data from 11 measles outbreaks in the United States between 2001 and 2018 to estimate that each outbreak cost a median $152,308 (range, $9,862 to $1,063,936).

The median cost per case was $32,805 (range, $7,396 to $76,154), and median cost per contact was $223 (range, $81 to $746).

The median estimates were based on 10 published studies on financial costs of outbreaks. Outbreaks in the reviewed studies included 129 confirmed measles cases in nine states, with a median of 2 cases (range, 1 to 58), and a median of 283 contacts (range, 44 to 8,231).

The review also included four patients who required hospitalizations, which carried a median direct medical costs per hospitalization of $14,456 in 2018 dollars ($11,202 in 2009 dollars), the authors said.

The study did not include any outbreaks in 2019, when the US reported the most cases since 1992. One outbreak last year topped 400 cases, and another topped 700 cases, with the latter causing New York City an estimated $6 million to combat, according to a September 2019 report.

"Based on the number of cases reported in 2019 (1,282), an estimated $42 million might have been spent responding to measles outbreaks in 2019," the authors concluded. "In this period of increased disease, understanding the full economic ramifications of responding to measles outbreaks is necessary to appropriately allocate valuable public health resources for maximum public benefit and to inform cost-of-illness and cost-effectiveness studies of measles and measles prevention."
Jan 22 Clin Infect Dis study
Sep 3, 2019, CIDRAP News story "US measles cases hit 1,234 as Brooklyn outbreak called over"

Phase 2 trial demonstrates good protection by oral flu vaccine

Results of a phase 2 trial demonstrate that Vaxart's oral flu vaccine provides similar protection as Fluzone quadrivalent in adults and produces a strong immune response with a good safety profile, according to a study yesterday in The Lancet Infectious Diseases.

The researchers, from Vaxart and elsewhere in the United States, assigned 178 adults aged 18 to 49 years old to receive VXA-A1.1, the oral vaccine made by Vaxart, of South San Francisco, California; Sanofi's quadrivalent (four-strain) Fluzone vaccine, or a placebo. Seventy participants received VXA-A1.1, 71 received Fluzone, and 36 got a placebo. In addition, 58 VXA-A1.1 recipients, 54 Fluzone recipients, and 31 in the control group were inoculated with influenza virus after receiving the vaccine.

The trial was conducted from August 2016 to April 2017, and Vaxart had reported preliminary results in October 2018. No oral flu vaccine has been licensed for use in the United States.

The researchers found that 17 people in the VXA-A1.1 group (29%), 19 (35%) in the Fluzone recipients, and 15 (48%) in the placebo group developed lab-confirmed flu after they were challenged with the virus. The Vaxart vaccine was also well tolerated and produced a strong immune response.

In a related commentary in the same journal, two Russian experts wrote, "The study by Liebowitz and colleagues provides promising data that could lead to an improved strategy for influenza immunisation…. The vaccine platform could be used to develop more broadly protective (ie, universal) influenza vaccines."
Jan 21 Lancet Infect Dis study
Jan 21 Lancet Infect Dis commentary
Oct 4, 2018, CIDRAP News scan on preliminary results

Stewardship / Resistance Scan for Jan 22, 2020

News brief

Pets may be protective against recurrent C difficile, study finds

In a surprising finding, pet ownership and increasing contact with pets may be protective against the recurrence of community-acquired Clostridiodes difficile infection (CDI), researchers from the University of Pennsylvania reported recently in Open Forum Infectious Diseases.

To investigate whether pet ownership is a risk factor for CDI recurrence, a hypothesis based on documented animal carriage of C difficile and overlap of strains isolated from animals and people, the researchers conducted a case-control study among 86 patients with recurrent CDI (cases) and 146 patients with nonrecurrent CDI (controls).

Study participants were sent a survey to ascertain the number and species of pets in the household at the time of the initial CDI diagnosis, and the degree of contact between patients and pets. Multivariable logistics regression modeling was used to determine the association between recurrence of CDI and pet ownership, while accounting for patient-level risk factors.

The results of the multivariable analysis showed that pet ownership was not significantly associated with CDI recurrence (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.38 to 2.72; P = 0.965) among all 232 patients. Furthermore, when the researchers analyzed a subset of 127 patients with community-associated or community-onset, healthcare-facility–acquired CDI, they found that increasing contact with pets was increasingly protective against recurrence: for every point increase in a pet contact score (out of 7 possible points), the odds of recurrence decreased by 14% (OR, 0.86; 95% CI, 0.74 to 1.00; P = 0.051).

The authors of the study conclude, "Although more research is needed to understand the transmission dynamics of C. difficile within a household and between pets and owners, it appears that pet ownership and close contact with pets are not associated with recurrence of CDI and may instead be protective against recurrence of CDI in patients with community-acquired or community-onset CDI."
Jan 18 Open Forum Infect Dis study

Before-hospital antibiotic exposure may heighten risk of C diff infection

In another study on CDI risk factors, researchers from Intermountain Healthcare and Stanford University found that cumulative antibiotic exposure prior to admission is significantly associated with the risk of subsequent CDI. The findings appeared yesterday in Antimicrobial Agents and Chemotherapy.

For the study, the researchers identified all symptomatic hospital-onset and healthcare-facility–associated, community-onset CDI cases among adults admitted to 21 Intermountain Healthcare hospitals from 2006 through 2012, then evaluated the risk associated with antibiotic exposure, including specific agents administered prior to and during admission, using multivariable logistic regression. While antibiotic use is a known risk factor for CDI, the degree to which various antibiotic classes are associated with CDI risk is not fully understood.

Overall, 2,356 cases of CDI occurred among 506,068 unique admissions, for an incidence rate of 46.6 per 10,000 admissions. After adjusting for demographics and other CDI risk factors, the analysis found that any antibiotic administered prior to admission was the predominant risk factor for CDI, contributing far more risk than antibiotics received during the hospital stay. For every antibiotic day of therapy prior to the index admission, odds of subsequent CDI increased by 12.8% (OR, 1.128; 95% CI, 12.2% to 13.4%; P < 0.0001). Odds of CDI were greatest with second- and third-generation cephalosporins, fluoroquinolones, and clindamycin. Doxycycline and daptomycin were associated with lower CDI risk.

The authors of the study say the data should be taken into consideration by antibiotic stewardship teams for identifying patients at risk for CDI.
Jan 21 Antimicrob Agents Chemother abstract