Ebola infects 3 more in the DRC, lifting cases to 60
Three more Ebola infections were confirmed in the Democratic Republic of the Congo (DRC) Equateur province over the weekend, raising the total to 60 cases, the World Health Organization (WHO) African regional office said on Twitter today. Of the total, 56 are confirmed and 4 are listed as probable.
Two more deaths were reported, raising the total to 24.
At a media briefing today, Mike Ryan, MD, who directs the WHO's health emergencies program, said the outbreak is worrying, given the dispersed nature of the outbreak, which is spread across 21 health areas in seven health zones. Also, he said nine people with confirmed infections are still in the community, a factor known to raise the risk of further transmission.
Investigations so far suggest that about one in three cases are linked to attending funeral, also a known transmission risk. Others have been linked to exposure in healthcare settings and among family members.
Ibrahima Soce Fall, MD, the WHO's assistant director-general for emergency response, said there are teams on the ground and the response is still scaling up, with participation by a range of partners, which is challenging in the context of the COVID-19 pandemic.
Jul 20 WHO African regional office tweet
Australian study shows low rate of appropriateness for pre-surgery antibiotics
Analysis of data from a survey of surgical antimicrobial prophylaxis (SAP) conducted in Australian hospitals found a low rate of appropriateness and identified several factors that influence appropriateness, Australian researchers reported in JAC-Antimicrobial Resistance.
The researchers analyzed all procedures audited from April 2016 through April 2019 in the Surgical National Antimicrobial Prescribing Survey (NAPS), which collects data on all antimicrobial prescriptions for surgical procedures, along with clinical information, procedure-related factors, and patient and hospital demographics. The aim of the study was to describe the patient, hospital, and surgical factors associated with appropriateness of antimicrobial choice for procedural SAP, with a focus on the top five antimicrobials and antimicrobial classes prescribed. SAP is the most common indication for antimicrobial use in Australian hospitals.
A total of 12,419 procedures with 14,150 prescribed initial procedural SAP doses were included for analysis. Appropriateness varied across the choice of antimicrobial agent but was low overall (57.7%).
The most common reason for inappropriate antimicrobial choice was that the spectrum of the selected antimicrobial was too broad (55.7%), which is associated with patient harms and is a potential driver of antimicrobial resistance. Allergy status, surgical procedure group, and the presence of prosthetic material were positively associated with cefazolin and aminoglycoside appropriateness (P < 0.05). There were no significant positive associations with glycopeptides and third- and fourth-generation cephalosporins.
"Identification of these prescribing trends supports an ongoing examination of SAP prescribing practices in Australia and identification of potential targets for interventions across multiple health sectors such as AMS [antimicrobial stewardship], guideline development, and hospital policy," the authors wrote.
Jul 18 JAC-Antimicrob Resist study
Focus groups reveal primary care docs less concerned about antibiotic resistance
In a series of focus groups conducted with primary care providers in four US cities, most participants consistently identified antibiotic resistance as a lower priority compared with other health concerns, and suggested that urgent care, retail clinics, and patient demand were the key drivers of inappropriate prescribing, researchers reported last week in BMJ Open.
The eight focus groups, which were conducted by the Pew Charitable Trusts and the American Medical Association in Chicago, Los Angeles, Philadelphia, and Birmingham, included family medicine and internal medicine physicians and pediatricians. In each focus group, an independent moderator asked the participants to rank a number of public health issues in terms of importance, then asked questions aimed at understanding physicians' attitudes and perceptions around antibiotic use and stewardship. A total 52 primary care providers participated in the recorded discussions.
Two of the main themes that emerged from the conversations were that antibiotic resistance is seen as less of a problem than issues such as obesity, diabetes, and opioid use, and that it does not affect the participants' patients or their daily practice.
Many felt resistance was a more pressing issue for sicker, hospitalized patients. When it came to inappropriate prescribing, participants suggested that urgent care and retail medicine clinics were to blame for prescribing antibiotics too frequently, and often returned to the theme of patient demand and fear of receiving poor patient satisfaction scores.
"We're under pressure all day," one pediatrician in Birmingham said. "You don't want to get written up, potentially, for being insensitive, or not taking care of them, or physician ratings."
Participants reacted positively to stewardship efforts aimed at patient and clinician education but were more skeptical of activities focused on measuring inappropriate prescribing and expressed distrust of tracking and reporting systems.
The authors of the study say it will be important to address these perceptions when designing stewardship interventions for outpatient settings.
Jul 14 BMJ Open study
H1N1v flu case reported in German child who had swine exposure
In a monthly update on zoonotic influenza infections, the WHO said Germany on Jul 3 notified it of a swine influenza variant H1N1 (H1N1v) infection, which involved a young child.
The 2-year-old boy started having symptoms on June9, and a sample was collected as part of routine flu surveillance. An unsubtypable virus was detected on Jun 15, and whole-genome sequencing on Jul 1 identified a Eurasian avian-like swine virus.
The patient recovered, and no similar infections were found among his contacts. Investigators found that the boy had visited a pig farm and had close contact with pigs 2 days before his symptoms began.
Antigenic studies on the virus isolated from the boy suggest some cross-reactivity with the seasonal 2009 H1N1 virus, which could point to some immunity in the general population against similar viruses.
The WHO update also covered to two earlier reported H9N2 infections in Chinese children and a variant H1N2 infection in a Brazilian swine slaughterhouse worker.
Jul 10 WHO flu at the human-animal interface report