News Scan for Jun 25, 2018

News brief

Last DRC Ebola contacts approach end of monitoring period

No new lab-confirmed Ebola infections were reported from the Democratic Republic of the Congo (DRC) over the past 3 days, though surveillance workers continue to report more suspected cases from the remote hot spots, while tests rule out earlier suspected cases.

The DRC's health ministry said today that as of yesterday, two new suspected cases were reported, one from Bikoro and the other from Iboko. Tests on four previously reported suspected cases were negative, bringing the overall outbreak total to 55 cases, 38 of them confirmed, 14 probable, and 3 suspected. The number of deaths remains at 28.

The illness onset from the last confirmed case was Jun 2, and the monitoring period for the patient's contacts is winding down. In its update today, the health ministry said the 21-day monitoring period for the last patients will end on Jun 27. A Jun 22 situation report from the World Health Organization (WHO) said as of Jun 20, 1,527 contacts had completed their follow-up periods, and only 179 were still being monitored.

Vaccination continues in the affected outbreak areas, and so far 3,280 have been immunized with the experimental Ebola vaccine VSV-EBOV. Most of the people vaccinated are from the two hardest hit areas, Bikoro and Iboko, both in a heavily forested area of Equateur Province.
Jun 25 DRC health ministry daily Ebola update
Jun 22 WHO situation report

In research developments, the Journal of Infectious Diseases today published several reports on Ebola. For example, a team that conducted a literature review of epidemiologic research and social and behavioral research published during West Africa's Ebola outbreak developed a roadmap for integrating the two areas to improve research efforts in future outbreaks. They said their findings support an action plan that involves data collection on community attitudes, behavior, and responses in real time.

Meanwhile, another study explored antibody response in nonhuman primates vaccinated with different Ebola vaccine platforms in an effort to understand more about correlates of protection, while another group reported the results of cell-culture screening for 12 possible Ebola treatments, which found multiple synergistic pairs.
Jun 25 J Infect Dis literature review
Jun 25 J Infect Dis report on Ebola antibody response in primates
Jun 25 J Infect Dis report on cell-culture Ebola drug combination testing

Tests confirm polio outbreak in Papua New Guinea

Papua New Guinea's national health department and the WHO confirmed an ongoing outbreak of vaccine-derived poliovirus type 1 (VDPV1) in Morobe Province.

So far, the outbreak contains one confirmed case in a 6-year-old boy, who experienced lower limb weakness at the end of April. Lab testing confirmed VDPV1 as the cause of the boy's acute flaccid paralysis.

"The United States Centers for Disease Control and Prevention confirmed that the same virus was also isolated from stool specimens of two healthy children from the same community. This means that the virus is circulating in the community—representing an outbreak of the virus," the WHO said.

Polio vaccine coverage is low in Morobe, with only 61% of children having received the recommended 3 doses of polio vaccine, the WHO said. In rare instances in undervaccinated populations vaccine-derived polioviruses can linger in communities, allowing it to acquire genetic changes genetic changes that can cause paralysis. Papua New Guinea hasn't reported a polio case since 1996 and the country and the rest of the WHO's Western Pacific region were certified as polio free in 2000.

A catch-up vaccination program is under way; to date, 845 children under the age of 15 have been vaccinated.
Jun 25 WHO press release

Stewardship / Resistance Scan for Jun 25, 2018

News brief

Letter from chief medical officer cuts antibiotic prescribing

The Behavioural Economics Team of the Australian Government, in partnership with Australia's Chief Medical Officer (CMO) and the Department of Health, released a new report showing that targeting high-prescribing physicians with a letter from the CMO helped lower the number of antibiotic prescriptions within 6 months.

To conduct the randomized control trial, researchers identified the top 30% antibiotic prescribers by region. The CMO sent letters explaining antimicrobial resistance to one group, no letters to a control group, and letters containing information comparing the physician's prescribing behavior to his or her peers to other groups.

Six months after receiving the letters, doctors who had received a letter that included peer comparisons had reduced their prescribing by 12%.

"Compared to GPs who did not receive a letter, the peer comparison letters resulted in a 9.3 to 12.3 percent reduction in prescription rates over six months. In comparison, the education-only letter reduced antibiotic prescriptions by 3.2 percent over six months," the authors said.

The authors concluded that a peer comparison letter, signed by a respected authority, was an effective way to target antibiotic overuse.
Jun 25 Australian Department of Health report

CMS proposal would halt reporting of hospital infection, other safety issues

A proposed rule from the Centers for Medicare and Medicaid Services (CMS) would halt public disclosure of hospital-associated infections, including those from methicillin-resistant Staphylococcus aureus and Clostridium difficile, and other patient safety problems, a nonprofit group warned in a Jun 12 call to action that urged concerned groups to comment before the rule is finalized and takes effect in November.

The safety data are contained in the Inpatient Quality Reporting Program, established by the George W. Bush administration in 2005, when the CMS Hospital Compare website began disclosing some of the safety measures, according to a Jun 19 USA Today report.

Consumers, businesses, some health providers, and policymakers had pushed for including the information on the website as a part of more transparent system that pays hospitals receiving Medicare payment to report errors, injuries, and infections. The group that sounded alarm about the proposed rule change is Leapfrog Group, a nonprofit hospital rating organization based in Washington, DC.

A CMS official has denied that it was proposing to remove the information from Hospital Compare and emphasized that the changes are open for public comment, the USA Today report said. Though hospitals haven't pushed for the change, the American Hospital Association said that the amount of information required by different federal programs is burdensome and that the change would allow them to focus more on patient safety.
Jun 19 USA Today story
Jun 12 Leapfrog Group call to action