DRC tracks 3 more Ebola cases, 3,194 total

Today the World Health Organization (WHO) dashboard shows 3 new Ebola cases in the Democratic Republic of the Congo (DRC), which raise the outbreak total to 3,194 cases, including 2,133 deaths. A total of 346 suspected cases are still under investigation.

Also today the DRC’s multisector Ebola committee (CMRE) said three cases yesterday originated in Kalunguta, Mambasa, and Mandima—all current virus hot spots.

In other outbreak news, the latest update from the WHO's African regional office said the response pause in Lwemba after a security incident is still ongoing after 13 days.

"The lack of response activities for a full 13 days in Mandima Health Zone is of grave concern, as it is likely that contacts are being lost to follow-up, new cases are not being reported and  transmission chains are not being broken. Hot spots persist as well as sporadic transmission in other health areas," the WHO said.
WHO dashboard
Sep 30 CMRE update
Sep 29 WHO African regional update


NIAID announces launch of multicenter universal flu vaccine program

With $51 million in first-year funding, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), yesterday launched a new research center network to develop more broadly protective and longer-lasting flu vaccines. The program is called the Collaborative Influenza Vaccine Innovation Centers (CIVICs), and NIAID will provide support over 7 years.

Anthony Fauci, MD, NIAID's director, said in an NIH news release that better flu vaccines are needed to more effectively fight flu at the global level. "With the CIVICs program we hope to encourage an exchange of ideas, technology and scientific results across multiple institutions to facilitate a more efficient and coordinated approach to novel influenza vaccine development," he said.

The program will support universal flu vaccine candidates through preclinical testing, clinical trials, and human challenge studies. Also, the program is designed to improve current seasonal flu vaccines, such as assessing alternative vaccine platforms or adjuvants.

The network consists of three Vaccine Centers, one Vaccine Manufacturing and Toxicology Core, two Clinical Cores, and one Statistical, Data Management, and Coordination Center (SDMCC). NIAID said the Vaccine Centers will focus on designing novel vaccines that emphasize cross-protection against flu strains among healthy adults and groups at high risk for flu complications. The centers—Ichan School of Medicine at Mount Sinai, Duke University, and the University of Georgia—will also examine new ways to study flu viruses and human immune response to them.

Then the most promising vaccine will advance to small phase 1 clinical trials in healthy adults conducted by the Clinical Cores: the University of Maryland School of Medicine and Duke University. Successful candidates in phase 1 trails will advance to phase 2 trials in healthy adults or in certain age or risk groups.  The Vaccine Manufacturing and Toxicology Core—centered at Duke University—will develop and make vaccine candidates for clinical trials, and the SDMCC at Digital Infuzion, Inc., will analyze data, share findings among the groups, and ensure that the data are available in publicly accessible databases.
Sep 30 NIH news release


Researchers report poor results for passive immunity for treating flu

Two groups of researchers yesterday published new findings on passive immunity for treating flu, one assessing immune plasma for severe flu and the other examining hyperimmune intravenous immunoglobulin for influenza A and B. Though neither study showed effectiveness, the hyperimmune treatment showed promise against influenza B.

Both studies appeared in The Lancet Respiratory Medicine.

In the first study, researchers randomly assigned 140 patients in the United States who were hospitalized with influenza A between 2016 and 2018 to immune plasma containing either high or low titers of hemagglutination inhibition (HI) antibodies specific to circulating flu strains. In the second study looking at hyperimmune intravenous immunoglobulin, investigators enrolled 329 adults from nine countries over five flu seasons who had influenza A or B and compared the treatment group with those who received saline placebo.

Both studies found no overall benefit for flu patients, based on HI assay findings. For the hyperimmune treatment, antibody affinity analysis supported possible clinical benefit against influenza B.

In a related commentary on both studies that appeared in the same issue, two experts from Harvard Medical School wrote that the studies raise key questions and highlight gaps in understanding antibody-related immunotherapies. Also, they note that the data provide key clues to improving the care of people hospitalized with flu and other infections. The authors are Sanjat Kanjilal, MD, and Michael Mina, MD, PhD.

The two wrote that both studies provide convincing evidence that absolute HI antibody titers to flu might not be reliable lab correlates for protection. Also, they note that earlier studies of convalescent serum involved blood drawn from patients shortly after natural infection, which likely had antibodies protective against circulating flu strains. In contrast, the two trials used plasma from healthy donors, which likely affected the antibody composition.

For influenza B, they said the beneficial effect likely depends on context and that the quality and not the quantity of antibodies will drive efficacy. They concluded that both studies provide strong support for the need for new correlates of protection against flu to help define protective and therapeutic titers for the development of new flu therapeutic classes.
Sep 30 Lancet Respir Med abstract on immune plasma for severe flu
Sep 30 Lancet Respir Med abstract on hyperimmune IV immunoglobulin
Sep 30 Lancet Respir Med commentary


WHO advisors recommend one new zoonotic flu virus vaccine candidate

During a meeting last week in Geneva to recommend strains to include in the Southern Hemisphere's 2020 flu season, an advisory group to the WHO also assessed the latest zoonotic flu viruses. The experts recommended one new candidate vaccine virus, according to a report posted yesterday on the WHO's website.

During meetings twice a year to recommend seasonal flu vaccine strains for the Northern and Southern Hemispheres, the group also reviews genetic characterizations of recent zoonotic samples to gauge if any new candidate vaccine viruses are needed for pandemic preparedness.

Since the group's last meeting in February there were single H5N6 flu cases in China and Nepal and one human H7N9 case in China, plus detections in environmental samples collected in a poultry market linked to the human case. Single H9N2 cases were reported in China and Oman that involved different lineages. Also, one human infection with variant H1N1 was reported during that period in the United States.

The advisors recommended one new H7 vaccine candidate, an influenza A/Gansu/23277/2019-like virus. They noted that the hemagglutinin proteins of H7N9 viruses isolated from infected humans and associated poultry markets had 16 amino acid substitutions compared with previously characterized candidate vaccine viruses.
Sep 30 WHO candidate pandemic virus recommendations


Basil-linked Cyclospora outbreak winds down; 36 more illnesses reported

A multistate Cyclospora outbreak linked to fresh basil imported from Mexico appears to be over, with 36 more illnesses added to the overall total, the US Centers for Disease Control and Prevention (CDC) said yesterday. The event led to 241 known illnesses in 11 states, though all of the exposures occurred in restaurants in five states: Florida, Minnesota, New York, Ohio, and Wisconsin.

Six people were hospitalized, and no deaths were reported. The latest illness onset was Jul 26.

Product distribution records suggested Siga Logistics de LL de CV of Morelos, Mexico, exported the basil that sickened people. The importer recalled the potentially affected basil on Jul 24. 

In July the CDC reported a steep rise in domestic infections related to Cyclospora cayetanensis, a parasite that is spread by eating food and drinking water contaminated with feces. Illnesses can cause profuse diarrhea that can last weeks to months. In late August, the CDC reported 1,696 domestic Cyclospora cases in 33 states, and it said it's not known if any of the illnesses in other states were linked to fresh basil.

Domestic and travel-related Cyclospora cases typically rise in the summer. Past outbreaks have been linked to imported fresh produce such as raspberries, basil, cilantro, and snow peas.
Sep 30 CDC update
Aug 16 CIDRAP News scan "Multistate Cyclospora outbreak linked to imported basil sickens 73 more"


USDA names first director of National Bio and Agro-Defense Facility

The US Department of Agriculture (USDA) today named Alfonso Clavijo, DVM, PhD, the first permanent director of the National Bio and Agro-Defense Facility (NBAF) in Manhattan, Kansas.

As director, Clavijo will manage the USDA's new 574,000-square-foot research and diagnostic facility, which will protect agricultural systems against animal diseases.

"As NBAF's first permanent director, his extensive leadership experience will be a great asset in helping NBAF achieve its vision of being a national asset that protects U.S. agriculture and consumers through cutting-edge research, diagnostics, training, and development of vaccines and other countermeasures," said Chavonda Jacobs-Young, PhD, administrator for USDA's Agricultural Research Service, in a USDA news release.

The NBAF is slated to open in 2021 and be fully operational by 2023. Clavijo’s appointment begins on Oct 13.

Before this appointment, Clavijo served as laboratory executive director of the Canadian Food Inspection Agency's National Centres for Animal Disease and directed the management of biosafety level 2 through 4 facilities that allow for the contained study of pathogens that cause foreign animal diseases.
Oct 1 USDA
press release

Stewardship / Resistance Scan for Oct 01, 2019

News brief

VA study finds negative MRSA nasal swabs effective at ruling out infection

A study today in Clinical Infectious Diseases indicates that nasal screening of patients for methicillin-resistant Staphylococcus aureus (MRSA) colonization has a high negative predictive value (NPV) for ruling out MRSA infection and could be a powerful antibiotic stewardship tool.

In a retrospective study conducted across Veterans Affairs (VA) medical centers nationwide, researchers from the VA Western New York Healthcare System looked at data from all VA patients who were screened for MRSA colonization via the nares (nostrils) from 2007 (when the screening policy was initiated in VA medical centers) to 2018. They then evaluated the subsequent clinical cultures collected within 7 days of the nares swab for the presence of MRSA. The aim was to determine whether the absence or presence of MRSA nasal carriage predicts the presence of MRSA in clinical cultures.

Nasal screening on admission was done in 96.5% of patients. The cohort yielded 561,325 clinical cultures from a variety of anatomical sites, mainly urine (40%), wound (24.7%), respiratory (16.2%), and blood (12.5%). A positive screen for MRSA nares occurred in 22.9% of patients, and MRSA was identified in 8.3% of subsequent clinical cultures. The sensitivity and specificity of MRSA nasal screening for positive MRSA clinical culture were 67.4% and 81.2%, respectively, and the NPV of a negative MRSA nares swab for ruling out MRSA infection was 96.5%. The positive predictive value was only 24.6%.

The NPV was highest for ruling out MRSA in urinary cultures (99.2%), followed by intra-abdominal cultures (98.5%), blood cultures (96.5%), respiratory cultures (96.1%), and wound cultures (93.1%).

The authors of the study conclude, "This study suggests that a negative MRSA nares swab, taken within 7 days of culture, is useful to predict the absence of MRSA in a subsequent clinical culture. This information may be used as a stewardship tool to avoid the use of or de-escalate anti-MRSA therapy. It is not, however, appropriate to use MRSA nares as a tool to predict current infection."
Oct 1 Clin Infect Dis abstract


High global MDR prevalence, death noted in A baumannii pneumonia

A systematic review and meta-analysis of data from 29 countries highlights the global burden and severity of Acinetobacter baumannii causing nosocomial pneumonia, researchers from Australia and Malaysia reported yesterday in The Journal of Infection.

Among the 6,445 studies and reports screened from four databases, the researchers identified 126 relevant studies on A baumannii in patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). The review aimed to provide a global picture of the  prevalence of multidrug-resistant A baumannii (MDRAB) in HAP and VAP, and the associated mortality rate. While A baumannii is known to be intrinsically highly resistant to many antibiotics, and numerous studies have reported on the prevalence of MDRAB in HAP and VAP, those studies have been geographically limited.

A meta-analysis of the 126 studies found that the overall prevalence of multidrug resistance among A baumannii causing HAP and VAP was 79.9%, with the highest reported prevalence in Central America (100%), Latin America and the Caribbean (100%), and Western Europe (100%). The regions with the lowest prevalence were Eastern Europe (70.6%), North America (69.8%), and Eastern Asia (64.6%). Among countries, the prevalence ranged from 56% (Argentina) to 100% (Mexico, Cuba, Uruguay, Nepal, Pakistan, Lebanon, Qatar, and Croatia).

The overall mortality estimate pooled from 27 studies was 42.6%, with the highest reported rates in Western Asia (56.2%), Southern Europe (55.7%), and Northern Africa (53.3%). The lowest reported mortality rates were in Western Europe (33.3%), Southeast Asia (31.9%), and North America (28.6%). The mortality rate among countries ranged from 28% (Iran) to 68% (Greece).

The authors of the study say the differences in MDRAB prevalence likely reflect the level of urbanization, sanitation, poverty, and variation in medical resources.

"It is clear that the burden of MDRAB in HAP and VAP and the mortality rate is high," they write. "Continuous monitoring of drug resistance and strict infection control are recommended for the prevention and control of MDRAB in HAP and VAP."
Sep 30 J Infect abstract

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