Officials note 1 new Ebola case but troubling developments in hot spot

Today the Democratic Republic of the Congo (DRC) confirmed one new case of Ebola in the ongoing outbreak in North Kivu and Ituri provinces, but the World Health Organization (WHO) spotlighted some troubling signs in its weeks update.

The single case raises the outbreak total to 3,228. There were 4 new fatalities also reflected today on the WHO online Ebola dashboard, which raises the total number of deaths during the 14-month outbreak to 2,157. Officials are still investigating 443 cases.

Also today, the DRC's Ebola technical committee (CMRE) provided information on three cases reported yesterday. All three were in Mandima, the current hot spot of the outbreak.

The WHO today, in its latest disease outbreak news report, noted 15 new confirmed cases reported in North Kivu and Ituri provinces during the week of Oct 7 through Oct 13. But despite the decrease in cases, Mandima and Biakato Mine health area have reported increasing cases.

In Mandima, officials have noted a decline in the proportion of confirmed cases listed as contacts (from 57% to 13%) and an increase in the proportion of cases dying outside of Ebola treatment centers (from 14% to 27%) this past week—both worrisome indications of increased transmission risk—the WHO said.

A recent qualitative investigation in Mandima and Biakato Mine Health Area also produced troubling results: Less than half of respondents said they would call a hotline if they or a member of their community were suspected to have Ebola, and less than half said they would encourage a family member to go to an Ebola treatment center.
WHO Ebola dashboard
Oct 16 CMRE report
Oct 17 WHO disease outbreak news update


MERS infects 1 more in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) today reported a new human MERS-CoV case, the seventh to be reported this month.

The patient is a 57-year-old man from the city of Uyun Al Jawa in Al Qassim region in the central part of the country. The man's contact with camels isn't known and his exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as primary, meaning he probably didn't contract the virus from another known MERS patient.

In its latest monthly update, the WHO Eastern Mediterranean regional office said 2,468 MERS-CoV cases have been reported globally as of the middle of September, with at least 850 of them fatal. The vast majority have been reported in Saudi Arabia.
Oct 17 MOH update


ECDC: Local Zika case in France poses very low transmission risk

The European Centre for Disease Prevention and Control (ECDC) yesterday posted a risk assessment for a local Zika case detected in southern France, which is thought to involve vector-borne transmission, which if confirmed would mark the first case of its kind in Europe.

On Oct 11 the ECDC noted the case in its weekly communicable disease threat report and said it would soon publish a more detailed risk assessment.

The patient is from the city of Hyeres in Var department in the country's southeast. He or she had Zika symptoms during the first half of August, and lab tests confirmed the case on Oct 1. The investigation found the patient had not traveled to any countries that have a history of Zika transmission, along with no evidence of sexual transmission. No imported infections were reported in the patient's area for 2019.

Further investigation is under way to determine how the patient contracted Zika virus, but for now, health officials suspect vector-borne transmission.

Mosquito control measures have been implemented near the patient's home, and so far, no other Zika illnesses have been detected. The ECDC noted that Aedes albopictus, one of the mosquito species capable of carrying the virus, is widely established in southern Europe. However, Ae albopictus in Europe is considered a less competent vector than its tropical and subtropical relatives.

More sporadic cases or clusters of locally acquired Zika infections are possible, especially in Mediterranean areas of Europe in the summer and early fall, so a case in southern France isn't surprising, the ECDC said. Officials assess the risk of Zika spread as very low, given the lack of evidence of a more extensive cluster and the fact that decreasing temperatures as autumn progresses aren't favorable for sustaining transmission.
Oct 16 ECDC risk assessment
Oct 11 ECDC communicable disease threat report


Survey: Most doctors do not have injectable STI antibiotics on site

According to a study yesterday in Emerging Infectious Diseases, most American office-based physicians who treat patients for sexually transmitted infections (STIs) do not have on-site access to injectable antimicrobials, the first-line treatment for uncomplicated gonorrhea and primary and secondary syphilis.

Researchers used the results of the 2016 Physician Induction File of the National Ambulatory Medical Care Survey to determine how many American physicians use injectable antimicrobials. A total of 1,030 physicians representing an estimated of 330,581 physicians in the United States, completed the survey, the authors said.

Of those physicians, 45.2% said they saw patients for STI evaluation, but 77.9% of those who saw STI patients said they did not have access to penicillin G benzathine (used for syphilis), while 56.1% said they did not have access to intramuscular ceftriaxone (used for gonorrhea).

Physicians in the South were more likely to have access to injectables, as were those in the western United States, where congenital syphilis has been most commonly observed, the authors said.

Rates of STIs are on the rise in the United States, with increased rates of gonorrhea (+75%) and syphilis (primary and secondary, +153%) cases in 2017 compared with 2013. "Mitigating the lack of medication availability to treat these infections will help public health officials stop the rise in STI disease," the authors concluded.
Oct 16 Emerg Infect Dis study

Stewardship / Resistance Scan for Oct 17, 2019

News brief

FDA advisors approve new antibiotic cefiderocol for complicated UTI

In a 14-2 vote, the US Food and Drug Administration (FDA) Antimicrobial Drugs Advisory Committee yesterday recommended that the new antibiotic cefiderocol, made by Shionogi & Co, Ltd, of Japan, be approved for complicated urinary tract infection (cUTI), including pyelonephritis, caused by gram-negative bacteria in patients who have limited or no alternative treatment options available, the company said in a news release.

Committee members weighed an imbalance in deaths in the CREDIBLE-CR trial, a phase 3 study that compared cefiderocol against the best available therapy in patients with cUTIs, severe pneumonia, and bloodstream infections or sepsis caused by carbapenem-resistant infections. Death rates in the cefiderocol group outpaced those in the other group 15.8% to 8.2%, but the data also showed an imbalance in deaths caused by underlying comorbidities, 9.9% to 4.1%. The experts also analyzed data on a separate phase 3 trial and a phase 2 trial.

Isao Teshirogi, PhD, Shionogi president and CEO, said in the release, "Patients with cUTIs caused by Gram-negative pathogens continue to face a serious challenge with high morbidity and mortality rates. If approved, we believe cefiderocol could help address a significant unmet need in an area with limited treatment options to fight these life-threatening infections."

Cefiderocol is a siderophore cephalosporin with a novel method of penetrating the tough outer membrane of gram-negative bacteria, including carbapenem-resistant pathogens. It is eligible to be fast-tracked for FDA approval. 

The FDA is not bound by the committee's vote but typically follows its recommendations.

Some committee member said any FDA approval should carry with it a boxed warning on the drug's label, the strongest the agency uses, according to a story yesterday by MedPage Today. The two committee members who voted no—Peter Weina, MD, PhD, of Defense Health Headquarters in Falls Church, Virginia and Susanne May, PhD, with the University of Washington in Seattle expressed safety concerns and said more research is needed.
Oct 16 Shionogi news release
Oct 16 MedPage Today story


Antibiotic prescribing high for non-bacterial respiratory illness in Japan

About one third of Japanese patients with non-bacterial acute respiratory tract infections (NB-ARTIs) are inappropriately prescribed antibiotics, according to a new study in PLOS One.

The observational study used longitudinal claims data between April 2012 and June 2017. Though the monthly antibiotic prescribing rate per 100 NB-ARTI consultations decreased by 19.2% during the study period, the authors said the average monthly rate was still 31.65 prescriptions per 100 NB-ARTI consultations.

"Approximately 89% of antibiotics prescribed for NB-ARTI during the study period were broad-spectrum antibiotics, specifically third-generation cephalosporins (40.1%), macrolides (34.1%), and fluoroquinolones (14.4%)," the authors said. Adults ages 19 to 29 were the most likely to be prescribed antibiotics for NB-ARTI.

The diagnoses that yielded the highest antibiotic prescriptions were acute bronchitis and acute tonsillitis.

"Identified factors associated with inappropriate antibiotic prescription in our study, such as patients of working-age, clinic types, and specialties of clinics may be associated with patient expectation for antibiotics, time pressure, and diagnostic uncertainty, respectively," the authors concluded.
Oct 16 PLOS One study 

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