Flu Scan for Jan 27, 2017

News brief

H7N9 avian flu sickens 2 more in China

On the eve of Lunar New Year in China, ringing in the year of the rooster, two of the country's provinces reported new H7N9 avian flu cases, Hunan and Guizhou, according to provincial health department statements translated and posted by FluTrackers, an infectious disease news message board.

The patient from Hunan is a 67-year-old man who had contact with poultry and is hospitalized in critical condition. Guizhou province didn't list the patient's age or gender but said he or she is hospitalized.

China is in the midst of its fifth wave of H7N9 since the virus emerged in humans in early 2013. Officials reported a large, early spike in activity in December, with the illness level in January so far trending even higher. Except for two small clusters this year, most cases involve contact with poultry and their environments, especially at live markets, and Chinese researchers said recently that the rise in human cases is likely to reflect a rising disease levels in birds.
Jan 27 FluTrackers thread on Hunan case
Jan 27 FluTrackers thread on Guizhou case


Study in UK kids shows modest LAIV protection against severe flu

The nasal-spray flu vaccine showed moderate protection against flu severe enough to require hospitalization in young English children during the 2015-16 flu seasons, in line with earlier estimates for flu in kids who had mild disease in Europe, researchers reported yesterday in Eurosurveillance.

The United Kingdom is in its fourth year of rolling out a universal flu vaccination recommendation for children ages 2 through 16, offering healthy kids a single dose of live-attenuated influenza vaccine (LAIV). The children received quadrivalent LAIV during the 2015-16 season.

Researchers have published reports showing protection in primary care settings over the last three seasons, but the new study is the first to measure protection against more severe disease. Last summer US vaccine advisors recommended against using LAIV this season because of problems with vaccine effectiveness over the past three seasons, a pattern not seen in Europe. Scientists from Medimmune, the maker of FluMist, are still investigating the reasons for the lack of effectiveness, but in November they said reduced fitness of the H1N1 vaccine viruses are a likely culprit.

For the UK study, researchers looked at 176 children ages 2 to 6 whose lab-confirmed flu infections were reported to the UK Severe Influenza Surveillance System. Vaccine effectiveness (VE) for all flu types was 54.5% (95% confidence interval [CI], 31.5%-68.4%). Against H1N1, the dominant strain that season, VE was 48.3% (95% CI, 16.9%-68.4%), and against influenza B VE was 70.6% (95% CI, 33.2%-87.1%).

For comparison, VE for the same season for UK children with mild disease was 57.6%. The investigators said the findings support the continued rollout of the flu vaccination program for children and that ongoing monitoring is needed, especially given US patterns.
Jan 26 Eurosurveill report

News Scan for Jan 27, 2017

News brief

More than 100 new cases of yellow fever reported in Brazil

Yesterday Brazil's health ministry reported 129 new suspected cases of yellow fever this week, with two more states, Goias and Matto Grosso do Sul, reporting infections. The country now has 550 suspected or confirmed cases of the mosquito-borne disease.

The vast majority of cases, 502, have been in Minas Gerais state. Espirito Santo has 33 cases, while a smattering of illnesses have been documented in Bahia, San Paulo, Goias, and Matto Grosso do Sul.

As of yesterday, 72 cases have been confirmed as yellow fever, 23 were not confirmed, and 455 are under investigation. Since the first of the year, 105 people have died, 90 in Minas Gerais.

Earlier this week, Brazil's health ministry said that it would make 11.5 million yellow fever vaccines available this year. Usually, only 1 million doses are used in the country in a year.  In 2016, Brazil helped respond to a vaccine shortage crisis by supplying yellow fever vaccines to Angola and the Democratic Republic of the Congo during a yellow fever epidemic.

Four nature reserves, Pedra Azul, Forno Grande, Mata das Flores, and Cachoeira da Fumaca, were also closed this week to limit the spread of the disease.
Jan 26 Brazilian health ministry statement


Lassa fever, MERS, Zika make the WHO's top-priority disease list

Coronaviruses, such as MERS-CoV (Middle East respiratory syndrome coronavirus) and SARS (severe acute respiratory syndrome), and hemorrhagic fevers such as Lassa and Crimean Congo hemorrhagic fever (CCHF) top the list of the World Health Organization's (WHO's) priority disease list for 2017.

The list was crafted earlier this week after an informal meeting held with consultants for the WHO's blueprint for research and development arm in Geneva.

In addition to the diseases mentioned, the WHO singled out filoviral diseases (Ebola and Marburg), Nipah, Rift Valley fever, severe fever with thrombocytopenia syndrome, and Zika as being the top threats in 2017.

The list adds to the previous list, compiled in 2015, which included CCHF, Ebola and Marburg, MERS, SARS, Lassa, Nipah, and Rift Valley fever.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, which publishes CIDRAP News, said leaving out influenza was a major mistake on the WHO's part.

"It perpetuates the myth that we're ready for a worldwide flu outbreak," said Osterholm. "We're not."
Jan 26 WHO list of pathogens
Jan 26 WHO R&D
Dec 11, 2015, CIDRAP News Scan on WHO priority list


New MERS case confirmed in Saudi healthcare worker

The Saudi Arabian Ministry of Health (MOH) said today that a healthcare worker in Jeddah has been diagnosed as having MERS-CoV.

The 30-year-old Saudi man is in stable condition after presenting with symptoms of MERS-CoV. The MOH said he is a healthcare worker who contracted the disease in a healthcare setting. In the first week of this month, the MOH reported a small healthcare outbreak in Buraydah.

The new case raises Saudi Arabia's MERS-CoV total to 1,547 infections, including 641 deaths. Ten people are still in treatment or monitoring.
Jan 27 MOH report

ASP Scan (Weekly) for Jan 27, 2017

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

VHA says its stewardship efforts have cut antibiotic use 12%

Originally published by CIDRAP News Jan 26

More than 90% of Veterans Health Administration (VHA) hospitals have developed written antimicrobial stewardship policies, and the agency's Antimicrobial Stewardship Initiative has cut antibiotic use 12% overall so far, VHA officials noted yesterday in an analysis in Infection Control and Hospital Epidemiology.

The analysis of the 140-plus VHA medical facilities in the United States found that 92% had written stewardship policies by 2015. The investigators also noted that, while the proportional distribution of antibiotics did not change, inpatient antibiotic use decreased significantly (P < .0001) after the VHA stewardship initiative activities were implemented. They reported a 12% decrease in antibiotic use overall.

The analysis also noted significantly declining use overall of antimicrobials prescribed for resistant gram-negative organisms, including carbapenems, and declining hospital readmission and mortality rates. They also reported decreased rates of Clostridium difficile infection.

The VHA's stewardship efforts include continuing education, disease-specific guidelines, and development of example policies.
Jan 25 Infect Control Hosp Epidemiol study


European experts call for innovation on antimicrobial use in food animals

Originally published by CIDRAP News Jan 26

European health and food safety experts say in a new report that while efforts to reduce the use of antimicrobials in food-producing animals have had an impact, innovative solutions are needed to further protect animal and public health.

In a joint report issued this week, experts from the European Medicines Agency (EMA) and the European Food Safety Authority (EFSA) reviewed the measures that have already been taken by European Union (EU) nations and concluded that the wide range of control strategies implemented have produced favorable results, especially in northern European countries. These strategies use a multifaceted approach, take into account the local livestock production system, and have certain elements in common, such as national targets for reducing antimicrobial use.

But the authors note that while it's reasonable to assume that these efforts have had an impact on antimicrobial resistance in food-producing animals and food, assessing that impact has been difficult.

Beyond continuing efforts to encourage responsible antimicrobial use in food-producing animals, the authors conclude that more antimicrobial reduction strategies are necessary, including improved disease prevention measures to stop the spread of microorganisms within and between farms. In addition, they argue that antimicrobial alternatives, such as vaccines, probiotics, and bacteriophages, should be considered. And they suggest that alternative farming systems that require fewer antimicrobials without sacrificing animal health should be explored.

"It is clear that strategies that are already available can be implemented immediately and will have a positive impact on levels of antimicrobial resistance," EFSA Executive Director Bernhard Url, DVM, says in a press release. "At the same time, there is a need for innovative solutions—we need to find alternative ways to prevent and treat bacterial infections in animals." 
Jan 24 EMA and EFSA joint scientific opinion
Jan 24 EMA and EFSA press release


Study shows high MDR Staph capitis levels in French NICUs

Originally published by CIDRAP News Jan 26

The multidrug-resistant Staphylococcus capitis clone, NRCS-A, that has been isolated from neonatal intensive care units (NICUs) in 17 countries is plaguing some NICUs in France, according to a research letter in Emerging Infectious Diseases today.

The French team conducted a lab-based retrospective epidemiologic probe of 47 of the country's 57 NICUs to estimate NRCS-A prevalence. The researchers found that only 4 NICUs were completely free of the bacterium. Of the 43 affected NICUs, NRCS-A strains accounted for up to 46% of cases of positive blood cultures from newborns, with a median of 13%.

The authors conclude that these data and other global data "unquestionably demonstrate the unusual worldwide endemicity of the multidrug-resistant NRCS-A clone in NICUs. In addition, the epidemiologic data from France highlight the propensity of NRCS-A to invade and settle in most NICUs on a national scale.

"Once endemic in a NICU, NRCS-A strains expose infected neonates to a risk of therapeutic failure because treatment of neonatal sepsis involving methicillin-resistant coagulase-negative staphylococci is usually based on vancomycin and aminoglycosides, to which NRCS-A isolates are not susceptible."
Jan 26 Emerg Infect Dis research letter


Study shows nasal MRSA in med students before healthcare exposure

Originally published by CIDRAP News Jan 25

A small study from Israel showed that carriage of methicillin-resistant Staphylococcus aureus (MRSA) can occur in the noses of medical students even before they have healthcare exposure, indicating community acquisition of hospital strains, according to the findings in Antimicrobial Resistance and Infection Control.

The investigators followed 58 medical students for 19 months, noting that S aureus carriage steadily increased in their nasal specimens, from 33% at baseline to 38% at 13 months and 41% at 19 months. They also noted that 7 students (12%) carried 13 MRSA isolates, and that MRSA was found in 4 of them before they began their clinical rotations. Two of those students carried different MRSA strains at various times, and 1 had persistent nasal carriage of MRSA.

The authors concluded, "Compared with previous reports, higher rates of MRSA carriage were evident. . . . carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains."
Jan 23 Antimicrob Resist Infect Control study


Analysis: Rapid screening tests can lower MRSA surveillance costs

Originally published by CIDRAP News Jan 24

Rapid screening tests can help hospital intensive care units (ICUs) reduce unnecessary surveillance costs for methicillin-resistant MRSA, according to a new study in the American Journal of Infections Control.

For the study, investigators set out to analyze the costs associated with two surveillance approaches commonly used in ICUs to mitigate MRSA infections. One approach is universal preemptive isolation, in which all patients are screened upon admission and isolated until the absence of MRSA carriage is shown. This strategy, the authors explain, can result in some non-colonized patients being unnecessarily isolated, which leads to excess costs.

As a result, some hospitals use a targeted isolated strategy, in which all patients are screened but only MRSA-positive patients are isolated. The downside of this approach, however, is that delaying the isolation of colonized individuals while waiting for the results of screening tests could lead to MRSA transmission to other patients.

The question investigators were trying to answer was whether rapid screening tests, though more expensive than conventional screening methods, can help enhance both these surveillance approaches and reduce costs by providing quicker screening results and removing non-colonized patients from isolation sooner or reducing the number of days a MRSA-positive patient is not isolated.

Four screening tests were evaluated, including conventional culture and chromogenic agar 48-hour test, which generate results in a few days, and chromogenic agar 24-hour and polymerase chain reaction (PCR) screening tests, which produce results within 24 hours

In their cost and sensitivity analysis, the investigators found that the total cost of universal preemptive isolation was lowest when PCR screening tests were used, resulting in a cost of $82.51 per patient. For targeted isolation surveillance, they found that the total cost was lowest when using the chromogenic agar 24-hour test, which produced a cost of $8.54 per patient.

"With knowledge of the screening test that minimizes inappropriate and total costs, hospitals can maximize the efficiency of their resource use and improve the health of their patients," the authors conclude.
Jan 23 Am J Infect Control study


Antibiotic shows early promise against bacteremia, infective endocarditis

Originally published by CIDRAP News Jan 23

Drugmaker Theravance Biopharma, Inc., of Dublin, reported today that telavancin, a US Food and Drug Administration–approved antibiotic for the treatment of skin infections and pneumonia caused by S aureus, has demonstrated positive clinical responses in patients with bacteremia and infective endocarditis (IE).

In an ongoing observational study designed to evaluate how telavancin—sold under the brand name Vibativ—is being used by physicians to treat patients in real-world clinical settings, researchers reported that the drug demonstrated positive clinical responses in 64.4% of 45 patients with diagnoses of bacteremia or IE, with 6.7% of patients failing treatment and 28.9% considered non-evaluable. Positive clinical response was defined as cure or improvement leading to step-down oral therapy.

The researchers also reported that 53% of the patients had bacteremia or IE that was caused by MRSA, while 13% were sickened by methicillin-susceptible S aureus (MSSA). Other pathogens included coagulase-negative staphylococci (9%) and Enterococcus (7%). The median telavancin daily dose and duration of treatment were 750 mg and 14 days. 

The results were presented at the Society of Critical Care Medicine's 46th Critical Care Congress and have not yet been peer reviewed.

Co-author Kerry Cleveland, MD, a professor of medicine at the University of Tennessee Health Science Center, said in a company press release. "Based on these results, we believe that Vibativ may represent an alternative treatment option for these patients." 
Jan 23 Theravance Biopharma press release

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