News Scan for Dec 03, 2019

News brief

More illness reported in blackberry-linked hepatitis A outbreak

Federal health officials today said 2 more hepatitis A infections have been reported in an outbreak linked to fresh blackberries from Fresh Thymes markets, raising the total to 16. One more state—Missouri—is reporting a case, putting the number of affected states at six.

So far, no deaths have been reported, and nine people have been hospitalized for their infections. The most recent illness onset is Nov 15.

The epidemiological investigation shows that patients ate conventional blackberries from Fresh Thymes Farmers Market stores in Indiana, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin.

The US Food and Drug Administration (FDA) said the traceback investigation suggests that the berries came from a distributor that ships fresh berries to Fresh Thymes markets in 11 states: Iowa, Illinois, Indiana, Kentucky, Michigan, Missouri, Minnesota, Nebraska, Ohio, Pennsylvania, and Wisconsin.

The FDA has urged consumers in the 11 states who bought the blackberries between Sep 9 and Sep 30 to discard them and if they ate them to talk to a health provider about receiving postexposure prophylaxis for hepatitis A.
Dec 3 FDA update
Dec 2 CDC


Bacteria testing on Tanzanian bushmeat reveal zoonotic threats 

Tests on bushmeat samples in Tanzania's Western Serengeti revealed 27 different bacteria groups, some of which included Bacillus, Brucella, Coxiella, which include species that cause anthrax, brucellosis, and Q fever. A research team from Penn State and their collaborators in Africa published their findings yesterday in Scientific Reports.

For the study, they collected 56 bushmeat samples from the main large herbivores, including buffalo, zebra, and giraffe, from the Serengeti National Park and surrounding areas.

With broad genetic sequencing, they characterized the microbiomes in each sample. The most common phyla (bacteria group) they found were Firmicutes, Proteobacteria, Cyanobacteria, and Bacteroidetes. Within the phyla, they found DNA signatures of bacteria within the Bacillus, Brucella, and Coxiella genera, all of which are potentially dangerous zoonotic pathogens. They also found a high prevalence of bacteria in the Clostridium genus, which causes diseases such as botulism and tetanus. The microbiomes in samples from wildebeest collected during the dry season contained more than 78% Clostridial species.

They concluded that the findings provide a better understanding of microbiomes linked to major food sources in Tanzania and point to a need for more investigations on potential health risks regarding the harvest, trade, and consumption of bushmeat in sub Saharan Africa.

Vivek Kapur, PhD, associate director of the Huck Institutes of Life Sciences at Penn State, said in a press release from the university that understanding which bacteria are present is needed to help plan ways to curb outbreaks, and the group's next objective is to fine-tune the focus on specific pathogens to more accurate gauge the disease threat. "Ultimately, our goal is also to help build capabilities for rapid diagnosis and risk mitigation in the countries of origin to address these risks before they become a problem globally," he said.
Dec 2 Penn State press release
Dec 2 Sci Rep


Nepal faces growing dengue outbreak linked to increasing temperatures

More than 14,000 cases of dengue have been diagnosed in Nepal since May, according to an article today in The Guardian. The cases, which include six deaths, represent an unprecedented outbreak tied to warmer temperatures that have made the Himalayan country more hospitable to the mosquitoes that carry the virus.

Dengue was first documented in 2004 in Nepal, but until this year only minor outbreaks in the southern part of the country had been recorded. This year, 67 of Nepal's 77 districts, including those at higher elevation, have reported cases of the viral disease, The Guardian reports, and some officials estimate that the actual number of cases has topped 100,000.

"The role of climate change in poor countries where the health system is not robust is very big," Meghnath Dhimal, chief research officer at the Nepal Health Research Council, told the British newspaper. "There has been a rapid geographical expansion of dengue, especially from the lowland to the highland."

Experts attribute the outbreak to the climate crisis, an extended rainy season, and rapid urbanization.
Dec 3 Guardian

Stewardship / Resistance Scan for Dec 03, 2019

News brief


Non–beta-lactam allergy not nearly as common as reported, study finds

A study of Australian children has found that only 1 in 5 with a reported non–beta-lactam antibiotic (NBLA) allergy had a true allergy, Australian researchers reported today in Pediatrics.

The retrospective study looked at children ages 0 to 18 at a tertiary pediatric hospital in Melbourne who had a suspected NBLA allergy and who had a skin test or intravenous or oral challenge test from May 2011 through June 2018. Over the course of the 7-year study period, 141 children had 150 evaluations of 15 different NBLAs, with a median time from the initial reported reaction to allergy evaluation of 1.9 years.

Overall, 27 of the 150 challenge results for NBLAs (18%) were positive. The frequency of reported reactions was highest for trimethoprim-sulfamethoxazole (15 of 46, 32.6%) and macrolides (8 of 77, 10.4%). Of the challenges that had positive results, most (23 of 27, 85.2%) had symptoms on repeat challenge that were similar to those initially reported. Four children reported initial anaphylactic reactions, but none had severe reactions on re-challenge or required adrenaline.

The authors of the study say the findings indicate that 80% of children with a reported NBLA allergy could be de-labeled, which could help preserve first-line antibiotics for these patients. They also note that while the median time to allergy evaluation was 1.9 years, delay in confirmation or exclusion of an NBLA allergy extended up to 14.9 years. They recommend that testing should occur promptly after an initial reaction.

"Improved access to standardized and reliable allergy testing protocols to delabel children are urgently needed," they conclude.
Dec 3 Pediatrics abstract


Study touts benefits of reviewing antibiotics for discharged patients

A single-center study in Infection Control and Hospital Epidemiology highlights discharge antibiotic review as a potential stewardship tool.

The study examined a 19-month period (June 2017 to December 2018) during which the antibiotic stewardship team at an 87-bed Veterans' Affairs hospital in Wisconsin reviewed the electronic health records of patients discharged from the hospital with oral antibiotics for appropriateness of antibiotic drug choice, duration, and dosing.

Because of limited resources, reviews were conducted only twice weekly, sometimes 3 to 4 days after patients had been discharged. Interventions recommended by the stewardship team included antibiotic discontinuation; change of antibiotic, dose, or duration; and diagnostic testing. Verbal and/or written recommendations were made to the prescribing service and, in some cases, the pharmacist.

Overall, 929 patients were discharged with antibiotics during the study period, and the stewardship team suggested changes in 90 prescriptions (9.7%). The most common reasons for intervention were antibiotic not indicated (43.3%), incorrect duration of therapy (24.4%), and preferred alternate antibiotic could have been chosen (23.3%). In 52 of the 90 interventions, the intervention was unable to be acted upon because the antibiotic course had already been completed; of the remaining 38 interventions, 22 (57.9%) were accepted by providers.

Common disease states intervened upon were chronic obstructive pulmonary disease (COPD, 24.4%), urinary tract infection (UTI, 18.8%), pneumonia (15.5%), and skin and other soft-tissue infection (SSTI, 15.5%).

The authors of the study note that while prescribers appeared to welcome feedback and suggestions on prescribing, the low acceptance rate could indicate increased barriers to intervention that are unique to discharged patients. Going forward, they suggest that focusing discharge stewardship interventions on common conditions like COPD, UTI, pneumonia, and SSTI may increase review efficiency, and that performing reviews prior to discharge could have a greater impact on patient care.
Nov 29 Infect Control Hosp Epidemiol abstract

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