News Scan for Oct 16, 2020

News brief

US emergency sick leave act tied to reduced COVID-19 cases

The emergency sick leave provision of the Mar 18 bipartisan Families First Coronavirus Response Act (FFCRA) appears to have reduced the spread of the virus. A Health Affairs study yesterday found that states where workers could get up to 2 weeks of paid sick leave showed 417 fewer confirmed cases per day, or an average of 1 prevented case per day per 1,300 workers.

The lack of universal access to paid sick leave in the United States makes it an outlier among nations in Europe and the Americas. Twenty-seven percent of all US workers and more than half of food and accommodation industry workers are ineligible for paid sick leave. The emergency sick leave provision of the FFCRA is estimated to provide paid sick leave benefits to roughly half of the US workforce.

Previous studies of flu transmission showed higher rates of "presenteeism"—working sick with a contagious disease—among employees lacking paid sick leave. The study authors sought to evaluate whether FFCRA emergency sick-leave provisions reduced presenteeism and decreased the number of reported new COVID-19 cases in states where workers gained access to the benefit.

Using a variety of statistical models and controlling for state differences in testing and stay-at-home orders, the study authors found significant decreases in the number of reported new COVID-19 cases in states where workers gained paid sick leave as a result of FFCRA (376 to 495 fewer cases per day). The authors highlighted an average decrease of 56% in new cases per day, in line with previous studies showing a 40% reduction in influenza-like-illness with sick pay mandates.

"Although our findings suggest that the U.S. emergency sick leave provision was a highly effective policy tool to flatten the curve in the short-run, it only contains up to two weeks of paid sick leave and is set to expire at the end of 2020," the study authors noted.

"If employees take their emergency sick leave as a precautionary measure or because they are quarantined for the standard time of two weeks, they obviously are unable to take paid sick leave again, which may force them to work sick and potentially spread the virus in the future," the authors warned.
Oct 15 Health Aff study

Rural residents, men, young people more mask-averse; mandates effective

A PLOS One study yesterday showed that gender, age, and location factor into voluntary mask-wearing, with females, older individuals, and urban or suburban residents more likely to comply. The study also demonstrated that mask mandates established in July and August brought mask-wearing to levels above 90% for all groups.

Masks have been shown to be effective in reducing the spread of COVID-19, but significant public resistance to mask-wearing exists. The observational study of 9,935 Wisconsin retail shoppers from June through August examined the demographics of mask wearers and resisters before and after the implementation of mask mandates.

In June, 41.5% of shoppers in grocery or big-box retail stores wore a mask, a figure less than half that demonstrated to significantly reduce the spread of COVID-19 (85%). Females wore masks more than males (45% versus 38%), and individuals older than age 65 were more likely to wear masks than middle-aged (ages 30 to 65) people (57% versus 41%) or younger (ages 2 to 30) people (37%).

The odds of observing someone in urban or suburban areas wearing a mask were around four times higher than in rural locations (urban odds ratio [OR], 3.847, 95% confidence interval [CI], 3.157 to 4.689; suburban OR, 4.124, 95% CI, 3.418 to 4.975).

Mask-wearing compliance increased from June to late July with the imposition of store mask mandates (93% compliance from Jul 22 to Jul 31). After the Aug 1 state mandate, researchers found mask-wearing compliance at 96% overall, with 2% of shoppers continuing to resist mask-wearing.

Higher rates of mask wearing among older people may reflect an awareness of the increased risk of severe COVID-19 in this group. The authors hypothesize that gender differences may reflect a perception of mask-wearing as a sign of fragility or weakness among some men, as suggested in previous studies. "In this case, public health messaging that focuses on aligning masks with masculinity would likely be beneficial to improve usage among males in the United States," the authors noted.
Oct 15 PLOS One study

New polio cases in the Middle East, West Africa

Six countries—Afghanistan, Pakistan, Ivory Coast, Guinea, Mali, and Niger—confirmed 26 new polio cases in this week's update from the Global Polio Eradication Initiative. This marks an increase from last week, when 18 cases were reported across Afghanistan, Chad, and Burkina Faso. (The latter did report a circulating vaccine-derived poliovirus type 2 acute flaccid paralysis case this week).

In Asia, Afghanistan had 1 more wild poliovirus type 1 (WPV1) case in Khost province, raising the country's total for the year to 52 WPV1 cases, compared with last year's 16. Pakistan confirmed 3 more WPV1 cases, with 1 in Balochistan province and 2 in Punjab province. The country now has 77 total WPV1 cases this year; in 2019, it had 72 WPV1 cases at this time and 147 cases overall.

In 2019, Ivory Coast, Guinea, and Mali all had no cases of polio, but this week's report showed continued cases of circulating vaccine-derived poliovirus type 2 (cVDPV2). Ivory Coast had 4 new cVDPV2 cases, with 1 each in the provinces of Gbokle-Nawa-San-Pedro, Loh-Djiboua, Poro-Tchologo-Bagoue, and Tonkpi, raising the year's total to 33. Guinea reported 11 cVDPV2 cases, which increased the year's total by 61% to 29. Of the new cases, most are in Kankan (5) and N'zerekore (3) provinces. Mali had 4 new cases, with one each in Bamako and Mopti and 2 in Sikasso, making for 5 total in the year.

Also in Africa, Niger reported 3 new cases, with 1 each in the Dosso, Niamey, and Tahoua provinces. Compared with 1 cVDPV2 case last year, the country has had 7 thus far this year.
Oct 13 GEPI weekly report

CDC: Peach-linked Salmonella outbreak appears to be over

The Centers for Disease Control and Prevention (CDC) said today that a Salmonella Enteritidis outbreak linked to fresh peaches appears to be over, with 23 more illnesses and 5 more affected states noted in its final update on the investigation.

The new cases bring the outbreak's overall total to 101 illnesses and the number of affected states to 17. Twenty eight people were hospitalized, and no deaths were reported.

The CDC first reported the outbreak in the middle of August. Illness onsets ranged from Jun 29 to Aug 27. Canada also reported 57 related illnesses from two provinces.

Investigators said the outbreak was likely linked to loose and bagged peaches packed or supplied by Prima Wawona or Wawona Packing Co. and sold at multiple grocery stores. The company recalled the products on Aug 22, and they are now past their shelf life.
Oct 16 CDC final outbreak notice
Oct 15 Public Health Agency of Canada update

ASP Scan (Weekly) for Oct 16, 2020

News brief

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

Study will examine risk factors for multidrug-resistant infections

Originally published by CIDRAP News Oct 15

The University of Texas Health Science Center at Houston (UTHealth) announced yesterday that it has received an $11 million grant from the National Institute of Allergy and Infectious Diseases to conduct a 5-year study to better understand why some critically ill patients develop multidrug-resistant infections.

Using state-of-the-art genomic analysis and microbiome analysis, researchers at UTHealth will seek to identify the microbial and clinical factors involved in infections caused by vancomycin-resistant enterococci, extended-spectrum beta-lactamase– and carbapenemase–producing Enterobacterales, and Clostridioides difficile. They'll follow study participants hospitalized in intensive care units at Memorial Hermann Hospital-Texas Medical Center, as well as those in the bone marrow transplant unit at the University of Texas MD Anderson Cancer Center, to understand why some patients colonized with these pathogens develop infections and others don't.

"We want to learn more about how these three classes of organisms colonize the gastrointestinal tract of critically ill patients and, eventually, cause infections in these patient populations," Cesar Arias, MD, MSc, PhD, the study's principal investigator and professor of infectious disease at McGovern Medical School at UTHealth, said in a press release.

Arias says the goals of the study will be to create an algorithm to determine whether patients have a low, medium, or high risk for these infections, and to develop future interventions based on that knowledge.
Oct 14 UTHealth press release

German researchers report C difficile pacemaker infection

Originally published by CIDRAP News Oct 15

In a case study yesterday in Open Forum Infectious Diseases, German researchers reported what they say is the first documented case of a pacemaker infection caused by Clostridioides difficile, a pathogen typically associated with intestinal infections.

The case involved a 75-year-old man who underwent pacemaker implantation at a hospital in Munich following an acute ischemic stroke and treatment for aspiration pneumonia. No specific antibiotic prophylaxis was used for the procedure because the patient was still on antibiotics (piperacillin/tazobactam) for pneumonia. The patient was discharged to a rehabilitation facility 4 days after the procedure, then readmitted to the hospital 7 days later with fever and a reddened pacemaker incision site.

Blood cultures and swab samples from the pacemaker, the leads connected to the device, and the pocket where the leads were implanted all came back positive for C difficile, as did stool samples tested to detect intestinal colonization. One toxigenic strain, RT014, was found in both the stool and the blood samples, but the patient showed no signs of gastrointestinal problems or diarrhea. Antibiotic treatment was switched to intravenous (IV) vancomycin and oral metronidazole, with oral antibiotic therapy switched to vancomycin after 3 days. After 42 days of IV and oral vancomycin, the pacemaker was reimplanted.

Although the route of infection is unclear, the authors of the study suggest the C difficile bacteria could have been on the patient's skin or in the hospital environment. Given the high numbers of asymptomatic C difficile carriers and the growing use of implantable cardiac devices, they say they're surprised there haven't been more reports of extra-intestinal C difficile infections.

"With rising numbers of implanted cardiac electronic devices and the high incidence of C. difficileinfections and colonisations, bloodstream and device infections with C. difficile might be a potentially growing issue," they wrote. "Recommendations for management of extra-intestinal C. difficile infection risk and treatment are needed."

C difficile is the leading cause of hospital-acquired diarrhea in the United States and Europe.
Oct 14 Open Forum Infect Dis abstract

CARB-X taps Swiss company to develop antibiotic for Enterobacteriaceae

Originally published by CIDRAP News Oct 14

CARB-X announced today that it is awarding up to $2.62 million to Swiss biopharmaceutical company Polyphor AG to develop a new antibiotic to treat infections caused by Enterobacteriaceae, including carbapenem-resistant Enterobacteriaceae (CRE).

The antibiotic being developed by Polyphor is a thanatin-derivative peptide that targets the lipopolysaccharide transport protein in gram-negative bacteria to break down their outer membrane. The company says antibiotics in this class have shown potent and specific activity against Enterobacteriacea, including extremely drug-resistant strains like CRE.

"Polyphor's project enriches the pool of novel approaches to deliver a therapeutic that can treat infections caused by multidrug-resistant Gram-negative pathogens, for which only one new class since 1962 has been approved for use in patients," CARB-X research and development director Erin Duffy, PhD, said in a press release. "It is in the early stages of development, and if successful and approved, it could potentially change the way these life-threatening infections are treated and save lives."

This is the second CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) award for Polyphor. For today's award, the company will be eligible for an additional $15.82 million in funding if certain project milestones are met.

Since its launch in 2016, CARB-X has awarded more than $252 million to support early development of 70 antibacterial products.
Oct 14 CARB-X press release

Quality improvement program linked to reduce antibiotics in NICU

Originally published by CIDRAP News Oct 14

An initiative aimed at addressing gaps in antibiotic stewardship was associated with decreased antibiotic use and exposure in the neonatal intensive care unit (NICU) of a New York children's hospital, researchers reported today in Pediatrics.

The quality improvement (QI) initiative begun in 2016 at the Golisano Children's Hospital set out to decrease the antibiotic use rate (AUR) by 20% in the NICU by focusing on addressing gaps in the core elements of antibiotic stewardship programs outlined by the Centers for Disease Control and Prevention.

Strategies for reducing antibiotic use included data collection and analysis, audit and feedback on prescribing patterns, development of written guidelines for common infections, implementation of a sepsis risk calculator (SRC) to determine if evaluation for sepsis was warranted, and a focus on antibiotic use in preterm infants. The primary outcome measure was AUR, and the secondary outcome measure was the percentage of infants discharged without receiving antibiotics while in the NICU.

The monthly AUR decreased from 27.6% at baseline to 15.5%, a 43.8% reduction, and has been sustained for more than 18 months. The authors of the study attribute the decline to implementation of the SRC, adopting a 36-hour rule-out period for sepsis evaluations, a 36-hour antibiotic hard stop, and novel guidelines for early-onset sepsis (EOS) evaluation among infants younger than 35 weeks.

The percentage of infants discharged without antibiotic exposure increased from 15.8% to 35.1%. The percent of infants younger than 36 weeks undergoing evaluation for EOS decreased by 42.3% and for those under 35 weeks by 26.0%.

"We believe our methods for achieving improvement, which involved a rich understanding of our current system, rigorous testing, standardization of practices, and analyzing data over time, are applicable to all teams focused on QI," the authors wrote.
Oct 14 Pediatrics abstract

$100 million next-generation genomics initiative begins in Africa

Originally published by CIDRAP News Oct 13

A group led by the African Commission through the Africa Centres for Disease Control and Prevention (Africa CDC), yesterday launched the Africa Pathogen Genomics Initiative (Africa PGI), a $100 million, 4-year partnership to expand and integrate next-generation genomic sequencing (NGS) capabilities across the continent to improve health surveillance and lab networks and better tackle antimicrobial resistance (AMR).

"The Africa PGI will help Member States build their capacities to operate strong surveillance and laboratory networks supported by advanced technologies to reduce the burden of disease and respond to outbreaks quickly and effectively," Africa CDC Director John Nkengasong, PhD, MS, said in a press release.

While some institutions in Africa already have access to NGS technology, the necessary finances, training, and database infrastructure has not been in place for widespread use. To address this, critical partners in the effort include Illumina and Oxford Nanopore, which are providing NGS machines and training; the Bill and Melinda Gates Foundation and the US Centers for Disease Control and Prevention, which are providing funding and technological assistance such as the Advanced Molecular Detection program; and Microsoft, which will be working with Africa PGI on its digital architecture and more.

Africa PGI hopes to create systems to better prevent, track, and control the approximately 140 infectious disease outbreaks that the continent sees each year as well as problems due to AMR. Besides creating a real-time, shared database, the initiative will also establish a training program for pathogen genomics and connect participants with international research opportunities.
Oct 12 Africa CDC press release

FDA considers revising criteria for ranking medically important antibiotics

Originally published by CIDRAP News Oct 12

The US Food and Drug Administration (FDA) late last week published a concept paper outlining potential revisions to criteria that the agency uses to guide the use of medically important antimicrobial drugs in veterinary medicine.

The FDA says the proposed approach for updating the current ranking of antibiotics, which was created in 2003 under Guidance for Industry (GFI) #152, would take into account an improved understanding of antimicrobial resistance, changes in human clinical practices, and other scientific advances. The revised criteria would also more broadly consider the importance of these antibiotics in human medicine, beyond their use in treating foodborne bacterial infections.

Under the current criteria, medically important antibiotics are ranked as critically important, highly important, or important for human medicine (a fourth category includes antibiotics not important for human medicine). The FDA uses these rankings to make decisions about how these antibiotics can be used in veterinary medicine, and to assess the antibiotic resistance risks involved. The approach outlined in the concept paper proposes categorizing antibiotics into three tiers—highest impact, intermediate impact, and lowest impact—that take into consideration the potential human health impact if resistance emerges to an antibiotic in one of these tiers.

"These revised criteria are intended to better characterize the overall importance of a drug for treating human infections, whether or not they are foodborne," the FDA said in a press release. "However, in addition to this importance ranking, other risk factors would be considered as part of an overall assessment of antimicrobial resistance risks associated with the use of an antimicrobial drug in animals."

The FDA is seeking comment on the concept paper and will hold a virtual meeting to discuss the details on Oct 16.
Oct 9 FDA press release
Oct 9 FDA concept paper