Flu Scan for Oct 06, 2017

News brief

CDC: 9 more H3N2v cases reported in Maryland, Michigan

In its latest weekly FluView report today, the US Centers for Disease Control and Prevention (CDC) said it has received reports of nine more variant H3N2 (H3N2v) influenza cases, eight from Maryland and one from Michigan, its first of the year.

The CDC said all nine patients reported exposure to pigs at two fairs in the week before they became ill. Eight are children and one is an adult older than 50. One of the patients was hospitalized, but all are recovering or have recovered. Investigators have found no human-to-human transmission. Six of the eight cases have been confirmed as H3N2v and three are presumed positive based on testing at Maryland's public health lab.

Maryland has reported several human cases since the middle of September, and the CDC said the state's number of cases is declining. The CDC said the Michigan case isn't related to the ongoing investigation in Maryland. The Michigan patient is a child who had recently visited the Allegan County Fair, which took place Sep 8 through Sep 16, according to a statement from the Allegan County Health Department (ACHD). Allegan is in southwestern Michigan.

The Maryland Department of Health (MDH) in its latest update said 40 presumptive positive and confirmed cases have been detected as of Oct 4. The total reflects an increase of 3 cases since an update earlier this week. Two people were hospitalized.

So far this year, 61 variant flu cases have been reported to the CDC, 56 of them involving H3N2v, 3 due to H1N2v, and 3 presumed H3N2v positives from Maryland undergoing further CDC testing.
Oct 6 CDC FluView report
Oct 6 ACHD statement
Oct 6 MDH case count

 

H7N9 features keep CDC experts on high alert

In an update on H7N9 avian influenza in China at the ID Week meeting in San Diego this week, Tim Uyeki, MD, MPH, an expert with the CDC's influenza division, pointed out several features of the virus and the disease that have the CDC closely following the developments.

He said the CDC has identified three viruses as highest risk, and H7N9 raises the greatest concerns. The other two are H5N6 and H5N1, according to a report yesterday from Infectious Disease Special Edition. When H7N9 emerged in humans 2013, it was the first time a low-pathogenic virus caused fatal infections in humans, raising alarm at the CDC and elsewhere.

Uyeki said that, of 40 clusters reported so far, a little more than a third involved secondary infections with a close contact, usually in a household member without poultry exposure. No transmission beyond two generations have been reported, he said. H7N9's appearance in health settings in unrelated people, including patients and health workers, underscores the important of carefully following infection control protocols, he added.

Until the fifth wave, which wound down over the summer, experts had seen little antigenic drift, but the most recent surge of activity last winter was marked by the emergence of a highly pathogenic form, which has so far been confirmed in 28 patients in five of China's provinces.

"We really need to keep our eye on this," he said, adding that another concern is increased receptor binding. H7N9 is unusual, because it can infect both lower and upper respiratory tracts. "This is a significant pandemic advantage for the virus."

Other worries are that resistance to neuraminidase inhibitors isn't present in the poultry viruses, but it has evolved during patient treatment. Though resistance has increased from 4% to 10%, it is still uncommon, and clinicians recommend early treatment with neuraminidase inhibitors, he said.

Uyeki, however, said high-dose corticosteroids should be avoided, because they have been associated with prolonged viral shedding, nosocomial infection, ventilator-associated pneumonia, and increased mortality at 30 and 60 days.
Oct 5 Infectious Disease Special Edition story

News Scan for Oct 06, 2017

News brief

Syria reports 7 new vaccine-derived polio cases

Syria has confirmed seven new cases involving vaccine-derived poliovirus 2 (cVDPV2) infection and Pakistan has reported four detections of wild poliovirus 1 (WPV1) in environmental samples, the Global Polio Eradication Initiative (GPEI) said today in its weekly update.

Five of the cases in Syria are from the city of Al Mayadin in eastern Syria, one is from Abu Kamal district in Deir ez-Zor governorate, and one is from Al-Thawrah district of Raqqa governorate. Syria has now reported 47 cVDPV2 cases this year, and the global total is 56, compared with 3 at this time last year.

Three of the four WPV1 environmental detections in Pakistan were in Sindh province and one was in Balochistan province. This year Pakistan has reported 5 WPV1 cases and Afghanistan 6, for a global total of 11 so far in 2017. That compares with 25 global WPV1 cases at this time last year.
Oct 6 GPEI update

 

WHO ships 1.2 million antibiotics as Madagascar plague cases top 200

The World Health Organization (WHO) today said it has shipped nearly 1.2 million doses of antibiotics and provided $1.5 million in emergency funds in response to a plague outbreak in Madagascar that has sickened 231 people and killed 33.

The WHO has delivered 1,190,000 doses of antibiotics to the country's Ministry of Health and its partners this week, and plans to deliver 244,000 more soon, the agency said in a news release. The different types of antibiotics will be used both to treat those infected with the Yersinia pestis bacterium that causes the disease and for prevention (prophylactic use) in those who may be exposed. The drugs can treat up to 5,000 patients and protect up to 100,000 people who may have been exposed.

"Plague is curable if detected in time," said Dr. Charlotte Ndiaye, WHO representative in Madagascar. "Our teams are working to ensure that everyone at risk has access to protection and treatment. The faster we move, the more lives we save."

Most of the cases and deaths involve pneumonic plague, the more dangerous form of the disease that affects the lungs and is transmitted through coughing at close range, the WHO said. The agency is asking for an additional $5.5 million to launch a comprehensive response and save lives.

The outbreak has grown by 99 cases since the WHO's Oct 2 update.
Oct 6 WHO news release

In an Oct 4 WHO situation report, the WHO said that 124 of 194 cases (63.9%) and 21 of 30 deaths (70.0%) as of Oct 3 involved the pneumonic form. The case-fatality rate associated with that form is 16.9%, compared with 15.5% among cases overall.

The WHO said in the report, "A revision to the risk assessment is currently underway. An initial rapid risk assessment based on the situation as of 19 September 2017, concluded that the overall risk at national level was high due to the high transmissibility of pneumonic plague associated with severe disease and detection of this outbreak more than two weeks after the first case died, during which cases travelled to different parts of the country, including the capital Antananarivo."

It rated the regional risk moderate because of frequent flights to neighboring Indian Ocean islands and the global risk as low.
Oct 4 WHO situation report

 

CDC reports 11 more Cyclospora cases, with source still not known

The US Centers for Disease Control and Prevention (CDC) today reported 11 new Cyclospora cases since its previous update on Sep 29, raising the multistate total to 1,065, with many of the cases linked to infections in people who didn't travel and pointing to food as a likely source.

At least 597 (56%) of the infected people didn't have a history of recent international travel, which raises the likelihood of foodborne illness. Texas is by far the hardest-hit of the 40 affected states, with 172 cases, followed by Florida with 78 and New York (including New York City, which the CDC lists separately) with 47. The latest illness onsets were on Sep 13.

So far no food vehicle has been identified, but the CDC noted in its update that previous outbreaks have involved imported fresh produce such as basil, cilantro, mesclun lettuce, raspberries, and snow peas.

Cyclospora infection is caused by the Cyclospora cayetanensis parasite. Symptoms can include watery diarrhea, appetite loss, cramping, bloating, and fatigue.
Oct 6 CDC update

 

Antimicrobial use in Danish animals drops for 3rd straight year

Total antimicrobial consumption in Danish food and companion animals has fallen for the third consecutive year, according to the annual DANMAP report that is based on 2016 data. It's from researchers at Statens Serum Institut and from the National Veterinary Institute and the National Food Institute, both departments at the Technical University of Denmark (DTU).

In 2016, total antimicrobial consumption in kilograms was down about 5% in Danish animals, compared with a drop of 4% in 2015 and 2% in 2014. And overall antimicrobial use has declined 10% since 2013, which is the equivalent of 12 tons of drugs, according to a DTU National Food Institute news release yesterday.

The 2016 reduction was substantially driven by a 4% reduction in antimicrobial use in swine production compared with 2015, as pig production in Denmark constitutes about 85% of the country's meat production and about 75% of veterinary-prescribed drugs.

After 2 years of much higher than normal drug use in poultry because of serious outbreaks in poultry, antimicrobial use in that industry dropped 36% from 2015 levels. And use in aquaculture was at its lowest in a decade in 2016, the report noted.

Antimicrobial use in pets increased slightly from 2015 to 2016 but has generally decreased in the past 5 years, especially regarding the consumption of third- and fourth-generation cephalosporins.

"A reduction in the use of antimicrobials is necessary if we are to tackle the problem of antimicrobial resistant bacteria," division head Flemming Bager with the National Food Institute said in the release. "The Danish Veterinary and Food Administration has in recent years implemented several initiatives to limit consumption, and it is positive to see that the downward trend in consumption continues."
Oct 5 DTU National Food Institute news release
Oct 5 DANMAP
report

ASP Scan (Weekly) for Oct 06, 2017

News brief

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

Antimicrobial use in Danish animals drops for 3rd straight year

Total antimicrobial consumption in Danish food and companion animals has fallen for the third consecutive year, according to the annual DANMAP report that is based on 2016 data. It's from researchers at Statens Serum Institut and from the National Veterinary Institute and the National Food Institute, both departments at the Technical University of Denmark (DTU).

In 2016, total antimicrobial consumption in kilograms was down about 5% in Danish animals, compared with a drop of 4% in 2015 and 2% in 2014. And overall antimicrobial use has declined 10% since 2013, which is the equivalent of 12 tons of drugs, according to a DTU National Food Institute news release yesterday.

The 2016 reduction was substantially driven by a 4% reduction in antimicrobial use in swine production compared with 2015, as pig production in Denmark constitutes about 85% of the country's meat production and about 75% of veterinary-prescribed drugs.

After 2 years of much higher than normal drug use in poultry because of serious outbreaks in poultry, antimicrobial use in that industry dropped 36% from 2015 levels. And use in aquaculture was at its lowest in a decade in 2016, the report noted.

Antimicrobial use in pets increased slightly from 2015 to 2016 but has generally decreased in the past 5 years, especially regarding the consumption of third- and fourth-generation cephalosporins.

"A reduction in the use of antimicrobials is necessary if we are to tackle the problem of antimicrobial resistant bacteria," division head Flemming Bager with the National Food Institute said in the release. "The Danish Veterinary and Food Administration has in recent years implemented several initiatives to limit consumption, and it is positive to see that the downward trend in consumption continues."
Oct 5 DTU National Food Institute news release
Oct 5 DANMAP 
report

 

Scientists develop rapid susceptibility test for urinary tract infections

Originally published by CIDRAP News Oct 4

California researchers have developed a rapid test to detect antibiotic susceptibility in urinary tract infections (UTIs) in less than 30 minutes, which could allow patients to be diagnosed and prescribed effective antibiotics during just one healthcare visit, according to a study today in Science Translational Medicine.

The team of scientists used an ultrafast single-molecule DNA amplification and quantification method called digital real-time loop-mediated isothermal amplification (dLAMP), which directly counts bacterial genomes in urine samples instead of relying on lab cultures, which can take days. The researchers diluted and incubated the samples for 15 minutes before dLAMP testing, which takes about 7 minutes. The dLAMP analysis calculated the ratios of DNA concentration between untreated samples and those treated with antibiotics to determine susceptibility and resistance levels among UTI pathogens.

The researchers validated the test using 51 clinical samples that had already been confirmed as either susceptible or resistant to ciprofloxacin or nitrofurantoin.

UTIs, which almost always are treated with antibiotics, account for about 8 million primary care visits a year, and antibiotic resistant infections are a growing threat, the authors note.

They conclude, "Here, we solved three problems to determine phenotypic antibiotic susceptibility in clinical samples within 30 min. First, we used digital quantification of a DNA marker to reduce the antibiotic exposure time to 15 min. Second, we showed that dAST [digital antimicrobial susceptibility testing] is robust to the presence of commensal bacteria and clinical urine matrices. Third, we developed and optimized a rapid, high-resolution measurement method for quantifying NA [nucleic acid] targets that shortens the measurement step to less than 10 min."
Oct 4 Sci Transl Med abstract

 

Acute kidney injury tied to combo antibiotics in hospitalized kids

Originally published by CIDRAP News Oct 3

Researchers from Philadelphia and Cincinnati yesterday reported a potential tripling of the risk of acute kidney injury in children administered intravenous (IV) vancomycin combined with piperacillin/tazobactam, according to their study in JAMA Pediatrics.

The retrospective cohort study included 1,915 children hospitalized for 3 or more days and prescribed IV vancomycin plus one other antipseudomonal beta-lactam combination therapy at six large US children's hospitals from Jan 1, 2007, through Dec 31, 2012. Patients with underlying kidney disease or abnormal serum creatinine levels on hospital days 0 to 2 were excluded from the analysis.

Of the 1,915 patients, 157 (8.2%) had antibiotic-associated acute kidney injury. After adjusting for various potential confounders, the investigators determined that the adjusted odds ratio for sustaining such injuries after receiving IV vancomycin plus piperacillin/tazobactam was 3.4 compared with IV vancomycin plus other beta-lactam combo therapies.

The authors conclude, "Pediatricians must be cognizant of the potential added risk of this combination therapy when making empirical antibiotic choices."
Oct 2 JAMA Pediatr study

This week's top reads