News Scan for Oct 24, 2019

News brief

Chronic wasting disease found in 2 North Dakota deer, 1 in Badlands

Officials in North Dakota confirmed chronic wasting disease (CWD) in two mule deer hunted in McKenzie County in the Badlands and in Divide County on the Canadian border. The former represents the first documented CWD case in the Badlands, while the disease was first detected in Divide County last fall.

"This is an iconic place to hunt big game where people travel to from across the state," said Charlie Bahnson, DVM, of the North Dakota Game and Fish Department, in a press release, referring to the Badlands. "By no means does this first detection spell doom for hunting in this area, as long as we are proactive in trying to keep infection rates from climbing. We also need to reduce the chance of CWD spreading to new areas."

CWD is a fatal neurodegenerative prion disease that affects cervids, including deer, elk, and moose. Its been detected across North America, South Korea, Finland and Norway.

Although CWD has not been found in humans, researchers worry the illness could mirror other prion diseases, as happened with bovine spongiform encephalopathy (BSE, or "mad cow" disease), and transmit to humans who eat CWD-infected game.

North Dakota does not currently have carcass transportation restrictions in place for unit 4B in McKenzie County, where the deer was harvested, but Bahnson recommends that hunters submit their deer from that area for CWD testing.
Oct 21 North Dakota Game and Fish press release


Saudi Arabia reports new MERS case as study examines death predictors

Saudi Arabia today reported another MERS-CoV infection, the ninth in October.

In a statement, the Ministry of Health (MOH) said the patient is a 73-year-old man from Al Muzahimiyah in Riyadh province, which is located in the central part of the country. The man's exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as primary, meaning he wasn't likely exposed to another patient. His exposure to camels, a main source of the virus, is unknown.

The World Health Organization said recently in an update of cases through September that since the first human illnesses were detected in 2012, it has received reports of 2,468 cases, at least 851 of them fatal.
Oct 24 Saudi MOH statement

Meanwhile, in research developments, a team from Saudi Arabia who analyzed a cohort of patients hospitalized for MERS-CoV to assess factors associated with death found that septic shock or organ failure on admission was a significant predictor, according to a study in BMC Infectious Diseases.

The study included 63 people with lab-confirmed MERS-CoV infections who were admitted to Buraidah Central Hospital in Al Qassim from 2014 to 2017. The mean age was 60, and most (47) patients were men. All but 2 were treated with ribavirin and interferon.

Mortality was 25.4%, and those with septic shock and or organ failure on admission were more likely to die than those admitted with pneumonia and/or acute respiratory distress syndrome. The researchers added that age, sex, and underlying conditions weren't significantly linked to death.
Oct 22 BMC Infect Dis abstract


NIAID announces launch of human flu challenge trial

The National Institute of Allergy and Infectious Diseases (NIAID) announced yesterday that, with its support, scientists have begun a human flu challenge trial—which is a polite way of saying that volunteers are willingly having flu viruses sprayed up their nose in the name of advancing scientific knowledge about influenza.

The first doses of challenge virus were administered to 5 volunteers earlier this week. Up to 80 people aged 18 to 50 years will be enrolled in the trial at four Vaccine and Treatment Evaluation Units (VTEUs). The NIAID is a part of the National Institutes of Health (NIH).

In an agency news release, NIAID Director Anthony S. Fauci, MD, said, "These trials provide a powerful tool to study many aspects of influenza disease progression and also can help to efficiently assess new treatments and vaccine candidates. Expanding the capacity to perform human challenge trials is a key goal in NIAID's strategic plan to support the development of vaccines that confer broad and durable protection against influenza. This new trial at the VTEUs will help us achieve that goal.”

Volunteers will receive a nasal spray containing a carefully engineered seasonal flu strain. NIAID scientists developed the challenge virus to reliably produce mild to moderate flu. It has been administered to about 400 participants in four previous similar trials conducted by the NIH.
Oct 23 NIAID news release


Investigators to study meningitis vaccine for gonorrhea prevention

The NIAID awarded researchers at the University of Alabama at Birmingham (UAB) up to $10 million to investigate the possible use of Bexsero, a licensed meningococcal vaccine, against gonorrhea, according to a UAB news release yesterday.

The 3-year grant begins with $3.5 million this year, with the possibility of up to $10 million to be used by UAB to conduct a clinical trial at UAB and two additional sites.

"Vaccines represent a crucial path forward to ensuring the health of the population in the United States, and a vaccine for this infection could enhance the reproductive and sexual health of millions of people globally. It's really exciting," said Jeanne Marrazzo, MD, MPH, director of UAB's division of infectious diseases and the principal investigator of the study, in a press release.

According to UAB, there are more than 580,000 newly diagnosed cases of gonorrhea in the United States each year and increasing rates of treatment-resistant infections. Currently, only one class of antibiotics, cephalosporins, is used to treat gonorrhea.

The phase 2 study will include about 2,000 volunteers at risk for gonorrhea; some will get Bexsero, while others will get a placebo injection. The volunteers will be observed and followed to assess their risk of contracting gonorrhea over time.
Oct 23 UAB press release

Stewardship / Resistance Scan for Oct 24, 2019

News brief

Colistin-resistant Klebsiella infections documented at Indian hospital

A new study in Infection Control and Hospital Epidemiology describes several cases of colistin-resistant Klebsiella pneumoniae infections at a hospital in northern India.

The retrospective study, conducted by researchers from India and the US Centers for Disease Control and Prevention (CDC), focuses on 22 patients at the All India Institute of Medical Sciences in New Delhi who were diagnosed with colistin-resistant K pneumoniae infections from January 2016 through October 2017. The patients were identified as part of an investigation that aimed to determine the extent of colistin-resistance in K pneumonia isolates at the hospital, describe patient characteristics, and characterize transmission dynamics. The high prevalence of carbapenem resistance in gram-negative bacteria in India has led to increasing use of colistin, and recent reports have documented the identification of colistin-resistant K pneumonia in Indian hospitals.

Of the 22 patients, 16 had undergone a surgical procedure prior to the infection, and 7 had a history of exposure to colistin. Ten of the patients died. The 34 isolates collected from the patients represented 4% of all K pneumoniae isolates collected during the study period. Analysis of the isolates found that 100% were multidrug-resistant and 68% were extensively drug resistant; in addition to colistin, all isolates were resistant to carbapenems, extended-spectrum cephalosporins, and penicillin/beta-lactam inhibitors.

Whole-genome sequencing revealed the presence of several carbapenemase genes in the isolates, but no MCR genes. Colistin resistance was attributed to several chromosomal mutations. Sequencing also revealed 8 unique multilocus sequence types (STs), the most common being ST231 (5 isolates), ST11 (4 isolates), and ST14 (4 isolates) — these are well-documented multidrug-resistant K pneumoniae strains that have caused hospital outbreaks in Europe and Asia.

The authors of the study note that half of the patients had been transferred from other facilities, which suggests colistin-resistant K pneumoniae may be widely distributed in other hospitals in India.

"Action is needed from a broad range of stakeholders, including clinicians, microbiologists, and public health officials, to limit the spread of this critically important MDRO (multidrug-resistant organism)," the authors write.
Oct 18 Infect Control Hosp Epidemiol abstract


Peruvian study finds MDR-TB just as transmissible as drug-sensitive TB

A study conducted in Peru has found that household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) were at higher risk of TB infection than contacts exposed to patients with drug-sensitive TB, and had a similar risk of developing active disease, US and Peruvian researchers reported today in BMJ.

From September 2009 through September 2012, the researchers enrolled 3,339 index patients from health centers in Lima who had microbiologically confirmed TB disease, and 10,160 household contacts. Of those contacts, 6,189 were exposed to drug-sensitive strains of Mycobacterium tuberculosis, 1,659 to strains that were resistant to isoniazid or rifampicin, and 1,541 to MDR-TB strains (resistant to isoniazid and rifampicin). The main outcomes of the study were TB infection and incidence of active disease among household contacts after 12 months of follow-up.

The results showed that contacts of MDR-TB index patients had an 8% (95% confidence interval [CI], 4% to 13%) higher risk of TB infection by the end of follow-up compared with contacts exposed to drug-sensitive TB patients. The relative hazard of incident TB disease did not differ among contacts exposed to MDR-TB compared with those exposed to drug-sensitive TB (adjusted hazard ratio, 1.28; 95% CI, 0.9 to 1.83).

The authors of the study say the results are significant for TB control efforts because they suggest that there is no fitness cost associated with drug resistance in M tuberculosis.

"If M tuberculosis drug resistance exacts no fitness cost, the incidence of drug resistant and multidrug resistant tuberculosis will be expected to fall more slowly than would be expected," they write.

They add, "Our findings provide evidence that invites guideline producers to take action by targeting drug resistant and multidrug resistant tuberculosis, such as the early detection and effective treatment of infection and disease. These guidelines should include the wider deployment of existing tools and the development of diagnostic and therapeutic strategies designed specifically for people already infected with drug resistant tuberculosis."
Oct 24 BMJ study

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