News Scan for Mar 28, 2019

News brief

CDC switches first-line treatment for severe malaria to IV artesunate

Today the US Centers for Disease Control and Prevention (CDC) switched its recommendation for first-line treatment for severe malaria to a drug not approved by the Food and Drug Administration (FDA) because the previously recommended drug will no longer be produced by the manufacturer.

Effective Apr 1, the newly recommended drug is artesunate, which the World Health Organization already recommends as first-line treatment for severe malaria. The old drug, quinidine gluconate, will no longer be made by Eli Lilly. Quinidine is the only intravenous (IV) malaria drug approved by the FDA for use in the United States.

"While at this time, artesunate is neither FDA approved nor commercially available in the United States, CDC has taken action to ensure IV artesunate is available through an expanded use investigational new drug (IND) protocol, an FDA regulatory mechanism," the CDC said in a news release. "This IND for IV artesunate allows an effective antimalarial to be available through CDC for treatment of severe malaria in the United States.

"Clinical studies have shown that IV artesunate is safe, well tolerated and can be administered to infants and children, and to pregnant women in their second and third trimesters and during lactation. In the first trimester of pregnancy, the benefits of IV artesunate treatment outweigh the risk of death and poor outcomes due to severe malaria."

Starting Apr 1, US clinicians must call the CDC's malaria hotline (770-488-7788) to obtain IV artesunate. Upon approval of the case by a CDC expert, the drug will be released for free to 1 of 10 quarantine stations the agency has stocked with artesunate across the country, where it will be available for pickup.

About 300 people each year in the United States develop severe malaria, the CDC says.
Mar 28 CDC news release
CDC artesunate website

Saudi Arabia confirms 2 more MERS infections, 1 in Hofuf

Saudi Arabia's Ministry of Health (MOH) today reported two more MERS-CoV cases in Hofuf and Riyadh, according to updates to its epidemiologic week 13 report.

A 53-year-old woman from Hofuf was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). Her case is listed as primary, meaning she likely did not contract the virus from another person, and she did not have contact with camels. This is the second primary case in Hofuf in as many days.

A 76-year-old man from Riyadh was also diagnosed as having MERS. The MOH said the man had contact with camels, a known MERS risk factor.

The cases lift Saudi Arabia's MERS-CoV total for the year to 111, which includes 57 linked to a large outbreak in Wadi ad-Dawasir that has mostly involved healthcare spread.
Mar 28 MOH report

European countries sign pandemic vaccine contract with Seqirus

The European Commission (EC) and 15 member states today signed framework contracts with Seqirus to produce and supply pandemic vaccine, according to a statement from the group.

Contracts are part of a European Union (EU) joint procurement agreement designed to improve the region's preparedness against disease threats, ensure equitable access, and ensure fairer prices for medical countermeasures. Similar negotiations are under way with another pharmaceutical company, with a second round to contracts, in an effort to maximize vaccine coverage based on the tailored needs of EU member states.

The countries are Belgium, Croatia, Cyprus, Estonia, France, Germany, Greece, Ireland, Luxembourg, Malta, the Netherlands, Portugal, Slovakia, Slovenia, and Spain. According to the EC, the countries signing the contracts make up about half of the EU population.

Vytenis Andriukaitis, the EC's commissioner for health and food safety, said in the statement, "Today's signature signals a new era in the access of EU citizens to pandemic influenza vaccines. Member States signing the contracts can rest assured that their citizens will have access to vaccines in case of an influenza pandemic at the best price available. This is one additional example where acting together we get stronger and achieve more."
Mar 28 EC statement

Sweden detects its first chronic wasting disease case

For the first time Sweden has detected chronic wasting disease (CWD)—in a moose, according to a post on ProMed mail, an infectious disease tracking site.

"The 16-year-old moose was euthanized after being observed emaciated, staggering, walking in circles, and apparently blind," said Ann Lindberg, DVM, of the National Veterinary Institute of Sweden in a post on ProMed, the reporting service of the International Society for Infectious Diseases.

CWD is one type of transmissible spongiform encephalopathy—fatal brain diseases characterized by misfolded prion protein that affects cervids (deer, elk, moose, and caribou). North America and parts of Europe have documented cases of the disease. Sweden joins Norway and Finland as Nordic countries with documented CWD in moose.
Mar 27 ProMed mail post

Colorado tick fever identified in four Oregon residents

State officials in Oregon identified four cases of Colorado tick fever (CTF) in 2018, more cases than in previous years, and no common tick exposure was found. The report was published today in the CDC's Morbidity and Mortality Weekly Report (MMWR).

Over the past decade, Oregon has averaged one case of CTF annually. The four cases occurred in three men in their 70s and one woman in her 50s who all reported spending at least 5 hours per day outside, and all reported a tick bite in the 2 weeks preceding illness.

"Symptom onset in all four patients was in May, and all had fever, leukopenia (white blood cell count <4.0 x 103/μL), and thrombocytopenia (platelet count <150 x 103/μL)," the authors said. "Three patients reported experiencing a biphasic illness, where their initial fever and symptoms diminished and then returned again a few days later. Three patients were hospitalized (range 1–3 days), and all recovered from their illness."

No common location was shared by the patients.

CTF is found in the western parts of the United States and Canada and is transmitted by infected Rocky Mountain wood ticks. Though rarely fatal, the virus can cause fever and non-specific symptoms, and up to 30% of patients require hospitalization. There is no treatment for CTF.
Mar 29 MMWR study

Stewardship / Resistance Scan for Mar 28, 2019

News brief

Wendy's urged to cut use of medically important antibiotics in beef supply

Consumer and public health advocacy group U.S. PIRG Education Fund is calling on the nation's third-largest burger chain to reduce its reliance on beef raised with the routine use of medically important antibiotics.

The group held events today in front of Wendy's franchises in New York and Chicago to urge the restaurant chain to follow the lead of McDonald's, which announced in December 2018 that it would partner with its beef suppliers to reduce the use of medically important antibiotics for disease prevention in its beef supply chain. McDonald's was the first major burger chain to release a policy on antibiotic use in beef.

Wendy's is one of several fast-food chains that have stopped serving chicken raised with medically important antibiotics, and it currently sources up to 20% of its beef from suppliers that have cut the use of the antibiotic tylosin in their cattle. But Matt Wellington, director of U.S. PIRG's Stop the Overuse of Antibiotics campaign, which has pushed several restaurant chains to reduce routine use of medically important antibiotics in their meat supply chains, says the company can do more.

"We can't waste life-saving medicines to produce cheap beef," Wellington said in a U.S. PIRG (Public Interest Research Group) press release. "The cost to our health is too high, and Wendy's can use its buying power to help move the beef industry away from overusing antibiotics."
Mar 28 U.S. PIRG press release

Former UK advisor on antibiotic resistance criticizes drug industry

Lord Jim O'Neill, an economist and former advisor to the British government on antibiotic resistance, suggested yesterday that nationalizing part of the pharmaceutical industry may be a way to stimulate new antibiotic development.

O'Neill—former chair of the British government's Review on Antimicrobial Resistance—told BBC News that he was shocked that pharmaceutical companies have failed to develop new antibiotics for drug-resistant infections. He suggested that the answer may be for the government to create a new public body to acquire the antibiotic research and development programs that many drug companies have been abandoning.

"If you had asked me three years ago, I would have thought that would have been a bit crazy," O'Neill told the BBC. "But nearly three years after our review came out, there's endless talk but there's no progress in waking up the pharmaceutical industry to want to do this.

"So, by default, I find my mind thinking why not explore the idea of some public utility that's got public-purpose ownership of it, just take it away from them and take it over," he said.

A 2015 report by the Review on Antimicrobial Resistance called for creating a $2 billion global innovation fund to boost investment in new antibiotic research and development, and suggested that from $1.6 billion to $3.7 billion a year would be needed to provide "pull" incentives to encourage drug companies to develop new antibiotics. The first report by the group warned that antimicrobial resistance could kill an extra 10 million people a year, and cost up to $100 trillion, by 2050 if nothing is done to slow or halt it.

In January, the British government announced a new payment model for antibiotics, under which the National Health Service would pay pharmaceutical companies up front for access to effective antibiotics. The government hopes the model, which aims to delink the value of antibiotics from sales volume, could help spur new antibiotic development.
Mar 27 BBC News story

Review: Cefazolin an option for methicillin-sensitive staph bacteremia

A systematic review and meta-analysis of data from more than 11,000 patients published yesterday in Clinical Microbiology and Infection suggests that cefazolin is at least equally effective as anti-staphylococcal penicillins (ASP) in treating methicillin-sensitive Staphylococcus aureus bacteremia (SAB), and associated with less nephrotoxicity.

The review looked at 14 non-randomized studies on the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB, and a meta-analysis was conducted to estimate relative risk (RR) of the two treatments on the primary end point—90-day all-cause mortality. Secondary end points included 30-day all-cause mortality, treatment failure/relapse, and nephrotoxicity. The researchers also looked at outcomes in a subset of patients with high pathogen loads, including those with endocarditis and abscesses.

Seven of the studies reported the primary end point and showed an overall 90-day mortality of 25.1% (703/2,802) in the ASP group and 18.2% (289/1,589) in the cefazolin group, resulting in an RR of 0.71 (95% confidence interval [CI], 0.50 to 1.02). For the secondary end points, the researchers found that cefazolin may be associated with lower 30-day mortality (RR, 0.70; 95% CI 0.54 to 0.91) and less nephrotoxicity (RR, 0.36; 95% CI, 0.21 to 0.59), but they were uncertain whether cefazolin and ASP differ regarding treatment failure/relapse (RR, 0.84; 95% CI, 0.59 to 1.18), as the quality of the evidence was very low.

The subgroup analysis showed that cefazolin may be associated with equal 30-day and 90-day mortality for patients with endocarditis (RR, 0.71; 95% CI, 0.12 to 4.05) and abscesses (RR, 1.17; 95% CI, 0.30 to 4.63).

The authors say the main limitation of the review is that all the available evidence comes from non-randomized, single-center studies with an inherent high risk of bias. They suggest multicenter randomized controlled trials are needed to identify the safest and most effective treatment for patients with SAB.
Mar 27 Clin Microbiol Infect abstract