News Scan for Aug 08, 2019

News brief

PAHO reports steep rise in Americas measles cases

Countries in the Americas have reported a 70% increase in the number of measles cases since mid June, according to an update yesterday from the Pan American Health Organization (PAHO).

Since the first of the year 14 countries or territories in the region have reported 2,927 measles cases. The three countries with the most cases are the United States (1,172), Brazil (1,045), and Venezuela (417). Since the middle of June, 7 countries have reported cases, mostly of which have been in Brazil (923), the United States (128), and Venezuela (85).

Given continuing imported cases and ongoing outbreaks, PAHO, a World Health Organization (WHO) regional office, urged countries to take several steps, including maintaining 95% vaccine coverage, vaccinating at-risk populations, and maintaining a vaccine stockpile for prevention and outbreak control.
Aug 7 PAHO measles update

In other measles developments, San Diego County yesterday reported its first measles case of the year, according to a statement from the county's Health and Human Services Agency (HHSA).

The patient is an 11-month-old resident who had recently traveled to the Philippines. The baby is currently hospitalized, and health officials said he or she may have exposed others while getting care at a clinic and a hospital.
Aug 7 San Diego HHSA statement

CDC arbovirus report shows uptick of neuroinvasive West Nile virus

The US Centers for Disease Control and Prevention (CDC) today published an analysis of 2,813 arbovirus infections for 2018, focusing on insect-borne disease acquired domestically. As in past years, West Nile virus (WNV) made up the vast majority of cases, with 94%, but the neuroinvasive form of the disease was nearly 25% higher than the average during 2008 to 2017.

More La Crosse virus disease cases were reported in 2018 than any year since 2011, and the virus continued to be the most common source of neuroinvasive arboviral disease in children. The report appears in the latest issue of Morbidity and Mortality Weekly Report (MMWR).

The CDC said arbovirus remained an ongoing blood and tissue safety concern, with 2018 seeing the first documented case of Powassan virus transmission from blood transfusion and two WNV cases in solid-organ recipients from the same infected donor, signaling the first transplant-related cases since 2013.

Fewer Jamestown Canyon virus cases were reported in 2018 than in 2017, but at levels still higher than previous years. The CDC added that case increases in that viral diease might be linked to an increase in awareness and testing.

The agency urged healthcare providers to consider arboviral infections when assessing the differential diagnosis for aseptic meningitis or encephalitis, to obtain appropriate specimens, and to promptly report cases to public health officials.
Aug 9 MMWR report

WHO pandemic preparedness survey finds room for improvement

A new WHO survey on countries' pandemic preparedness revealed gaps, even in high- and middle-income countries, and it determined that targeted support is needed in some low-income countries, especially in Africa. The 56-page report with a June date on it appeared recently on the WHO's website.

The 55-question survey was completed by 104 of the 194 WHO member states. Overall, 88% said they had a national flu pandemic preparedness plan, but 54% aren't publicly available. The vast majority (88%) of countries said they plan to develop or update their plans in the next 1 to 2 years.

The survey found that only 40% had tested their plans in the past 5 years and that more than half weren't aware or were aware and had not consulted WHO guidance and planning tools.
In questions to gauge capacity areas, the global score was 29.4 (63.9%) of 46 possible points, with the score for high-income countries at 75%, upper-middle 66.6%, lower-middle 59%, and low-income 38.5%.

Overall, countries scored highest in preparing for an emergency and lowest in updating the status of national pandemic preparedness plans. Other gaps included establishing mechanisms to secure access to pandemic vaccine, including nonpharmaceutical measures in pandemic plans, preparing risk communications plans, developing plans to handle excess deaths, and establishing methods for conducting flu surveillance and severity assessments.
June WHO pandemic preparedness survey

Stewardship / Resistance Scan for Aug 08, 2019

News brief

Italian hospital study finds improved use of pre-surgery antibiotics

A surveillance study of Italian hospitals found improved compliance with surgical antimicrobial prophylaxis (SAP) guidelines over a 6-year period, Italian researchers reported yesterday in the American Journal of Infection Control.

The study by researchers from the University of Turin was conducted in 42 hospitals participating in a national surveillance system for surgical site infections (SSIs). According to data from the European Centre for Disease Prevention and Control, SAP for the prevention of SSIs accounts for 17.4% of antimicrobial use in Italy, but compliance with national SAP guidelines varies widely, and there are concerns that Italian physicians do not routinely follow recommendations. The investigators evaluated data from 2012 through 2017 to assess the prescribing practices and SAP compliance with Italian national guidelines and the association between SAP compliance and SSI risk.

A total of 24,861 surgical procedures were monitored over the study period, and a total of 827 SSIs occurred. Overall compliance with SAP guidelines was achieved in 35.41% of procedures in 2012 and increased to 60.79% of procedures in 2017, and the risk ratios (RRs) for appropriate SAP increased by 22% each year, with significant increasing trends over time found for overall compliance, timing, and duration. Adequate antibiotic choice (RR, 0.57; 95% confidence interval [CI], 0.5 to 0.65), duration of administration (RR, 0.51; 95% CI 0.45 to 0.57), and overall compliance (RR, 0.65; 95% CI, 0.59 to 0.72) were all associated with a significantly reduced SSI risk.

The authors of the study conclude, "Interventions to improve SAP compliance with national guidelines could significantly contribute to reducing antimicrobial resistance, both by reducing the burden of HCAIs [healthcare associated infections] and by promoting more prudent use of antimicrobials."
Aug 7 Am J Infect Control abstract

Multidrug-resistant bacteria found in urban rats

A study today in Eurosurveillance by German and Austrian researchers suggests urban rats could be potential spreaders of multidrug-resistant bacteria.

The researchers looked for the presence of antimicrobial-resistant bacteria in 62 urban brown rats captured in Vienna in 2016 and 2017. They were looking specifically to see whether the rats carry extended-spectrum beta-lactamase-producing Enterobacteriaceae, fluoroquinolone-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus spp (MRSA). Pharyngeal and nasal samples were collected from the animals, and the researchers characterized the isolates using microbiologic and genetic methods.

Eight multidrug-resistant Escherichia coli and two extensively drug-resistant New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Enterobacter xiangfangensis ST114 (members of the Enterobacter cloacae complex) were isolated from 9 of 62 rats. Nine of the Enterobacteriaceae isolates carried the blaCTX-M gene and one carried the plasmid-encoded ampC gene. Forty-four MRS, belonging to seven different staphylococcal species, were isolated from 37 of 62 rats. The overall presence of antimicrobial-resistant bacteria in the rats was 62.9%.

"Although the interaction between urban wildlife reservoirs of AMR [antimicrobial resistance] and human health risk remains unclear, the overall prevalence of AMR we observed in the sampled rats is of concern," the authors of the study write, noting that several of the rats colonized with multidrug-resistant isolates were captured in a neglected garden used by the homeless. "This particular situation enhances the risk of spillover of antimicrobial-resistant bacteria."

The authors say the results stress the importance of urban wildlife species as bio-indicators for AMR surveillance programs in urban ecosystems.
Aug 8 Eurosurveill study