News Scan for Jan 17, 2019

News brief

WHO profiles December Saudi MERS cases

The World Health Organization (WHO) yesterday posted a summary of five MERS-CoV cases reported by Saudi Arabia during December, covering new clinical details that weren't included in initial reports.

Three patients had known exposure to camels before they got sick, and all had also been exposed to camel milk, both of which are known to pose a risk of contracting MERS-CoV (Middle East respiratory syndrome coronavirus). Four patietns are from Riyadh, including the ones who had contact with camels. One of the Riyadh patients, an 80-year-old woman, had contact with an earlier case-patient.

None are healthcare workers. One of the patients is from Najran, located in the country's southwest.

The group includes four men and the 80-year-old woman. Their ages ranged from 45 to 80, and all had underlying medical conditions. All except one were hospitalized, and so far, none of them died.

As of Dec 31, the WHO has received reports of 2,279 MERS-CoV cases since the virus was first reported in humans in 2012. The number of associated deaths is at least 806. Most of the illnesses have been reported in Saudi Arabia.
Jan 16 WHO statement


Study finds HPV vaccination gap in younger adolescents

Full vaccination against human papillomavirus (HPV) is critically low in younger adolescents, with only about 16% fully immunized by age 13, a team from Emory University reported today in the Journal of Infectious Diseases.

The investigators based their findings on 2016 data from the annual parent survey conducted by the Centers for Disease Control and Prevention (CDC). The goal of their study was to look at HPV vaccine series completion before the 13th and 15th birthday.

Overall, 43.4% of teens ages 13 to 17 were fully vaccinated against HPV, but only 15.8% of them had gotten all of their recommended doses by their 13th birthday.

The gap at the earlier ages poses a problem, because timely HPV vaccination at ages 11 and 12 has been shown to provide a stronger response to the vaccine, providing better protection against HPV infection and the cancers the viruses can cause in later life. Also, adolescents vaccinated before age 15 need only two HPV doses rather than three.

In other study findings, adolescents with more than one health provider weren't as likely to be current with HPV vaccination by age 13 or 15, hinting at a need for good record keeping and better use of state immunization information systems. Also, the team said increased provider awareness is needed to ensure immunization opportunities are not overlooked, especially given that HPV is one of three vaccines that 11- to 12-year-olds can be given at the same time.

In a related commentary, two experts from the University of North Carolina highlighted the wide geographic differences in HPV vaccination coverage, which they say requires more study. For example, they note coverage ranges from 26% in Rhode Island to 8% in Arkansas. They also said the study findings underscore the need for scalable interventions to encourage HPV vaccination according to recommended guidelines.
Jan 17 J Infect Dis abstract
Jan 17 J Infect Dis
Jan 17 Infectious Diseases Society of America
press release


WHO to probe reports of racism, sexism, misconduct

Allegations of racism, sexism, and corruption at the WHO, which learned of them last year from anonymous emails to top managers, have triggered an internal investigation, according to a report from the Associated Press (AP), which has obtained three emails.

The emails claimed systematic racial discrimination against Africans and instances of wrongdoing, including alleged misspending of Ebola funds targeted to the current Democratic Republic of the Congo (DRC) outbreak.

According to the AP, an email sent last April charged discrimination and abuse by Geneva WHO staff against African colleague, and two others raised concerns about senior officials attempting to stifle probes into the problems. An email sent in December said actions of a senior doctor involved in the Ebola response were unprofessional and racist, including belittling of a subordinate at a meeting in November.

Another email about the Ebola response questioned how the WHO was spending donated Ebola funds, including an alleged $1 million to transport three vehicles from Dubai by jet. Sarah Russell, a WHO spokeswoman quoted in the story, said the WHO shipped 10 vehicles from Dubai, because none were available in the DRC that met minimum safety standards, and that the cost to transport them was $237,801.

David Webb, who directs the WHO's oversight office, told the AP that Director-General Tedros Adhanom Ghebreyesus, PhD, had asked him to investigate the claims, which will be done independently with WHO staffers. Outside observers, however, questioned if the actions were enough.

In a statement in response to today's story, the WHO said the anonymous allegations that were circulating internally were addressed by Tedros openly in global meeting with staff and that "WHO has zero tolerance for misconduct or discrimination of any kind." The agency added that it recently strengthened its oversight mechanisms and has a proven process for handing misconduct allegations, including an independently run integrity hotline.
Jan 17 AP story
Jan 17 WHO


Study: Symptomatic Zika virus results in prolonged positive antibody tests

About 73% of people with confirmed symptomatic Zika virus still test positive for antibodies 12 to 19 months after infection, according to a study yesterday in Emerging Infectious Diseases.

The study was based on samples taken from 62 Zika patients in Miami–Dade County, Florida, who had Zika virus disease confirmed by real-time reverse transcription PCR (rRT-PCR) and symptom onset between June and October of 2016.

At follow-up, 45 (73%) patients had detectable Zika virus IgM, and overall, 91% of 43 specimens collected at 12 to 15 months post-symptom onset were IgM positive or equivocal, and 18 (95%) of 19 specimens collected at 16 to 19 months were positive or equivocal.

"All participants had Zika virus neutralizing antibodies at 12–19 months after their acute illness, and 39 (63%) had dengue virus neutralizing antibody titers at follow-up. Using a definition of positive or equivocal Zika virus IgM with confirmatory Zika virus neutralizing antibodies, 57 (92%) would have had a diagnosis of recent Zika virus or flavivirus infection on the basis of results from their follow-up specimens," the study authors said.

The results highlight the difficulty of using serologic diagnosis for flaviviruses such as Zika, especially to assess the timing of recent infection, and support the current recommendation to use nucleic acid amplification for testing asymptomatic pregnant women with possible Zika exposure.
Jan 16 Emerg Infect Dis study

Stewardship / Resistance Scan for Jan 17, 2019

News brief

Analysis finds antibiotic use still routine in infants with viral lung infections

About one fourth of children younger than age 2 who are seen in US emergency departments (EDs) for bronchiolitis, a common viral lung infection in that age-group, received an antibiotic prescription, despite 2006 recommendations against the treatment in the absence of documented bacterial infection.

Researchers from Canada's McGill University based their findings on data from an annual survey on ED visits by the US Centers for Disease Control and Prevention (CDC), publishing their findings today in the Journal of the Pediatric Infectious Diseases Society.

They found that, from 2007 to 2015, about 25% of children younger than 2 years who were seen in the ED for bronchiolitis received antibiotics, reflecting only a minimal improvement compared with earlier years and no significant changes in antibiotic prescription rates during the 9 years that followed the 2006 American Academy of Pediatrics guidance. Of kids who received antibiotics, 70% didn't have a documented bacterial infection.

Also, the team found an association between increased antibiotic prescribing for the condition and hospitals that weren't teaching hospitals nor pediatric hospitals, suggesting that those facilities might benefit most from efforts to encourage providers to follow the guidelines.

Brett Burstein, MD, PhD, MPH, senior author of the study, said in a Pediatric Infectious Disease Society (PIDS) press release today that targeted interventions to reduce inappropriate prescribing are essential. "But at the same time, informing the lay public about the potential downstream consequences and why it is important not to over-treat viral conditions are equally important," he added.
Jan 17 J Pediatric Infect Dis Soc abstract
Jan 17 PIDS
press release


FDA grants Fast Track status to new C difficile antibiotic

The US Food and Drug Administration (FDA) has granted Fast Track designation to a new investigational antibiotic for Clostridioides difficile infection (CDI), according to a press release yesterday from Acurx Pharmaceuticals.

ACX-362E is a novel, narrow-spectrum oral antibiotic based on inhibition of the enzyme DNA polymerase IIIC, which is required for bacterial replication and pathogenesis in C difficile. The drug is currently being tested in a phase 1 clinical trial. The company expects to launch a phase 2 trial at the end of year.

Under the Fast Track designation, ACX-362E will receive expedited review from the FDA. The agency grants the designation to drugs that treat serious or life-threatening conditions and fulfill an unmet medical need. The CDC has identified C difficile, which sickens nearly 500,000 Americans each year, as an urgent threat.

"If approved, we believe our new antibacterial, ACX-362E, will be an important therapeutic alternative for patients with CDI," Acurx managing partner Robert DeLuccia said in the press release. "The Fast Track designation will allow Acurx to work more closely with the FDA to bring ACX-362E to physicians and patients as soon as possible."
Jan 16 Acurx Pharmaceuticals press release

This week's top reads