News Scan for Jun 20, 2019

News brief

MERS sickens 1 more in Saudi Arabia

Health officials in Saudi Arabia today reported another MERS-CoV case, which involves a 70-year-old man from Medina who had recent contact with camels.

The country's Ministry of Health (MOH) classified the patient's illness as primary, meaning he likely didn't contract MERS-CoV (Middle East respiratory syndrome coronavirus) from another patient. Contact with camels is a known risk factor for contracting the disease.

Saudi Arabia has now reported 152 cases for the year. The World Health Organization said in a recent update that it has received reports of 2,442 cases since the virus was first detected in humans in 2012, the vast majority of them from Saudi Arabia. At least 842 people have died from their infections.
Jun 20 Saudi MOH epidemiologic week 25 report


CDC calls past flu season 'moderately severe,' with 2 waves

In a wrap-up of the 2018-19 flu activity today, officials said the season was moderately severe, longer than usual, and marked by two similarly large waves, the first from 2009 H1N1 and the second from H3N2. The US Centers for Disease Control and Prevention (CDC) published its snapshot of the season today in Morbidity and Mortality Weekly Report (MMWR).

Very little activity was reported from influenza B, which made up only 4% of flu viruses that tested positive at public health labs, lower than previous seasons. Most 2009 H1N1 viruses were similar to the cell-cultured vaccine virus, but health officials saw considerable diversity in clade 6B.1A viruses, part of the reason vaccine advisors updated their recommended vaccine strain for the upcoming season. Labs noted antigenic drift in the H3N2 strain, with increased circulation of 3C.3a viruses, which prompted an update to that vaccine strain for the season ahead.

Hospitalization rates were lower for adults last season compared with the year before, but about the same for children. As of May 18 the CDC had received reports of 116 pediatric flu deaths, and of 104 of those with known histories, about half of the children had an underlying medical condition that put them at increased risk for flu complications.

The CDC said flu caused from 37.4 million to 42.9 million infections, 17.3 million to 20.1 million clinic visits, 531,000 to 647,000 hospitalizations, and 36,400 to 61,200 deaths.
Jun 21 MMWR report


Peru notes Guillain-Barre spike in first half of 2019

Peru has noted a more than doubling of Guillain-Barre Syndrome (GBS) in 2019 compared with 2018, according to a risk assessment today from the European Centre for Disease Prevention and Control (ECDC).

As of Jun 13, Peru has reported 548 GBS cases since the beginning of the year. Among these cases, 391 (71%) were detected during epidemiologic weeks 23 and 24 (Jun 3 through 16). From January through June 2018, Peru recorded only 215 cases.

Because of the increase, the Peruvian Ministry of Health has declared a state of emergency in five regions: Junin, La Libertad, Lambayeque, Lima, and Piura. The cases are widespread, and the source of the infections is unknown at this time.

"Guillain-Barre is known to be triggered by bacterial infections, respiratory viruses, enteroviruses and arboviruses such as dengue and Zika," the ECDC said.
Jun 20 ECDC report

Stewardship / Resistance Scan for Jun 20, 2019

News brief

Study finds physician education tied to fewer urgent antibiotics

A study involving nine emergency departments and acute care centers in California and Colorado found that educating physicians and patients about safe antibiotic use was tied to a 34% drop in inappropriate antibiotic prescribing, but the absolute reduction was fairly small because levels were already low to begin with.

Writing in Academic Emergency Medicine yesterday, researchers in the two states describe two approaches designed to help physicians make better choices about prescribing antibiotics for acute respiratory infections. One approach offered educational materials from the "Be Antibiotics Aware" campaign from the US Centers for Disease Control and Prevention for patients and providers, plus an on-site physician stewardship "champion." The other more intensive approach provided education and behavioral "nudges," which gave each physician feedback on prescribing rates and other information.

The investigators then tracked 44,820 visits for respiratory infections caused by viruses—which don't require antibiotics—among 292 providers at five emergency departments and four urgent care centers. They found that, after adjusting for health‐system and provider‐level effects, inappropriate antibiotic prescribing fell from 2.2% (95% confidence interval [CI], 1.0%-3.4%) before the interventions to 1.5% (95% CI, 0.7%-2.3%) with an odds ratio of 0.67 (95% CI, 0.54 to 0.82). Both interventions yielded similar results.

"Our study shows that this relatively simple approach can get us to near-zero inappropriate antibiotic use for acute respiratory infections," said senior author Larissa May, MD, MSPH, MSHS, of the University of California-Davis, in a UC-Davis new release.
Jun 19 Acad Emerg Med abstract
Jun 19 UC-Davis news release


Dutch researchers report increased resistance in E coli in livestock, poultry

A longitudinal analysis of Escherichia coli isolated from fecal samples from chickens, pigs, and calves in the Netherlands found generally increasing levels of antimicrobial resistance, according to a report today in Eurosurveillance.

Dutch researchers collected fecal samples at slaughter from broilers, pigs, and veal calves from 1998 to 2016—about 300 samples from each animal type per year. They observed a statistically significant increasing resistance trend for all antimicrobials tested except tetracycline among broilers from 1998 to 2009, then a decreasing trend in all antibiotics from 2009 to 2016.

In pigs, resistant counts were generally lower than in broilers except for tetracyclines, where they were a bit higher. Resistance also increased in veal calves, but, because of a sampling change in 2012, results could not be compared directly with the other animal species. The authors also reported sporadic detection of colistin-resistant isolates since 2010, which increased in poultry.
Jun 20 Eurosurveill report

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