News Scan for Mar 03, 2020

News brief

Saudi health ministry reports new MERS case

Today Saudi Arabia's Ministry of Health (MOH) reported a new MERS-CoV case in Unayzah, bringing the March tally to two infections, after the ministry reported 18 in February.

The MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 61-year-old man who reported contact with camels, a known MERS risk factor. The MOH listed the case as primary, meaning he is unlikely to have contracted the virus from another person. The patient is not a healthcare worker.

Infection with MERS-CoV can cause severe illness and death. The virus can transmit between humans but has done so mainly in healthcare settings, according to the World Health Organization (WHO).

As of Jan 31, 2020, the WHO said that it had received reports of 2,519 laboratory-confirmed MERS infections, including 866 associated deaths. The vast majority of these cases occurred in Saudi Arabia.
Mar 3 Saudi MOH report


Flu vaccination may not prevent hospitalization or death in seniors

A large observational study of people 55 to 75 years old in England and Wales from 2000 to 2014 found no evidence that flu vaccination reduced hospitalizations or deaths in this age-group, which is at high risk for serious complications of the flu.

The National Institute on Aging–funded study, published in today's Annals of Internal Medicine, used data from patient surveys and administrative records from 170 million episodes of care and 7.6 million deaths.

The researchers found an overall 0.6 (95% confidence interval [CI], -1.5 to 2.7) change in hospitalization rate for flu and pneumonia per 10,000 persons at age 65 after vaccination, and flu vaccine effectiveness against hospitalization was -5.8% (95% CI, -25.3% to 12.9%) in people 65 and older. Change in death rate due to flu and pneumonia in this group was also 0.6 and likewise not statistically significant (95% CI, -0.2 to 1.4), while vaccine effectiveness against death was -17.3% (95% CI, -40.7% to 6.0%) in seniors.

The US-based authors said that flu vaccines may be mildly effective against serious outcomes in older people and that they should continue receiving them, particularly high-dose versions. They add, "Supplementary strategies, such as vaccinating children and others who are most likely to spread influenza, may also be necessary to address the high burden of influenza-related complications among older patients."

Previous observational studies with traditional research designs have suggested that flu vaccination reduces hospitalizations and deaths in the older population, leading health authorities in some countries to prioritize their vaccination. The authors point out, however, that the potential for bias and confounding in observational data have led some experts to question that strategy's effectiveness.

The authors said their study used a regression discontinuity design to reduce bias and confounding. "[Our] estimates were precise enough to rule out results from many previous studies," they wrote.
Mar 3 Ann Intern Med abstract


WHO says Northern Hemisphere flu still elevated, Europe may have peaked

Flu activity is still elevated in much of the Northern Hemisphere but appears to have peaked in some European countries, according to the WHO's latest global flu update yesterday.

In North America, flu activity remains elevated, predominantly with influenza A and B viruses.

East Asia reports a decrease in flu activity, while Central Asia also reports elevated flu activity, although it has ebbed in some countries. North Africa continues to experience increased activity of flu strains A and B.

The Caribbean, Central America, tropical Africa, and southern Asia report low levels of flu activity, with some exceptions, the WHO said. Southeast Asia continues to report flu activity in some countries.

Globally, of flu viruses tested in the first half of February, 62.8% were influenza A and 37.2% were influenza B. Of the subtyped A viruses, 66.5% were 2009 H1N1, and 33.5% were H3N2. Of the characterized B viruses, 99% belonged to the B-Victoria lineage, the report said.
Mar 2 WHO influenza update


WHO reports 4 new Lassa fever cases and 1 death in Benin

The WHO's African regional office has reported a new Lassa fever outbreak in Benin that has infected four and killed one.  

The outbreak, first reported to WHO on Feb 19, is in Borgou department in the northeast. The index patient was a 40-year-old woman in Kwara state in western Nigeria on the border with Benin who visited a local health center for symptomatic treatment of a nonfebrile illness on Feb 11.

Her condition deteriorated, causing abdominal pain and bleeding from multiple orifices. When she was transferred to the Borgou Department University Hospital Centre in Benin on Feb 17, she was confused and weak, vomiting blood, and bleeding abnormally from her uterus. She died on Feb 18, and blood specimens confirmed Lassa virus infection.

From Feb 18 to 24, three relatives and contacts of the patient were transferred to the same hospital in Benin with a similar illness and tested positive for Lassa fever. They are currently in isolation and receiving care. Thirty-four contacts, including 23 healthcare workers, have been identified in Benin and Nigeria and are being monitored daily, the WHO said.

Several Lassa fever outbreaks have occurred since 2014, usually at the peak of outbreaks in Nigeria, where the disease is endemic.
Mar 1 WHO report

Stewardship / Resistance Scan for Mar 03, 2020

News brief

Stewardship intervention tied to improved prescribing for kids' UTIs

A study conducted in a large healthcare system in Colorado found that a multicomponent intervention was associated with increased use of first-line antibiotics among children with uncomplicated urinary tract infections (UTIs), researchers reported today in Pediatrics.

The intervention at Kaiser Permanente Colorado (KPCO), instituted in April 2017 after a gap analysis identified frequent use of broad-spectrum antibiotics in the treatment of pediatric UTIs, involved several educational and process improvements aimed at key drivers of prescribing practices. In addition to developing new local clinical practice guidelines for pediatric UTIs that recommended the narrow-spectrum antibiotics cephalexin or sulfamethoxazole and trimethoprim as initial therapy, KPCO conducted a 2-hour educational session on the new guidelines, added them to a searchable online repository, and added a pediatric UTI algorithm and order set to the electronic health record.

To determine the impact of the intervention on prescribing for pediatric UTIs, KPCO researchers conducted an interrupted time-series analysis to compare prescribing before and after the implementation date (January 2014 to September 2018).

Among the 2,142 outpatient UTIs identified (1,636 pre-intervention and 506 post-intervention), after adjusting for clustering of UTIs within treating clinicians, the analysis found that the proportion of UTIs treated with first-line antibiotics increased from 43.4% pre-intervention to 62.4% post-intervention (P < .0001). Use of cephalexin increased from 28.9% to 53% (P < .0001), while use of the second-line antibiotic cefexime decreased from 17.3% to 2.6% (P < .0001). The changes were sustained for 1 year after the intervention. Researchers also observed a decrease in the average antibiotic treatment duration.

The authors note that the design of the study prevents them from inferring that the intervention caused the change in prescribing, and that it's not possible to determine which components were associated with the improvements.

They conclude, "Despite the limitations inherent in a nonexperimental study design, the methods and interventions developed in the current study may be informative to other learning health systems and other content areas when conducting organization-wide quality improvement initiatives."
Mar 3 Pediatrics abstract


Funding for new drug-resistant malaria treatments announced

The European & Developing Countries Clinical Trials Partnership (EDCTP) announced today that it will invest €21.9 million (US $24.5 million) to combat drug-resistant malaria in Africa and address other areas of urgent need in malaria treatment.

The EDCTP grant, awarded to the new PAMAfrica consortium led by the Medicines for Malaria Venture (MMV), will support a clinical trial for new combinations of compounds for treating complicated and uncomplicated malaria that fully active against artemisinin-resistant strains. Two other trials will assess a rapid-acting treatment for severe malaria and a new malaria treatment for malnourished babies.

MMV, drug maker Novartis, and other partners will provide an additional €22 million (US $24.6 million) over 5 years.

"Antimalarial drug resistance, originally seen in Southeast Asia, is being reported in Africa and may threaten current treatments," MMV Chief Scientific Officer Timothy Wells, PhD, said in a joint news release from EDCTP, MMV, and Novartis. "It is important to have new therapies that are active against this emerging threat of resistance."

The PAMAfrica consortium includes Novartis and research organizations from Burkina Faso, Gabon, Germany, Mozambique, Spain, and Uganda.
Mar 3 EDCTP, MMV, Novartis news release

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