News Scan for Mar 11, 2019

News brief

Saudi Arabia reports more MERS in hot spots, hits 100 cases for year

In updates for epidemiologic weeks 10 and 11, the Saudi Arabian Ministry of Health (MOH) announced five new cases of MERS-CoV today and over the weekend, including two in Wadi ad-Dawasir, the site of an ongoing hospital-based outbreak.

Today the MOH said a 60-year-old man in Wadi ad-Dawasir contracted MERS-CoV (Middle East respiratory syndrome coronavirus). The man had no camel contact and is listed as a secondary case contact. A 51-year-old man from the same city was diagnosed as having MERS, according to a Mar 9 MOH report. He had camel exposure.

Also on Mar 9, a 39-year-old man from Uqlat As Suqur was diagnosed with the viral disease. He also had camel exposure.

Yesterday the MOH recorded two cases, the first in a 47-year-old man with camel contact from Hafar Al-Batin who is also a secondary case contact. A 64-year-old woman from Khamis Mushait was also diagnosed as having MERS yesterday. She is a secondary case contact, and did not have any exposure to camels.  

With these 5 new cases, Saudi Arabia has now recorded 100 cases since Jan 1, including 56 in Wadi ad-Dawasir, many of which have been healthcare-related.

The World Health Organization's regional office for the Eastern Mediterranean (WHO EMRO) published a summary of MERS activity in February, noting 76 cases (68 in Saudi Arabia, 8 in Oman). The agency said that, through February, global MERS totals since 2012 had reached 2,374 lab-confirmed cases and 823 deaths, for a case-fatality rate of 34.6%. More than 83% of the cases have been in Saudi Arabia.
Mar 9 MOH report

Mar 10-11 MOH report
Mar 11 WHO EMRO update


Study: Zika disease generally mild in children 

Infection with Zika can cause severe malformations in children exposed to the virus prenatally, but it results in relatively mild illness in kids who contract it outside of the womb, according to a study today in Clinical Infectious Diseases.

The study is based on pediatric cases of the disease reported to the US Centers for Disease Control and Prevention in 2016 and 2017 from 10 states. A total of 144 cases in patients ages 1 through 17 were matched with adult patients, and all congenital and perinatal infections were excluded from the study.

Of the 141 pediatric patients, none experienced neurologic disease and none died. Only 1 patient was hospitalized, though 20 were seen in an emergency department. Almost all the patients (94%) presented with a rash, 74% had a fever, and 36% had conjunctivitis. Children older than 11 tended to present with higher fevers and more arthralgia and myalgia compared with younger patients. 

"The symptoms frequently reported among children with Zika virus disease are common to many childhood illnesses and are not notably different than those experienced by adults," the authors concluded. "Healthcare providers should consider Zika virus disease in the differential diagnosis for children with acute onset of fever, rash, arthralgia, or conjunctivitis, who reside in or traveled to an area with active Zika virus transmission."
Mar 11 Clin Infect Dis study


WHO launches new global flu strategy

The WHO today released a global influenza strategy for 2019 through 2030, with the main goal of protecting people in all countries from the threat by preventing seasonal flu, controlling zoonotic flu transmission, and preparing for the next pandemic.

In a press release, the WHO said the new strategy is its most comprehensive and far-reaching to date. Of the two main strategies, the first is to build stronger country capacity for surveillance, response, prevention, control, and preparedness, with the WHO calling for every country to have a tailored influenza program. The second strategy is developing better tools to prevent, detect, control, and treat flu, such as developing more effective vaccines and treatments and making them accessible to all countries.

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in the release that partnerships and country-specific work have improved preparedness, but the world is still not prepared enough. "This strategy aims to get us to that point. Fundamentally, it is about preparing health systems to manage shocks, and this only happens when health systems are strong and healthy themselves," he said.

The 31-page strategy fits with the WHO mandate of improving core public health capacities and will have the added benefit of helping countries better identify other infectious diseases, such as MERS-CoV infection. It was developed through consultation with member states, academia, civil society, industry, and experts inside and outside the WHO.
Mar 11 WHO press release
WHO global influenza strategy


Groups unveil guide for advancing One Health zoonotic disease strategy

Three global health groups today launched a guide to help countries fill gaps in using a One Health approach for addressing zoonotic diseases. Known as the Tripartite Zoonoses Guide (TZG), the 166-page document was published by the United Nations Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the WHO.

According to an OIE press release, the guide spells out principles, best practices, and options to assist countries in reaching sustainable and function collaboration at the human-animal-environment interface. The groups also designed the guide to be flexible enough to address other health threats, such as food safety and antimicrobial resistance.

Operational tools are still being developed for use alongside the guide, whose main topics cover capacity building related to:

  • Multisectoral, One Health coordinating mechanisms
  • Planning and emergency preparedness
  • Surveillance and information sharing
  • Joint risk assessment for zoonotic disease threats
  • Risk reduction, risk communication, and community engagement
  • Workforce development

Also included in the guide are techniques to help countries monitor and evaluate the function and impact of the recommended steps. The three groups emphasize that the TZG guide's One Health approach helps countries make the best use of limited resources and is geared toward blunting the impact that zoonotic diseases have on the livelihoods of small producers, nutrition, and trade and tourism.
Mar 11 OIE press release
Mar 11 TZG guide


ECDC: Italy, Poland, France, and Austria reporting increase in measles

The European Centre for Disease Prevention and Control (ECDC) late last week said several European countries are reporting an increase in measles cases in recent weeks, with four nations reporting more than 100 cases in January.

For January, 19 countries reported a total of 881 measles case, with 10 reporting no cases, the ECDC said. Romania, Italy, Poland, and France had the highest case counts with 261, 165, 133, and 124 cases, respectively.

The ECDC said overall the case counts were markedly up compared with November and December of 2018, with Italy, Poland, and Austria recording the largest increase in case numbers. From February 2018 to January 2019, Italy has recorded 22% of all measles cases reported in the European Union.

In the past year, the ECDC said 77% of all measles cases occurred in unvaccinated case-patients.

"Measles continues to spread across Europe because vaccination coverage in many countries is suboptimal," the ECDC said. "Only four EU/EEA countries (Hungary, Portugal, Slovakia and Sweden) reported at least 95% vaccination coverage for both doses of in 2017."
Mar 8 ECDC update

Stewardship / Resistance Scan for Mar 11, 2019

News brief

VA study finds significant antibiotic over-prescribing in outpatients

A new study by pharmacists with a Veterans Affairs (VA) hospital in upstate New York has found that 40% of the antibiotics prescribed for outpatients were inappropriate. The findings appeared in the American Journal of Infection Control.

The prospective observational cohort study, conducted at the VA Western New York Healthcare System, analyzed outpatient antibiotic prescriptions for 1,063 veterans over a 4-month period (June 2017 through September 2017). The researchers evaluated whether the antibiotic was appropriate for the indication, whether the selected antibiotic was first-line therapy or based on culture data, and whether the dose and duration of the antibiotic were appropriate. The primary objective was to identify the most commonly overused antibiotics and their associated syndromes.

The study found that 40% of the antibiotic prescriptions were unnecessary, the selected drug was inappropriate in 48% of cases, and the duration and dose were inappropriate in 25% and 19% of patients, respectively. The most common indications resulting in unnecessary antibiotics, based on the targeted included antibiotics, were urinary tract infections (21%), bronchitis (20%), skin and skin structure infections (17%), and sinusitis (10%). Azithromycin was the most commonly prescribed unnecessary antibiotic (37%) of the targeted agents, followed by ciprofloxacin (16%), amoxicillin/clavulanate (13%), and cephalexin (12%). Altogether, these drugs accounted for nearly 80% of unnecessary drug use.

The authors of the study suggest an outpatient stewardship program that focuses on these four drugs, including the use of alerts whenever the drugs are prescribed, could provide the most opportunities for intervention.
Mar 9 Am J Infect Control study


FDA grants priority review for new TB drug

The US Food and Drug Administration (FDA) has granted priority review to the new drug application for pretomanid, a novel tuberculosis (TB) drug candidate.

TB Alliance, which developed pretomanid, is seeking approval of the drug as part of a regimen for the treatment of multidrug-resistant (MDR), extensively drug-resistant (XDR), and treatment non-responsive MDR-TB. The regimen will also include bedaquiline and linezolid. In a phase 3 clinical trial of patients with XDR-TB and treatment non-responsive MDR-TB, interim results on the first 75 patients indicated 89% had a favorable outcome, with their clinical infection resolved and sputum cultures negative for TB after 6 months of treatment and 6 months of follow-up.

The World Health Organization estimates that roughly 558,000 cases of drug-resistant TB were diagnosed in 2017; 82% and 8.5% of these cases were MDR-TB and XDR-TB, respectively. The current success-rate for MDR-TB treatment is only 54%, compared with 82% for non-resistant TB.

TB Alliance says the FDA's decision is expected in third quarter 2019.
Mar 8 TB Alliance news release

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