News Scan for May 01, 2017

News brief

Saudi MERS case linked to camel exposure

Over the weekend the Saudi Arabian Ministry of Health (MOH) said there was a new case of MERS-CoV diagnosed in a man who had contact with camels in the weeks prior to illness.

A 69-year-old Saudi man from Buraydah is in stable condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus) infection. The man had direct exposure to camels, a known risk factor for contracting the virus.

The new case brings Saudi Arabia's total to 1,599 MERS-CoV cases, 661 of them fatal, since the virus was first detected in humans in 2012. Seven people are still being treated for their infections, the MOH said.
Apr 29 MOH update

Leaked document says Puerto Rico underreporting Zika complications

A document leaked to Stat says that Puerto Rico is miscounting the number of birth defects seen in that country due to prenatal Zika infections.

According to a Stat story today, the Puerto Rico Department of Health (PRDH) has been accused by the Centers for Disease Control and Prevention (CDC) of obscuring the count since December, and recording only cases of confirmed microcephaly while disregarding other birth defects linked to the mosquito-borne disease.

"There is a large discrepancy between the number of cases identified by ZAPSS that meet CDC surveillance case definition and numbers reported by PRDH," the article says. ZAPSS is the Zika Active Pregnancy Surveillance System.

The leaked document is an outline of a CDC plan to get PRDH Zika surveillance on the same page as the Atlanta-based agency. According to sources, Puerto Rico has not registered "dozens and dozens" of babies born with birth defects.

In other Zika news, the March of Dimes has announced the creation of a new registry called Zika Care Connect (ZCC). The registry allows users to enter their zip codes and find a healthcare provider who has experience with Zika virus. Maternal fetal medicine specialists, pediatric neurologists, audiologists, and ophthalmologists are listed on the Web site, along with the numbers for a ZCC help line for those diagnosed with Zika virus while pregnant.
May 1 Stat story
March of Dimes ZCC

Chikungunya outbreak in Americas grows by 825 cases

Countries in the Americas reported 825 new chikungunya cases, the Pan American Health Organization (PAHO) reported on Apr 28, pushing the total for the year over 30,000.

PAHO reported just a handful of new cases in its Apr 21 update, but it had noted 7,231 and 9,522 new confirmed and suspected cases in its previous two updates. The case count for 2017 has now reached 30,666, PAHO said.

Nicaragua accounted for a fair share of the increase, reporting its first 317 cases of the year. Panama had the next largest increase, with 305 new cases and 623 for the year. Peru recorded 69 new cases and 558 for the year.

Many nations, however, have not reported on their chikungunya situation for weeks. Brazil, for example, has not reported on the most recent 5 weeks of data, and it has accounted for 88% of cases so far this year. No new deaths were reported last week, keeping that number at seven, all in Brazil.

The chikungunya outbreak began in late 2013 on the Caribbean island of St. Martin and has now sickened at least 2,417,693 people.
Apr 28 PAHO update

Stewardship / Resistance Scan for May 01, 2017

News brief

Novel C diff antibiotic tops vancomycin in phase 2 trial

A phase 2 trial of the novel antibiotic ridinilazole in adults with Clostridium difficile infections showed that it performed better than vancomycin, one of three drugs used to routinely treat infections, and was well tolerated, with a similar adverse event profile.

An international group of researchers, including some from Summit Therapeutics, the drug's maker, published the findings on Apr 28 in The Lancet Infectious Diseases.

From June 2014 to Aug 2015 the investigators recruited 100 patients from 33 centers in the United States and Canada, randomly assigning half to the ridinilazole group and half to receive vancomycin. Their efficacy analysis is based on 69 patients: 36 ridinilazole recipients and 33 who got vancomycin. Sustained clinical response was seen in 66.7% (24) of ridinilazole subjects compared with 42.4% (14) of those who were treated with vancomycin. Recurrence was seen in 4 (14.3%) of 28 ridinilazole patients, compared with 8 (32.8%) of 23 vancomycin patients.

The researchers also found that ridinilazole performed better than vancomycin in patients older than 75 years, those with severe disease, and those who required other antibiotics, though the differences weren't always statistically significant.

The results support further development of the drug, the team concluded.

In a related commentary in the same issue, Simon Goldenberg, MD, with King's College London, wrote that the development of new drugs to treat C diff infections is vital, and ridinilazole appears to have many qualities that make it a good candidate for further development. He noted that the study was limited by the inclusion of patients who were slightly younger than the profile of C diff patients treated in everyday practice, with few who had previous infections. "Discounting these shortcomings, it is rare for a study of an antimicrobial to show statistical superiority over the standard of care," he wrote.
Apr 28 Lancet Infect Dis abstract
Apr 28 Lancet Infect Dis commentary

Study: Prescription length for strep throat is based on history, not science

A review published today in The Pediatric Infectious Disease Journal shows that the traditional 10-day course for antibiotics prescribed for strep throat has no basis in scientific evidence. Instead, the prescription length was determined 60 years ago, and is no more efficacious than a shorter course of treatment.

Streptococcal pharyngitis is a common diagnosis for a sore throat, and rarely can lead to serious complications, including rheumatic fever. Physicians traditionally prescribe a 10-day course of penicillin for the bacterial infection, but there are no studies that prove this prescription length is clinically valuable. Instead, it's a blanket recommendation that came out of the "penicillin boom" that followed World War II, a time when rheumatic fever was much more common in the United States.

Falling rates of rheumatic fever and the rise of non-penicillin antimicrobials should prompt clinicians to reconsider the need for 10 days of penicillin, the authors said. But, the subconscious power of the number "10" and a long clinical history will make changing prescribing patterns difficult.

"The 10-day rule appears to be an example of a more general phenomenon in clinical medicine, the fierce inertia of established usage," the authors concluded.
May 1 Pediatr Infect Dis J article