WHO details 4 more MERS cases in Saudi Arabia

News brief

The World Health Organization (WHO) yesterday posted an update on Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia that covers four cases reported by the country since the WHO's last update in April. Three of the patients had recent contact with camels. No secondary cases were reported, and none were fatal.

The WHO said the four MERS-CoV cases were reported between Dec 29, 2021, and Oct 31, 2022. Symptom onsets ranged from Dec 27 through Jun 9. All patients—three men and a woman—are aged 23 to 68 years and weren't healthcare workers. All had underlying conditions and were hospitalized. The men had contact with camels and had consumed camel milk. The agriculture ministry's related investigations identified the virus in camels in those three instances. So far, the 23-year-old woman's exposure source isn't known.

Two patients are from Riyadh province, from the cities Afif and Al Kharj. The others are from the Mecca in Mecca province and Buridah in Al Qassim province (see WHO map at left).

The WHO noted that the number of MERS-CoV cases has declined since the start of the COVID-19 pandemic, likely due to health officials prioritizing COVID-19 activities. Also, the WHO said COVID-19 protective measures may have reduced MERS-CoV transmission. However, the WHO said MERS-CoV circulation continued in dromedary camels and that the zoonotic threat remains.

The WHO said the latest cases from Saudi Arabia lift the global total since September 2012 to 2,600 cases, 935 of them fatal.

Antimicrobial stewardship tied to less fluoroquinolone use

News brief

Implementation of an antimicrobial stewardship program (ASP) across a four-hospital health system was linked to a substantial decrease in the use of fluoroquinolones and increased susceptibility of Pseudomonas aeruginosa and Escherichia coli to levofloxacin, finds a study published yesterday in Antimicrobial Stewardship & Healthcare Epidemiology.

Kentucky-based Norton Healthcare researchers led the analysis of fluoroquinolone use and antimicrobial susceptibility among hospitalized adults in the 10 years after ASP implementation, which was spearheaded by an infectious diseases pharmacist in 2011. Each quarter from 2016 to 2020, the team calculated and reported fluoroquinolone use by days of therapy (DOT) per 1,000 patient-days. P aeruginosa and E coli susceptibility were reported from 2011 to 2020.

The ASP initially focused on formulary optimization, guidelines for optimal antimicrobial use, updates to order sets (grouping of orders to standardize and expedite drug ordering), and clinician and pharmacist education. Later, it focused on providing audit and feedback for patients who were taking broad-spectrum antimicrobials. Routine fluoroquinolone use was discouraged mainly through order-set revisions.

Fluoroquinolone use fell 74% over the 5-year period, with an average decrease of 3.45 DOT per 1,000 patient-days per quarter. Over 10 years, levofloxacin susceptibility rose 57% for P aeruginosa and 15% for E coli. On average, P aeruginosa susceptibility to levofloxacin climbed 2.7% each year and had a strong negative correlation with fluoroquinolone use. E coli susceptibility to levofloxacin rose, on average, 1.3% each year and also was negatively correlated with fluoroquinolone use.

The authors noted that antimicrobial resistance, driven by inappropriate use of antimicrobial drugs, is a public health threat. Fluoroquinolone, for example, has been widely prescribed for many different types of infections, including those that may have been more appropriately treated with an alternative drug. Fluoroquinolones, they said, are the only antibiotic class available for enteral (via the gastrointestinal tract) administration for the treatment of Pseudomonas infections.

"These results demonstrate the value of stewardship services and highlight the effectiveness of an infectious diseases pharmacist led antimicrobial stewardship program," they wrote.

High-path avian flu hits poultry in 6 states

News brief

Over the past week, highly pathogenic avian flu outbreaks have been reported in poultry in six states, including three hit by more outbreaks in commercial facilities, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

Regarding the outbreaks in commercial settings, Minnesota reported another outbreak at a turkey farm in Otter Tail County that houses 28,200 birds, and Tennessee reported that the virus hit a broiler farm housing 20,900 birds in Bledsoe County. Also, New York reported an outbreak at a live-bird sales and slaughter facility in Queens County that had 170 birds.

Meanwhile, other states reported more outbreaks in backyard birds, including Florida (Hillsborough, Seminole, and Duval counties), Mississippi (Lowndes County), and Michigan (Lapeer County).

New-onset diabetes risk higher in recovering COVID-19 patients

News brief

People recovering from COVID-19 are at higher risk of a new diabetes diagnosis, a research team from Beijing reported this week in BMC Medicine. Their findings come from a meta-analysis of nine studies that included nearly 40 million participants, the largest of its kind.

Previous studies tied diabetes to an increased risk of severe COVID-19, but another recent meta-analysis suggested a link between newly diagnosed diabetes and infection with the virus.

Of the nearly 40 million participants across the studies, the group identified 200,000 diabetes cases, with a post-COVID incidence per 1,000 person-years of 15.53 and a relative risk of 1.62 compared to people who weren't infected with COVID. The increased risk persisted by age, sex, type of diabetes, follow-up time, and COVID severity, and it was significant, even when the authors accounted for undetected confounding.

They note that an increased risk of diabetes has also been found for other viruses, but their analysis shows a 20% higher risk of developing diabetes following COVID compared to patients with other upper respiratory viruses and an 82% increased risk compared to the general population.

Possible mechanisms include the effect of SARS-CoV-2 on pancreatic cells and the cytokine storm in those who have an exaggerated immune response to the virus, which might promote insulin resistance.

The researchers wrote that their findings reinforce the need for clinicians to pay attention to patients' glucose metabolism in the post-acute phase of COVID-19, especially in the first 3 months following infection.

Shorter regimen for resistant TB could save $740 million a year

News brief

An analysis yesterday by researchers with the TB Alliance, Stop TB Partnership, World Health Organization (WHO), and other groups estimates that the recently approved BPaLM/BPaL treatment regimen for drug-resistant tuberculosis (DR-TB) could save governments up to $740 million a year, enough to supply more than 400,000 people with almost a year's worth of DR-TB treatment.

The all-oral BPaLM/BPaL regimen consists of 6 months of bedaquiline, pretomanid, linezolid and moxifloxacin, with the option of dropping moxifloxacin for infections involving fluoroquinolone resistance. The therapy will be included in WHO guidelines for treating DR-TB.

The experts' analysis factored in drug costs, healthcare costs, and patient-incurred cost in arriving at their projections. In the study, published in PLOS Global Public Health, they estimate that the cost of implementing the regimen is 40% to 90% less expensive than current drug courses, even without including patient-incurred costs.

According to WHO data cited in a TB Alliance news release, an estimated 440,000 people every year contract DR-TB. Before this new regimen, DR-TB treatment lasted 18 months or longer and included a complex cocktail of medicines that was hard to tolerate. Shorter regimens that lasted 9 to 11 months were found to be effective several years ago, but even then, more than 40% of patients were unable to complete treatment.

"TB is a difficult disease to cure, requiring a combination of medicines that all have different ways of eliminating a bacterium that is absolutely tenacious," said Sandeep Juneja, MBA, a co-author and Senior Vice President, Market Access, of TB Alliance. "The significant savings generated by switching to short therapies will help health systems bridge the gap in TB care."

Coauthor Saurabh Rane, a member of Survivors Against TB in Mumbai, India, added, "The new regimen can save patients both time and suffering. The faster TB patients can return to health, the better it is for everyone."

Study: Severe COVID less likely in kids of vaccinated parents

News brief

Children younger than 5 years whose parents were vaccinated against COVID-19 appeared to be at reduced risk of hospitalization during the Delta and Omicron variant waves in France, according to a research letter published yesterday in JAMA Network Open.

Universite de Paris-Cite researchers led the observational study of 163 preschoolers hospitalized during the Delta (39%) and Omicron (58%) periods from May 12, 2021, to Feb 14, 2022. During the study period, French children in that age-group were not eligible for COVID-19 vaccination, while the rate of two-dose vaccination in adults rose from 7% to 92%.

The data were extracted from the COVID-19 Pediatric Observatory (PANDOR) surveillance study of hospitalized pediatric COVID-19 patients in France.

The estimated hazard ratios for hospitalization among children with vaccinated versus unvaccinated parents were 0.03 (95% confidence interval [CI], 0.02 to 0.06) during the Delta era and 0.21 (95% CI, 0.14 to 0.33) amid Omicron, or 97% and 79% protection, respectively.

"The association between parent vaccination and reduced risk of admission for SARS-CoV-2 in children younger than 5 years suggests that parents played a major role in transmitting SARS-CoV-2 to their young children during both waves, but the association between protection and vaccination seemed lower in the Omicron vs Delta period," the study authors wrote. "The Omicron variant has been shown to be more transmissible, and the vaccine effectiveness against infection seems lower."

The researchers noted that the study didn't consider whether the children had siblings, other potential sources of infection in the household, environmental changes, lockdowns, compliance with physical distancing, dates of parental vaccination, or receipt of booster vaccines, the latter of which constitutes a bias, considering the change in vaccine effectiveness over time and across variants.

"These results should not be extrapolated to other variants, such as the predominant [Omicron] variants BA.4 and BA.5," they wrote. "Nonetheless, these results reinforce recommendations for widespread vaccination of parents of young children."

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