News Scan for Oct 23, 2013

Meningococcal vaccine option for babies
Drug-resistant bacteria in the ICU

ACIP OKs additional meningococcal vaccine for risk-group babies

A federal advisory group today approved a measure to include a new meningococcal vaccine option for youngsters ages 2 months and older at risk for meningitis infection.

The vote from the Advisory Committee for Immunization Practices (ACIP), whose recommendations are usually accepted by the Centers for Disease Control and Prevention (CDC), paves the way for Menveo, a Novartis vaccine that protects against Neiserria meningitides groups A, C, Y, and W-135, to be included as another choice for health providers.

In August the US Food and Drug Administration (FDA) expanded the age indication for Menveo to babies as young as 2 months old. The quadrivalent vaccine has been available for use in 11- to 55-year-olds since 2010 and in 2- to 10-year-olds since 2011.

Today's measure passed by a 13-to-1 vote, with 1 abstention. ACIP recommendations become official when they are published in the CDC's Morbidity and Mortality Weekly Report.

During the public comment part of today's meningococcal vaccine discussion, representatives from two groups spoke out in support of expanding its use in routine childhood vaccinations. Currently, ACIP recommends routine meningococcal vaccination for children ages 11 through 18 years.

John Becker, an activist in the lesbian, gay, bisexual, and transgender community, said meningitis outbreaks in the gay community pose a risk to children who live in one of the more than 115,000 households where same-sex couples are raising children. He said lack of a routine vaccination recommendation puts younger children at risk for bacterial meningitis. Becker has launched a petition to urge the CDC to expand its recommendation.

Frankie Milley, founder of Meningitis Angels, an organization that represents families affected by the disease, also urged ACIP to expend the recommendation to all children, even though the medical literature suggests it is not cost effective and the disease burden in the United States is generally low. "This should be a routine or permissive recommendation," she said.
Oct 23-24 ACIP agenda
Aug 2 CIDRAP News Scan "FDA OKs meningococcal vaccine for babies starting at 2 months"


Study: ICU hand and body washing may lower drug-resistant bugs

Improved hand hygiene plus unit-wide chlorhexidine body washing reduced the acquisition of antimicrobial-resistant bacteria in intensive care units (ICUs), especially methicillin-resistant Staphylococcus aureus (MRSA), a study today in The Lancet Infectious Diseases found.

A large group of European researchers conducted the study in three phases at 13 ICUs:

  1. A 6-month baseline period
  2. An interrupted time series study of chlorhexidine body washing and improved hand hygiene for 6 months after the baseline period
  3. A 12- to 15-month cluster randomized trial following the time series study

In the randomized trial, the ICUs were assigned to either conventional screening (chromogenic screening for MRSA and vancomycin-resistant enterococci [VRE]) or rapid screening (polymerase chain reaction for MRSA and VRE and chromogenic screening for highly resistant Enterobacteriaceae), with precautions for established carriers.

The investigators found that mean hand hygiene practice improved from 52% in phase 1 to 69% in phase 2 and 77% in phase 3.

For trends in acquisition of antimicrobial-resistant bacteria, weekly incidence rate ratio (IRR) was 0.976 for phase 2 and 1.015 for phase 3. For step changes, weekly IRR was 0.955 for phase 2 and 0.634 for phase 3.

The decrease in phase 2 was largely caused by changes in acquisition of MRSA, the authors reported. Trends in MRSA acquisition rose during phase 1 and fell during phase 2 an average of 3% to 6% per week. Acquisition of resistant bacteria was lower in the conventional screening group than in the rapid screening group but did not differ significantly.

French scientists commenting on the study in the same issue said, "This pragmatic study provides important evidence for systematically including hand-hygiene strategies in any programme to control multidrug-resistant bacteria."
Oct 23 Lancet Infect Dis study abstract
Oct 23 Lancet Infect Dis commentary extract

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