News Scan for Feb 04, 2014

MERS death in UAE
UCSB meningitis vaccination
Compounding-pharmacy risks
Antimicrobial use in Europe

WHO reports death of MERS patient in UAE

A 33-year-old United Arab Emirates man who fell ill with Middle East respiratory syndrome coronavirus (MERS-CoV) in December died on Jan 16, the World Health Organization (WHO) announced today.

The man, a healthcare worker in Dubai, got sick after he was exposed to another MERS-CoV patient, a 68-year-old Dubai man who later died, the WHO reported previously. The healthcare worker had a history of chronic bronchial asthma and chronic kidney disease.

In the same statement today, the WHO noted a fatal MERS-CoV case that was reported by Saudi Arabia on Jan 28, involving a 60-year-old Riyadh man who had underlying medical conditions. He fell ill on Jan 19, was hospitalized Jan 24, and died 4 days later, the agency said.

The man had no contact with other MERS-CoV patients, but whether he had any contact with animals was unknown, the WHO said.

With today's announcement, the WHO's MERS-CoV count stands at 181 confirmed cases and 79 deaths. The agency has not yet recognized the case reported yesterday by Saudi Arabia in a 67-year-old Riyadh man.
Feb 4 WHO statement
Related Jan 29 CIDRAP News story
Related Jan 3 CIDRAP News item


Vaccine cleared for UCSB meningococcal disease outbreak

The US Food and Drug Administration (FDA) has approved an investigational new drug (IND) application submitted by the Centers for Disease Control and Prevention (CDC) for an unlicensed serogroup B meningococcal vaccine to be used in the response to an outbreak at the University of California at Santa Barbara (UCSB).

In a Jan 31 letter to students, parents, faculty, and staff announcing the development, USCB said it, the CDC, and local public health departments have planned a 2-week vaccination clinic from Feb 24 through Mar 7 to administer the first of two doses. Dates haven't been finalized yet for the second dose.

Bexsero, made by Novartis, is already licensed for use in Europe, Canada, and Australia. It targets serogroup B, which is not covered by US meningococcal vaccines.

The CDC submitted the IND in late December based in investigation of an outbreak on the UCSB campus that sickened four students in November, including on illness that resulted in a permanent disability.

According to the latest CDC background information about the outbreak, no new illnesses have been detected since Nov 21, but based on the history of sporadic cases in the Santa Barbara community and the UCSB's outbreak, health officials decided that a vaccination would be prudent. The vaccine is recommended for all undergraduate students and faculty, staff, and graduate students who live in UCSB residence halls or who have certain medical conditions.

Health officials conducted a similar campaign to help curb an outbreak at Princeton University. The CDC said the two outbreaks aren't related; the UCSB outbreak is caused by strain ST32, and the Princeton outbreak is caused by strain ST409.
Jan 31 USCB letter to students, parents, faculty, and staff
Jan 31 CDC update on UCSB meningococcal disease outbreak
Jan 7 CIDRAP News scan "CDC submits IND for meningococcal vaccine use at UCSB


Two studies highlight risk from compounding pharmacies

Two studies in JAMA Internal Medicine yesterday illustrate the effects of contaminated drugs from compounding pharmacies, even when no cases are reported.

The first study, described in a research letter, involved Hamigera insecticola fungal contamination in an intravenous (IV) magnesium sulfate solution detected after a nurse at the Yale-New Haven Hospital in Connecticut noticed a substance floating in an IV bag. Pharmacy personnel then recalled all 12,000 units of 44 products from the compounding pharmacy that were used in the hospital and two affiliated facilities.

Hospital personnel contacted 1,309 patients and 460 physicians who may have been exposed to the contaminated products, but no infections were detected. The hospital's response, however, involved an estimated 14,915 hours of personnel time and an estimated cost of $874,989.

The second study highlights a seven-patient outbreak of Burkholderia cepacia bacteria in fentanyl infusion administered at Duke University Hospital in Durham, N.C., and prepared by the on-site Duke Compounding Facility.

The patients ranged in age from 6 to 62 years, with a median age of 40. B cepacia matching the outbreak strain was detected in environmental samples from the compounding facility.

An accompanying commentary notes that 90% of US hospitals use compounded sterile preparations, which may pose a risk because they aren't required to meet FDA standards. In the commentary, Allan Coukell, BScPharm, of the Pew Charitable Trusts, recommends that physicians prefer products from FDA-approved compounding pharmacies that meet good manufacturing practice standards.
Feb 3 JAMA Intern Med research letter
Feb 3 JAMA Intern Med study abstract
Feb 3 JAMA Intern Med commentary


Trends in European antimicrobial use hold generally steady

Antimicrobial use in Europe has stayed steady or increased slightly from 2010 to 2011, varying considerably by country and showing a north-to-south gradient, according to the second annual report of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net), released today by the European Centre for Disease Prevention and Control (ECDC).

The report covers community and hospital use of antimicrobials in 2011 from 27 European Union (EU) member states plus two EEA non-EU countries, Iceland and Norway. Included in the report is systemic use of antibacterials, antimycotics and antifungals, and antivirals. The largest proportion of antimicrobial consumption occurs in the community setting, notes the report.

Among the data presented, median community consumption of antibacterials was 19.5 defined daily doses (DDD) per 1,000 inhabitants per day in 2011, which was slightly higher (an increase of 1 DDD) than in 2010. Consumption ranged from 11.4 in the Netherlands to 35.1 in Greece. In a trend analysis of the period 2007 to 2011, only three countries—Belgium, Malta, and the United Kingdom—showed a significant increase; none showed a significant decrease.

Median hospital consumption of antibacterials (from 18 reporting countries) ranged from 1.0 DDD per 1,000 inhabitants per day in the Netherlands to 3.2 in Romania. This level of use was similar to 2010.

Antiviral consumption (from 24 countries), which was reported together for community and hospital sectors, showed the highest inter-country variation of all the agents, with Lithuania the lowest, at 0.4 DDD per 1,000 inhabitants per day, to Portugal, the highest, at 4.3.

Most of the antivirals were HIV/AIDS drugs, says the report, followed by herpes drugs, except in Lithuania, where influenza drugs showed the highest consumption. According to the report, the high use of antivirals "may reflect the burden of viral diseases rather than targets for improving practices and a more prudent use of antiviral agents."
Feb 4 ESAC-Net report
Feb ECDC news release on the report
ECDC interactive database on antimicrobial consumption
ECDC interactive database on antimicrobial resistance

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