News Scan for May 06, 2015

Treating C diff with C diff
Dengue in Brazil
Niger meningitis spreads

Nontoxic strain of C diff may help prevent recurrent infections

A potentially promising way to lower the risk of recurrent Clostridium difficile infections is to fight fire with fire, in the form of oral doses of a nontoxigenic strain of C diff, according to a report yesterday in the Journal of the American Medical Association (JAMA).

C diff is the most common cause of healthcare-associated infections in US hospitals, and 25% to 30% of patients have recurrent infections, says the report by Dale N. Gerding, MD, of the Edward Hines Jr. VA Hospital in Hines, Ill., and Loyola University Chicago in Maywood, Ill., and colleagues.

The phase 2 study included 168 patients who had received successful antibiotic treatment for C diff at 44 study centers in the United States, Canada, and Europe. The patients were randomly assigned to receive doses of 10 thousand or 10 million spores per day of a nontoxic C diff strain called NTCD-M3 in liquid form for 7 or 14 days, or a placebo.

Of 168 patients who started treatment, 157 completed it. A recurrent infection occurred in 30% of the placebo group, versus 11% of patients who received any dose of NTCD-M3. The lowest recurrence rate, 5%, was in patients who received 10 million spores for 7 days.

The team found that fecal colonization with NTCD-M3, which occurred in 69% of treated patients, was linked to better results. Just 2% of the colonized patients had a recurrence, versus 31% of those without colonization.

As for safety, adverse events were reported in 78% of the treated patients and 86% of the placebo patients. The only adverse event more common in the treatment group was headache, at 10%, versus 2% of placebo patients.

"Results of this study confirm findings of earlier studies that showed that if we can establish non-toxic C diff as a resident of the gut of the patient, that we can protect the patient from infection by the toxic strains of C diff," Gerding commented in a Loyola University press release.

He said the findings warrant further study to confirm that NTCD-M3 can prevent recurrent infections and also forestall first infections in those at high risk.
May 5 JAMA article
May 5 JAMA
press release
May 5 Loyola
press release


Number of dengue cases in Brazil more than triple that of last year

Close to 746,000 cases of dengue fever, 229 of them fatal, have occurred in Brazil from the start of the year to Apr 18, which is 235% more than occurred in the same period last year, BBC News reported yesterday. Relaxed prevention efforts and home storage of water are thought to be behind the epidemic.

Nine of Brazil's 27 states are seeing cases, with more than half the cases occurring in Sao Paulo, which is the country's most populous state. The rate nationwide is 368 cases per 100,000 population, considered an epidemic by World Health Organization (WHO) standards.

After a glut of cases in 2013 that was even worse than the current level, countermeasures were undertaken, but the resulting large decrease in cases in 2014 may have led to relaxation of prevention efforts this year, says the article.

The mosquitoes that carry dengue breed in stagnant water. A drought in the area this year has resulted in more people storing water at their homes, which could be providing sites for mosquitoes to multiply.

Dengue is spread through the bite of female mosquitoes. Last week, one Brazil city released up to 1 million mosquitoes genetically modified in a way that causes the dengue virus to stop growing in their bodies, a trait that is passed to subsequent offspring, and that also interferes with the reproduction process. The result is that the dengue-carrying mosquito population drops; the method has been used in a number of areas globally in recent years.

No vaccine against dengue is yet available, but trials are under way.
May 5 BBC News story


Niger's meningitis cases near 4,000 with 265 deaths, amid vaccine shortage

The number of cases of meningitis in Niger since the beginning of the year has risen rapidly to about 3,856, with at least 265 deaths, said a Reuters story yesterday. The WHO put the number at about 1,500 with 150 deaths just a week ago.

Five of the country's eight regions have been affected, with Niamey, the capital and largest city, particularly hard hit.

A shortage of vaccine is adding to the spread, the story said. Schools were closed and a vaccination campaign for children 2 to 15 years of age launched in April, but schools reopened after a week and vaccines have not reached them. "We only have 50 percent of what's needed to cover our vaccination targets," Niger official Mano Aghali said.

Neisseria meningitides serogroup C has been found to be predominant in the outbreak, according to the WHO, and the Reuters story says type W135 and "pneumococcal kinds" of meningitis are also present.
May 5 Reuters story
Most recent (Apr 29) WHO update on the outbreak

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