News Scan for Jan 12, 2016

H7N9 case in China
Fecal transplant for C diff
Reassessing colistin use

China confirms new H7N9 avian flu case

Taiwan officials today reported a new H7N9 avian flu case on the mainland, while Hong Kong's Centre for Health Protection (CHP) provided details on eight recent cases in Zhejiang and Jiangsu provinces.

The new case involves a Taiwanese businessman who does business in Kunshan, Jiangsu province, Taiwan's Centers for Disease Control (CDC) said in a news release. The man became ill either in late December or early January and was listed in critical condition in an intensive care unit on Jan 5. Nasopharyngeal swabs from the man tested positive for H7N9 yesterday.

The man's age is not specified. In fact, the news release focuses more on the man's son, who is 26. Officials commend him for reporting himself as a potential case even though he never had symptoms and tested negative yesterday.

China has now confirmed 707 H7N9 avian flu patients since the outbreak began in 2013, according to a case list maintained by FluTrackers, an infectious disease message board. The latest wave, which began last fall, now totals 21 cases.
Jan 12 Taiwan CDC news release
FluTrackers H7N9 case list

In related news, the Hong Kong CHP statement reported that all eight recent H7N9 avian flu cases in Zhejiang and Jiangsu provinces involved poultry exposure, often at live-bird markets. The patients, five women and three men, range in age from 29 to 65.

And yesterday, China's agriculture ministry, in a poultry H7N9 surveillance report for December, noted low to moderate levels in eight provinces, according to a translation posted by infectious disease blog Avian Flu Diary. Interestingly, the two provinces reporting the most detections, Sichuan and Gansu, are two that have never reported a human H7N9 case.
Jan 12 CHP statement
Jan 12 Avian Flu Diary post


Study finds frozen fecal transplantation as effective as fresh

In a recent study, authors found that frozen fecal microbiota transplantation (FMT) was just as effective in treating the gut bacterial infection Clostridium difficile (C diff) as fresh FMT.

The study used enema to administer both frozen and fresh FMTs to adults from July 2012 to September 2014 in six academic medical centers in Canada. By tracking if diarrhea, the main C diff infection (CDI) symptom, resolved for 13 weeks after FMT without adverse events occurring, the authors were able to claim whether the treatments were effective, or "clinically resolved," according to the study.

The researchers found that 83.5% of frozen and 85.1% of fresh FMT treatments in the study's per-protocol population (178 patients) resolved CDI to clinical standards. The modified intention-to-treat population (219 patients) also met the 15% noninferiority margin of the study.

Many CDIs occur in healthcare settings because administered antibiotics can clear out the healthy microbiomes in patients' digestive systems, allowing C diff to take over. From 2000 to 2007, deaths by CDI increased 400% (to14,000 deaths per year) because a stronger strain developed, according to the US Centers for Disease Control and Prevention. Additionally, by 2000, a strain of C diff already showed resistance to the common fluoroquinolone antibiotics.

Traditional treatments have become increasingly ineffective in resolving refractory and recurring cases. Currently, more than 60% of patients who have had CDI will get it again, according to the study's press release. FMT is proposed to give patients healthy microbiomes to be able to fight off that infection.

The authors said they hope their findings will promote the validity of frozen FMT and centralized stool banks, making FMT a more available treatment for CDI.
Jan 12 JAMA study
Jan 12 press release on the study
Jan 12 JAMA editorial on the study

Europe to reassess colistin use in animals after recent MCR-1 findings

The European Medicines Agency (EMA) in the coming months will be reassessing its advice on using the last-line antibiotic colistin in light of recent reports of a colistin-resistance gene called MCR-1 from numerous countries, the agency said yesterday in a news release.

The European Commission made the request, the EMA said, after MCR-1 was confirmed in samples from pigs, meat products, and humans. Colistin has been used for more than 50 years in both humans and animals but recently has been pressed into service as a last-chance antibiotic for people who have multidrug-resistant infections.

"Because of its important role as a last defence against antimicrobial resistant bacteria, the Agency will consider if its 2013 advice on the responsible use of colistin in animals, particularly pigs, needs to be updated in light of the recent discovery," the EMA said.

The EMA's Committee for Veterinary Medicinal Products (CVMP) has requested to reconvene the Antimicrobial Advice Ad Hoc Expert Group, which developed the 2013 guidance.

The conclusions of the expert group will be submitted to the CVMP and the EMA's Committee for Medicinal Products for Human Use for review and formal adoption before the updated advice is submitted to the European Commission. The EMA expects to finalize the guidance within 6 months.
Jan 11 EMA press release

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