News Scan for Apr 01, 2016

Saudi MERS case
Campylobacter in raw milk
US drug-resistance effort
MCR-1 in Spain
Cold-attenuated polio vaccine

Saudi Arabia reports new MERS case in Buraydah

Saudi Arabia's Ministry of Health (MOH) today reported a new, fatal MERS-CoV case in Buraydah, the first there this month after the city reported 34 MERS cases in March.

Today's MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 75-year-old Saudi woman whose infection was contracted in a healthcare setting, as have most of the cases in the Buraydah cluster, which was first noted on Mar 3. The woman died from her infection. She had preexisting disease and was not a healthcare worker, the MOH said.

Her case brings the MERS-CoV total in Saudi Arabia since the outbreak began in 2012 to 1,363 infections, including 583 deaths. Thirteen patients are still undergoing treatment, the MOH said.
Apr 1 MOH update


Study: Raw milk can harbor Campylobacter even after negative tests

Raw milk can harbor dangerous bacteria, even when routine testing results show it to be uncontaminated, says a report from Utah on a 2014 outbreak of confirmed or suspected campylobacteriosis in 99 individuals. The report appears in today's issue of Morbidity Mortality Weekly Report (MMWR).

The outbreak began in May 2014 with three patients who tested positive on pulsed field gel electrophoresis for Campylobacter jejuni. They had all consumed raw milk from an unnamed dairy in Weber County in northern Utah. The dairy's routine testing, which is required monthly of dairies selling raw milk in Utah and consists of somatic cell and coliform counts, had yielded results within acceptable levels (<400,000 somatic cells/mL and <10 coliform colony forming units/mL).

Enhanced testing after the illnesses were identified showed C jejuni in the dairy's milk.

Officials suspended the dairy's permit in August and then reinstated it Oct 1 after follow-up cultures were negative. However, seven more C jejuni cases occurred by Nov 4, and the permit was permanently revoked Dec 1.

In total, 99 people in Utah, 85 (86%) of them from northern counties, were identified through lab testing and patient interviews as having confirmed (59) or probable (40) cases of campylobacteriosis from May 9 to Nov 6, 2014. Patients ranged in age from 1 to 74 years; 10 were hospitalized, and 1 died.

Of the 98 patients for whom exposure history was available, 53 reported drinking raw milk, 52 of them milk from the Weber Country dairy; 4 drank raw milk but could not name the dairy where it was purchased, and 14 bought raw milk at the dairy but did not report drinking it.

The authors point out that "Current raw milk testing standards do not readily detect contamination." They recommend more education of consumers about the dangers associated with consuming unpasteurized milk, and they conclude, "The safest alternative is to consume pasteurized milk."
Apr 1 MMWR study


President's advisory council publishes draft antibiotic resistance report

Yesterday the US Presidential Advisory Council on Combating Antibiotic Resistant Bacteria (PACCARB) released a draft report recommending steps to advance the goals of the National Action Plan on Combating Antibiotic Resistant Bacteria (CARB), such as focusing on "one health" surveillance and bolstering antibiotic research and development (R&D).

The move was met with approval from leading infectious disease groups.

In addition to its one-health approach—which means cross-discipline collaborations surrounding human, animal, and environment health—and drug R&D, the PACCARB report calls for a federal champion of the CARB initiative, coordination of the federal response to the problem, adequate funding, development of critical partnerships, and employing economic incentives for scientific advances.

"I am pleased to see national progress that will drive lasting change on all the different facets of antibiotic resistance," said Louise M. Dembry, MD, MS, MBA, president of the Society for Healthcare Epidemiology of America (SHEA), in a press release. "The foundation of good antibiotic resistance prevention and control efforts include not only antibiotic stewardship but also solid infection prevention interventions such as hand hygiene, environmental disinfection and careful use of medical devices, to name just a few. Preventing transmission is part of protecting patients from getting an antibiotic-resistant bacterial infection."

The Infectious Diseases Society of America (IDSA) approved of the comprehensive approach. The organization said in a news release yesterday, "We were particularly pleased that the recommendations included investment in a strong [infectious disease] physician workforce, which will be necessary for leading antibiotic stewardship programs; conducting clinical trials for new antibiotics, diagnostics and vaccines; and leading other activities to combat resistance.

"We also welcome the PACCARB support for the Limited Population Antibacterial Drug (LPAD) approval pathway that will facilitate R&D of some of the most urgently needed new antibiotics to address unmet medical needs."
Mar 31 PACCARB draft report
Mar 31 SHEA
press release
Mar 31 IDSA
news release


MCR-1 gene detected in Spanish hospital patients

In one of the few reports of the MCR-1 antibiotic resistance gene detection in humans, Spanish researchers yesterday reported on findings from a collection of Escherichia coli isolates collected between 2012 and 2015 from a single hospital in Barcelona. They published the details in Eurosurveillance.

The MCR-1 gene disables the antibiotic colistin, an older drug that is often used in raising food animals. However, the drug is considered a last-line treatment in the battle against multidrug-resistant infections. Chinese researchers first described MCR-1 in November 2015. Since then, several research teams have found the gene in their bacterial collections, though mainly from food and agricultural sources.

In the new report, researchers looked at 10,011 E coli clinical specimens collected from a teaching hospital. Colistin resistance was found in 53 (0.5%), with the MCR-1 found in 15 samples, which ranged from blood, urine, sputum, and a surgical wound. No epidemiologic links were found among the patients. One was from a nursing home, and nine had been hospitalized in the previous year. None of the patients had traveled abroad.

Seven of the isolates weren't multidrug-resistant (MDR), which the authors said might not be clinically relevant, but still raises concerns that the problem could get worse owing to the exchange of resistance genes across different microbiome populations—food animals, environment, and humans. They added that colistin use varies in hospitals and that its use increased 14-fold at their hospital from 2007 to 2014.

The researchers emphasized that urgent global actions are needed to curb veterinary use of the drug to guard its usefulness for treating MDR gram-negative bacteria.
Mar 31 Eurosurveill report


Cold-attenuated polio vaccine called safe, highly immunogenic

A newly developed polio vaccine cannot replicate at normal body temperature and provokes a high immune response, according to findings published yesterday in PLOS Pathogens.

Researchers from Janssen Infectious Diseases and Vaccines in the Netherlands developed an attenuated alternative to oral polio vaccine, which contains live attunuated viruses that can become virulent in certain circumstances, and to conventional inactivated polio vaccine (cIPV), which is safer but more expensive and is made from virulent wild-type strains. The CAVA (cold-adapted viral attenuation) vaccine replicates in human cells only at temperatures of 26 to 30 degrees C, far below the normal body temperature of 37 degrees C.

Three CAVA vaccine prototypes combine 31 mutations from 3 poliovirus clones to create a synthetic viral genome. Fourteen of these mutations were particularly successful in preventing replication of poliovirus types 1, 2, and 3 at normal body temperature. Genes from cIPV were added to enhance immunogenicity.

More than 360 human cells injected with the CAVA strains remained healthy when kept at normal body temperature for two weeks. In mouse models, the CAVA vaccines did not become neurovirulent at 37 degrees C, the authors said.

All three CAVA vaccines produced high antibody titers that at 150% of the vaccine dose were comparable to the immune response provoked by cIPV, and one CAVA prototype had a similar immunogenicity profile to the conventional vaccine at 100% of the dose.

Given the ongoing biosafety risks associated wth manufacturing of cIPV, cold-attenuated strains deserve more research to determine safety and immunogenicity as a potential replacement, the authors said.
Mar 31 PLOS Pathog study

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