Deadly measles complication more common than previously thought

New research presented at IDWeek today shows that a deadly neurologic complication from childhood measles is much more common than previously thought. The study, presented by researchers from the University of California, Los Angeles (UCLA), describes the frequency of subacute sclerosing panencephalitis (SSPE), which is 100% fatal.

Infants under the age of 12 months are too young to get the measles, mumps, and rubella (MMR) vaccine and rely on herd immunity to offer passive protection. If a baby contracts measles in his or her first year of life, it was previously assumed that the child had a 1 in 100,000 chance of suffering from SSPE. Now, new data from California health records suggests SSPE occurs in 1 of every 609 cases. Seventeen patients with SSPE were identified between 1998 and 2015, all of whom contracted measles before being vaccinated, according to an IDWeek news release.

"This is really alarming and shows that vaccination truly is life saving," said James D. Cherry, MD, an author of the study and a distinguished research professor of pediatrics and infectious diseases at the UCLA David Geffen School of Medicine at the University of California Los Angeles.

The only way to prevent the complication is encourage that everyone get vaccinated against measles, which is usually a two-dose vaccine given between 12 and 15 months of age, with a follow-up at age 5, the researchers say. The study authors suggest limiting travel outside of the United States, including to Europe, before a child has received both doses.
Oct 28 IDWeek press release

Early promising findings for meningitis B immunization in UK infants

In September 2015 the United Kingdom became the first country to introduce a vaccine against Neisseria meningitidis serogroup B strains (Bexsero, made by GlaxoSmithKline) into the routine vaccination schedule for infants, and researchers yesterday reported the first evidence of its effectiveness and impact against the disease.

The vaccine was highly effective and cut meningococcal B illnesses incidence babies by 50%, a team from Public Health England reported in The Lancet.

UK health officials recommend two-dose priming at ages 2 and 4 months and a booster dose at 12 months for all infants born since July 2015, plus a catch-up program for babies born in May or June of 2015.

Using surveillance data the researchers identified cases diagnosed from Sep 1, 2015, to Jun 30, 2016, and compared meningococcal B illnesses in vaccine-eligible kids with cohorts in the previous 4 years and among vaccine-ineligible children.

At 95.5% for one dose and 88.6% for two doses, coverage was high for the new vaccine in its first 10 months. Two-dose effectiveness was 82.9% (95% confidence interval, 24.1% to 95.2%) against all meningitis B cases, and the team found a 50% lower incidence of disease in the vaccinated group compared with vaccine-eligible kids in the previous 4 years.

In a commentary in the same Lancet issue, two experts wrote that the findings shed new light on the breadth of immune response, especially since 2013 findings from the first use of the vaccine in young adults in an outbreak setting showed that a third weren't protected against the circulating strain. The authors are Nicole Basta, PhD, MPhil, from the University of Minnesota, and Hannah Christensen, PhD, with the University of Bristol in the United Kingdom.

The new findings highlight the key role of population-based studies for gauging the impact of new vaccines and are encouraging for preventing disease in infants, the two wrote. Longer-term follow-up is needed to gauge how long protection lasts, but they noted that the findings are reassuring for other countries considering adding the meningitis B vaccine to their routine immunization schedules.
Oct 27 Lancet abstract
Oct 27 Lancet commentary

NIH grants help US universities boost West Africa research capacity

That Fogarty International Center (FIC) of the National Institutes of Health (NIH) has awarded four US universities a total of $200,000 in an outreach program to strengthen research capacity to study Ebola and other emerging viral diseases in Ebola-hit countries in West Africa, the NIH announced this week in a news release.

The collaborations aim to develop research training proposals that would strengthen the skills required to evaluate vaccines, develop new diagnostic tests and treatments, and identify the most effective intervention strategies for disease outbreaks. The planning grants, at about $50,000 each, are also designed to help the universities prepare to compete for larger, longer-term FIC grants to implement research training programs.

The awards went to Duke, Tulane, Vanderbilt, and Yale universities. The first three are collaborating with institutions in Sierra Leone, while Yale's project involves work with researchers in Liberia.

FIC Director Roger I. Glass, MD, PhD, said, "By training local researchers in epidemiology and lab skills, and helping them form networks with U.S. scientists, we believe future disease outbreaks can be better contained."
Oct 26 NIH news release

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

C Diff DNA found on hospital surfaces during outbreak

Originally published by CIDRAP News on Oct 27.

In a study today in the American Journal of Infection Control, the authors found Clostridium difficile DNA on 71% of hospital surfaces during a C difficile outbreak, and on 28% of the surfaces 2 years after the outbreak ended.

The disease is easily spread in hospitals because its spores are resistant to most disinfectants. The bacteria can also live on inert surfaces and is one of the leading causes of diarrhea in elderly hospital patients.

From January through July 2009, a C difficile outbreak linked to a mortality rate of 11% occurred in a Costa Rican general hospital. Twenty-four surface samples were collected during the outbreak, with another 54 surface samples collected 2 years later. Overall, C difficile DNAwas detected in 40% of the 75 environmental samples, with a 2.5-fold increase during the outbreak.

About 67% of bedrails and walls were C difficile–positive during the outbreak.

"These results reinforce the relevance of strict hygiene procedures and cleaning measures in the control of C difficile infections in hospitals, even in the absence of outbreaks," the authors concluded.
Oct 27 Am J Infect Control study

Hospital ASP program reduces antibiotic use 17% in children

Originally published by CIDRAP News on Oct 26.

A new study in the Journal of the Pediatric Infectious Diseases Society showed that a low-cost antibiotic stewardship program (ASP) substantially reduced antibiotic use among pediatric hospital patients.

Previous studied have shown that 33% to 72% of pediatric patients admitted to a hospital receive antimicrobials, but approximately 50% of those are unnecessary. This study followed an ASP at Randall Children's Hospital (RCH) in Portland, Ore. RCH is a nonfreestanding hospital (90% of children in the United States are treated at nonfreestanding hospitals) with 165 tertiary-care beds, including 24 pediatric intensive care unit (ICU) beds and 46 neonatal ICU beds.

The ASP was launched in in April 2013 and consisted of two actions: Engaging physician groups for systematic improvement, and provide 72-hour prospective auditing and feedback to optimize appropriate antibiotic use. RHC had five physicians in a pediatric infectious disease group leading the ASP. The group educated other physicians and created a protocol for antibiotic prophylaxis in pediatric cardiac surgery.

The authors compared antibiotic use in the 1 year prior to ASP implementation with 2 years after. They found that antibiotic use was reduced by 16.8 %, and use of vancomycin decreased by 38%. Cost savings were estimated to be $67,000 per year over the 2-year post-intervention period.

"We found that with limited dedicated resources, a simple ASP can reduce antibiotic use substantially in a nonfreestanding children's hospital," the authors concluded.
Oct 21 J Pediatr Infect Dis Soc abstract

NDA submitted for new antibiotic for hospital-treated skin infections

Originally published by CIDRAP News on Oct 25.

Melinta Therapeutics yesterday submitted a New Drug Application (NDA) to the US Food and Drug for the approval of intravenous and oral Baxdela (delafloxacin), an antibiotic for the treatment of bacterial skin and skin structure infections.

Baxdela is an investigational anionic fluoroquinolone for hospital-treated skin infections that acts against a broad spectrum of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). The NDA is based on the results of two phase 3 studies in which the drug met the primary endpoint—non-inferiority to a combination regimen of vancomycin plus aztreonam in reducing lesion size within 48 to 72 hours—and was well tolerated. The most common side effects were mild diarrhea and nausea.

"Baxdela, if approved, represents a potentially attractive treatment option for the nearly 3 million patients hospitalized annually in the U.S. with serious skin infections," Melinta CEO Eugene Sum, MD, said in a press release. "These patients have a high rate of treatment failure, and frequently have underlying medical conditions that pose challenges to the choice of antibiotic."

Baxdela has been designated a Qualified Infectious Disease Product by the FDA, a designation that accelerates the approval process.
Oct 24 Melinta Therapeutics press release

FDA approves new C difficile drug

Originally published by CIDRAP News on Oct 24.

The US Food and Drug Administration (FDA) has approved a new drug for the treatment of C difficile infection (CDI), according to a news release its manufacturer, Merck.

The drug, Zinplava (bezlotoxumab), was approved Friday for the treatment of recurrent CDI in adults who are also receiving antibacterial drug therapy for CDI and are at high risk of CDI recurrence. Zinplava is a human clonal antibody that works by binding itself to a toxin produced by C difficile bacteria (toxin B) and neutralizing it. Merck says the drug should be available early next year. 

Merck says the adverse reactions reported in association with the drug include heart failure (primarily in patients with underlying congestive heart failure), nausea, pyrexia, and headache. Patients with underlying congestive heart failure are advised to use the drug only when the benefit outweighs the risk. Zinplava should be used only in conjunction with antibacterial treatment for CDI.

CDI, which can cause mild-to-severe diarrhea, is one of the most common healthcare-associated infections. According to the Centers for Disease Control and Prevention, CDI was responsible for nearly half a million illnesses in the United States in 2011, and 29,000 patients died within 30 days of infection. Recurrent CDI tends to affect patients over the age of 65 who have compromised immune systems.
Oct 21 Merck press release

Journal supplement provides overview of antifungal stewardship

Originally published by CIDRAP News on Oct 24.

The Journal of Antimicrobial Chemotherapy has released a November supplement devoted to antifungal stewardship.

The supplement is an open-access compilation of information presented at the November 2015 meeting of the Continuing Antifungal Research and Education (CARE) program, which brought together infectious disease physicians, medical microbiologists, pharmacologists, and other experts to participate in a series of lectures and clinical case presentations on the challenges of managing invasive fungal diseases (IFDs).

Like antibiotic stewardship, antifungal stewardship aims to preserve the future effectiveness of antifungal agents and improve patient outcomes. While IFDs occur less frequently than infections caused by drug-resistant bacteria, the management of IFDs poses unique challenges, including high case-fatality rates and high drug costs. These challenges, plus the emerging threat of antifungal resistance, are the principle rationale behind antifungal stewardship.

The supplement assesses the current landscape for the treatment of IFDs such as candidiasis, aspergillosis, cryptococcosis, fusariosis, and mucormycosis; describes the different strategies for effective antifungal stewardship programs; and evaluates how such programs have been implemented in different clinical settings and in different regions of the world.
November J Antimicrob Chemother supplement