News Scan for Oct 03, 2016

MRSA in UK pork
Online antibiotic Rx
Chikungunya increase
Anthrax vaccine funds
Yellow fever vaccine

Livestock-associated MRSA found in UK pork products

Samples of UK-produced pork products have tested positive for a livestock strain of methicillin-resistant Staphylococcus aureus (MRSA), according to a report today by The Guardian.

Working in conjunction with the Bureau of Investigative Journalism (BIJ) and the Alliance to Save Our Antibiotics, the paper found that 3 out of 97 samples of minced pork sold in UK supermarkets Asda and Sainsbury's tested positive for MRSA CC398. BIJ reports that the bacterium in all 3 samples was fully resistant to tetracyclines and partially resistant to fluoroquinolones, which are widely used in intensive pig farming. The two Asda samples were also resistant to macrolide and lincosamide antibiotics, while the Sainsbury sample was resistant to trimethoprim.

Officials with the Department for Food, Environment and Rural Affairs (Defra) told The Guardian that if meat is handled and prepared properly, the risk for human infection is low. The main initial effect of MRSA CC398 is a skin infection, but it can have more serious consequences in people with compromised immune systems.

According to Eurosurveillance, CC398 is the dominant MRSA strain in European livestock today, with pigs being the primary host. It's also become a frequent cause of human colonization and disease on the continent, mainly affecting people who have direct livestock contact and members of their household. But studies in Denmark, where the reservoir of MRSA CC398 in pigs has been expanding, have shown some spillover into patients with no direct exposure to livestock. The Guardian and BIJ report that an estimated 12,000 people in Denmark have contracted MRSA CC398 in the past decade.

The Guardian and BIJ also found that, because of a regulatory loophole, live breeding pigs entering the UK from Denmark are not screened for MRSA CC398 because it's not classified as a notifiable disease by Public Health England. That means the UK's pig herd could be at risk of wider contamination.

Defra officials told The Guardian that the government is reviewing options for surveillance.
Oct 3 Guardian story
Oct 3 BIJ report
Sep 17, 2015, Eurosurveillance research article


Investigation reveals antibiotic overprescribing by UK online pharmacies

Britain's General Medical Council (GMC) says it's launching a probe into UK-based online pharmacies after a BBC investigation revealed that some are inappropriately selling antibiotics to customers.

In the BBC investigation, a reporter posing as a 16-year-old patient was easily able to obtain antibiotics for a dental infection, an ear infection, and a urinary tract infection over the course of 3 days after filling out an online questionnaire. The online requests were all approved by the same doctor, and the reporter—who's also a general practitioner—received a selection of antibiotics within 24 hours. Many of the antibiotics were not appropriate to the infection for which they were requested.

Of the 17 online pharmacies investigated, the BBC found that many were not following the guidelines for antibiotic prescribing put forward by Britain's National Institute for Health and Care Excellence.

"Overprescribing of antibiotics risks the health of us all, and it is important that every practising doctor in the UK reflects on current guidance," GMC chief executive Niall Dickson said in a statement. "Although we cannot comment on specific investigations, the BBC has produced serious allegations and we will be looking into them carefully."

The report comes at a time when Britain's National Health Service (NHS) has been urging doctors to curb overprescribing of antibiotics. In May, the NHS announced it would offer funding to hospitals and other providers that reduce inappropriate prescribing.
Oct 2 BBC investigation
Oct 2 GMC statement


Americas countries report 539 more chikungunya cases

Countries in the Americas reported 539 more chikungunya cases over the past week, with just a handful of countries reporting new cases, the Pan American Health Organization (PAHO) said in a Sep 30 update.

The total is down sharply from the 47,931 new confirmed, suspected, and imported cases reported the previous week, but is more in line with the 2 weeks before that, which had 510 and 1,788 new cases. Many locations, however, haven't reported any new cases for several weeks.

A large chunk of the new cases are from Guatemala, which had 210, and Costa Rica, with 107. Other countries reporting a few dozen more infections include Colombia, Ecuador, and El Salvador. The overall number of deaths remained the same, at 108. So far this year the United States has reported 86 imported chikungunya cases.

The Americas' outbreak began in December on St. Martin in the Caribbean. Since then the region has recorded 2,181,961 chikungunya cases.
Sep 30 PAHO update


HHS awards $200 million for next-generation anthrax vaccine development

The US Department of Health and Human Services (HHS) has awarded Emergent BioSolutions of Gaithersburg, Md., almost $200 million to develop its next-generation anthrax vaccine NuThrax, the agency said in a Sep 30 news release.

The 5-year, $198.7 million contract between the Biomedical Advanced Research and Development Authority (BARDA), part of HHS's Office of the Assistant Secretary for Preparedness and Response, funds the remaining development activities required for the company to apply to the US Food and Drug Administration (FDA) for the vaccine's licensure. The work includes a phase 2 study to evaluate the vaccine's safety and whether it interacts with an antibiotic administered as part of the routine treatment following anthrax exposure, as well as a phase 3 clinical study to determine the effectiveness of the vaccine candidate.

The contract also includes a provision about vaccine purchasing and options to buy vaccine for the Strategic National Stockpile. Before FDA licensure, the stockpiled vaccine could be used after an anthrax attack if authorized for emergency use by agency.

"BARDA is sponsoring the development of NuThrax to help better protect our nation from this threat," said Richard Hatchett, MD, acting director of BARDA. "This vaccine could provide protection in fewer doses than the anthrax vaccine currently available, potentially producing better health outcomes if it was needed during a public health emergency."

NuThrax, also known as "AV7909" contains an immune-boosting adjuvant called CPG 7909. Studies involving NuThrax so far indicate that two doses administered 14 days apart appear sufficient to stimulate a protective immune response against anthrax, HHS said.
Sep 30 HHS press release


Yellow fever and dengue vaccine combo OK for toddlers

Administering yellow fever vaccine with tetravalent dengue vaccine in healthy toddlers doesn't affect the immunogenicity or safety of the yellow fever vaccine, according to a study of healthy children in Colombia and Peru.

Researchers recently reported their findings in the October issue of The Pediatric Infectious Disease Journal. The study was funded by Sanofi Pasteur, the maker of the yellow fever and dengue vaccines used in the randomized, observer-blinded, phase 3 controlled trial.

The team enrolled 792 children ages 12 to 13 months from different centers in Colombia and Peru from September 2011 to September 2013. One group received yellow fever vaccine and the first dengue vaccine dose together, followed by the second and third doses of dengue vaccine 6 and 12 months later. The second group received yellow fever vaccine with a placebo, then the first and second doses of dengue vaccine 6 and 12 months later.

Yellow fever seroconversion rates didn't vary much between the placebo and concomitant vaccination group: 100% and 99.7%, respectively. After two injections of dengue fever, the percentage of participants above the targets for titers of the four dengue serotypes was 91.2% to 100% for the group that received the concomitant doses and 97.2% to 100% in the second group. The team didn't find any safety concerns during the trial.

The researchers concluded that combining the two vaccines against the two disease—both flaviviruses—results in a good yellow fever antibody response with no impact on safety, and combining the vaccines at the same office visit could offer public health benefits while conserving health resources.
October Pediatr Infect Dis J abstract

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