News Scan for Dec 28, 2016

More Saudi MERS cases
Abx prescription feedback
Pakistan polio update
Chikungunya update

Three more MERS cases reported in Saudi Arabia

Saudi Arabia late yesterday announced three more MERS cases in three cities, raising the total over the past week to six cases.

All three cases are listed as primary, meaning there are no known links to other MERS-CoV (Middle East respiratory syndrome coronavirus) cases, the Saudi Ministry of Health (MOH) said. None of the patients work in healthcare or had exposure to camels.

The MOH listed the patients as:

  • A 50-year-old Saudi man from the southwestern city of Khamis Mushait, listed in critical condition
  • An 82-year-old Saudi man from the southern city of Najran, also in critical condition (the report came 2 days after the news of MERS in a 63-year-old Najran woman)
  • A 42-year-old Saudi woman who lives in Riyadh and is in stable condition (her case is the third reported in Riyadh since Dec 22)

The MOH update also noted the recovery of three other patients, two in Riyadh and one in Hofuf, whose cases were announced earlier.

With the latest developments, Saudi Arabia's overall tally of MERS cases has reached 1,518, which includes 631 deaths and 12 patients still getting treatment.
Dec 27 MOH update

Study: Personalized prescription feedback program had no impact on antibiotic prescribing

A study yesterday in JAMA Internal Medicine shows that a 2-year antibiotic prescription feedback program did not change antibiotic prescribing among Swiss physicians.

The randomized trial included 2,900 primary care physicians with the highest antibiotic prescription rates in Switzerland. For the study, the physicians were randomly split into two groups. In the intervention group, physicians received quarterly updates from October 2013 to October 2015 showing the rate of antibiotic prescriptions they had written per 100 consultations in preceding months compared to the adjusted average in peer physicians, along with evidence-based antibiotic prescribing guidelines. The control group received no material. None of the physicians in either group were aware of being part of a controlled trial, and the investigators didn't know which physicians were assigned to the intervention and control groups.

The primary outcome of the trial was the prescribed defined daily doses (DDD) of any type of antibiotics to any patient per 100 consultations. Investigators also assessed antibiotic prescriptions per age group and per type of antibiotic.

Overall, the investigators found that while antibiotic prescription rates were lower in both groups of physicians during the 2-year intervention period compared to the baseline period (12 months prior to randomization), there was no difference in antibiotic prescribing between the intervention and control groups in either the first year of intervention (between-group difference 0.81%) or second year (between-group difference -1.73%). Quarterly feedback did reduce antibiotic prescribing to older children and adolescents (ages 6 to 18) by -8.6% in the first year and to young- and middle-age adults (ages 19 to 65) by -4.6% in the second year, but those findings were not consistent over the entire intervention period and the authors note that they should be cautiously interpreted.

Aside from fewer macrolide prescriptions in the intervention group in the second year, no impacts were observed on prescribing of specific antibiotic types.

Although their study found that quarterly feedback had no impact on antibiotic prescribing, the authors suggest that "more intense and better tailored" prescription feedback approaches merit further evaluation, since prescription feedback interventions are less resource intensive than other antibiotic stewardship approaches.
Dec 27 JAMA Intern Med study


WHO: Pakistan polio cases may hit record low, but virus still lurks

Pakistan may set a record low this year for its number of wild polio virus cases, but a vaccine-derived polio virus was found in environmental samples recently, the World Health Organization (WHO) said yesterday in an annual summary report on the country's polio battle.

As of Dec 21, 19 wild poliovirus type 1 (WPV1) cases had been reported in Pakistan this year, which is the fewest ever and involves the fewest affected areas, the WHO said.

Most of the polio cases during the last six months were reported in "non-reservoir areas" that are considered to be vulnerable to polio re-infection, the WHO said, adding, "There have been no paralytic cases of wild poliovirus from the traditional polio reservoirs in Pakistan since February 2016."

Vaccine-derived poliovirus type 2, however, was identified recently in environmental samples in Quetta, Balochistan province, the WHO reported. Two isolates with apparent genetic linkages were found in samples collected on Oct 20 and Nov 28.

In response, authorities are planning vaccination campaigns with monovalent oral polio vaccine type 2 in Quetta and neighboring areas, with the first of a series of drives scheduled to start Jan 2, the agency said. In addition, the health ministry is strengthening a search for cases of acute flaccid paralysis and conducting a field investigation of the circulation of the strain.

The area affected by the type 2 virus is part of a "transnational common reservoir for WPV1 that extends into southern Afghanistan," where stopping WPV1 transmission is the top priority for federal, provincial, and district health teams, the WHO reported.

National and sub-national vaccination campaigns using bivalent oral polio vaccine are planned for this month and January and February 2017, the agency said. "These campaigns are critical to addressing the remaining pockets of under-immunized populations sustaining low-intensity WPV1 transmission within the common reservoir."

Pakistan, Afghanistan, and Nigeria are the last three countries where polio is endemic.
Dec 27 WHO summary


Americas chikungunya total grows by 56,000

In its latest update on chikungunya activity in the Americas, the Pan American Health Organization (PAHO) reported 56,282 new suspected, confirmed, and imported cases, a steep rise that mainly reflects the addition of cases reported from Brazil over the past 12 weeks.

For the epidemiological weeks 37 through 49 Brazil reported 27,311 more suspected cases along with 28,536 confirmed ones, making up most of the 56,282 new cases reported from the region, according to PAHO's Dec 23 update. Due to a lull in reporting by many countries, the number of chikungunya cases saw much smaller rises in the previous 2 weeks, increasing by only 33 cases last week and 256 the week before.

Several countries last week reported small increases, including Mexico, Costa Rica, El Salvador, Colombia, and Guatemala. Another is Aruba, which added 228 cases to its total, reflecting infections over a 19-week period.

Countries in the Americas have now reported 498,182 suspected, confirmed, and imported chikungunya cases. The outbreak began in late 2013 on the Caribbean island of St. Martin and has now sickened 2,376,622 people.
Dec 23 PAHO update

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