News Scan for Jan 19, 2017

Avian flu in Europe, India, Niger
Sepsis and antibiotic Rx
More yellow fever in Brazil
Meningococcal protection
Pre-surgery baths

More H5N8 Europe, H5N1 outbreaks in India and Niger

In the latest avian flu developments, two European countries confirmed more highly pathogenic H5N8 in wild birds, as India and Niger reported poultry outbreaks from the H5N1 subtype, according to reports to the World Organization for Animal Health (OIE). Also, Chile's agriculture ministry yesterday reported a second low-pathogenic H7 outbreak in turkeys.

Slovakia today reported three more outbreaks involving eight wild swans found dead on Jan 9 near three villages in Nitra principality in the southwestern part of the country. Ukrainian officials reported one more outbreak involving 21 wild swans found dead on Jan 15 in Ternopl region in the southwest. Both countries had recently reported their first H5N8 detections.

In H5N1 developments, India's agriculture ministry today reported an outbreak at a farm in Gujarat state in the west that began on Dec 31, killing 25 of 191 poultry. Niger's outbreak began Dec 5 on a household farm in Tillaberi region, killing 14 of 22 birds, including ducks and hens.

Chile's second recent H7 outbreak occurred in the same Valparaiso region where the virus led to the culling of about 34,000 turkeys, according to an agriculture ministry statement translated and posted by Avian Flu Diary, an infectious disease news blog. The new event also involves a turkey farm, said to be related to the first. Culling operations targeted 35,000 more birds.
Jan 19 OIE report on H5N8 in Slovakia
Jan 19 OIE report on
H5N8 in Ukraine
Jan 19 OIE report on
H5N1 in India
Jan 19 OIE report on
H5N1 in Niger
Jan 18 Avian Flu Diary
post on H7 in Chile


Revised sepsis guidelines include antibiotic prescribing, optimization

A fourth revision of international guidelines for managing sepsis and septic shock, published today in JAMA, includes several updates on antibiotic prescribing, including a recommendation for quick control of source infections.

The guidelines, first published in 2004 and revised in 2008 and 2012, are from the Surviving Sepsis Campaign, Society of Critical Care Medicine, and European Society of Intensive Care Medicine.

In emphasizing rapid source-infection control, the guidelines recommend instituting broad-spectrum intravenous antibiotics as soon as possible and within an hour surgery or  a procedure, such as the retrieval of a catheter suspected to be infected. The step is recommended because any delay has been tied to an increased risk of death. The guidelines also advise using antibiotic dosing strategies based on pharmacokinetics and pharmacodynamics principles when such tests are available, because initial doses for sepsis cases are often too low.

The authors of the guidance, which was developed with the input of 55 international experts, provide a "weak recommendation" (meaning not as strongly backed by evidence) for the use of empirical combination antibiotic therapy in patients with septic shock, but not for sepsis without shock. The reason for using antibiotics from two different classes in this situation would be to address the increased frequency of antimicrobial-resistant pathogens.

To optimize stewardship, the guidance says to assess patients daily for de-escalation of antimicrobials and to narrow therapy based on cultures, clinical improvement, or both.

Sepsis occurs when the body's infection-fighting response causes life-threatening organ dysfunction. It is a leading cause of death, morbidity, and expense and contributes to one third to a half of deaths of hospitalized patients, the authors write.
Jan 19 JAMA guidelines
Jan 19 JAMA commentary on the guidelines


Brazil's yellow fever outbreak total climbs to 206 cases

An outbreak of yellow fever in Brazil's Minas Gerais state has grown to 206 suspected and probable cases, and the neighboring state of Espirito Santo—thought to be outside the risk area—is now reporting 4 suspected cases, the Pan American Health Organization (PAHO) said yesterday in an update.

The case total in Minas Gerais reflects a steep increase from the 110 cases reported by the World Health Organization (WHO) in a Jan 13 statement on the outbreak.

PAHO said 53 deaths have been reported, up from 30 reported by the WHO last week.

Yellow fever cases have now been reported in 29 cities in Minas Gerais, including 22 that have also reported outbreaks in monkeys. Animal outbreaks have also been reported in 14 Espirito Santo cities.

The WHO has said that the outbreak area has low yellow fever vaccination coverage, because the region is thought to have a low risk of transmission.
Jan 18 PAHO update
Jan 17 CIDRAP News scan "
WHO: 110 suspected cases of yellow fever in Brazil"

In a related development, Brazil's Rio de Janeiro state has asked the health ministry for 200,000 yellow fever doses to vaccinate people in 14 cities in regions that border Minas Gerais and Espirito Santo states to help prevent the spread of the disease, the Rio Times reported today. The health ministry will provide 400,000 doses to Espirito Santo state, the report said.
Jan 19 Rio Times story


Study shows waning meningococcal vaccine protection 3 to 8 years out

US researchers yesterday reported the full dataset that led the Centers for Disease Control and Prevention (CDC) in 2010 to recommend a booster dose of the four-strain meningococcal vaccine, MenACWY-D. The results of the case-control study, published in Pediatrics, showed waning vaccine effectiveness (VE) several years after vaccination.

CDC and other US investigators analyzed data from 123 preadolescents vaccinated at surveillance sites from Jan 1, 2006, through Aug 31, 2013. A single dose of the vaccine at age 11 to 12 years was initially expected to provide protection through the teen years.

But the group found that VE was 79% in the first year post-vaccination, 69% at 1 to less than 3 years, and 61% at 3 to less than 8 years. Overall VE in those 8 years was 69%. Results were controlled for underlying medical conditions and smoking.

The researchers also found that VE was 77% against serogroup C and 51% against serogroup Y. Those two strains accounted for 49% and 44% of the 36 illnesses, respectively.

In September a study in Vaccine showed that a booster dose of MenACWY-D lifted antibody levels 4 to 6 years after the initial immunization.
Jan 18 Pediatrics abstract
Sep 19, 2016, CIDRAP News item "Booster for meningococcal vaccines proves safe, effective"


Review finds no infection benefit from pre-surgery chlorhexidine baths

Although preoperative bathing with 4% chlorhexidine is recommended to prevent surgical site infection (SSI), a meta-analysis yesterday by Brazilian scientists failed to find evidence of a benefit from the practice, according to their review in the American Journal of Infection Control.

The team reviewed 243 studies and found 8 for inclusion in the analysis based on the Jadad Scale. Pooled data from the studies, which covered 10,665 patients, found SSI rates for chlorhexidine bathing, placebo, and soap without antiseptic to be 7.1%, 9.1%, and 5.1%, respectively. Head-to-head comparison of chlorhexidine with placebo (relative risk [RR], 0.91) and with soap (RR, 1.06) showed no benefit for the antiseptic bathing.

The authors conclude, "Controlled clinical trials are needed to assess the effect of preoperative chlorhexidine bathing on infection rates following clean surgery before the incorporation of this intervention in health care services."
Jan 18 Am J Infect Control review

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