News Scan for Oct 09, 2017

Monkeypox spreads
Saline IV bag shortage
Antibiotics for bloodstream infection

More Nigerian states reporting monkeypox cases as total reaches 31

The Nigerian Centre for Disease Control (NCDC) today reported that six more states have suspected cases of monkeypox, a disease caused by a rare smallpox-like virus. There are now 31 suspected cases in seven states: Bayelsa, Rivers, Ekiti, Akwa Ibom, Lagos, Ogun, and Cross River.

All patients are currently hospitalized and improving, according to an NCDC statemen. The agency said it was first notified of a possible outbreak on Sep 22, when an 11-year-old boy from Bayelsa state presented with symptoms of the disease. Eleven people, including a doctor, were confirmed to have the virus late last week.

"Nigerians are once [again] advised to remain calm, avoid self-medication and report any suspected case to the nearest health facility. Public health authorities across the country have been well informed on what to do when a suspected case arises," said Dr. Chikwe Ihekweazu, CEO of the NCDC.

Monkeypox is transmitted through contact with infected animals and is usually self-limiting. In rare cases, infection can be fatal.
Oct 9 NCDC statement


Puerto Rico hurricane damage stretches supply of IV saline

Damage in Puerto Rico from Hurricane Maria has disrupted the nation's supply of some intravenous (IV) saline and dextrose bags, the Washington Post reported today. Baxter International, one of the makers of small-volume IV bags, widely used for rehydration and to dilute medications, said "multiple production days" were lost in the aftermath of the storm, and it has established a system to allocate the product to hospitals based on past purchases.

On Oct 6, Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, issued a statement saying the FDA is taking new steps to mitigate the impact of two recent hurricanes on the island's medical product manufacturing sector, alongside its ongoing efforts to directly assist Puerto Rico's residents. He said pharmaceutical and biological products account for about 30% of the territory's gross domestic product, and 10% of all drugs consumed by Americans are made in Puerto Rico. "And that doesn't even account for medical devices. Puerto Rico is vital to the health and wellbeing of Americans," he said.

Some facilities were hit harder than other, but the ones that sustained minor damage are running on generator power and aren't back at full production. "New shortages could result from these disruptions, and shortages that existed before the storms could potentially be extended," Gottlieb said, adding that the FDA is in close contact with senior management at the companies.

The FDA says it is monitoring 40 products on a list of critical products for which shortages could have a substantial public health impact. The FDA said it will provide more details on specific products as appropriate and as it learns more.

According to the Post story, Puerto Rico is home to more than four dozen FDA-approved drug making facilities, including ones owned by Pfizer, Merck, Eli Lilly, Johnson & Johnson, Bristol-Myers Squibb, and Amgen. A Baxter spokesman told the Post that limited IV fluid production is under way in Puerto Rico and that the company is leveraging its global production capacity to support the supply as operations are restored in Puerto Rico. Some US hospitals have said they haven't been affected by the shortage, while others said supplies are tight.
Oct 9 Washington Post story
Oct 6 FDA statement


Short-course antibiotics perform well in Enterobacteriaceae bacteremia

Scientists have determined that short courses of antibiotics yield similar clinical outcomes as prolonged courses for Enterobacteriaceae bacteremia and may protect against subsequent multidrug-resistant gram-negative bacteria, according to a new study in PLoS Medicine.

The recommended duration of antibiotic treatment for bloodstream infections caused by Enterobacteriaceae is 7 to 14 days. Researchers from the Antibacterial Resistance Leadership Group compared the outcomes of patients receiving 6 to 10 days versus 11 to 16 days of antibiotics for Enterobacteriaceae bacteremia in patients who were treated in one of three medical centers from 2008 through 2014.

The team matched 385 short-course bacteremia patients with the same number of prolonged-course patients. Median treatment duration was 8 days in the former group and 15 in the latter.

They found no difference between the groups in mortality and recurrent bloodstream infections. They detected a trend toward a protective effect of short-course antibiotic therapy on the emergence of multidrug-resistant gram-negative bacteria but not a statistically significant difference.
Oct 8 Clin Infect Dis abstract

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