News Scan for Jan 04, 2018

Sexually transmitted Zika
Sanofi fined
Typhoid vaccine
Non-vaccinating parents
Real-time C diff alert

LA County reports first sexually transmitted Zika case

Health officials in Los Angeles County today announced the area's first sexually transmitted Zika case, which involves a male resident who traveled to Mexico and had Zika symptoms in early November and his female partner, who did not travel.

In a statement today, the Los Angeles County Department of Public Health (LACDPH) said the woman had Zika symptoms that began after the man returned to Los Angeles County. The country routinely tests mosquitoes that can carry Zika virus. No cases transmitted by local mosquitoes have been reported in the county. Since 2015, 122 Zika cases have been reported in Los Angeles County, of which 121 were imported.

Jeffrey Gunzenhauser, MD, MPH, the county's interim health officer, said in the statement, "This case is a reminder to take precautions during sex or avoid sex if you or your partner have traveled to an area with risk of Zika." The LACDPH said Zika transmission is still occurring in Mexico, other parts of Latin America, and other regions.
Jan 4 LACDPH press release


Philippines fines Sanofi over Dengvaxia

Today the Philippines health secretary announced the country has fined the French pharmaceutical giant Sanofi Pasteur $2,000 and suspended use of the company's Dengvaxia dengue vaccine.

Health Secretary Francisco Duque cited violations on product registration and marketing of the controversial dengue vaccine, which has been linked to severe dengue infections in children.

Last month, Sanofi said Dengvaxia should not be used in people without evidence of a prior dengue infection, as the vaccine may make subsequent infections with the flavivirus more severe. Since then, the Philippines has been mired in a public health crisis, as more than 700,000 school-age children have already received at least one dose of the trivalent vaccine.

According to Reuters, the Filipino government spent 3.5 billion pesos ($70.2 million) for the Dengvaxia public immunization program in 2016 to reduce the 200,000 dengue cases reported in that country annually.
Jan 3 Reuters story


WHO prequalifies first typhoid vaccine

The World Health Organization (WHO) has prequalified the first conjugate vaccine for typhoid, Bharat Biotech's Typbar-TCV, allowing United Nations (UN) agencies to procure and use it.

In October, the Strategic Advisory Group of Experts (SAGE) on immunization, which advises the WHO, said typhoid conjugate vaccines (TCVs) should be used for children over 6 months of age in typhoid-endemic countries. TCVs are long-lasting vaccines that can be incorporated into standard childhood immunization programs.

SAGE also called for the introduction of TCVs in countries with the highest burden of typhoid disease or evidence of antibiotic resistance to Salmonella enterica serotypeTyphi, the bacterium that causes the disease. The WHO said use of the vaccine should reduce the use of antibiotics for treatment of presumed typhoid fever and limit antibiotic resistance in Salmonella Typhi.

Typhoid can be a deadly infection transmitted by contaminated food and water. Globally, the WHO said there are between 11 million and 20 million cases and between about 128,000 and 161,000 typhoid deaths annually.
Jan 3 WHO statement


Trusting 'complementary' practitioners linked to poor vaccine uptake

A new survey of Australian parents shows that those who do not vaccinate their children are more likely to trust non-mainstream sources of medical information and advice, including complementary medicine (CM) practitioners.

The results of the survey were published yesterday in Vaccine. A total of 429 parents of children ages 6 or older participated in the online survey. Approximately 12.9% of participants reported taking their children to a complimentary medical practitioner, including chiropractor or herbalist, in the previous 12 months. 

Children were much less likely to be vaccinated if their parents had been influenced by a complementary medicine practitioner (odds ratio [OR], 0.03) or had visited a CM-practitioner (OR, 0.09) in the previous year. In contrast, children were much more likely to have been vaccinated if they had visited a pediatrician within the previous year (OR, 5.01).

The fast majority of parents in the study, 93.5%, reported that their child's immunizations were up to date, and more than 78% said they followed advice on vaccines from pediatricians.

"Concerns about pharmaceutical medicine safety and post-modern beliefs (e.g., rejection of authority) can be associated with CM use," the authors concluded. "These beliefs may translate to vaccine-hesitancy, and parents may trust advice from a CM-practitioner about vaccination if they value this form of health care more broadly."
Jan 3 Vaccine study


Real-time C diff notification reduces time to effective therapy, study finds

Implementation of a real-time notification system to alert a pharmacist-led antimicrobial stewardship program (ASP) of Clostridium difficile infection (CDI) in patients reduced the time to effective antimicrobial therapy, a team of pharmacists reported yesterday in the American Journal of Infection Control.

The single-center, retrospective cohort study was conducted at a 433-bed tertiary medical center in Lexington, Kentucky, and consisted of two arms: patients treated for CDI prior to implementation of a real-time notification system for CDI, and those treated post-implementation. The system notified the pharmacist-led ASP team via a secure listserv when toxigenic strains of C difficile were detected in the microbiologic laboratory. The pharmacists then notified the patient's healthcare provider to ensure that effective antimicrobial therapy and contact precautions were initiated.

The primary outcome of the study was time to initiation of effective antimicrobial therapy. Secondary outcomes included time to enter an order of effective antimicrobial therapy in the electronic medical record and time to initiate contact precautions.

The total number of patients in the study was 66: 44 in the pre-implementation cohort and 22 in the post-implementation cohort. Comparison of the two study arms showed that the median time from CDI detection to initiation of effective antimicrobial therapy fell from 5.75 hours in the pre-implementation patients to 2.05 hours post-implementation. The notification system also resulted in a shorter time from CDI detection to order entry of effective antimicrobial therapy—0.6 hours compared with 3 hours. In addition, median time to contact precautions dropped from 4.8 hours to 9 minutes.

The authors of the study say further research is needed to investigate the clinical impact of these outcomes on hospital length-of-stay, mortality, incidence of CDI, and total costs.
Jan 3 Am J Infect Control abstract

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