News Scan for Mar 27, 2018

Lassa fever in Nigeria
Zika cardiac findings in babies
Infection prevention & antibiotic stewardship
Emergency funds for WHO

WHO: Nigeria's Lassa fever outbreak slowing but far from contained

The pace of new infections in Nigeria's Lassa fever outbreak is starting to slow, but the epidemic is far from contained, the World Health Organization (WHO) and the Nigeria Centre for Disease Control (NCDC) said yesterday in a statement.

NCDC's latest data show that the number of new confirmed and probable cases has been falling for 5 consecutive weeks, hinting that public health steps are making an impact. However, the groups said they expect more infections until the end of the dry season. Though Lassa fever is endemic in Nigeria, the current outbreak is its largest, and the number of cases reported in January and February has already eclipsed the total for all of 2017.

Early investigation suggests that the circulating virus is similar to previous outbreaks and that the spread isn't being fueled by a more virulent strain. Chikwe Ihekweazu, MD, MPH, NCDC's chief executive officer said, however, that more studies are under way to see what led so many people to become infected. "Even with a downward trend, until we can better understand the causes behind its rapid spread, we must treat the outbreak as a priority," he said.

The NCDC update said that, for the week ending Mar 25, 18 new cases have been confirmed, raising the 2018 total to 394. Also, 118 more suspected cases were reported, lifting that total to 1,613.

Six more deaths were reported last week, putting the outbreak's fatality total at 134. The case-fatality rate is 24.1%, slightly lower than the previous week. The number of affected states remained at 19, and no new infections were reported in healthcare workers.
Mar 26 WHO statement
Mar 25 NCDC situation report


Cardiac defects common, but not severe in Zika-affected babies

Major cardiac defects in infants exposed to Zika virus before birth are 10 times more common than in the general population, but they aren't typically severe enough to prompt immediate treatment, a research team from the Oswaldo Cruz Institute in Brazil reported yesterday in PLoS Neglected Tropical Diseases.

The group based its findings on clinical exams of 120 babies born from November 2015 to January 2017 in Rio de Janeiro whose Zika exposure was confirmed by maternal blood or amniotic fluid tests or lab tests of samples from the infant after birth. Cardiologic assessment include echocardiography performed by pediatric cardiologists. The authors said their study is the first to report echocardiogram findings.

Forty-eight (40%) had cardiac defects on echocardiography; 13 babies (10.8%) had major cardiac defects, considerably higher than the general population. Major defects included atrial septal defect, ventricular septal defect, and patent ductus arteriosus, though none were severe.

Frequency of major defects was higher in infants born to mothers who had experienced a rash in the second pregnancy trimester, those who had problems seen on cerebral imaging after birth, and in those who were preterm. None of the babies needed cardiac procedures or surgery in the first days to months of life.

The authors said the findings suggest that babies with suspected or confirmed congenital Zika infections should receive the same cardiac follow-up as newborns in general, which typically includes a complete physical exam at birth and oxygen saturation measurement before discharge. Routine echocardiography for all Zika-exposed babies doesn't appear to be warranted, which is a consideration in Brazil and other settings that lack the facilities to do the test.
Mar 26 PLoS Negl Trop Dis study


Position paper stresses infection control, antibiotic stewardship synergy

In an update to a 2012 document, a position paper from three professional medical groups emphasized that infection prevention and control (IPC) and antibiotic stewardship programs are inextricably linked. The Association for Professional in Infection Control (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP) published their update yesterday in two association journals, the American Journal of Infection Control and Infection Control and Hospital Epidemiology.

The new version of the position paper highlights the synergy of IPC and antibiotic stewardship programs, including the important of a well-functioning IPC program as a central component of a successful antibiotic stewardship strategy, according to a SHEA press release.

Mary Lou Manning, PhD, lead author of the position statement, said the vital work of both programs cannot be done independently. "They require interdependent and coordinated action across multiple and overlapping disciplines and clinical settings to achieve the larger purpose of keeping patients safe from infection and ensuring that effective antibiotic therapy is available for future generations," she said in the release. The groups note that multidrug-resistant organisms cause a significant share of healthcare-associated infections and are more difficult to great because of fewer and sometimes no antibiotics that can treat the illnesses.

Aligning the two programs makes them more effective than antibiotic stewardship measures alone, affirming that a well-functioning IPC program is key to antibiotic stewardship strategy success, the authors wrote.

The groups acknowledge that successful antibiotic stewardship programs require significant investments from healthcare facilities. Changing practices, prescribing patterns, and other medical team behaviors will take time but is critical for stemming the rise of antimicrobial-resistant and Clostridium difficile infections, the groups wrote. They also urged healthcare leaders to prioritize IPC and antibiotic stewardship as part of wider patient safety initiatives, adding that IPC and stewardship leaders should collaborate on their communications with hospital executive teams.
Mar 26 Infect Control Hosp Epidemiol position paper
Mar 26 SHEA press release


Donors pledge $15.3 million more to WHO contingency fund

At a meeting in Geneva yesterday, 11 countries pledged a total of $15.3 million more to the WHO emergency fund, which helps support a more rapid response to infectious disease outbreaks and other health crises, the WHO said today in a press release.

The additional funds were pledged by Canada, Denmark, Estonia, Germany, South Korea, Kuwait, Luxembourg, Malta, the Netherlands, Norway, and the United Kingdom. Contributions ranged from $20,000 to $5.6 million. The new pledges could increase emergency fund levels to $23 million.

The WHO said the emergency fund fills a critical gap between when a need for an emergency response is identified and when funds from other sources can be tapped. Unlike other sources, the emergency fund can release money within 24 hours, helping deliver an immediate and early response. It is seeking further donor commitments to reach its $100 million target for the 2018-2019 biennium.

Several countries were making their first pledges, including Denmark, Kuwait, Luxembourg, Malta, and Norway. The United Kingdom boosted its overall commitment from $10.5 million to $16 million, making it the second largest donor after Germany.

Peter Salama, MBBS, MPH, the WHO's deputy director general for emergency preparedness and response, said the fund is already proving its value, and without the emergency funds, recent outbreaks of Ebola in the Democratic Republic of Congo, Marburg virus disease in Uganda, and pneumonic plague in Madagascar would have gotten out of control. "By acting decisively and quickly, we can stop disease outbreaks and save thousands of lives for a fraction of the cost of a late response," he added.

According to the WHO, in 2017 the fund provided nearly $21 million for response actions in 23 countries, with most allocations released within 24 hours. Over half (56%) went to countries in the WHO's African region, 28% went to locations in the Eastern Mediterranean region, and 11% went to nations in the South East Asian region.
Mar 27 WHO news release

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