News Scan for Nov 07, 2018

News brief

MERS infects another in Riyadh, Saudi Arabia

Saudi Arabia's health ministry reported one new MERS-CoV case involving a 54-year-old man from Riyadh, according to a Saudi Ministry of Health (MOH) report today for epidemiologic week 45.

The man is hospitalized for his MERS-CoV (Middle East respiratory syndrome coronavirus) infection, and the investigation revealed he didn't have contact with camels and didn't contract the illness from another sick patient.

According to a recent update from the World Health Organization, since 2012 it has received 2,262 reports of lab-confirmed MERS-CoV cases, at least 803 of them fatal. Saudi Arabia has been by far the hardest-hit country.
Nov 7 Saudi MOH report

Feds share more details about cake mix Salmonella outbreak

Federal health officials today revealed new details about a multistate Salmonella outbreak with potential links to certain Duncan Hines cake mixes, including that the subtype is Salmonella Agbeni and an inspection is under way at the facility that produced the cake mixes.

The US Centers for Disease Control and Prevention (CDC) said ConAgra Brands on Nov 5 recalled four varieties of the mix after Oregon authorities identified Salmonella Agbeni in a box of Duncan Hines white cake mix. The CDC's Pulse Net database, the national subtyping network, identified five infections with the same Salmonella Agbeni DNA fingerprint from three states: Maryland (2), Ohio (2), and Wisconsin (1).

Illness onsets range from Jun 13 to Sep 17, and patient ages range from 26 to 72. Three of the patients are women. No hospitalizations or deaths have been reported.

Interviews with sick people about foods they ate and other exposures the week before they became ill found that two had eaten cake and one reported eating raw cake mix, but brand information wasn't available. The CDC said it is working with state health departments and the Food and Drug Administration (FDA) to see if they ate cake or raw cake mix produced by Duncan Hines.

Antibiotic resistance testing on the strain is under way by the CDC's National Antimicrobial Resistance Monitoring System (NARMS).

Meanwhile, the FDA said today in an update that it is conducting an investigation at the cake mix facility and is collecting environmental and product samples for testing.
Nov 7 CDC investigation notice
Nov 7 FDA statement

Serology study finds 2nd human H7N2 avian flu case in 2016 cat outbreak

A serological survey of shelter workers exposed to cats infected in an outbreak of low-pathogenic H7N2 avian influenza in New York City in 2016 found one additional human case, bolstering evidence of cat-to-human transmission. Researchers from New York City and the CDC reported their findings on Nov 5 in the Journal of Infectious Diseases.

The outbreak was first reported at a municipal animal shelter, following the detection of the H7N2 virus in a cat with severe pneumonia that had to be euthanized. H7N2 had never been reported in cats before, and widespread transmission followed among cats at two more of the city's animal shelters. The spread of the virus raised concerns about possible human infections in shelter workers, and screening tests by the New York City health department confirmed an infection in one person, a veterinarian who had helped obtain respiratory samples from cats.

In follow-up serological testing to see if there were any other human infections and to gauge the exposure risk, the research team tested 121 shelter workers. One had serologic evidence of H7N2 infections, for a seroprevalence of 0.8% (95% confidence interval, .02% to 4.5%). Five people had low positive titers to H7N2, hinting at possible infection, but the researchers couldn't rule out cross-reactive antibody response to seasonal flu viruses.

They concluded that serology allowed them to confirm a subclinical mild infection that would have gone undetected. The patient had experienced mild symptoms, including sore throat, muscle pain, and cough. The individual who tested positive is only the fourth person in the United States to be infected with an H7N2 virus and the only serologically confirmed human infection connected to cat exposure.
Nov 5 J Infect Dis abstract
Dec 27, 2016, CIDRAP News scan "Vet contracts H7N2 from cats in New York City"

Stewardship / Resistance Scan for Nov 07, 2018

News brief

OECD: Interventions to reduce resistant bacteria could save lives, money

A report today from the Organization for Economic Co-operation and Development (OECD) suggests that investment in a package of measures to reduce antimicrobial resistance (AMR) could avert thousands of deaths each year and save money in the long run.

According to the OECD analysis, the proportion of infections caused by antibiotic-resistant bacteria could increase from 17% in 2015 to 18% in 2030 across the 33 OECD countries, with resistance to second- and third-line antibiotics expected to be 70% higher by 2030. In countries outside the OECD, resistance rates are higher and projected to grow even faster. If no effective action is taken, the report warns, an estimated 2.4 million people in Europe, North America, and Australia could die between 2015 and 2050, and OECD countries could spend up to $3.5 billion a year on AMR-related complications.

The report suggests, however, that governments could counter the problem with a combination of five affordable public health interventions: (1) improved environmental hygiene in healthcare facilities, including better hand hygiene; (2) stewardship programs to promote more prudent use of antibiotics; (3) use of rapid diagnostic tests to differentiate between bacterial and viral infections; (4) delayed antibiotic prescribing; (5) and public awareness campaigns.

"All the assessed interventions are 'best buys' to tackle AMR in the assessed countries given their high impact on population health, affordability to implement, and excellent cost-effectiveness ratio," write the authors of the report. "Savings from delayed prescriptions, improved hand hygiene, and, in most cases, from stewardship programmes exceed the cost of implementation."

The OECD analyzed three different packages of interventions and estimated that a mixed intervention package that includes stewardship programs, use of rapid diagnostic tests, mass media campaigns, and enhanced hospital hygiene could avert up to 47,000 deaths and save around $3 per person a year in OECD countries.
Nov 7 OECD report

'Pioneering' AMR initiatives to be highlighted at upcoming conference

The Wellcome Trust announced today that it has chosen two projects that are taking "pioneering" action to combat AMR to present their work at the upcoming Call to Action conference in Ghana on Nov 18-19.

One of the projects is based in Bangladesh and involves a community dialogues approach to helping prevent the growth of AMR. Led by the University of Leeds in collaboration with the Malaria Consortium and ARK Foundation, the project trains volunteers to facilitate dialogues with community members about the rational use of antibiotics. From April 2018 through July 2018, volunteers hosted more than 200 meetings in the Comilla district of Bangladesh.

The other project is Superheroes Against Superbugs, a program that teaches schoolchildren in India about bacteria, antibiotics, and resistance and encourages them to create a dialogue about AMR through comic books, short animated films, and other creative concepts.

The two initiatives will be highlighted on day one of the Call to Action conference, which will bring together health officials from national governments and agencies and representatives from the private and philanthropic sectors to address the most critical gaps in tackling the development and spread of drug-resistant infections. The conference is being co-hosted by Wellcome Trust, the United Nations Foundation, and the governments of Ghana and Thailand.
Nov 7 Wellcome Trust news release

Nationwide survey in Japan finds deep misconceptions about antibiotics

A nationwide survey in Japan has found that misconceptions about antimicrobials and antimicrobial resistance (AMR) abound, and many have taken antimicrobials inappropriately, with almost half having obtained antibiotics for the common cold, according to a study in PLOS One.

Researchers conducted the online survey in March 2017 and collected data from 3,390 participants. Questions focused on antibiotic use, knowledge about the drugs and AMR, sources of antibiotic information, and behavior and perception of antibiotics during visits with healthcare providers.

Almost half (46.2%) of the respondents had taken antibiotics, 45.5% of them for the common cold, which doesn't require antibiotics. The study also found that 11.7% of participants stored antibiotics at home and 23.6% said they had stopped or adjusted antibiotic doses by themselves; 1.9% of respondents had taken leftover antibiotics.

Regarding antibiotic and AMR knowledge, only 21.9% knew that antibiotics could not kill viruses, which compares with 43% in Europe, the authors said. In addition, only 24.6% of Japanese knew antibiotics were not effective against colds and influenza. Although 67.5% of participants knew that antibiotics would not work in the future unless used properly, only about 20% of them knew what kind of diseases or pathogens they target. Only 7.1% answered all four questions about antibiotics correctly.

During medical visits, 10.2% asked for antibiotic prescriptions from their physicians, and 30.2% believed that physicians who prescribed the drugs for the common cold were good.

The authors conclude, "Although information about antibiotics and AMR has not been adequately shared to the Japanese public, the majority of them who did have the correct information reported their wish for changes to improve the behaviour of people with regards to use of antibiotics."
Nov 5 PLOS One study