News Scan for Jan 24, 2020

News brief

CDC confirms 15 new pediatric flu deaths, slight ILI rise

In its weekly FluView update today, the US Centers for Disease Control and Prevention (CDC) reported 15 new pediatric deaths attributed to influenza. CDC estimates this season there have been at least 15 million flu illnesses, 140,000 hospitalizations, and 8,200 deaths from flu.

So far, the 2019-20 season has seen 54 pediatric deaths, 37 of which have been linked to influenza B, the dominant strain in the country. During the severe 2017-18 influenza season, the CDC tracked 188 pediatric deaths.

After two weeks of declining numbers, the CDC said flu activity was up slightly this past week, with influenza-like illness (ILI) rates going from 4.7 to 5.0. ILI activity was high in New York City, Puerto Rico, and 35 states, compared with 32 states the week before.

Data from public health laboratories last week showed 51.9% of positive lab specimens were influenza B, and 48.1% influenza A. Of subtyped influenza A samples, 94.4% were (H1N1)pdm09, and 5.6% were H3N2. Almost all (99.4%) of B viruses are from the Victoria lineage.

Hospitalization rates rose slightly this week, to 24.1 per 100,000, which is similar to the same period in other seasons.
Jan 24 CDC FluView

 

Third day in row with no new Ebola cases in DRC

For the third day in a row, no new cases were recorded on the World Health Organization's (WHO's) online Ebola dashboard, so the outbreak still stands at 3,416 cases, including 2,239 deaths. A total of 501 suspected cases are under investigation.

According to the latest Disease Outbreak News summary published by the WHO yesterday, transmission has stabilized in the DRC, with only nine cases—all in Beni—recorded from Jan 15 to 21.

"The number of new confirmed cases reported each week has remained stable over the past six weeks, with approximately 14 new EVD cases reported weekly," the WHO said. "In addition, improved surveillance indicators such as the proportion of cases listed as contacts and followed prior to detection, and the decreased time to isolation of cases are encouraging signs."

The WHO said the current transmission chain is comprised of 82 confirmed and probable cases reported. Half of those cases occurred because of exposure in the community, 37% were due to nosocomial transmission, and 2% of patients were exposed during community deaths or funerals.
WHO Ebola dashboard
Jan 23 WHO Disease Outbreak News report

 

Three new Saudi MERS cases reported, 2 in health workers

Saudi Arabia's Ministry of Health (MOH) today reported three new MERS-CoV cases identified this week, including another healthcare worker from Abha city, the third healthcare infection noted in that city this week.

The woman from Abha is 36, and her infection with MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as "secondary," meaning she likely contracted the virus from another person. She is identified as a healthcare worker.

A 30-year-old man from Al-Kharj has also been diagnosed as having the coronavirus. His infection is listed as primary, meaning it is not likely he contracted the virus from another person. The MOH also said the patient had camel contact.

A 63-year old woman from Dhurma was also diagnosed as a primary patient. She did not have camel contact.

The three new cases raise Saudi Arabia's MERS-CoV total for January to nine cases. The WHO said in its latest monthly update that 2,499 cases have been lab-confirmed since the virus emerged in people in 2012, including 861 fatalities. The vast majority of the cases have been in Saudi Arabia.
Jan 24 Saudi MOH report

 

Six countries report polio cases, including first in 2020 (in Pakistan)

According to the weekly polio update from the Global Polio Eradication Initiative (GPEI) posted today, Afghanistan has one more wild poliovirus type 1 (WPV1) case and Pakistan has two more WPV1 cases, including the world's first case of 2020.

All other cases add to the 2019 tally.

Three countries have more circulating vaccine-derived poliovirus type 2 cases: the Democratic Republic of the Congo (10), the Philippines (2), and Togo (1). Also, Malaysia has two more cases of circulating vaccine-derived poliovirus type 1.

The case in Afghanistan occurred in Herat province, and brings the total number of WPV1 cases reported in 2019 to 29. The two cases in Pakistan occurred in Khyber Pakhtunkhwa province, and one of them is the first case diagnosed in 2020. There were 136 cases in 2019, GPEI said.

The DRC cases bring 2019's total to 73, and new cases in the Philippines bring that country’s 2019 total to 13.
Jan 24 GPEI report

ASP Scan (Weekly) for Jan 24, 2020

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

BARDA boosts funding for development of new C difficile antibiotic

Summit Therapeutics yesterday announced that the Biomedical Advanced Research and Development Authority (BARDA) has awarded the company an additional $8.8 million for clinical and regulatory development of an investigational antibiotic for treating Clostridiodes difficile infection (CDI).

The additional funding is for a new clinical trial for ridinilazole in adolescent patients. Ridinilazole is a oral small-molecule antibiotic designed to selectively kill C difficile bacteria and preserve patients' beneficial gut bacteria, leading to sustained CDI cures. Summit, of Cambridge, Mass., says the adolescent trial is expected to support a New Drug Application for ridinilazole.

The award brings BARDA's total committed funding for the project to $62.4 million.

"BARDA's continued support for ridinilazole is instrumental in helping to bring this potential CDI treatment option to patients, whose current treatment options fail to sustain cures for one third of the population," Glyn Edwards, CEO of Summit, said in a company press release. "We thank BARDA for its commitment to ridinilazole, innovation and public health."

The Centers for Disease Control and Prevention estimates that there were 223,900 CDI cases in hospitalized patients in 2017, 12,800 CDI-related deaths, and $1 billion in attributable healthcare costs.
Jan 23 Summit Therapeutics press release

 

Initiative aims to mobilize investors in fight against drug resistance

At the World Economic Forum in Davos yesterday, a coalition of public and private-sector organizations announced an effort to engage the financial sector in tackling antimicrobial resistance (AMR).

The aim of the "Investor Year of Action on AMR" is to "leverage influence to make change happen," according to a press release from the Farm Animal Investment Risk & Return (FAIRR) initiative, which is one of the groups backing the effort. During the year-long initiative, investors will be encouraged to assess and integrate risks, opportunities, and impacts, and make investment decisions, with AMR in mind.

Other groups involved in the initiative include the UK Department of Health and Social Care, the Access to Medicines Foundation, and Principles for Responsible Investment (PRI).

"The World Bank believes AMR could cause greater economic damage than the 2008 financial crisis, potentially decreasing global annual GDP by up to 3.8% by 2050," said Fiona Reynolds, chief executive of PRI. "If investors fail to take action on antimicrobial resistance, the public health consequences could be catastrophic and entire sectors from food to pharmaceuticals face industry-wide risk. The investor year of action on AMR is a timely and important initiative that capital markets cannot afford to ignore."
Jan 23 FAIRR press release

 

Paper highlights pharmaceutical support for stewardship

Originally published by CIDRAP News Jan 23

A paper today in Clinical Infectious Diseases outlines the role that pharmaceutical companies can play in antibiotic stewardship.

The paper, authored by representatives of Merck & Co., argues that while pharmaceutical companies have a leading role in developing new antibiotics and vaccines to counter the threat of AMR, many companies are also actively supporting antibiotic stewardship efforts. It goes on to explain why pharmaceutical companies invest in stewardship.

First and foremost, they write, since stewardship is essential to improving patient outcomes and quality of care, companies in the infectious disease space have a social responsibility to support it. But they also note that pharmaceutical companies can benefit from stewardship in a number of ways. For example, improved surveillance and greater awareness of local and regional resistance patterns enables clinicians to recognize patients who might appropriate novel antibiotics. In turn, if those novel antibiotics produce better outcomes for patients, clinicians will advocate for them. In addition, reducing inappropriate antibiotic use could slow the development of resistance in currently available drugs and prolong their commercial lifespan. 

The paper goes on to point out ways in which large pharmaceutical companies are well-suited to promote judicious antibiotic use, and to highlight some of Merck's stewardship activities.

"As illustrated by this case study, the pharmaceutical industry is well-positioned to play a part in the global response—not only through drug and vaccine development, but also through taking tangible action to support responsible antimicrobial use," the authors write. 
Jan 23 Clin Infect Dis paper

 

New antimicrobial resistance research lab launched in Liverpool

Originally published by CIDRAP News Jan 23

The University of Liverpool and the Liverpool School of Tropical Medicine yesterday announced the launch of a new lab for AMR research at The Centre of Excellence in Infectious Disease Research (CEIDR).

According to a CEIDR press release, the new National Institute for Health Research Antimicrobial Resistance Laboratories will provide state-of-the-art infrastructure for scientists to develop personalized antibiotic therapies to prevent and treat drug-resistant infections.

CEIDR says the lab's research goals will include developing new antibiotic molecules, vaccines, and other antibacterial products, personalizing their use, and ensuring they are used in a sustainable manner. Other planned projects include the creation of a city-wide surveillance and feedback system to promote optimal antibiotic use and detect AMR in Liverpool.

"With Liverpool's long and pioneering history in infectious diseases research, and its considerable strengths in enabling sciences and technologies, CEIDR is in a prime position to contribute to the national and international agenda in AMR," said Dame Sally Davies, the UK Special Envoy on Antimicrobial Resistance.
Jan 22 CEIDR press release

 

Pets may be protective against recurrent C difficile, study finds

Originally published by CIDRAP News Jan 22

In a surprising finding, pet ownership and increasing contact with pets may be protective against the recurrence of community-acquired CDI, researchers from the University of Pennsylvania reported recently in Open Forum Infectious Diseases.

To investigate whether pet ownership is a risk factor for CDI recurrence, a hypothesis based on documented animal carriage of C difficile and overlap of strains isolated from animals and people, the researchers conducted a case-control study among 86 patients with recurrent CDI (cases) and 146 patients with nonrecurrent CDI (controls).

Study participants were sent a survey to ascertain the number and species of pets in the household at the time of the initial CDI diagnosis, and the degree of contact between patients and pets. Multivariable logistics regression modeling was used to determine the association between recurrence of CDI and pet ownership, while accounting for patient-level risk factors.

The results of the multivariable analysis showed that pet ownership was not significantly associated with CDI recurrence (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.38 to 2.72; P = 0.965) among all 232 patients. Furthermore, when the researchers analyzed a subset of 127 patients with community-associated or community-onset, healthcare-facility–acquired CDI, they found that increasing contact with pets was increasingly protective against recurrence: for every point increase in a pet contact score (out of 7 possible points), the odds of recurrence decreased by 14% (OR, 0.86; 95% CI, 0.74 to 1.00; P = 0.051).

The authors of the study conclude, "Although more research is needed to understand the transmission dynamics of C. difficile within a household and between pets and owners, it appears that pet ownership and close contact with pets are not associated with recurrence of CDI and may instead be protective against recurrence of CDI in patients with community-acquired or community-onset CDI."
Jan 18 Open Forum Infect Dis study

 

Before-hospital antibiotic exposure may heighten risk of C diff infection

Originally published by CIDRAP News Jan 22

In another study on CDI risk factors, researchers from Intermountain Healthcare and Stanford University found that cumulative antibiotic exposure prior to admission is significantly associated with the risk of subsequent CDI. The findings appeared yesterday in Antimicrobial Agents and Chemotherapy.

For the study, the researchers identified all symptomatic hospital-onset and healthcare-facility–associated, community-onset CDI cases among adults admitted to 21 Intermountain Healthcare hospitals from 2006 through 2012, then evaluated the risk associated with antibiotic exposure, including specific agents administered prior to and during admission, using multivariable logistic regression. While antibiotic use is a known risk factor for CDI, the degree to which various antibiotic classes are associated with CDI risk is not fully understood.

Overall, 2,356 cases of CDI occurred among 506,068 unique admissions, for an incidence rate of 46.6 per 10,000 admissions. After adjusting for demographics and other CDI risk factors, the analysis found that any antibiotic administered prior to admission was the predominant risk factor for CDI, contributing far more risk than antibiotics received during the hospital stay. For every antibiotic day of therapy prior to the index admission, odds of subsequent CDI increased by 12.8% (OR, 1.128; 95% CI, 12.2% to 13.4%; P < 0.0001). Odds of CDI were greatest with second- and third-generation cephalosporins, fluoroquinolones, and clindamycin. Doxycycline and daptomycin were associated with lower CDI risk.

The authors of the study say the data should be taken into consideration by antibiotic stewardship teams for identifying patients at risk for CDI.
Jan 21 Antimicrob Agents Chemother abstract

 

Researchers awarded $25 million for diagnostics based on gene signatures

Originally published by CIDRAP News Jan 21

Imperial College London announced yesterday that it has won a €22.5 million ($25 million US) grant to work with researchers in 15 countries over 5 years to develop a rapid test to diagnose infectious diseases based on personalized gene signatures after taking the next 2 years to develop a library of gene signatures covering common infections and other diseases.

The new approach could speed diagnosis for serious conditions like pneumonia, tuberculosis, sepsis, meningitis, and inflammatory and immune diseases to under 2 hours, the College said in a news release. The researchers believe diagnoses could be made accurately and rapidly on the first blood sample taken when a patient attends a hospital or clinic by identifying the pattern of genes switched on in each patient's blood.

"In the future the whole basis of medical diagnosis could be based on molecular signatures," said Imperial team lead Mike Levin, MBE, PhD. Previous research by Imperial College investigators indicated that using unique gene signatures can predict a bacterial infection with 95% to 100% accuracy. Rapid diagnostics for infections can lower costs, improve patient outcomes, and reduce antimicrobial resistance.

The international group, comprising scientists from 11 European nations and Australia, Gambia, Nepal, and Taiwan, will, in the next 2 years, build a library of gene signatures in which the signatures of all common infectious and inflammatory diseases will be stored and made publicly available.
Jan 20 Imperial College news release

 

Meta-analysis shows stewardship promise for decision support tools

Originally published by CIDRAP News Jan 21

A meta-analysis demonstrates that clinical decision support systems (CDSSs) may effectively improve antibiotic prescribing, although there is limited evidence available on the use of such tools in primary care, according to a study yesterday in the Journal of Antimicrobial Chemotherapy.

Investigators noted that most of the 57 studies that reported on CDSS effectiveness were non-randomized trials with low methodologic quality, but they were able to separately assess the randomized controlled trials (RTCs), which were of moderate methodologic quality. Overall, 26 studies reported data on the appropriateness of antibiotic therapy, with 23 conducted in hospitals and 2 in primary care.

Of the hospital studies, 20 (including 2 RCTs) yielded sufficient data for the meta-analysis. The researchers found that appropriate antibiotic therapy was twice as likely to occur following the implementation of CDSSs (OR, 2.28, 95% CI, 1.82 to 2.86). Results for the 2 RCTs, however, were less rosy, with a 1.24 OR (95% CI, 0.95-1.62).

The use of CDSSs was also associated with an 18% relative decrease in mortality (OR 0.82, 95% CI, 0.73 to 0.91) among the 18 studies (2 RCTs) that analyzed that metric. CDSS implementation was also tied to less antibiotic use and decreased hospital stays, antibiotic duration, and cost of therapy.

The authors conclude, "Our findings suggest that a focus on system requirements and implementation processes would improve CDSS uptake and provide more definitive benefits for antibiotic stewardship."
Jan 20 J Antimicrob Chemother abstract

Stewardship / Resistance Scan for Jan 24, 2020

News brief

BARDA boosts funding for development of new C difficile antibiotic

Summit Therapeutics yesterday announced that the Biomedical Advanced Research and Development Authority (BARDA) has awarded the company an additional $8.8 million for clinical and regulatory development of an investigational antibiotic for treating Clostridiodes difficile infection (CDI).

The additional funding is for a new clinical trial for ridinilazole in adolescent patients. Ridinilazole is a oral small-molecule antibiotic designed to selectively kill C difficile bacteria and preserve patients' beneficial gut bacteria, leading to sustained CDI cures. Summit, of Cambridge, Mass., says the adolescent trial is expected to support a New Drug Application for ridinilazole.

The award brings BARDA's total committed funding for the project to $62.4 million.

"BARDA's continued support for ridinilazole is instrumental in helping to bring this potential CDI treatment option to patients, whose current treatment options fail to sustain cures for one third of the population," Glyn Edwards, CEO of Summit, said in a company press release. "We thank BARDA for its commitment to ridinilazole, innovation and public health."

The Centers for Disease Control and Prevention estimates that there were 223,900 CDI cases in hospitalized patients in 2017, 12,800 CDI-related deaths, and $1 billion in attributable healthcare costs.
Jan 23 Summit Therapeutics press release

 

Initiative aims to mobilize investors in fight against drug resistance

At the World Economic Forum in Davos yesterday, a coalition of public and private-sector organizations announced an effort to engage the financial sector in tackling antimicrobial resistance (AMR).

The aim of the "Investor Year of Action on AMR" is to "leverage influence to make change happen," according to a press release from the Farm Animal Investment Risk & Return (FAIRR) initiative, which is one of the groups backing the effort. During the year-long initiative, investors will be encouraged to assess and integrate risks, opportunities, and impacts, and make investment decisions, with AMR in mind.

Other groups involved in the initiative include the UK Department of Health and Social Care, the Access to Medicines Foundation, and Principles for Responsible Investment (PRI).

"The World Bank believes AMR could cause greater economic damage than the 2008 financial crisis, potentially decreasing global annual GDP by up to 3.8% by 2050," said Fiona Reynolds, chief executive of PRI. "If investors fail to take action on antimicrobial resistance, the public health consequences could be catastrophic and entire sectors from food to pharmaceuticals face industry-wide risk. The investor year of action on AMR is a timely and important initiative that capital markets cannot afford to ignore."
Jan 23 FAIRR press release

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