News Scan for Mar 06, 2020

US flu activity drops
DRC Ebola countdown
Antibiotic use in US children's hospitals
Polio in Afghanistan, Pakistan, Africa
Global measles incidence

For third week in a row, US flu activity declines

For the third week in a row, US flu levels dropped last week, the Centers for Disease Control and Prevention (CDC) said today in its weekly FluView report. But the CDC said the flu season continues to be tough on children, as 11 new pediatric flu-related deaths were confirmed.

"Pneumonia and influenza mortality has been low, but 136 influenza-associated deaths in children have been reported so far this season," the CDC said. "This number is higher for the same time period than in every season since reporting began in 2004-05, except for the 2009 pandemic." The pediatric death toll was 144 in the 2018-2019 flu season.

All regions are still reporting elevated flu activity, but rates of outpatient visits for influenza-like illness (ILI) dropped last week, from 5.5% to 5.3%. The percentage of specimens positively identified as influenza also dropped, from 28% to 24.3%.

The number of jurisdictions reporting high ILI activity included New York City, Puerto Rico, and 40 states, down from 43 states last week. The number of jurisdictions reporting regional or widespread flu increased, however, from 48 to 51.

The cumulative hospitalization rate rose from 52.7 to 57.9 per 100,000 population last week. Children ages 0 to 4 years were hospitalized at a rate of 84.9 per 100,000 population, and those 65 or older were hospitalized at a rate of 147.5 per 100,000 population.
Mar 6 CDC FluView report


DRC starts countdown to Ebola outbreak end

In its weekly snapshot on the Democratic Republic of the Congo (DRC) Ebola outbreak yesterday, the World Health Organization (WHO) said the country hasn't reported a new case since Feb 17. The agency added that, on Mar 3, the last patient confirmed with the disease was discharged from an Ebola treatment center.

The WHO said that although the events marked an important milestone, there's still a high risk of recurrence and it's critical to maintain response operations. A country must pass 42 days, which equals two incubation periods, after the last infected person tests negative a second time.

As of Mar 3, the country's overall outbreak total stood at 3,444, which includes 134 probable cases and 2,264 deaths. The WHO praised the international community for covering about half of the $83 million price tag for battling the virus from January through June of this year, but it still needs $40 million in support to continue response activities.

Ebola virus can persist in some body fluids in protected parts of the body, such the eyes or testes, and cases linked to survivors in past outbreaks have triggered new transmission chains. Early in the outbreak, the DRC and its partners established a national program for Ebola survivors. The WHO said 1,160 people have survived the disease, about three fourths of them adults.

In published remarks, Ibrahima Soce Fall, MD, the WHO's assistant director for emergency response, today said the last patient to leave treatment was a woman in Beni. "This is why it's critical to maintain surveillance and rapid response capacities. And that's what we are doing. We're still in full response mode."
Mar 5 WHO update
Mar 6 WHO comments on last case
WHO online Ebola dashboard


Study finds wide variability in antibiotic use at US children's hospitals

A cross-sectional examination of antibiotic use in US children's hospitals has found that, on any given day, more than a third of hospitalized children are receiving an antibiotic, and 1 in 8 are receiving a broad-spectrum antibiotic, US researchers reported today in Infection Control and Hospital Epidemiology.

The study, conducted by researchers from Vanderbilt University Medical Center, looked at antibiotic prescribing at 51 US children's hospitals that participate in the Children's Hospital Association's Pediatric Health Information System. Single-day assessments of antibiotic use among all patients at the hospitals were conducted on May 3, 2017; Aug 2, 2017; Oct 25, 2017; and Jan 31, 2018. The main outcome of interest was receipt of an oral, intravenous, or inhalation antibiotic on the study day.

Of 52,769 total hospitalized children, 19,174 (36.3%) received antibiotics on the study day and 6,575 (12.5%) received broad-spectrum antibiotics. The overall prevalence of antibiotic use varied across hospitals, ranging from 22.3% to 51.9%, and did not appear to be explained by the clinical complexity of patients. Antibiotic use prevalence was 29.2% among medical patients and 47.7% among surgical patients.

Although there was no significant seasonal variation in antibiotic use, regional prevalence varied, ranging from 32.7% in the Midwest to 40.2% in the West (P < .001). Among hospital units, pediatric intensive care unit patients had the highest prevalence of both overall and broad-spectrum antibiotic use, at 58.3% and 26.6%, respectively (P < .001).

The authors of the study say further exploration of the main drivers of inpatient antibiotic use variability could help inform antibiotic stewardship efforts.
Mar 6 Infect Control Hosp Epidemiol abstract


New polio cases reported in Pakistan, Afghanistan, African countries

The latest weekly update from the Global Polio Eradication Initiative (GPEI) today shows six counties reporting new cases, with Afghanistan and Pakistan reporting new wild polio virus type 1 (WPV1) infections and four African nations reporting vaccine-derived cases.

The two WPV1 cases in Afghanistan, one each in Helmand and Zabul provinces, are the country's first cases of 2020. In 2019, Afghanistan reported 29. The four WPV1 infections in Pakistan—one each in Punjab, Khyber Pakhtunkhwa, Sindh, and Balochistan provinces—bring the country's 2020 total to 21, compared with 146 WPV1 cases in all of 2019.

The circulating vaccine-derived polio virus type 2 (cVDPV2) cases reported in Africa include 1 in Angola in Benguela province; 4 in Chad's Ouaddai, Chari Baguirmi, Batha, and Logone Oriental provinces; 2 in the DRC's Lualaba and Tshopo provinces; and 1 case in Ethiopia's Oromyia province. In addition, Angola reported two cVDPV2-positive environmental samples, and Somalia and Ivory Coast each reported one cVDPV2-positive environmental sample. Malaysia reported thee cVDPV2-positive environmental samples.

GPEI says the risk of further cVDPV2 spread across the Lake Chad subregion remains high.

The update also noted that Iran has been removed from the list of outbreak countries after months of consultations and a high level of poliovirus surveillance sensitivity, triggered by the May 2019 isolation of WPV1 in a sewage sample from Sistan and Balochistan province.
Mar 6 GPEI weekly update


WHO study shows uptick in global measles incidence

Global measles incidence increased from 2013 through 2018, and while reasons for the rise are multifactorial and vary by country, inadequate immunization is a key factor, researchers from the World Health Organization (WHO) reported yesterday in the Journal of Infectious Diseases.

The analysis of case-based measles surveillance data reported to the WHO, World Bank country income status, and estimates of national immunization coverage found that a total of 1,495,559 suspected measles cases were reported from 2013 through 2018, and 899,800 were eventually classified as measles. Global annual incidence for 2018 was 46 cases per million persons, the highest annual incidence in the study period. Of the 899,800 measles patients, 45% never received the measles vaccine, 12% received one dose, and 30% had an unknown vaccination history.

Lower- and middle-income countries accounted for 66% of cases, with 70% coming from  Nigeria, India, Philippines, Ukraine, and Pakistan. Seventy-seven percent of patients were under the age of 15, with the incidence highest in those under the age of 1. The median age of patients increased by country income status, and in high-income countries with historically stronger vaccination programs, patients had higher median ages.

The analysis also found that high-income countries have many cases in people 15 and older who were unvaccinated or undervaccinated. That's a shift from the prevaccine era, when 95% were immune by age 15, the authors of the study note, and a finding that could help guide measles elimination efforts in those countries.

"To achieve elimination, immunization programs and primary care services must be strengthened, and strategies targeting those outside the age of most routine immunization services also need to be undertaken in some countries to close remaining immunity gaps," the authors wrote. They also urged countries to improve case-based surveillance.
Mar 5 J Infect Dis study

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