News Scan for Jul 31, 2020

News brief

Kids 5 and younger could spread COVID-19 as much as adults, study finds

Children younger than 5 years with mild or moderate COVID-19 have much higher levels of coronavirus genetic material in their nose and throat than do older children and adults, according to a research letter published yesterday in JAMA Pediatrics.

Researchers at the Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University analyzed data from 145 kids within the first week of symptoms of mild or moderate coronavirus infection, comparing loads of SARS-CoV-2, the virus that causes COVID-19, in 46 children younger than 5 years, 51 children 5 to 17 years, and 48 adults 18 to 65 years old.

Reverse transcriptase-polymerase chain reaction amplification cycle threshold values revealed that very young children had 10 to 100 times more coronavirus RNA in their upper respiratory tract than older kids and adults.

The authors noted that their study could detect only viral RNA, not live virus, although some previous studies have shown a correlation between higher viral RNA levels and the ability to culture live virus.

They said their findings could mean that young children, who often have mild or asymptomatic illness, spread the virus as much as other age-groups. This mode of transmission may have been underrecognized due to the rapid closure of schools and daycare facilities earlier in the pandemic, which prevented large studies of schools as a conduit of community spread.

"Behavioral habits of young children and close quarters in school and day care settings raise concern for SARS-CoV-2 amplification in this population as public health restrictions are eased," they wrote. "In addition to public health implications, this population will be important for targeting immunization efforts as SARS-CoV-2 vaccines become available."
Jul 30 JAMA Pediatr research letter

Ebola infects 3 more in DRC Equateur outbreak, 72 total, with 31 deaths

Three more Ebola cases have been confirmed in the Democratic Republic of the Congo (DRC) Equateur province Ebola outbreak, raising the total to 72, the World Health Organization (WHO) African regional office said on Twitter today.

The fatality count declined by 1, bringing that total to 31.

The WHO has said the rising incidence and geographic spread is concerning, as is the number of confirmed cases that remain in the community or have been lost to follow-up, factors that raise the risk of further spread.

The outbreak, the DRC's 11th, is occurring in the same province in the country's northwest region, where an outbreak occurred in 2018 that sickened 54 people, 33 of them fatally.
Jul 31 WHO African regional office tweet

Guinea reports first vaccine-derived polio cases; 3 countries report more

Four countries reported more vaccine-derived polio cases, including the first from Guinea, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

In the Middle East, Pakistan reported two more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, one each from Punjab and Sindh provinces, raising the total for the year to 50.

In Africa, Chad reported four more cVDPV2 cases, three from Logone Oriental province and one from Logone Occidental, raising the total for 2020 to 40 from two separate outbreaks.

The DRC reported two more cVDPV2 cases, one each from Kongo Central and Kwilu provinces, raising its total this year to 20. And Guinea reported eight cVDPV2 cases, its first such detections. All were from Kankan region in the eastern part of the country.
Jul 30 GPEI weekly report

Hawaii probes exposure source in H3N2v flu case

Health officials in Hawaii have reported a variant H3N2 (H3N2v) infection in a child younger than 18, the US Centers for Disease Control and Prevention (CDC) said today in its weekly flu update. The patient was not hospitalized and has recovered.

In the past, H3N2v cases have been linked to swine exposure at agricultural fairs in the summer, but so far, no exposure to swine has been reported in Hawaii's patient, and an investigation into the source is under way.

The CDC said the H3N2v case is the first to be reported in the United States since 2018. A large H3N2v outbreak occurred in 2011 and 2012 in the United States, mostly in children exposed to pigs.
Jul 31 CDC FluView report

Food Outbreak Scan for Jul 31, 2020

News brief

Canada finds imported red onion link to Salmonella Newport outbreak

Red onions imported from the United States are the likely source of a Salmonella Newport outbreak in Canada that has a genetic fingerprint similar to illnesses reported in the US outbreak.

A rapidly growing outbreak in the United States was first announced in early July, though investigations hadn't uncovered a source. Last week, the US Centers for Disease Control and Prevention (CDC) said 212 cases had been reported from 23 states. At the time, the Public Health Agency of Canada (PHAC) reported 59 cases from five provinces and noted that it was working with the CDC to identify a possible common source.

The PHAC said many of the sick patients reported eating red onions before getting sick, and a traceback investigation pointed to contaminated red onions imported from the United States and distributed in central and western Canada. It said more information is needed to determine the cause of contamination in the red onions, and it advised consumers to avoid eating red onions or products containing raw red onions from the United States.

So far, 114 Salmonella Newport illnesses from five provinces, mostly from British Columbia and Alberta, have been confirmed in Canada, an increase of 55 cases. People who got sick reported eating red onions at home, in restaurants, and in residential care settings.
Jul 30 PHAC update
Jul 27 CIDRAP News scan "CDC warns of growing Salmonella outbreak from unidentified source"

**CDC: 473 more Salmonella illnesses linked to backyard poultry**

In the last month, 473 more people have been sickened in the United States by Salmonella linked to contact with backyard poultry. A total of 938 people in 48 states are part of at least 15 multistate outbreaks tied to backyard birds, according to an update from the Centers for Disease Control and Prevention (CDC).

Also, four more serotypes have been added to the investigation: Braenderup, Muenchen, Thompson, and Typhimurium.

"The number of illnesses reported this year exceeds the number reported at the same time of the year in previous outbreaks linked to backyard flocks," the CDC said. "Stay healthy around your backyard flock by washing your hands, keeping your birds outside your house, and supervising young children around your flock."

Among people the CDC has information for, 151 people have been hospitalized, and one death has been recorded in Oklahoma. Approximately 28% of ill people are children younger than 5 years, the CDC said. Illnesses started on dates from Jan 14 to Jul 14. Ill people range in age from less than 1 year to 94 years, with a median age of 32.

In epidemiological interviews, 74% of ill people reported handling chicks and ducklings in the weeks preceding their illnesses. The birds came from a number of different hatcheries, stores, and websites.
Jul 29 CDC update

ASP Scan (Weekly) for Jul 31, 2020

News brief

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

Trial evaluates antibiotic combination for MRSA bacteremia, endocarditis

Originally published by CIDRAP News Jul 30

A randomized phase 3 trial found that the combination of daptomycin and fosfomycin provided higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis, but the difference did not reach statistical significance, Spanish researchers reported yesterday in Clinical Infectious Diseases.

The open-label superiority trial was conducted in 18 Spanish hospitals, with patients randomly assigned to receive either 10 milligrams (mg) of intravenous daptomycin per kilogram daily plus 2 grams of intravenous fosfomycin every 6 hours or 10 mg of daptomycin per kilogram daily. The primary endpoint was treatment success 6 weeks after the end of therapy. Secondary endpoints included microbiological failure, complicated bacteremia, and adverse events leading to treatment discontinuation.

Of the 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. The results showed that treatment success was achieved in 40 of 74 patients (54.1%) who received daptomycin plus fosfomycin and 34 of 81 patients (42.0%) who received fosfomycin alone (relative risk, 1.29; 95% confidence interval [CI], 0.93 to 1.8; P = 0.135). The final microbiologic evaluation found that daptomycin plus fosfomycin was associated with lower microbiologic failure than fosfomycin alone (0 vs 9 patients; P = 0.003) and lower complicated bacteremia (16.2% vs 32.1%; P = 0.022).

Adverse events leading to treatment discontinuation occurred in 13 of 74 (17.6%) of patients treated with daptomycin plus fosfomycin, compared with 4 of 81 patients (4.9%) treated with daptomycin alone (P = 0.018). The most frequent serious events were cardiac failure (4 cases) and hypokalemia (2 cases).

"In conclusion, daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance," the authors wrote. "Our results suggest that this antibiotic combination could be more effective in younger patients and those with more severe disease."
Jul 29 Clin Infect Dis abstract

COVID-19 study identifies phases of antibiotic prescribing

Originally published by CIDRAP News Jul 30

An analysis of patients admitted to a Spanish hospital for COVID-19 has identified two specific phases of antibiotic use, Spanish researchers reported today in Infection Control & Hospital Epidemiology.

The before-and-after cross-sectional study compared antibiotic prescribing data at the hospital from two periods: Jan 1 to Apr 30, 2019 (pre-COVID) and Jan 1 to Apr 30, 2020 (COVID). The COVID period saw more than 1,293 admissions for COVID-19 and 317% increase in critical care bed usage.

The analysis found that antibiotic use was similar in January and February 2019 and 2020 but increased significantly in March and April 2020 compared with the pre-COVID period, rising from 73.3 defined daily doses (DDDs) per 100 patient-days in March 2019 to 87.8 DDDs/100 patient-days in March 2020 and from 69.8 DDDs/100 patient-days in April 2019 to 93.2 DDDs/100 patient-days in April 2020.

The researchers also observed that during the first COVID-19 peak in March, use of amoxicillin/clavulanate trended upward rapidly, consistent with the hospital's recommendations for empiric antibiotic prescribing in COVID-19 patients. But during the second peak, there was increased use of broader-spectrum antibiotics and reduced use of amoxicillin-clavulanate. This corresponded with increased admission to critical care for patients with severe illness, "probably corresponding with an increase in nosocomial infection," the authors wrote.

The authors said the findings suggest antimicrobial stewardship principles should be standardized to provide the safest antibiotic therapy for COVID-19—a recommendation that has also been made by the World Health Organization (WHO) to ensure that antibiotics aren't being used inappropriately during the pandemic.

"In conclusion, our data supports the WHO concern about inappropriate use of antibiotics during the pandemic, and the recent change in its guidelines discouraging empirical antibiotics in COVID-19," they wrote. "Long-term studies are needed to assess the impact of the increase in antibiotic usage during COVID-19 pandemic on the hospital flora, and in turn, how this might affect future nosocomial infection and antimicrobial resistance trends worldwide."
Jul 30 Infect Control Hosp Epidemiol abstract

New community-acquired pneumonia antibiotic approved in Europe

Originally published by CIDRAP News Jul 30

Nabriva Therapeutics, of Dublin, announced this week that the European Commission has approved lefamulin for the treatment of community-acquired pneumonia (CAP) following a review by the European Medicines Agency (EMA).

The approval of lefamulin, which is sold under the brand name Xenleta, was based on efficacy data from two phase 3 trials—LEAP 1 and LEAP 2—that found the antibiotic was non-inferior to standard-of-care moxifloxacin in the treatment of adults with CAP and was generally well-tolerated. The drug has a novel mechanism of action that company officials say has a low propensity for the development of resistance.

"The marketing authorization of Xenleta provides an important step forward for patients with CAP, offering the first new antibiotic class approved by the EMA in decades," Nabriva CEO Ted Schroeder said in a company press release. "We believe the approval of Xenleta is a significant improvement in the fight against antimicrobial resistance and we are excited to bring this critically needed medicine to patients throughout Europe."

Approximately 3 or 4 million cases of pneumonia occur in the European Union annually.

Lefamulin was approved by the US Food and Drug Administration for treatment of adult CAP patients in August 2019.
Jul 28 Nabriva press release

Collaborative AMR research projects announced involving India, Fiji

Originally published by CIDRAP News Jul 28

The United Kingdom and India today announced a new collaboration on five new research projects to tackle antimicrobial resistance (AMR).

The projects, scheduled to begin in September, aim to develop a better understanding of how waste released from antibiotic manufacturing affects microbial systems and contributes to the spread of AMR in the environment. The British and Indian governments are each contributing £4 million (US $5.2 million) to the projects.

India is one of the world's leading manufacturers of antibiotics, along with China. Scientists and researchers have long worried that the release of inadequately treated wastewater from antibiotic manufacturing plants in India is contributing to the spread of AMR.

"Today's announcement is another demonstration of our excellent research relationship and will strengthen the important fight against antimicrobial resistance," Sir Philip Barton, the United Kingdom's High Commissioner to India, said in a press release.
Jul 28 UK.gov press release

In other international AMR research news, Australia's Commonwealth Scientific and Industrial Research Organization (CSIRO) announced the launch of a 3-year research project with the government of Fiji to monitor antibiotic use and AMR in humans, animals, and the environment.

Researchers from the two countries will collect data from hospitals, farms, and the environment in Fiji to identify AMR trends and hot spots. The project also aims to build local laboratory and research capabilities in Fiji.

"This research has the potential to be leveraged across the Pacific region, including Australia," CSIRO biosecurity research director Paul De Barro, PhD, said in a press release. "The opportunity for Australia being part of this collaborative project means we can take a proactive and coordinated approach to tackling antimicrobial resistance."
Jul 28 CSIRO press release