News Scan for Sep 28, 2020

Southern Hemisphere flu vaccine strains
New antibiotic for hospital pneumonia
Durable fecal transplant effectiveness
CDC ends Cyclospora probe

WHO experts recommend strains for Southern Hemisphere 2021 flu vaccine

World Health Organization (WHO) flu vaccine advisors recently met to recommend the strains to include in vaccines for the Southern Hemisphere's 2021 season, which—when compared with the Northern Hemisphere upcoming-season version—swaps out the 2009 H1N1 strain.

For the egg-based H1N1 vaccine component, the experts recommend replacing the A/Guangdong-Maonan/SWL1536/2019-like virus with an A/Victoria/2570/2019-like virus. And for the cell-based H1N1 vaccine component, they recommend replacing the A/Hawaii/70/2019-like virus with an A/Wisconsin/588/2019-like virus.

When compared with the Southern Hemisphere's current-season vaccine, the group's recommendation swaps out both the 2009 H1N1 strains and the H3N2 strain for egg-based vaccines, switching from the A/South Australia/34/2019-like virus to an A/Hong Kong/2671/2019-like virus.

Recommendations for the other strains for both trivalent and quadrivalent formulations are the same as for the Northern Hemisphere.

The WHO noted that the COVID-19 pandemic has disrupted flu surveillance, and the Southern Hemisphere hasn't yet started its 2020 flu season. With that in mind, the  amount of genetic and antigenic data were significantly lower than the advisory group typically has when making its flu vaccine virus recommendations.
Sep 25 WHO recommendations
Sep 25 WHO Q and A


FDA approves cefiderocol for hospital-acquired, ventilator-associated pneumonia

Japanese drug maker Shionogi, with US headquarters in Florham Park, New Jersey, announced today that the Food and Drug Administration (FDA) has approved the company's supplemental New Drug Application for cefiderocol.

The FDA's approval means that cefiderocol, sold under the brand name Fetroja, can be used to treat patients who have hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) caused by gram-negative pathogens. The antibiotic was initially approved for treatment of complicated urinary tract infections.

The expanded indication is based on the results of a phase 3 APEKS-NP trial, which showed that cefiderocol was non-inferior to meropenem for treating HABP/VABP patients.

"Nosocomial pneumonia is one of the most common hospital-acquired infections and a rising number are caused by difficult-to-treat, multidrug-resistant pathogens, which can be a deadly threat for patients," lead trial investigator Richard Wunderink, MD, of Northwestern University's Feinberg School of Medicine, said in a company press release. "The results from the APEKS-NP study show that cefiderocol is a much-needed additional option for the treatment of patients with HABP and VABP due to multidrug-resistant gram-negative bacteria."

Cefiderocol is a cephalosporin antibiotic with a novel mechanism of penetrating the tough outer membrane of gram-negative bacteria with and the ability to overcome resistance mechanisms used by gram-negative pathogens to evade antibiotics.
Sep 28 Shionogi press release


Fecal transplant provides long-term C diff protection despite exposures

Mayo Clinic researchers report that a fecal microbiota transplant (FMT) was 78% effective at preventing Clostridioides difficile infection (CDI) recurrence at 1 year despite subsequent exposure to the toxoid in 460 FMT patients.

The retrospective study, published late last week in Clinical Infectious Diseases, found that 76.8% of adult patients were exposed to the healthcare system after FMT, and 78.1% of 374 patients with risk factor exposure had a durable response at 1 year.

The most common underlying diseases in the patients were inflammatory bowel disease (21.9%), chronic liver disease (12.8%), cancer (11.7%), and chronic kidney disease (3.9%). In total, 31.3% of patients received antibiotics for their infections, while 21.7% received acid suppressants. In multivariable analysis, use of antibiotics was independently tied to a less durable response (hazard ratio, 0.27).

The authors concluded, "Majority of patients had a durable response to FMT despite exposure to CDI risk factors." They called for larger studies to identify predictors of durable response in patients who have and have not taken antibiotics.

CDI, the leading cause of diarrhea in hospital patients is one of the most common infections associated with exposure to the healthcare system. FMT, which involves the transfer of stool from a healthy donor into the colon of an infected patient, is reserved for patients who have had several CDI bouts that didn't respond to antibiotic treatment.
Sep 25 Clin Infect Dis abstract


CDC closes investigation into Cyclospora outbreak that sickened 701

The US Centers for Disease Control and Prevention (CDC) announced late last week that it has ended its investigation into the 701-case, 14-state outbreak of Cyclospora tied to bagged salad mixes from the Fresh Express production facility in Streamwood, Illinois.

Outbreak cases were reported from May 11 to Jul 24. Thirty-eight people (5%) were hospitalized, but no deaths were reported. The numbers reflect 11 new cases since the CDC's previous update on Aug 14.

On Jun 27, Fresh Express issued a recall on the salads containing iceberg lettuce, red cabbage, or carrots produced at its Streamwood facility. The plant had also produced private-label bagged salads for sale at Aldi, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart.

According to an PDA update, the Cyclospora is believed—but not proven—to have originated in an irrigation canal that had supplied water to a farm in Port St. Lucie, Florida.

Cyclospora cayetanensis is a microscopic parasite that can cause diarrhea, loss of appetite, and other gastrointestinal symptoms.
Sep 24 CDC update
Sep 25 FDA update
Aug 17 CIDRAP News scan on previous update

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