News Scan for Nov 11, 2020

Community antibiotic use in LMICs
E coli outbreak and romaine recall
Few reports of flu activity
Avian flu in 4 countries

Study finds frequent use of key antibiotics in 4 low-resource nations

A study of community-level antibiotic use in patients in four low- and middle-income countries (LMICs) found frequent use of broad-spectrum antibiotics considered at risk of becoming ineffective owing to rising antibiotic resistance, an international team of researchers reported today in Clinical Microbiology and Infection.

As part of an effort to optimize antibiotic use in LMICs, the Neglected Infectious Diseases DIAGnosis (NIDIAG)-Fever study investigated the causes of infections in patients with persistent fever who were admitted to hospitals in Cambodia, the Democratic Republic of the Congo (DRC), Sudan, and Nepal.

The researchers described the prevalence and choice of antibiotics before and at study inclusion, applying the World Health Organization's (WHO's) Access/Watch/Reserve (AWaRe) classification, which was introduced in 2017 to provide an indirect indication of the appropriateness of antibiotic use at national and global levels. They also looked at the route of administration and analyzed factors associated with prior antibiotic use.

Of 1,939 people included in the study, 428 (22.1%) reported prior use of one or more antibiotics, ranging from 6.3% in Cambodia (24 of 382) to 35.5% in Nepal (207/583). Of 545 antibiotics, the most frequently used were Watch antibiotics, which accounted for 64.4% (351/545) of antibiotics used, ranging from 23.6% in the DRC to 82.1% in Nepal. Parenteral administration ranged from 5.9% to 69.6% between study sites. Antibiotic use was most frequent among patients aged 5 to 17 years (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.19 to 1.71) and men (RR, 1.29; 95% CI, 1.09 to 1.53).

No association was found between antibiotic use and specific symptoms. Of 555 antibiotics started before study inclusion, 49.5% (275) were discontinued at study inclusion.

"These findings emphasize the need to monitor and optimize community- or primary healthcare-level antibiotic use in LMICs," the authors wrote.
Nov 11 Clin Microbiol Infect abstract


Romaine lettuce possible source for third recent US E coli outbreak

In the third multistate Escherichia coli O157:H7 outbreak reported this fall—this one affecting 12 people—Tanimura & Antle, of Salinas, California, is recalling its packaged single-head romaine lettuce that was packaged Oct 15 and 16, the Centers for Disease Control and Prevention (CDC) said yesterday.

Among the 12 E coli infections across six states, 5 patients have been hospitalized. Illinois has 4 cases, and Michigan, California, and Pennsylvania each have 2. Illness-onset dates range from Sep 2 to Oct 14.

A routine inspection by the Michigan Department of Rural and Agriculture Development found the same strain of E coli in the romaine that was identified among ill people associated with the outbreak, but further investigation needs to be done to show a conclusive link. Of the 11 ill people who have been interviewed, all say they ate leafy greens, including romaine lettuce (5), spinach (5), iceberg lettuce (3), and red leaf lettuce (3).

For now, the CDC recommends not to eat, sell, or serve any of Tanimura & Antle's recalled, packaged single-head romaine lettuce, which has the UPC number 0-27918-20314-9 and the produce traceability initiative sticker 571280289SRS1 and 571280290SRS1.
Nov 10 CDC outbreak report
Nov 6 Food and Drug Administration recall notice


Flu at low global levels, with sporadic or low activity in some countries

In its latest global flu update, the WHO said levels are still much lower than expected for this time of year, though some regions and countries are reporting sporadic or low-level activity.

The report covers roughly the last half of October and includes the caveat that flu activity and reporting might be influenced by COVID-19 measures and surveillance. In Europe, sporadic flu detections were reported, including in two French patients who were hospitalized after returning from West Africa.

In Africa, flu activity rose in Ivory Coast, with detections reported in Niger and Kenya.

Elsewhere, in Asia, China's flulike illness activity increased in the south to levels higher than reported for this time during the previous three seasons. In Southeast Asia, flu declined in Cambodia, but detections—mainly H3N2—continued in Laos. Elsewhere in Asia, Bangladesh and India reported low levels of activity.

In the Americas, Caribbean and Central American countries reported sporadic flu cases. In the United States, flu levels remained below the national baseline for all groups, except for children 0 to 4 years old.

Globally, of about 94,000 respiratory specimens tested at WHO-affiliated labs, only 140 were positive for flu. Influenza A made up 57.1% of the viruses, and of subtyped influenza A samples, 94.6% were H3N2.
Nov 9 WHO global flu update


Three nations note H5N8 avian flu outbreaks; Netherlands finds H5N1 reassortant

In the latest highly pathogenic avian flu developments, three European countries reported more detections in wild birds, including a United Kingdom report of a second outbreak in poultry and a Netherlands detection of an H5N1 reassortant, according to official reports and notifications from the World Organization for Animal Health (OIE).

The UK's Department for Environment, Food, and Rural Affairs (DEFRA) said today that H5N8, with a pathogenicity still to be determined, has been detected in broiler chickens at a farm near Leominster in Herefordshire. It also reported new highly pathogenic H5N8 detections in wild geese in Gloucestershire and swans in Devon and undetermined-pathogenicity H5N8 in a wild goose in Dorset.

The Netherlands reported four outbreaks in wild birds involving a highly pathogenic H5N1 reassortant that contains a hemagglutinin nearly identical to recent H5N8 isolates in wild birds, with the other genes from low-pathogenic avian influenza. The country also reported 19 more H5N8 outbreaks in wild birds, mostly from North Holland and Friesland provinces.

Meanwhile, in separate reports, Germany reported 42 more H5N8 outbreaks in wild birds from Schleswig-Holstein and Mecklenburg-Vorpommern states and 1 more H5N5 outbreak from Mecklenburg-Vorpommern state. It also reported an H5N8 outbreak in backyard birds in Schleswig-Holstein state.

Elsewhere, Japan reported a second H5N8 outbreak in poultry in Kagawa prefecture. The event at a layer farm began on Nov 7, killing 24 of 48,000 birds. The rest were culled to curb the spread of the virus.
Nov 11 DEFRA report
Nov 7 OIE report on H5N1 in Dutch wild birds
Nov 7 OIE report on H5N8 in Dutch wild birds
Nov 7 OIE reports on H5N8 in Schleswig-Holstein and Mecklenburg-Vorpommern states
Nov 7 OIE report on H5N5 in Mecklenburg-Vorpommern state
Nov 7 OIE report on H5N8 in Schleswig-Holstein backyard birds
Nov 9 OIE report on H5N8 in Japan

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