News Scan for May 20, 2021

Pneumococcal vaccine and kids' antibiotics
Expert panel on zoonotic diseases
CWD expands in Virginia
Final ground turkey Salmonella update

Pneumococcal vaccines may affect use of kids' antibiotics

Antibiotic prescribing for young children in Israel sharply declined following implementation of pneumococcal conjugate vaccine (PCV), Israeli researchers reported today in Clinical Infectious Diseases.

Using data from the country's largest health maintenance organization, the researchers conducted an interrupted time series analysis of dispensed antibiotic prescription (DAP) rates for Israeli children under the age of 5 from July 2005 through June 2018. The 7-valent vaccine (PCV7) was introduced into Israel's National Immunization Plan (NIP) in 2009, and the 13-valent vaccine (PCV13) has gradually replaced it since 2010. Since then, a marked reduction in respiratory tract infections (RTIs) in Israeli children has been observed, but the impact on antibiotic prescribing has not been investigated.

The study also included a comparison of the DAP rate between Jewish and Bedouin populations in southern Israel, as prior to PCV implementation, pneumococcal diseases and RTIs were more prevalent among Bedouin children. PCV uptake was similar in Jewish and Bedouin children.

Following the implementation of PCV7/PCV13, DAP rates for children under 5 abruptly and significantly declined, largely driven by a decrease in amoxicillin and amoxicillin-clavulanate prescriptions, which prior to PCV implementation accounted for 75% of pediatric DAPs. The decline continued and stabilized at a reduced level within 5 years.  Children younger than 2 and Bedouin ethnicity were significantly associated with higher pre-PCV DAP rates, but also with a faster and greater decline post-PCV, achieving near elimination of gaps between ages and ethnic groups.

Among all children under 5, the annual mean reduction (per 1,000 child-years) of DAPs ranged between an absolute incidence rate ratio of 344.7 and a relative incidence rate ratio of 110.4. For amoxicillin/amoxicillin-clavulanate, the respective reductions were 300.2 and 142.3. Azithromycin was the only drug with increasing trends following PCV implementation.

"The overall DAP reduction rate translates into reduced pressure on the entire body microbiota," the study authors wrote. "However, consumption still remains high. Therefore, although PCV implementation is an important tool against antimicrobial resistance, efforts to develop other tools such as improvement of stewardship programs must be continued."
May 20 Clin Infect Dis abstract


New expert panel to advise global health leaders on zoonotic disease

Four international organizations today announced the formation of a new expert panel to improve understanding, and stop the emergence and spread, of zoonotic diseases.

Operating under the One Health approach, which recognizes the links between the health of people, animals, and the environment, the One Health High-Level Expert Panel will advise the United Nations Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health, the United Nations Environment Programme, and the World Health Organization (WHO) on the development of a long-term action plan to avert outbreaks of infectious diseases that emerge in animals.

According to a WHO press release, the ultimate aim of the panel will be to develop evidence-based recommendations for global, regional, national, and local action to help prevent zoonotic disease outbreaks that could trigger pandemics. Among the first steps will be conducting systematic analyses of research around factors that lead to disease transmission between animals and humans, developing risk assessment and surveillance frameworks, and identifying good practices for preventing zoonotic disease outbreaks.

The panel plans to focus on a few critical areas that could contribute to the emergence of diseases similar to H5N1 avian flu, Middle East respiratory syndrome (MERS), Ebola, and Zika, including food production and distribution, urbanization and infrastructure development, international travel and trade, and activities that affect biodiversity loss and climate change.

"This panel will contribute to advancing the One Health agenda, by helping to better understand the root causes of disease emergence and spread, and informing decision-makers to prevent long-term public health risks," FAO Director General Qu Dongyu said at press conference announcing the panel. "I encourage it to be a shining example of silo-breaking, systems thinking and open dialogue."
May 20 WHO press release


CWD detection in Virginia deer prompts new management zone

Wildlife officials in Virginia last week announced that routine surveillance turned up chronic wasting disease (CWD) in a 2-year-old deer that a hunter shot in Montgomery County and took to a taxidermist. The finding is significant, given that the harvest location is 160 miles from the closest earlier detection in the state.

In a press release, the Virginia Department of Wildlife Resources (VDWR) said the deer was brought to the taxidermist in November 2020, which assisted with obtaining a sample for testing as part of regular surveillance during the hunting season. The hunter did not notice any disease signs, and the deer appeared to be in good condition. So far, there is no known link to earlier detections.

Because of the distance from earlier detections, officials conducted an extensive investigation to confirm the harvest location. Based on the Montgomery County detection, officials created a new disease management area, marking the third for the state. The new areas includes Floyd, Montgomery, and Pulaski counties, which are now under new regulatory actions related to deer, including movement of carcasses and parts containing brain or spinal cord tissue. Further regulatory changes will be proposed next week at a wildlife resources board meeting.

The VDWR said it will expand testing in the new management area and in certain surrounding counties during the 2021-22 hunting season. Officials have been monitoring CWD prevalence in Virginia deer for more than 10 years. Since 2009, 109 of Virginia's deer have tested positive for CWD. During the current season, the Montgomery County sample was the only one of about 2,600 taxidermist-submitted samples that tested positive for CWD.

CWD, a fatal prion disease that affects deer, elk, reindeer, and moose, has been confirmed in 26 US states and three Canadian provinces but has not been reported in people.
May 12 VDWR statement


CDC ends probe of multistate ground turkey-linked Salmonella outbreak

The US Centers for Disease Control and Prevention (CDC) has wrapped up its investigation of a Salmonella Hadar outbreak tied to ground turkey, which sickened at least 33 people in 14 states.

The final outbreak notice, posted on May 18, reflects five more cases and two more affected states since the CDC's last update on Apr 12. The most recent illness-onset date was Apr 22. Based on information from 22 cases, 4 people were hospitalized, and no deaths were reported.

Sampling during an investigation by the US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) yielded the outbreak strain in an unopened package of ground turkey from a sick person's freezer. The outbreak strain was also identified in routine turkey samples collected by FSIS and state officials from multiple companies. On Apr 10, the USDA issued a public health notice for about 211,000 pounds of ground turkey products produced by Plainville Brands, of New Oxford, Pennsylvania, which were produced in December and distributed nationally. The trace-back investigation had linked the brand to the sample from the patient's freezer that tested positive.

Whole-genome sequencing revealed that the strain that sickened the patients was resistant to two antibiotics: streptomycin and tetracycline, the CDC said. It added that most people recover without antibiotic treatment and that the resistance wouldn't likely affect treatment choice.

Ground turkey products have been linked to several Salmonella outbreaks in the past, and health officials urge consumers to take precautions when handling and cooking raw turkey.
May 18 CDC outbreak notice
Apr 12 CIDRAP news scan

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