News Scan for Mar 17, 2022

Hydrogen peroxide for C difficile
Avian flu in New Hampshire flock
Potential drug for Creutzfeldt-Jakob disease

Hydrogen peroxide contamination tied to less C difficile infection

Implementation of a touchless hydrogen peroxide decontamination system at an acute care hospital was associated with a significant reduction in Clostridioides difficile infection (CDI) rates over a 10-year period, researchers reported today in the American Journal of Infection Control.

The restrospective study compared rates of healthcare-associated CDI at an acute care hospital in Pennsylvania before and after implementation of the aerosolized hydrogen peroxide (aHP) system, a whole-room fogging unit that generates an aerosolized dry-mist fog that covers all surfaces exposed to C difficile spores. The aHP system was used in patient rooms in conjunction with standard bleach cleaning upon discharge or transfer of a CDI patient.

The first study period included 27 months before implementation of aHP (July 2009 to September 2011) and 33 months after implementation (April 2012 to December 2014). The researchers also examined the effects of continued aHP usage over the following 5 years (January 2015 to December 2019).

The before-and-after period showed a reduction in CDI rates from 4.6 per 10,000 patient-days to 2.7 per 10,000 patient-days—a 41% reduction. Over 5 years of continued aHP, CDI rates continue to decline consistently, to 1.4 per 10,000 patient-days. The standardized infection ratio fell from 0.77 in 2015 to 0.5 in 2019.

Although the study authors note they could not account for potential confounders such as hand hygiene compliance, antibiotic usage rates, patient demographics, and cleaning practices, they are confident the aHP system contributed to the decline in CDI rates at the hospital. They suggest future studies should include a large randomized trial of aHP, especially in high-risk environments such as oncology units.
Mar 17 Am J Infect Control abstract


High-path avian flu strikes New Hampshire flock

In ongoing highly pathogenic avian flu activity, federal officials today reported the first detection in a New Hampshire flock, raising the number of states reporting the virus in backyard birds or commercial poultry this year to 16.

In a statement, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Services (APHIS) said New Hampshire's outbreak involves a backyard flock in Rockingham County, which is located in the southeast corner of the state on the Atlantic shore. In earlier waterfowl sampling, 53 positives have been reported, mostly from Rockingham County.

In related developments, the USDA also listed a fourth outbreak in Maine, which, like the previous events, also involves backyard birds. The new outbreak struck a backyard holding that has 173 birds in York County, located in the southern tip of the state on the Atlantic coast.

So far in the United States this year, there have been 38 separate outbreaks in backyard bird or commercial poultry. The detections in poultry and wild birds involved the Eurasian H5N1 strain that has also spread to other parts of the world and has been confirmed in one human infection.
Mar 17 USDA statement on high-path avian flu in New Hampshire
USDA wild bird avian flu page
USDA poultry outbreak page


Experimental drug for Creutzfeldt-Jakob disease shows some promise

A potential treatment for the prion infection known as Creutzfeldt-Jakob disease (CJD), developed by UK scientists, has shown "very encouraging" early results in six patients at University College London Hospitals (UCLH), according to a study yesterday in The Lancet Neurology.

Researchers at the MRC Prion Unit at UCL developed a monoclonal antibody called PRN100 that was administered to six UCLH patients with CJD—four women and six men—from October 2018 to July 2019.

CJD is a rare, always-fatal disease that causes brain damage and for which there is no licensed treatment. Most patients die within a few months of diagnosis.

Disease progression in three patients who received the drug appeared to stabilize, the study authors said, and none experienced side effects. Unfortunately, however, all six still died from CJD.

The study authors conclude, "These findings justify the need for formal efficacy trials in patients with CJD at the earliest possible clinical stages and as prophylaxis in those at risk of prion disease."

Senior author John Collinge, MD, who directs the MRC Prion Unit at UCL and led the development of the PRN100 treatment, said in a UCL press release, "Drugs used to treat other diseases have been tried experimentally in treating CJD in the past, but none has had an impact on disease progression or mortality. This is the first time in the world a drug specifically designed to treat CJD has been used in humans, and the results are very encouraging.

"While the number of patients we treated was too small to determine whether the drug altered the course of the disease, this is nevertheless an important step forward in targeting prion infections."

In a commentary in the same journal, German neurologist Inga Zerr, MD, wrote, "These outcomes are very encouraging and long awaited but, in light of the limitations, such as the small number of patients included and the use of historical controls, these results must be considered preliminary."
Mar 16 Lancet Neurol study and commentary
Mar 17 University College London press release

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