Danish study supports shorter antibiotics course for pneumonia
A study of hospitalized pneumonia patients in Denmark found similar outcomes between short-course and prolonged-course antibiotic therapy, Danish researchers reported yesterday in Clinical Microbiology and Infection.
For the study, researchers with University of Copenhagen Hospital prospectively followed patients admitted to four hospitals with community-acquired pneumonia (CAP) from November 2017 through February 2019. They included patients who had achieved clinical stability within 3 days of treatment and measured outcomes among those treated—as decided by the attending physician—with 8 to 14 days of antibiotic therapy (prolonged-course) and those treated with 4 to 7 days of therapy (short-course). The primary outcome was post-treatment mortality within 30 days, and secondary outcomes included readmissions or new antibiotics.
The study cohort included 1,151 patients with a median age of 74, with an equal distribution of men and women. The median treatment duration was 6 days in the short-course group and 9 days in the prolonged-course group.
The 30-day post-treatment mortality was 3.36% (11/327) in the short-course group and 3.40% (28/824) in the prolonged-course group (adjusted odds ratio [aOR], 1.05; 95% confidence interval [CI], 0.38 to 1.88). Readmission occurred in 15.6% (42/269) of short-course patient vs 14.0% (102/727) of prolonged-course patients (aOR, 1.07; 95% CI, 0.75 to 1.69) and new prescription of antibiotics in 11.9% (32/269) vs 12.1% (88/727) (aOR, 0.99; 95% CI, 0.61 to 1.49).
"Our findings support the increasing evidence on the effectiveness of short-course therapy in patients hospitalised with CAP," the study authors wrote, citing recent randomized controlled trials (RCTs) that have found short antibiotic courses for CAP to be non-inferior to longer courses. "These results could serve as an important adjunct to RCTs by enabling their findings to be more applicable in routine clinical settings."
Aug 18 Clin Microbiol Infect study
WHO releases first Ebola therapy guidance
The World Health Organization (WHO) today issued its first guideline for Ebola therapeutics, which has a strong recommendation for using two monoclonal antibodies, mAb114 (Ebanga) and REGN-EB3 (Inmazeb).
In a statement, the WHO said clinical trials on the two drugs were conducted during outbreaks in the Democratic Republic of the Congo. It said the medication guidance complements earlier clinical advice on supportive care, which consists of fluid replacement and symptom treatment, and is known to significantly improve survival.
The WHO said the new guidance covers a range of issues, including tests to administer, pain management, nutrition, and coinfections.
Richard Kojan, MD, who cochairs the guideline development group and is president of the Alliance for International Medical Action, said in the statement that the therapeutic guide is a critical tool to fight Ebola. "It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs," he said. "From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible."
In clinical trials evaluating various treatments, the two drugs stood out as more effective than others that were evaluated. The WHO said it does not recommend ZMapp or remdesivir.
In 2020, the US Food and Drug Administration (FDA) approved both drugs for treating Zaire ebolavirus infection. mAb114 is made by Ridgeback Biotherapeutics, based in Miami, and REGN-EB3 is made by Regeneron, based in New York. Both drugs are given by intravenous infusion.
Aug 19 WHO statement
UNICEF to buy malaria vaccine; Valneva starts chikungunya vax approval
In developments regarding vaccine against mosquito-borne diseases, UNICEF this week announced a contract with GSK worth up to $170 million to produce malaria vaccine, and Valneva announced that it has started the rolling submission process for its candidate vaccine that targets chikungunya.
UNICEF said the contract with GSK is its first to supply malaria vaccine and will lead to the production of 18 million doses of RTS,S/AS01 (RTS,S) over the next 3 years. It said the vaccine has the potential to save thousands of lives every year. It added that in 2020, nearly 500,000 children died from malaria in Africa alone, translating to a rate of one child death per minute.
RTS,S took 35 years to develop, and in 2019, a pilot routine vaccination program was launched in three hard-hit countries: Ghana, Kenya, and Malawi. Information from the programs guided WHO recommendations in 2021 for widespread use. A few months later, Gavi, the Vaccine Alliance, provided malaria vaccine funding for eligible countries, which broadened use of the vaccine.
Aug 16 UNICEF statement
Valneva, a vaccine company based in France, yesterday said it started the rolling submission process in applying for FDA approval of its vaccine against chikungunya.
The company is applying for approval of the use of the vaccine in adults ages 18 and older. Clinical trials are under way in adolescents in Brazil that, if successful, could support expanding use in younger people in the future. It hopes to complete the licensing submission by the end of the year. The FDA had earlier granted the vaccine accelerated approval and breakthrough therapy designations.
The vaccine, called VLA1553, is a live attenuated single-dose vaccine. The chikungunya virus, spread by Aedes mosquitoes, has spread to 120 countries, where it has been known to fuel large outbreaks.
Aug 18 Valneva press release
More polio cases in Niger, Nigeria, and Yemen
Three countries reported more polio cases this week, two in Africa and one in the Middle East, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update. All involved circulating vaccine-derived poliovirus type 2 (cVDPV2).
In Africa, Niger reported two more cases, both from Dosso, raising its total for the year to 10. Also, Nigeria reported three more cases, all from Zamfara, bringing its 2022 total to 33.
Elsewhere, Yemen reported two cases, including one from Abyan and one from Ibb. So far this year, the country has reported 82 cases, well above the 66 it reported for all of 2021.
Aug 18 GPEI update
H1N2v flu case detected in Oregon
The Centers for Disease Control and Prevention (CDC) today reported a variant H1N2 (H1N2v) case in a patient from Oregon who is younger than 18, according to its latest FluView update.
Investigators did not find that the patient had any contact with swine or had attended agricultural fairs. No other respiratory illnesses were found in the individual's household contacts. The patient was not hospitalized and has recovered from his or her illness.
The case marks the nation's fourth variant flu case of the season. A few weeks ago, three H3N2v cases were found in people who attended the same agricultural fair in West Virginia, which involved contact with pigs or pig environments.
Aug 19 CDC FluView update
Sporadic high-path avian flu outbreaks persist in US poultry
Four states—Pennsylvania, Florida, California, and Washington—reported more highly pathogenic avian influenza outbreaks in poultry over the past week, according to the latest update from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).
Pennsylvania's outbreak occurred at a location housing 90 backyard birds in Northampton County. Also in the east, Florida reported its second outbreak, which involved a sentinel flock of 10 birds in Osceola County.
In the west, California reported an outbreak at a backyard facility in Butte County that had 1,700 birds. And Washington reported an event, also involving backyard birds, in a flock of 2 poultry in Walla Walla County.
The outbreaks are part of a small but steady stream of avian flu activity that has continued in poultry over the summer. Since the outbreaks began earlier this year, poultry losses have totaled 40.1 million birds across 39 states.
In related developments, APHIS recently reported 60 more H5N1 detections in wild birds, raising the total to 2,104. Many of the new outbreaks involved black vultures found dead in Florida. Other states reporting more detections include California, Alaska, Washington, and New Jersey.
USDA APHIS poultry outbreak page
USDA APHIS wild bird detection page