News Scan for Dec 13, 2021

News brief

FDA unveils plan to improve foodborne outbreak response

The US Food and Drug Administration (FDA) last week released its Foodborne Outbreak Response Improvement Plan, which is designed to boost the speed, effectiveness, coordination, and communication of events for both the FDA and its investigation partners.

The plan included input from the US Department of Agriculture, the US Centers for Disease Control and Prevention, state health officials, and other stakeholders.

In crafting the new plan, the FDA also used input from an independent assessment on its current performance that it sought from the University of Minnesota School of Public Health. The FDA published the University of Minnesota's assessment, which the FDA had contracted. Led by Craig Hedberg, PhD, professor and co-director of the Minnesota Integrated Food Safety Center of Excellence, the team interviewed stakeholders, analyzed the FDA's current approach, and made a set of recommendations.

The FDA said the new plan has four priority areas, which it said will have the most impact. They include employing tech-enabled product trace-back, focusing on root-cause investigations, strengthening analysis and sharing of outbreak data, and making operational improvements.
Dec 9 FDA announcement
Dec 9 University of Minnesota
independent report


10% of Chinese COVID patients may have had incubations of 14+ days

A modeling study of COVID-19 patients in China in 2020 published late last week in BMC Public Health estimates that 10% had incubation periods longer than 14 days. The incubation period is the time between infection and symptom onset or diagnosis.

A team led by researchers at Fudan University in Shanghai determined that, of 11,425 patients who tested positive from COVID-19 from January to August 2020, 268 (10.2%) had incubation periods longer than 14 days.

These patients were at lower risk for severe disease (adjusted odds ratio [aOR], 0.39) and were less likely to transmit the virus to others (aOR, 50.4) than those with shorter incubation periods.

Most patients with prolonged incubation times were older than 60 years and were exposed to the virus in public places (median, 7.1 days) or workplaces (6.7 days) than at home (5.5 days). Imported COVID-19 cases also had longer incubation times than local cases (6.9 vs 6.4 days).

Patients 60 years and older and those diagnosed as having diabetes, however, were at greater risk for severe illness, and the former group was also more likely than those 45 and younger to spread the virus.

Patients whose time from symptom onset to hospital release was longer than 3 weeks had a shorter incubation than those with an interval of less than 3 weeks (median incubation, 5.6 vs 7.3 days).

The study authors noted that most previous studies had estimated COVID-19 incubation periods at 2 to 12 days. In December 2020, the US Centers for Disease Control and Prevention shortened the recommended quarantine after COVID-19 exposure from 14 to 7 to 10 days.

"Isolation and medical quarantine policies of 2 weeks currently in place may miss the patients with longer incubation period," the authors wrote.
Dec 9 BMC Public Health study


H5N6 avian flu sickens 1 more person in China

China reported another human H5N6 avian flu infection, marking its 28th case of the year, according to a Dec 11 statement from Hong Kong's Centre for Health Protection (CHP).

The patient is a 68-year-old man from the city of Huizhou in Guangdong province in southern China. He kept poultry at his home. His symptoms began on Dec 3, and he was admitted to the hospital on Dec 7, where he is in critical condition.

Since 2014, China has reported 53 human H5N6 cases, which includes 10 deaths. Though H5N6 cases are rare, the country has reported an uptick this year. The virus has been detected in birds in four Asian countries, though China and Laos are the only nations that have reported human infections.
Dec 11 CHP statement

Stewardship / Resistance Scan for Dec 13, 2021

News brief

UK study shows drop in antibiotics for respiratory infections during COVID

Antibiotic prescribing for respiratory tract infections (RTIs) fell in England during the first year of the pandemic, researchers reported today in the Journal of Antimicrobial Chemotherapy.

To assess changes in antibiotic prescribing for RTIs for 2020-2021, researchers with England's National Institute for Health Research extracted data from two large UK databases for primary and secondary care. They measured RTI antibiotic prescribing in prescription items per 1,000 population from January 2014 through February 2021 for primary care, and in defined daily doses per 1,000 population per day from January 2016 through February 2021 for secondary care. Previous research has shown that antibiotic prescribing in primary care in England fell by 14% from 2015 through 2019.

The analysis found that during 2020-2021, antibiotic prescriptions for RTIs in primary care fell an additional 12.4% per season compared with the pre-COVID period, with a sharp drop during the winter—a season that typically sees the highest level of antibiotic prescribing for RTIs. In winter 2020-2021, during the pandemic, RTI antibiotic prescriptions were cut nearly in half compared with the 2019-2020 winter. When the researchers combined antibiotic prescribing for RTIs in primary care with that of hospital emergency departments to account for possible shifts in health-seeking behaviors, the trend was similar to that primary care prescribing alone.

The study authors say COVID-19 restrictions, drastic reductions in person-to-person contact, and avoidance of healthcare settings likely all played a role in reduced RTI prescribing. They also note that the findings highlight the need for better rapid diagnostics to further reduce unnecessary antibiotics for RTIs.

"Rapid diagnostics in the community, such as lateral flow tests, have been effective in detecting SARS-CoV-2 and are quicker and cheaper than PCR tests," they write. "Diagnostics to differentiate viral and bacterial aetiologies could spare unnecessary antibacterial use and reduce GP [general practitioner] attendance in future winters."
Dec 13 J Antimicrob Chemother study


Resistance genes, multidrug resistance rising in E coli from food animals

In another study published today in the same journal, a team of Swiss researchers found that the prevalence of antimicrobial resistance genes (ARGs) and multidrug resistance (MDR) in Escherichia coli obtained from food-producing animals has been rising since 1980.

For the study, researchers with Switzerland's Institute of Integrative Biology and Institute for Environmental Decisions retrieved 7,632 E coli genomes from poultry, cattle, and swine from public databases and screened them for ARGs. They then compared resistance trends inferred from the genomic data with trends reported by phenotypic surveillance systems in the United States and Europe. The genomes originated predominantly from the United States (63.4%), followed by Europe (17.3%), Asia (13.2%), Africa (1.7%), Central and South America (1.7%), and Oceania (1.2%).

The analysis showed an increase in multidrug resistance (MDR) over time. In 1980, the E coli genomes carried, on average, genes conferring resistance to 1.69 antimicrobial classes in swine, 1.41 in swine, and 1 in cattle. By 2018, MDR rates increased 1.6 times, with E coli genomes carrying an average of genes conferring resistance to 2.65 antimicrobial classes in swine, 2.22 in poultry, and 1.58 in cattle.

The highest resistance levels were observed for tetracyclines (42.2% to 69.1%), penicillins (19.4% to 47.5%), and streptomycin (28.6% to 56.6%). The trends were consistent with resistance trends reported from phenotypic international surveillance programs.

Among the specific ARGs in which an increase was observed was the extended-spectrum cephalosporin gene blacmy-2, which is noteworthy because extended-spectrum beta-lactam antibiotics are not approved for use as growth promoters in Europe or the United States. The study authors say the presence of this ARG could be linked to use of these antimicrobials in food-producing animals prior to their ban, or to co-selection with other resistance genes.

"Furthermore, the increase in blaCMY-2 is concerning as this gene has been commonly identified in plasmids that might facilitate its dissemination in food animals," they write.
Dec 13 J Antimicrob Chemother abstract

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