News Scan for Mar 19, 2021

News brief

Culling completed at Wisconsin farm where CWD-positive deer found

Animal health officials in Wisconsin announced yesterday that they have completed depopulation of a white-tail deer herd at a Burnett County breeding farm where chronic wasting disease (CWD) was found in a buck in October 2020.

In a statement, the Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) said none of the remaining 14 deer tested positive for the disease. The 5-acre farm was quarantined after the 2020 detection in a 4-year-old buck, and no live animals or carcasses were allowed to leave the property.

The farm owner will received indemnity though a federal program, and the facility will not be permitted to keep cervids for 5 years, during which fences must be maintained, along with routine inspections. Burnett County is in western Wisconsin, on the Minnesota border.

CWD is a fatal prion disease that affects deer, elk, reindeer, and moose, and has affected 26 US states and three Canadian provinces. No cases have yet been reported in people.
Mar 18 DATCP statement

 

Groups urge Congress to boost funding for AMR, antibiotic development

A coalition of more than 50 organizations is calling on Congress to boost US investments in efforts to combat antimicrobial resistance (AMR) and develop new antibiotics.

In a letter sent yesterday to members of the House of Representatives and the Senate, organizations representing public health professionals, clinicians, scientists, patients, pharmaceutical and diagnostics companies, and animal agriculture experts called for increased funding in Fiscal Year 2022 for the Centers for Disease Control and Prevention's efforts to address AMR, including $672 million for the Antibiotic Resistance Solutions Initiative, $100 million for the National Healthcare Safety Network, and $60 million for the Advanced Molecular Detection program.

The letters also recommend increased FY 2022 funding for AMR research at the National Institutes of Health, the Combating Antibiotic Resistant Bacteria program at the Food and Drug Administration, the Broad Spectrum Antimicrobials program at the Biomedical Advanced Research and Development Authority, and AMR research and initiatives within the US Department of Agriculture, Department of Defense, and Department of State.

"Addressing AMR is central to strengthening our preparedness for future public health emergencies, as patients with respiratory infections, serious wounds or burns, or other conditions requiring hospitalization are all at risk for secondary resistant infections," the groups wrote. "A deeper federal investment commensurate with the gravity and importance of AMR is urgently needed."
Mar 18 coalition letter

 

Global survey shows countries making strides in efforts to address AMR

The latest global survey conducted by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations, and the World Organization for Animal Health indicates countries are making progress on efforts to address AMR, but much work remains.

The annual Tripartite AMR country self-assessment survey, released today, shows that, compared with previous years, the number of countries that have reached nationwide implementation on several indicators has risen. Increases were observed in the number of countries with developed national action plans, countries with functional multisectoral working groups on AMR, and countries that have implemented nationwide infection prevention and control programs aligned with WHO guidelines.

A total of 136 of 194 WHO member states responded to the survey. Response rates were 11.8% lower this year because of the COVID-19 pandemic.

Analysis of data from 115 countries that have responded to the survey over the past 3 years also showed increases in the percentage of countries with nationwide AMR awareness programs and a rising number of countries that are conducting national monitoring of antibiotic consumption and surveillance activities for resistance.

Data analysis also found, however, that fewer than 50% of countries have government-funded AMR awareness campaigns, and that much of the progress is occurring in higher-income countries. While the number of countries with national monitoring systems for antibiotic consumption has increased, they account for just 54% of respondents.

"Addressing AMR solely in higher-income countries will not be enough to reduce the burden of AMR globally, especially since lower-income countries might bear the brunt of the economic and health consequences of unchecked AMR," the authors of the analysis wrote.
Mar 19 Tripartite AMR survey

 

More vaccine-derived polio cases reported in 3 countries

Three countries reported more polio cases over the past week, all involving circulating vaccine-derived poliovirus type 2 (cVDPV2), according to the latest update from the Global Polio Eradication Initiative (GPEI)

In the Middle East, Afghanistan reported 1 case, involving a patient from Kandahar, raising the 2021 total to 18.

Meanwhile, two African nations reported new cases. South Sudan reported 4 cVDPV2 cases in three states: Unity, Warrap, and Lakes. The country has now reported 51 such cases, all linked to Chad's ongoing outbreak. Also, Nigeria reported 3 cases, 2 in Sokoto state and 1 in Kebbei, marking the country's first cases of 2021, after reporting 8 such cases in 2020.
Mar 18 GPEI weekly update

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COVID-19 Scan for Mar 19, 2021

News brief

B117 variant COVID-19 strain has 67% increased death risk, study says

For every 3 people who would have died from the previous dominant strains of SARS-CoV-2, 5 will die if they are infected with the B117 variant of concern (VOC), according to a UK study yesterday in Eurosurveillance.

The researchers determined that B117 has a 67% increased risk of 28-day mortality and an absolute death risk that increased with age and comorbidities, which is in line with recent studies in Nature and BMJ.

The researchers analyzed 184,786 COVID-19 test results from Nov 16, 2020, to Jan 11, 2021, that assessed spike gene target failure (SGTF), an indicator for B117. Of these, 91,775 (49.7%) were B117 cases, which led to 419 deaths, or 48.3% of the 867 total COVID-19 deaths. Participants were followed through death, 7 days prior to vaccination, or Feb 5, whichever came first.

Throughout the study, B117 became the dominant strain, going from 1.2% of the UK cumulative total in week 1 to 31.5% by week 8. The researchers found that while the infected groups were demographically similar, people with B117 tended to be younger (0.9% above 80 years vs 1.6%) and healthier (2.9% with more than two comorbidities vs 3.8%).

The hazard risk of B117 was 67% greater than the previous strain (95% confidence interval [CI], 1.34 to 2.09), according to the data. This translates to a 24.3% and 14.7% death rate for males and females at least 85 years old with two or more comorbidities, respectively, versus 16.7% and 9.7% from previous strains. However, the absolute death is much smaller in those below 65 with no comorbidities for both males (0.14% vs 0.09%) and females (0.07% vs 0.05%).

The results suggest that age and comorbidity effects on B117's outcomes are collinear and similar to their effects on previous strains. Because of this, the researchers write that vaccine priorities do not have to change.
Mar 18 Euro Surveill study

 

CDC survey shows remote learning in pandemic strains children, parents

The Centers for Disease Control and Prevention (CDC) today published a survey that shows that American families have been strained by school closures during the COVID-19 pandemic and suffer high levels of stress when children are given online instruction.

The survey, conducted Oct 8 through Nov 13, 2020, included 1,290 respondents who have children ages 5 through 12 enrolled in public or private school: 45.7% reported that their child received virtual instruction, 30.9% in-person instruction, and 23.4% combined instruction.

"For 11 of 17 stress and well-being indicators concerning child mental health and physical activity and parental emotional distress, findings were worse for parents of children receiving virtual or combined instruction than were those for parents of children receiving in-person instruction," the CDC said.

Among parents with children in online school, 24.7% reported worsened mental or emotional health of children, compared with 15.9% of children learning in person. Children who attended online school also had significantly decreased physical activity (62.9% vs 52.1%) and time spent outside (58.0% vs 42.4%), when compared with children given in-person instruction.

Parents of children receiving virtual instruction were also more likely than parents of children receiving combined instruction to report experiencing emotional distress (54.0% vs 42.9%), report loss of work (42.7% vs 30.6%), and have a conflict between working and providing child care (14.6% vs 8.3%).

"These findings suggest that virtual instruction might present more risks than does in-person instruction related to child and parental mental and emotional health and some health-supporting behaviors, such as engaging in physical activity, with combined instruction falling between," the authors concluded.
Mar 19 MMWR
study

 

COVID-19 linked with preeclampsia, stillbirth, and more in pregnant women

Maternal COVID-19 infection is associated with pregnancy complications such as preeclampsia, preterm birth, and stillbirth, and the disease is particularly associated with conditions that risk maternal and neonatal death, according to a review of 42 studies.

The study, published today in CMAJ, used unadjusted data covering 438,548 pregnant women from studies published through Jan 29.

COVID-19 was associated with preeclampsia (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.03 to 1.73; I2= 31%; based on 23 studies), preterm birth (OR 1.82; 95% CI, 1.38 to 2.39; I2= 64%; 18 studies), and stillbirth (OR 2.11; 95% CI, 1.14 to 3.90; I2= 24%; 6 studies). COVID-19 was not associated with gestational diabetes, cesarean delivery, postpartum hemorrhage, or neonatal death, but some associations were found when comparing severity.

Compared with mild COVID, severe infection was tied to greater risk of most outcomes, notably with an OR of 4.16 for preeclampsia and 4.29 for preterm birth. It also showed an association with gestational diabetes (OR, 1.99; 95% CI, 1.09 to 3.64; I2= 14%; 5 studies), cesarean deliveries (OR, 2.58; 95% CI, 1.64 to 4.06; I2= 43%; 8 studies), and low birth weight (OR, 1.89; 95% CI, 1.14 to 3.12; I2= 0%; 2 studies). Similarly, symptomatic COVID was associated with a greater effect on preterm birth (OR, 2.29; I2= 57%) and cesarean delivery (OR, 1.57; I2= 1%) than asymptomatic COVID-19.

The findings differ from prior findings from case reports and case series, according to a CMAJ news release. "Our meta-analysis of recent good-quality cohort studies with comparative data does not align with these previous reviews, and provides clear evidence that symptomatic or severe COVID-19 is associated with a considerable risk of preeclampsia, preterm birth and low birth weight," the study authors write.

"Clinicians should be aware of these adverse outcomes when managing pregnancies in patients with COVID-19 and adopt effective strategies to prevent or reduce risks to patients and fetuses," the researchers add.
Mar 19 CMAJ study
Mar 19 CMAJ news release

ASP Scan (Weekly) for Mar 19, 2021

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Groups urge Congress to boost funding for AMR, antibiotic development

A coalition of more than 50 organizations is calling on Congress to boost US investments in efforts to combat antimicrobial resistance (AMR) and develop new antibiotics.

In a letter sent yesterday to members of the House of Representatives and the Senate, organizations representing public health professionals, clinicians, scientists, patients, pharmaceutical and diagnostics companies, and animal agriculture experts called for increased funding in Fiscal Year 2022 for the Centers for Disease Control and Prevention's (CDC's) efforts to address AMR, including $672 million for the Antibiotic Resistance Solutions Initiative, $100 million for the National Healthcare Safety Network, and $60 million for the Advanced Molecular Detection program.

The letters also recommend increased FY 2022 funding for AMR research at the National Institutes of Health, the Combating Antibiotic Resistant Bacteria program at the Food and Drug Administration (FDA), the Broad Spectrum Antimicrobials program at the Biomedical Advanced Research and Development Authority, and AMR research and initiatives within the US Department of Agriculture (USDA), Department of Defense, and Department of State.

"Addressing AMR is central to strengthening our preparedness for future public health emergencies, as patients with respiratory infections, serious wounds or burns, or other conditions requiring hospitalization are all at risk for secondary resistant infections," the groups wrote. "A deeper federal investment commensurate with the gravity and importance of AMR is urgently needed."
Mar 18 coalition letter

 

Global survey shows countries making strides in efforts to address AMR

The latest global survey conducted by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations, and the World Organization for Animal Health indicates countries are making progress on efforts to address AMR, but much work remains.

The annual Tripartite AMR country self-assessment survey, released today, shows that, compared with previous years, the number of countries that have reached nationwide implementation on several indicators has risen. Increases were observed in the number of countries with developed national action plans, countries with functional multisectoral working groups on AMR, and countries that have implemented nationwide infection prevention and control programs aligned with WHO guidelines.

A total of 136 of 194 WHO member states responded to the survey. Response rates were 11.8% lower this year because of the COVID-19 pandemic.

Analysis of data from 115 countries that have responded to the survey over the past 3 years also showed increases in the percentage of countries with nationwide AMR awareness programs and a rising number of countries that are conducting national monitoring of antibiotic consumption and surveillance activities for resistance.

Data analysis also found, however, that fewer than 50% of countries have government-funded AMR awareness campaigns, and that much of the progress is occurring in higher-income countries. While the number of countries with national monitoring systems for antibiotic consumption has increased, they account for just 54% of respondents.

"Addressing AMR solely in higher-income countries will not be enough to reduce the burden of AMR globally, especially since lower-income countries might bear the brunt of the economic and health consequences of unchecked AMR," the authors of the analysis wrote.
Mar 19 Tripartite AMR survey

 

Australian study shows long-term benefits of ICU stewardship intervention

Originally published by CIDRAP News Mar 18

An audit of an electronic medical record–integrated antimicrobial stewardship intervention in an Australian intensive care unit (ICU) demonstrated long-term benefits and sustainability, Australian researchers reported today in Infection Control & Hospital Epidemiology.

The intervention in the ICU at Austin Health, a tertiary referral hospital in Melbourne, Australia, was implemented in August 2017 and involved 5-day-a-week stewardship ward rounds and review of compliance with stewardship recommendations 24 hours after each ward round. The impact of the intervention over a 9-month period had previously been demonstrated.

A review of antibiotic use in the ICU 2 years before and after the intervention showed an immediate decrease in the use of ceftriaxone, meropenem, piperacillin/tazobactam, and vancomycin, and an ongoing significant reduction in the use of vancomycin and ciprofloxacin after the intervention, but no significant long-term change in the use of piperacillin/tazobactam. Prescribing appropriateness rose from 51% during the pre-intervention period (2015-2016) to 73% after the intervention was implemented (2017-2018).

During the first year after the intervention, 87.6% of stewardship recommendations were implemented by ICU staff, and 89.3% of recommendations were implemented during the second year.

The study authors say future research should focus on risk-stratifying ICU patients who would benefit most from a stewardship review.
Mar 18 Infect Control Hosp Epidemiol study

 

Indian scientists isolate Candida auris in the environment

Originally published by CIDRAP News Mar 17

A team of Indian scientists yesterday reported the detection of Candida auris isolates from two sampling sites on islands in the Indian Ocean—the first time the multidrug-resistant yeast has been isolated in a natural environment. The discovery was reported in mBio.

Since it was first identified in a Japanese patient in 2009, C auris has spread to hospitals around the world, and has been declared an urgent health threat by the CDC. Because the yeast is capable of growing at higher temperatures and can tolerate hypersaline environments more than other Candida species, scientists in recent years have hypothesized that it may have existed in wetlands before becoming a clinically relevant pathogen, and that its emergence could be linked to global warming's effects on wetlands.

To further explore this hypothesis, scientists from the University of Delhi collected 48 samples of sediment and seawater from coastal wetlands, sandy beaches, tidal marshes, and mangrove swamps around the Andaman Islands in the Bay of Bengal. The climate of these islands is tropical, with hot and humid conditions.

The team isolated C auris from samples at two sites, with two isolates found in a salt marsh wetland and 22 on a sandy beach. Antifungal susceptibility testing showed that one of the salt marsh isolates and all 22 from the beach—which was high in human activity—were multidrug resistant. Whole-genome sequencing revealed that the isolates were genetically distinct from C auris isolates from Indian hospitals but broadly related to clade 1, which includes isolates from South Asia.

"The isolation of C. auris from this natural environment is noteworthy considering that until now this yeast has not been identified outside hospital environmental settings," the authors wrote.

They add that the significance of the discovery, its connection to human infections, and whether the pathogen exists in other ecological niches, need to be further explored.
Mar 16 mBio study

 

VA study links contact precautions with reduced MRSA transmission

Originally published by CIDRAP News Mar 17

Department of Veterans Affairs (VA) hospitals that conducted contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) had a nearly 50% reduction in MRSA transmission, researchers reported this week in JAMA Network Open.

In the study, researchers from the VA Salt Lake City Health Care System and the University of Utah School of Medicine applied mathematical models to data from patients admitted to VA acute care hospitals from January 2008 through December 2017 to determine whether contact precautions for MRSA carriers had any impact on patient-to-patient transmission. Contact precautions, which involve the use of gloves and gowns by healthcare staff when interacting with MRSA carriers and their environment, are one element of the MRSA Prevention Initiative introduced by the VA in 2007, but their effectiveness has been questioned. Other elements include surveillance and hand hygiene.

The cohort included 108 hospitals with more than 2 million unique patients, and over the study's duration, they had more than 5.6 million admissions and 8.4 million MRSA surveillance tests (9.3% positive). Among all admissions, 14.1% required contact precautions during their stay based on a positive MRSA test result. Pooled estimates found associations between contact precautions and transmission to be stable from 2008 through 2017, with estimated transmission reductions ranging from 43% (95% credible interval [CrI], 38% to 48%) to 51% (95% CrI, 46% to 55%). Over the entire 10-year study period, contact precautions reduced transmission by 47% (95% CrI, 45% to 49%).

Larger hospitals and those with higher admission screening compliance saw additional reductions in transmission associated with contact precautions compared with smaller hospitals with lower screening compliance. VA hospitals in the southern states saw less transmission reduction linked to contact precautions compared with facilities in other regions.

The study authors say the results provide an explanation for the decline in MRSA acquisition rates in VA hospitals since the MRSA Prevention Initiative began.
Mar 15 JAMA Netw Open study

 

FDA approves Melinta's Kimyrsa for skin infections

Originally published by CIDRAP News Mar 16

Melinta Therapeutics of Morristown, New Jersey, announced yesterday that the FDA has approved Kimyrsa (oritavancin) for treatment of adult patients with acute bacterial skin and skin-structure infections (ABSSSIs) caused by susceptible gram-positive pathogens, including MRSA.

Kimyrsa delivers a complete course of the lipoglycopeptide antibiotic oritavancin in a single, 1-hour 1,200 milligram (mg) intravenous infusion. The drug is an updated version of Orbactiv, which was approved by the FDA in 2014 for treatment of ABSSSIs and is infused over 3 hours.

The safety and efficacy of Kimyrsa was previously established in randomized clinical trials that showed that a single 1,200 mg infusion of Orbactiv was as effective 7 to 10 days of twice daily vancomycin in treating 1,987 ABSSSI patients, including 405 with documented MRSA infection. FDA approval was based on a pharmacokinetics study that showed the safety profile was favorable to Orbactiv.

Melinta says it plans to launch the drug this summer.

"We have responded to the requests of the medical community to provide an oritavancin product with a shorter infusion time," Melinta President and CEO Christine Ann Miller said in a company press release. "We believe that with the approval of Kimyrsa and product availability this summer, physicians and patients will now have a compelling new one-dose alternative to the current standard of multi-dose regimens for ABSSSI."

Nearly 14 million US patients develop ABSSSIs each year, with more than 3 million emergency department visits. The infections cost US hospitals roughly $4 billion annually.
Mar 15 Melinta press release

 

Central line-associated bloodstream infections rise during pandemic

Originally published by CIDRAP News Mar 16

A new study from researchers with the CDC shows a significant increase in central line–associated bloodstream infections (CLABSIs) in US acute care hospitals during the early months of the COVID-19 pandemic.

Published yesterday in Infection Control & Hospital Epidemiology, the study analyzed 13,136 inpatient units from 2,986 acute care hospitals and found that the standardized infection ratio (SIR) for CLABSI's in April, May, and June of 2020 climbed by 28% compared with the same months in 2019, from 0.68 to 0.87. Critical care units saw the greatest percentage increase (39%) in SIR, from 0.75 in 2019 to 1.04 in 2020, and ward locations experienced the second highest increase (13%). Critical care locations had the highest number of CLABSIs in the second quarter of 2020, with 1,911.

Among ward types, significant increases in the SIR occurred in pediatric medical-surgical wards (118%), neurosurgical critical care (108%), medical critical care (60%), and medical-surgical critical care (59%). The highest regional SIR in the second quarter of 2020 (1.07) was in the Upper Northeast and represented a 45% increase compared with 2019. Hospitals of all bed sizes saw increases in SIR.

The study authors say the changes in infection control practices that were made at acute care hospitals to accommodate increasing numbers of patients during the pandemic may have contributed to the increase in CLABSIs. From 2015 through 2019, there was a 31% decline in the national SIR for CLABSIs.

"The findings of this paper highlight a substantial increase in CLABSIs in hospitals throughout the United States coinciding with the COVID-19 pandemic," they wrote. "The results of this analysis can be used to understand the increase in HAI burden being placed on the nation’s healthcare system and to prioritize ongoing efforts to prevent infections and to drive patient safety."
Mar 15 Infect Control Hosp Epidemiol abstract

 

US school districts adopt antibiotic use standard for turkey products

Originally published by CIDRAP News Mar 16

An organization representing the 15 largest school districts in the United States announced last week that it is issuing a standard for responsible antibiotic use in turkey products sold to schools.

Under the new policy, the Urban School Food Alliance (USFA) will require that all turkey products purchased by its schools must be produced under a USDA process verified program that includes compliance with the Certified Responsible Antibiotic Use Standard (CRAU), which was developed in 2014 to minimize antibiotic use in poultry and give schools the option to buy poultry raised with responsible antibiotic use. The turkey industry is the most intensive user of medically important antibiotics, according to research from the Natural Resources Defense Council.

Poultry producers in conformance with CRAU are prohibited from administering antibiotics pre-hatch and from using medically important antibiotics for disease prevention, growth promotion, feed efficiency, or weight gain. They can only use medically important antibiotics to treat poultry diagnosed with a bacterial disease or control disease in poultry exposed to infectious bacteria.

Turkey is the second most served protein in USFA schools, which serve nearly 4 million students daily. The group issued a similar standard for chicken in 2014.

"Issuing this standard for responsible antibiotic use in turkey is the next step in the Urban School Food Alliance’s commitment to provide the healthiest food to students in all its member districts," Katie Wilson, PhD, USFA Executive Director, said in a press release. "By leveraging the collective purchasing power of Alliance districts, this standard sends an important message to the turkey industry and helps to improve the quality of food sold to the school marketplace."
Mar 11 USFA press release

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