News Scan for Nov 17, 2021

News brief

Monoclonal antibodies shown effective for breakthrough COVID-19 cases

New research from the Mayo Clinic shows monoclonal antibodies reduce the risk of hospitalization 77% in 1,395 patients who had breakthrough COVID-19 infections. The research was published yesterday in the Journal of Infectious Diseases.

To conduct the retrospective study, researchers compared outcomes of confirmed COVID-19 patients who were fully vaccinated treated with either bamlanivimab, bamlanivimab-etesevimab, or casirivimab-imdevimab, as single infusion from January to August 16, 2021, to those who did not receive treatment.

The average age of breakthrough patients was 54 years. Roughly 10% were cancer patients, and 69.8% had been fully vaccinated with the Pfizer-BioNTech vaccine, a mean 120 days prior to infection.

More than two thirds of the breakthrough infections—71.8%—occurred after June 2021, when the Delta (B1617. 2) variant was the dominant strain in the Midwest, where the study was conducted. The rate of hospitalization was 2.7% among patients treated with monoclonal antibodies, compared with 10.7% among those who did not receive therapy.

"Since the vast majority of our cohort developed breakthrough COVID-19 during the Delta surge, our finding also provides the clinical correlate to experimental data that suggested that casirivimab-imdevimab retains efficacy against SARS-CoV-2 B.1.617," the authors said.

Patients with significant comorbidities were most likely to have significant symptoms from breakthrough infections. Patients who had high blood pressure, chronic kidney disease, and cardiovascular disease were at increased risk, the authors said.
Nov 16 J Infect Dis


Maryland reports imported monkeypox case

Maryland officials and the Centers for Disease Control and Prevention (CDC) have confirmed a monkeypox infection in a state resident who had recently returned from Nigeria, the Maryland Department of Health (MDH) said yesterday in a statement.

The patient has mild symptoms and is recovering in isolation, but is not hospitalized.

The CDC said today that the patient's virus matches the strain that has been re-emerging in Nigeria since 2017. It added that it is working with the airline and other partners to reach passengers who may have been in contact with the patient. Mask use on the plane during the COVID-19 pandemic probably makes the risk of spread by respiratory droplets low, the CDC said.

Healthcare workers should be alert for poxlike lesions, especially among travelers from Nigeria, the CDC said. Since 2017, 218 monkeypox cases have been confirmed in Nigeria, and 8 exported cases were detected in other countries, including one in Texas in July.
Nov 16 MDH statement
Nov 17 CDC statement


Feds investigate discovery of smallpox vials in Pennsylvania lab

Federal officials and law enforcement are investigating a lab worker's discovery of vials labeled "smallpox" while cleaning out a freezer in a Pennsylvania vaccine research facility, CNN reported today.

The CDC told CNN that there's no sign that anyone was exposed to a small number of vials that appear to be intact. The lab worker who found the vials was wearing gloves and a face mask. The agency said it would share more details as available.

In 2014, National Institutes of Health (NIH) employees found decades-old vials that appeared to contain smallpox in an unused lab storage area on its Bethesda, Maryland, campus. Two vials contained viable virus, but no human infections were related to the discovery.

Smallpox was eradicated in the 1970s, but health officials remain concerned that remaining samples could pose a bioterror threat if terrorists obtain them. The last remaining known stockpiles are kept in approved labs in the United States and Russia. The World Health Assembly has often grappled with proposals to destroy the remaining stocks, which are kept to test smallpox countermeasures.
Nov 17 CNN story


South Africa reports out-of-season flu spike

South Africa's National Institute for Communicable Diseases (NICD) today issued an alert about an unseasonal spike in flu activity, which began in late August and showed a sharp increase in early November.

In a statement, the NICD said clusters have been reported from schools and workplaces, and that influenza B has been the most commonly detected strain. It added, however, that both influenza A viruses are also circulating. And though detection rates exceed earlier seasonal thresholds, the agency said absolute numbers are still relatively low, perhaps due to less healthcare-seeking behavior during the pandemic.

Officials said increased flu activity in the summer isn't typical and likely results from relaxed COVID-19 measures and an immunity gap due to flu not circulating for 2 years. They added that it is never too late to vaccinate, especially for people who have risk factors for flu complications.
Nov 17 NICD statement

In other flu developments, the European Centre for Disease Prevention and Control (ECDC) yesterday issued its first flu characterization for the new flu season, which said flu detections are still low across the region, but they are up sharply compared with the 2020-21 season and are close to the usual levels seen during previous seasons.

H3N2 is the dominant strain. Most H1N1 viruses are in the subgroup contained in Northern Hemisphere flu vaccines.

Meanwhile, H3N2 viruses are split between the Cambodia-like virus, which is covered by flu vaccines, and the Bangladesh-like virus, which is ascending, the ECDC said. Recent H3N2 samples from the Netherlands were Bangladesh-like viruses.
Nov 16 ECDC flu virus characterization report

Stewardship / Resistance Scan for Nov 17, 2021

News brief

G7 governments urged to do more to boost antibiotic development

A coalition of organizations from academia, healthcare, and the pharmaceutical industry sent a letter today to G7 governments calling for greater engagement in tackling antimicrobial resistance (AMR) and boosting the pipeline for new antibiotics.

The joint statement, issued ahead of World Antimicrobial Awareness Week, calls on G7 governments to explore a range of options, in collaboration with the private sector, to strengthen the antibiotic research and development pipeline from beginning to end. That includes support for basic research, funding to help companies transition from early-stage trials to late-stage clinical development, and development of financial pull incentives to ensure investment into innovative new antibiotics is rewarded.

The signatories, including the AMR Action Fund and the Global Antibiotic Research & Development Partnership, also call on G7 governments to develop new reimbursement models for novel antibiotics for drug-resistant infections to help ensure that patients in all countries have fast access to them, and to capitalize on the potential of vaccines to protect against infections and reduce the need for antibiotics.

"Only if we set these recommendations into immediate action, we will be able to build an innovative and sustainable ecosystem to effectively fight AMR," the groups said in the statement.
Nov 17 joint statement


UK report shows drop in antibiotic-resistant bloodstream infections

A new surveillance report released today by UK health officials shows that the number of antibiotic-resistant bloodstream infections (BSIs) fell in England from 2019 to 2020, a decline that likely reflects the impact of the COVID-19 pandemic and masks the rising burden of resistance.

Data from the eighth annual English Surveillance Programme for Antimicrobial Use and Resistance (ESPAUR) report indicates that the number of antibiotic-resistant BSIs fell from 65,583 in 2019 to 55,384 in 2020, a 15% decline. But that's mainly because the overall incidence of BSIs caused by key bacterial pathogens declined in 2020, led by a 59% decline in Streptococcus pneumoniae BSIs and a 14% reduction in Escherichia coli BSIs. The report suggests that decline was due in part to reduced contact between individuals, improved hand hygiene, reduced antibiotic prescribing, and fewer interactions with healthcare during the pandemic.

But the report also shows that among the bacteria that commonly causes BSIs (including E coli and Klebsiella pneumoniae), resistance to several key antibiotics rose from 2016 to 2019 before falling in 2020. And the number of BSIs caused by resistant pathogens rose annually over that period. Even with the 2020 declines, roughly 1 in 5 people with a BSI in 2020 had an antibiotic-resistant infection.

The UK's Health Security Agency says these findings suggest drug-resistant infections will likely climb once the pandemic is over.

"Antimicrobial resistance has been described as a hidden pandemic and it's important that we do not come out of COVID-19 and enter into another crisis," UKHSA chief medical advisor Susan Hopkins, MB BCh, said in a press release.

The ESPAUR report highlighted continuing declines in antibiotic prescribing in English healthcare. From 2016 to 2019, total antibiotic consumption fell by 6.6%, with an additional 10.9% reduction from 2019 to 2020. The greatest decline was observed within the General Practice (GP) setting, where prescribing fell by 10.4% from 2016 to 2019, with a further 9.4% reduction from 2019 to 2020.

Antibiotic use in hospitals, however, increased by 1.9% from 2016 to 2019, with an additional 4.8% increase from 2019 to 2020.
Nov 17 ESPAUR report
Nov 17 UKHSA press release

This week's top reads