UK report shows rise in resistant, sexually transmitted Shigella

A report yesterday from the United Kingdom's Health Security Agency (HSA) shows sexually transmitted Shigella infections are rising again in England after falling during the COVID-19 pandemic.

Analysis of data from two surveillance databases, the Second Generation Surveillance System (SGSS) and the Gastrointestinal Data Warehouse (GDW), shows Shigella infections climbed by 189% in SGSS and 172% in GDW from the third quarter of 2021 to the second quarter of 2022.

The number of travel- and non–travel-related Shigella cases began to climb following the easing of COVID-19 restrictions and is now nearing prepandemic levels. The increase was most notable (127%) in men who have sex with men (MSM), and the highest proportion of diagnoses among presumptive MSM was in London.

The report also found that among presumptive MSM, antimicrobial resistance is consistently high in Shigella flexneri and Shigella sonnei isolates, with 96% and 92% of isolates classified as multidrug-resistant (MDR) or extensively drug-resistant (XDR), respectively. A sustained increase in the proportion of XDR S sonnei has been driven by a resurgence of an S sonnei clade 5 outbreak strain.

In a recent study published in The Lancet Infectious Diseases, HSA investigators reported that of 72 confirmed cases Shigella cases identified in the United Kingdom from Sep 1, 2021, to Feb 9, 2022, all belonged to clade 5 and all were genotypically MDR or XDR.

While shigellosis is often associated with exposure to contaminated food and water, it can be transmitted through oral and anal sex and is considered a sexually transmitted disease. A report in February from the European Centre for Disease Prevention and Control (ECDC) noted an increase in XDR S sonnei infections in the United Kingdom and elsewhere in Europe and warned that the risk of spread among networks of MSM who engage in high-risk sexual practices, such as oral-anal contact, could be high in the coming months.
Sep 28 UK HSA report
Jul 6 Lancet Infect Dis study
Feb 23 ECDC rapid risk assessment


Randomized trial finds no impact from antibiotic prescribing feedback

A randomized trial conducted in Scottish primary care practices found that general practice-level feedback had no effect on antibiotic prescribing, researchers reported today in the Journal of Antimicrobial Chemotherapy.

For the Feedback on Antibiotic Prescribing in Primary Care (FAPCC) trial, 340 Scottish general practices were randomized to receive four quarterly antibiotic-prescribing feedback reports (the intervention group) or not (the control group) from the second quarter of 2016 to the first quarter of 2017. The reports included different clinical topics, benchmarking against national and health board prescribing rates, behavioral messaging with improvement techniques, and educational resources. The primary outcome was total antibiotic prescribing rate.

The baseline total antibiotic prescribing rate in the 181 intervention hospitals and 159 control hospitals was 1.93 prescriptions and 1.98 prescriptions per 1,000 patients per day, respectively. Total antibiotic prescribing rates were falling in both arms prior to the study, and the downward trend continued during the study period, falling to 1.83 (intervention) and 1.90 (control) prescriptions per 1,000 patients per day at the main analysis timepoint (1 year after the last feedback report was issued).

There was no evidence of intervention effect (adjusted rate ratio, 0.98; 95% confidence interval (CI), 0.94 to 1.02). There was also no evidence of effect on secondary prescribing or hospital admission outcomes.

The study authors hypothesize that the feedback had no impact on prescribing because it added little to existing antibiotic stewardship interventions that had been applied over the previous 14 years and had resulted in steady and substantial reductions in antibiotic prescribing in Scottish primary care. They suggest that focusing future feedback interventions on the highest prescribers may have a better return on investment, but say further research is needed.

"This well-designed, real-world, practice-level antibiotic prescribing feedback had minimal additional effects in the context of decreasing antibiotic prescribing and an established national stewardship program," they wrote. "Designing and implementing effective feedback interventions remains a priority to support challenging targets for reductions in antibiotic prescribing."
Sep 29 J Antimicrob Chemother study


Source unknown in Ghana's recent Marburg outbreak

Earlier this month, Ghana declared the end of its first Marburg virus outbreak, which resulted in three cases, two of them fatal, and yesterday the World Health Organization (WHO) fleshed out details about the investigation, including potential links to other African outbreaks.

The WHO said so far the source of the outbreak, declared over on Sep 16, isn't known. The index patient is a 26-year-old man who got sick on Jun 22, was hospitalized on Jun 26, and died the following day.

A 14-month-old child was admitted to the hospital on Jul 17, where he died on the third day of admission. The third illness involved a 24-year-old woman who was admitted to a government-run isolation center on Jul 26. The report did not note any connections among the three patients, though earlier reports said they were the child and wife of the index patient.

Outbreak responders identified and monitored 198 contacts.

The WHO said genetic sequences from Ghana's samples suggests they are related to sequences from Guinea's first Marburg outbreak in 2021. It also added that Ghana's sequences group with those from bats in Sierra Leone and samples from a 2004-2005 outbreak in Angola.
Sep 28 WHO statement on Marburg in Ghana
Sep 16 CIDRAP News scan
Jul 27 CIDRAP News scan


Avian flu strikes more poultry in 4 states

Four more states have reported highly pathogenic avian flu outbreaks in poultry flocks, according to the most recent updates from the US Department of Agriculture (USDA Animal and Plant Health Inspection Service (APHIS).

Two of the states reported outbreaks at commercial turkey farms. North Dakota reported the virus at a farm in Ransom County that houses 69,100 birds. Utah reported two outbreaks at turkey farms in Sanpete County, and taken together the Utah locations had 163,900 birds.

Minnesota and Oregon, meanwhile, reported more outbreaks in backyard birds. The Oregon Department of Agriculture said there were two outbreaks in backyard birds in Tillamook County, the first from that area.

The outbreaks have so far led to the loss of 46.6 million birds in 40 states.

In related developments, the USDA this week reported 180 more detections of the H5N1 avial flu strain in wild birds, raising the total to 2,650 since the middle of January. Most of the new detections were from hunter-harvested birds in Oklahoma, Illinois, and Indiana, and live-bird surveillance activities in New York.
USDA APHIS poultry avian flu updates
Sep 28 Oregon Department of Agriculture statement
USDA APHIS wild bird avian flu updates

COVID-19 Scan for Sep 29, 2022

News brief

COVID Omicron variant shown to spread better in households than Delta

The SARS-CoV-2 Omicron variant is much more transmissible among household members than Delta, with an estimated secondary attack rate (SAR) from thrice-vaccinated index patients of 46%, compared with 11% for Delta, finds a study published today in Nature Communications.

The SAR is the percentage of contacts who become infected by an index (initial) patient.

Norwegian Institute of Public Health researchers used contact tracing data to track the 10-day SAR of Omicron and Delta among 1,122 index patients infected with Omicron (59%) or Delta (41%) and 2,169 household contacts (60% for Omicron primary cases and 41% for Delta) from December 2021 to January 2022. The data represented 8 of Norway's 11 counties.

The estimated overall Omicron SAR was 51%, compared with 36% for Delta. The SAR among thrice-vaccinated index patients was 46%, versus 11% for Delta (relative risk [RR], 1.41). Although the average SAR was lower for both variants among contacts vaccinated with three doses, transmission was higher with Omicron than Delta among all vaccination groups except one-dose recipients.

Both twice- and thrice-vaccinated index patients were at comparable risk as unvaccinated index patients of spreading Omicron to adult household contacts (RR, 1.04 and 0.99, respectively). In contrast, Delta index patients who received three vaccine doses were at an 82% lower risk of spreading Delta (RR, 0.18).

There were no significant differences in risk of infection by age-group, sex, or time since the last vaccine dose in twice-vaccinated contacts.

Vaccine effectiveness (VE) for thrice-vaccinated adult household contacts was lower for Omicron than Delta (45% vs 65%) and higher than that of twice-vaccinated contacts, who had 27% protection against Omicron infection and 42% against Delta.

"Our study indicates that the higher overall SAR among household contacts of Omicron cases is most likely due to higher intrinsic transmissibility of this variant and lower vaccine effectiveness," the researchers wrote.

"Contacts vaccinated with three doses had a lower risk of infection with Delta and Omicron, but our findings suggest that three-dose vaccinated cases with Omicron infection can spread effectively in households," they concluded.
Sep 29 Nat Commun study


Study suggests pandemic altered personalities in US

The pandemic may have altered the trajectory of personality across the United States, especially in younger adults, according to a study in PLOS One. The findings challenge the hypothesis that personality traits are independent of environmental factors.

To conduct the study, researchers from the Florida State University College of Medicine used longitudinal assessments of personality from 7,109 people enrolled in the online Understanding America Study to look at five personality factors from before the pandemic (May 2014 through April 2020), during the early part of the pandemic (March to December 2020), and the adaptation phase of pandemic (2021 and 2022). The five traits were neuroticism, extraversion, openness, agreeableness, and conscientiousness.

A total of 18,623 assessments, with a mean of 2.62 per participant, were analyzed. Respondents were roughly 42% male, and between the ages of 18 and 109. There were few changes between 2020 personality traits and those from 2014-2020, but significant changes between traits seen in 2021-2022 and pre-pandemic.

Neuroticism remained largely unchanged in all three periods, but extraversion, openness, agreeableness, and conscientiousness declined in 2021 through 2022 compared to their level pre-pandemic, the authors wrote. Young adults had the biggest changes in traits compared to older adults.

"Change in personality from before to during the pandemic was approximately one-tenth of a standard deviation. Although modest in absolute terms, it can be put in the perspective of developmental changes that occur over adulthood," the authors explained. "Normative personality change has been estimated to be approximately one-tenth a standard deviation per decade in adulthood."
Sep 28 PLOS One


Qatar announces COVID test requirement for World Cup travelers

Ahead of World Cup soccer competition that begins in Qatar in the middle of November, tournament organizers today announced that visitors attending the event will need to test for COVID-19 before arriving, regardless of vaccination status.

The policy applies to anyone age 6 years and older, and it stipulates that the test must be done at a medical center in the country of origin, with the results submitted at the airport check-in counter.

In other international developments, Taiwan announced that it will end its COVID-19 quarantine for incoming travelers starting on Oct 13, according to Reuters. And Germany-based InflaRx submitted an emergency use authorization application to the US Food and Drug Administration for a first-in-class monoclonal anti-human complement factor antibody treatment.
Sep 29 FIFA World Cup statement
Sep 29 Reuters story
Sep 29 InflaRx statement

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