News Scan for Jul 18, 2018

News brief

California reports infant pertussis death

The California Department of Public Health (CDPH) yesterday announced that a baby from San Bernardino County has died from pertussis, marking the state's first death from the disease since 2016.

Karen Smith, MD, MPH, CDPH director and state public health officer, said in a press release that the baby's death is a tragedy for the family and for the state, since pertussis is a preventable disease. "This serves as a grim reminder that whooping cough is always present in our communities, and immunizations are the first line of defense."

In 2010, a large pertussis outbreak in California—its biggest since 1947—resulted in 986 cases in children and 10 related deaths in kids younger than 3. Babies can't begin vaccination against the disease until they are 2 months old, so public health officials depend on vaccination in pregnant women and infant contacts to protect the youngest, vulnerable population.

Provisional surveillance totals for 2017 from the US Centers for Disease Control and Prevention (CDC) show that nationally there were 13 pertussis deaths that year, 4 of them in children younger than 1 year.

Smith said no babies should have to be hospitalized due to vaccine-preventable disease, and certainly no baby should die. "I urge all pregnant women to get vaccinated against whooping cough as early as possible during the third trimester of every pregnancy," she said. The CDPH also recommends that parents immunize their babies as soon as possible, that 7th-grade students receive a whooping cough booster (tetanus, diphtheria, and acellular pertussis vaccine [Tdap]), and that adults receive a booster once in their lives.
Jul 17 CDPH news release
CDC provisional pertussis surveillance for 2017


Researchers detail contamination risk during PPE doffing

Researchers who tested 10 different personal protective equipment (PPE) protocols for protecting healthcare workers from Ebola virus found a higher risk of self-contamination with doffing and fewer problems with PPE sequences involving powered air-purifying respirators (PAPRs) and assisted doffing. A team from University of New South Wales in Australia reported their findings yesterday in the American Journal of Infection Control.

Ten participants were randomly assigned to use three different PPE protocols. The 10 protocols tested were from the World Health Organization, the CDC, the European Centre for Disease Prevention and Control, Health Canada, North Carolina, New South Wales, and Doctors Without Borders. To simulate Ebola contamination, researchers applied fluorescent lotion and spray to the PPE surface. Then to assess self-contamination, they used ultraviolet light to count fluorescent patches on the skin.

Large fluorescent patches were recorded after two sequences using coveralls, and small patches were detected after another coverall protocol and one involving gowns. Problems that were commonly reported included breathing difficulty, suffocation, heat stress, and fogged-up glasses. Most participants rated the PPE protocols high or medium for ease of donning and doffing, and those with PAPRs and assisted doffing were linked to fewer problems and had the highest ratings.

The team said the risk of self-contamination with gowns may be lower than coveralls, but they said gowns may not fully protect the body, and larger studies are needed to confirm the findings. They concluded that the study confirms the risk of self-contamination with PPE doffing and that protocols containing PAPR and assisted doffing should be preferred whenever possible during outbreaks of highly infectious pathogens.
Jul 17 Am J Infect Control abstract


High-path H5 avian flu outbreaks strike poultry in Ghana, Russia

In the latest highly pathogenic avian influenza outbreak developments, Ghana reported an H5 outbreak at a farm, its first since the end of 2016, and Russia reported more H5 outbreaks, part of ongoing activity since June, according to the latest reports from the World Organization for Animal Health (OIE).

In Ghana, the outbreak began on Jun 27 at a farm in Ashanti region in the south central part of the country, killing 2,033 of 6,451 susceptible birds. The survivors were culled to control the spread of the virus. An investigation found that the outbreak may be linked to an illegal movement of infected birds.

Elsewhere, Russia today reported 13 more H5 outbreaks from the western part of the country. The OIE report doesn't list a subtype, but a report last week from the United Kingdom said the Russian outbreaks involve H5N8.

Three of the outbreaks involved farms, and 10 were detected in backyard poultry. The events began between Jul 3 and Jul 15, killing 8,873 of 300,505 birds. Affected districts include Rostov, Republic of Tatarstan, Chuvashia Republic, and Nizhny Novgorod.
Jul 17 OIE report on H5 in Ghana
Jul 18 OIE report on H5 in Russia


Male mice may clear flu faster because of rapid lung healing

A new study showed that male mice may recover more quickly than their female counterparts from influenza infections because they produce more amphiregulin, a growth factor protein important in wound healing. The research was published in Biology of Sex Differences yesterday.

Researchers from Johns Hopkins Bloomberg School of Public Health conducted the study, which involved infecting live mice and human epithelial cells with a strain of 2009 H1N1 influenza virus. Female mice showed greater clinical disease than male mice, including pulmonary inflammation.

Expression of amphiregulin was greater in the lungs of male mice, as well as in primary respiratory epithelial cells derived from mice and a human male donors, than it was in females.

"The novel finding here is that females also have slower tissue-repair during recovery, due to relatively low production of amphiregulin," says senior study author Sabra Klein, PhD, an associate professor in the Department of Molecular Microbiology and Immunology at the Bloomberg School, in a John Hopkins press release.

The researchers said further study is needed to determine how amphiregulin is affected by testosterone, estrogen, and progesterone.
Jul 17 Biol Sex Differ study
Jul 17 Johns Hopkins University press release

Stewardship / Resistance Scan for Jul 18, 2018

News brief

New UK program targets farmers', veterinarians' antibiotic use

The United Kingdom's National Office of Animal Health (NOAH) launched a new best practices program meant to guide the responsible use of antibiotics among farmers and veterinarians. The program, which includes online training modules, is aimed at all those working in the sheep, dairy, beef, and pig sectors.

"The UK is at the forefront of global efforts to tackle antibiotic resistance. Recent statistics show there has been a 27 per cent drop in use of antibiotics in food-producing animals in the UK since 2014—meeting a government commitment two years early," British Biosecurity Minister Lord Gardiner said in a NOAH press release. "Our farmers and vets must be commended for driving down antibiotic use in livestock to this all-time low—setting an excellent example for others around the world to follow. But it is vital we continue making progress."

The training modules are available on the NOAH website or through the online Lantra eLearning platform.  According to NOAH, veterinarians will also be to access resource materials, enabling them to help train their clients.

A number of stakeholders helped create the training program, including the Responsible Use of Medicines in Agriculture Alliance (RUMA), the Veterinary Medicines Directorate (VMD), the British Retail Consortium (BRC), and leading academics.
Jul 17 NOAH press release


Thai study finds high colistin resistance, MCR-1 rates

A single-center study of hospitalized Thai patients who received colistin for treating Escherichia coli or Klebsiella pneumoniae infections found that 47.5% had colistin-resistant pathogens and 13.0% of isolates harbored the MCR-1 colistin-resistance gene. The findings appeared yesterday in Antimicrobial Resistance & Infection Control.

Researchers analyzed data on 139 adult patients in Siriraj Hospital in Bangkok from December 2016 through November 2017. They collected culture samples from the stool and infection site of each patient who received colistin at study enrollment, 3 and 7 days after study enrollment, and once a week thereafter to determine colistin resistance.

Colistin has been used to treat carbapenem-resistant gram-negative infections in Thailand, especially carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, for more than 10 years, the authors report. The prevalence of colistin-resistant A baumannii and P aeruginosa, however, is still less than 5%.

The team found an overall prevalence of colistin-resistant E coli or K pneumoniae colonization of 47.5%, with the prevalence rising from 17.3% at study enrollment to 30.2% afterward. The researchers found the use of fluoroquinolones, aminoglycosides, and colistin to be significantly associated with colistin-resistant pathogen colonization. They detected the MCR-1 gene in 13.0% of isolates and in 27.3% of subjects with colistin-resistant colonization. Colonization with colistin-resistant E coli or K pneumoniae persisted in 65.2% of the patients at the end of the study.
Jul 17 Antimicrob Resist Infect Control study


Study hints that herbal drug may cut risk of antibiotic resistance in dairy animals

A polyherbal drug used in India to prevent mastitis in livestock appears to reduce the persistence of antibacterial drugs in milk, a team from West Bengal University of Animal and Fishery Sciences reported yesterday in Scientific Reports.

Ceftriaxone is used to treat mastitis in dairy settings, but persistence of antibacterial drugs for prolonged periods in milk is thought to increase the probability of antimicrobial resistance, the authors wrote. Fibrosin, a proprietary blend of herbal ingredients, is marketed by an Indian company to facilitate cleaning of the udder by clearing tissue debris and aiding the flow of milk during mastitis.

To assess the impact of the herbal drug on antibiotic clearance, researchers divided 18 healthy lactating goats into three groups: a control group that got a single dose of ceftriaxone, one group of healthy goats that got a single dose of Fibrosin 1 hour before ceftriaxone injection, and one group of goats with mastitis that got a dose of Fibrosin 1 hour before ceftriaxone injection. Then they collected milk samples at several points up to 720 hours after dosing.

They found that the polyherbal drug hastened the excretion of ceftizoxime from milk compared to the control group; ceftriaxone could not be detected in milk.

The team concluded that adjunct single or repeated therapy of the polyherbal drug may block the persistence of ceftriaxone and shorten the persistence of ceftizoxime.
Jul 18 Sci Rep abstract

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