News Scan for Apr 11, 2018

News brief

Monkeypox confirmed in Liberia

Yesterday Liberian health officials warned of a monkeypox outbreak in the southern county of River Cess, according to China's state news service, Xinhua.

So far, officials have confirmed four cases of the smallpox-like virus, which is not typically deadly but can last several weeks. Officials are also monitoring some suspected cases. The incubation period for monkeypox can be up to 10 days, with lesions lasting 2 to 5 weeks.

Last year, Nigeria had Africa's largest recorded monkeypox outbreak, with 61 confirmed and 172 suspected cases

Monkeypox is most likely transmitted through the consumption or handling of contaminated bushmeat, a common practice in western and central Africa.
Apr 10 Xinhua


HHS spearheads largest exercise for moving highly infectious patients

The US Department of Health and Human Services (HHS) said yesterday that it began the largest ever exercise to test the nation's ability to safely and securely move patients who have highly infectious diseases to regional treatment centers.

More than 50 organizations are participating in the exercise, which is coordinated by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR). They include the State Department, the Department of Transportation, regional Ebola treatment centers, local and state health and emergency management agencies, hospitals, airports, and nongovernmental organizations.

Robert Kadlec, MD, who leads ASPR, said, "Saving lives during crises requires preparation and training." He said a tremendous amount of skill and synchronization are needed to move highly infectious patients in a way that protects patients and healthcare workers. "This type of exercise helps ensure that everyone involved is ready for that level of complexity."

The exercise involves moving seven people acting as Ebola patients in different regions of the country. The patients, one of whom is a child, present at one of five medical centers, where healthcare workers collect and ship samples and practice running lab tests. Medical teams will also practice isolating patients and using personal protective equipment (PPE). Then six patients, placed in mobile biocontainment units, will be flown to the regional treatment centers, and the pediatric patient will be transported by ground ambulance.

On arrival, local emergency responders will take patients from the airport to treatment centers by ground ambulances. The exercise runs through tomorrow, and participants will gather on Apr 13 to assess the exercise, compare experiences, and share best practices for moving patients with highly infectious diseases.
Apr 10 HHS press release


BiondVax launches US phase 2 trial of universal flu vaccine

BiondVax, a pharmaceutical company based in Israel, today announced that it began enrolling patients in the United States for a phase 2 clinical trial of its universal flu vaccine candidate, M-001.

In a press release, the company said the trial is sponsored by the National Institute of Allergy and Infectious Diseases and is being conducted under a Food and Drug Administration Investigational New Drug application. The vaccine was initially developed at the Weizmann Institute of Science in Israel. It contains nine epitopes common to influenza A and B viruses. Earlier phase 1/2 and phase 2 trials in Israel and Europe suggested that the vaccine was safe, well-tolerated, and immunogenic across a range of flu strains.

The US trial will enroll 120 participants ages 18 to 49 years at three sites. The volunteers will receive either two doses of M-001 or two doses of placebo, with doses spaced several weeks apart. Researchers will compare the safety and immunogenicity of M-001 and placebo. A few months after the second dose, all participants will receive the current unadjuvanted quadrivalent seasonal flu vaccine.

In March, BiondVax announced that it plans to launch a phase 3 trial of the vaccine later this year in Europe.
Apr 11 BiondVax press release


WHO to vaccinate nearly 1 billion Africans against yellow fever

The World Health Organization (WHO) announced yesterday plans to vaccinate almost 1 billion African people against yellow fever by 2026. The WHO is partnering with GAVI, the Vaccine Alliance, UNICEF, and 50 other health partners to target 27 African countries at high risk for yellow fever transmission.

"This comprehensive, global strategy offers an unprecedented opportunity to end the devastating Yellow fever epidemics that periodically impact Africa," said Seth Berkley, MD, CEO of Gavi, in a WHO press statement. "Ensuring that the most vulnerable communities have access to the vaccine through routine systems plays a central role in making this happen."

The WHO made the announcement at a regional meeting in Abuja, Nigeria, where it launched the Eliminate Yellow fever Epidemics (EYE) in Africa strategy, the largest vaccination program of its kind. EYE will uses preventive mass vaccination campaigns as well as routine immunizations to target populations across the continent.

In 2016, Angola and the Democratic Republic of the Congo saw re-emergence of yellow fever in large outbreaks that took 400 lives.
Apr 10 WHO statement 

Stewardship / Resistance Scan for Apr 11, 2018

News brief

Plasmid-mediated MCR-5 gene detected in isolates from Chinese pigs

Chinese and Swedish researchers have detected the colistin resistance gene MCR-5 in an Aeromonas hydrophila isolate from pigs in rural China, according to a study today in the Journal of Antimicrobial Chemotherapy.

The MCR-5-harboring isolate was found among fecal samples collected from backyard pigs from 194 households in rural areas of Shandong Province in August 2017. The identified isolate, I064-2, was resistant to colistin and displayed intermediate susceptibility to tetracycline, but was susceptible to several other antibiotics, including amikacin, gentamicin, ciprofloxacin, and meropenem.

Whole-genome sequencing of the isolate confirmed that the MCR-5 gene was located on a plasmid with genetic features similar to those found in other Aeromonas species, Enterobacteriaceae, and Pseudomonas species, a finding that suggests the possibility of horizontal transfer of the MCR-5-carrying segment among these bacterial species and genera.

Bacteria belonging to the Aeromonas genus cause diarrheal diseases and wound infections in humans and animals. Prior to this study, the MCR-5 gene had only been found in Salmonella spp. from poultry- and animal-derived food products in Germany.

"Further studies should focus on the surveillance of mcr-5 in colistin-resistant Gram-negative pathogens derived from animals, humans and the environment," the authors write.
Apr 11 J Antimicrob Chemother study 

Study finds beta-lactamase inhibitor restores susceptibility to carbapenem

In another study today in the Journal of Antimicrobial Chemotherapy, an international team of researchers report that the novel beta-lactamase inhibitor relebactam restored susceptibility to imipenem in gram-negative pathogens.

For the study, which was funded by Merck & Co., the researchers tested the in vitro activity of imipenem and imipenem/relebactam against isolates of Gram-negative ESKAPE pathogens (Klebsiella pneumoniaeAcinetobacter baumanniiPseudomonas aeruginosa and Enterobacter spp.) submitted by hospital laboratories in 17 European countries. The isolates were from intra-abdominal infections, urinary tract infections, and lower respiratory tract infections. Relebactam was tested at a fixed concentration of 4 mg/L in combination with doubling dilutions of imipenem.

Rates of susceptibility to imipenem and imipenem/relebactam among isolates of P aeruginosa, K pneumoniae, and Enterobacter spp. were 72/94.7%, 88.7/94.8%, and 95.6/96.8%, respectively. In addition, relebactam restored in vitro imipenem susceptibility in 81.1%, 54.2%, and 26.5% of imipenem-non-susceptible isolates of P aeruginosa, K pneumoniae, and Enterobacter spp. Against A baumannii, however, relebactam did not increase the number of isolates susceptible to imipenem. Most imipenem/relebactam-non-susceptible isolates harbored metallo-beta-lactamase, OXA-48, or GES carbapenemase genes.

Imipenem/relebactam has successfully completed two phase 2 clinical trials for treating complicated intra-abdominal infections and complicated urinary tract infections, and is currently in phase 3 development.

"Further development of imipenem/relebactam appears worthwhile as it may provide a valuable therapeutic option for treating patients with infections caused by carbapenem-non-susceptible isolates of Gram-negative bacilli, including ESKAPE pathogens," the authors write.
Apr 11 J Antimicrob Chemother study


Troubling rate of infections, antimicrobial use found in Scottish nursing homes

A national point prevalence survey (PPS) indicates that healthcare associated infections (HCAIs) affect three residents in every long-term care facility (LTCF) in Scotland, Health Protection Scotland reported yesterday.

The PPS, which was conducted in October 2017 and included data from 2,147 residents in 52 LTCFs in Scotland, found that the prevalence of HCAIs was 5.9%. Respiratory tract infections (38.1%), urinary tract infections (31%), and skin and soft-tissue infections (23%) were the most commonly reported HCAIs. The HCAI prevalence was more than twice the rate found in a PPS conducted by the European Centre for Disease Prevention and Control in 2010, though the results aren't directly comparable due to differences in survey protocol.

The PPS also found that the overall prevalence of systemic antimicrobial prescribing in Scottish LTCF was 6.5%, down slightly from the 2010 PPS (7.3%). The prevalence of antimicrobial prescribing for treatment of infections was 4.5%, and the prevalence of prescribing for prevention of infections was 1.3%. The most commonly prescribed antimicrobials for treatment of infection were amoxicillin, trimethoprim, flucloxacillin, and nitrofurantoin.

Scottish health officials said in a news release that the prevalence of HCAIs and the rate of antimicrobial prescribing at LTCFs, along with the challenges of infection prevention and control in these settings, represent a public health threat with implications for resident safety and antimicrobial resistance.

"Healthcare associated infections remain a public health threat across all care settings," said Health Protection Scotland's Jacqui Reilly, PhD. "Health Protection Scotland will develop national programmes to tackle these new threats and work with colleagues across health and social care settings to preserve antibiotics for future use."

The report concludes that a broader and coordinated public health approach to infection prevention and control and antimicrobial stewardship in LTCFs is needed.
Apr 10 Health Protection Scotland PPS
Apr 10 Health Protection Scotland
news release

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