News Scan for Sep 12, 2018

News brief

Nigeria, which has 113 confirmed monkeypox cases, aiding UK officials

The Nigeria Centre for Disease Control (NCDC) said today it is helping UK officials respond to their two recent monkeypox cases, which involve travelers from Nigeria, a country that has now reported 262 suspected cases.

In related news, Public Health England (PHE) today issued guidance for primary care physicians and for those cleaning and decontaminating the hospital rooms of patients who have monkeypox, which is related to smallpox (both of which are caused by orthopox viruses) and can be mistaken for chickenpox (caused by the varicella virus).

The NCDC said in a news release, "Following the recent report of the two cases in the UK, NCDC has been working with the UK’s public health agency; Public Health England (PHE), the public health departments in the affected states and other partners in Nigeria to investigate these cases." The NCDC has also been working closely with states across Nigeria to strengthen monkeypox surveillance, detection, and response and meets weekly to ensure coordination with the World Health Organization, the US Centers for Disease Control and Prevention (CDC), and other officials.

The NCDC said that, from September 2017 through Aug 31, 2018, Nigeria has had 262 suspected cases in 26 states. Of these, 113 have been confirmed in 16 states, with 7 fatalities. Southern Nigeria has been hardest hit.

PHE announced the UK cases on Sep 8 and yesterday. It said the cases don't appear to be epidemiologically linked. The first patient is being treated at Royal Free Hospital in London, while the second is at Royal Liverpool University Hospital.

In its guidance for primary care physicians, PHE emphasized that monkeypox does not spread easily between people, but human-to-human transmission can occur. The guidance includes diagnostic tips and prevention and control advice, such as the importance of wearing disposable gloves for patient contact. The cleaning and disinfection guidance includes proper use of personal protective equipment such as gowns, respirators, and eye protection.
Sep 12 NCDC news release
Sep 12 PHE primary care guidance
Sep 12 PHE decontamination guidance
Sep 11 CIDRAP News scan


Measles resurgence in Italy affected by public health cuts, study says

Cuts in public health funding—and not just the growing anti-vaccine movement—are to blame for the return of measles infections in Italy, according to a study today in the European Journal of Public Health.

The study, conducted by researchers at Bocconi University, looked at public health funding across different regions of Italy from 2000 to 2014, and found that for every 1% of funding cut from a region's healthcare budget, measles, mumps, and rubella (MMR) vaccination coverage decreased by 0.5 percentage points (95% confidence interval: 0.36–0.65 percentage points.)

MMR coverage rose from 74.1% in 2000 to 90.6% in 2012, which coincided with an increase in public health funding from 2000 to 2009 at an average rate of 3.5% per year. Between 2010 and 2014, funding dropped by about 2% per year. MMR coverage rose from 74.1% in 2000 to 90.6% in 2012, but by 2014 fell to  85.1%.

"The consequences can be illustrated by comparing two regions, Lazio, where public health spending fell by 5% and MMR coverage by over 3 percentage points, and Sardinia, a historically deprived region, where public health spending partly rose and MMR rates remained approximately steady," the authors said.

"Our analysis suggests that austerity measures adopted in Italy contributed significantly to the resurgence of measles," the authors concluded.
Sep 12 Eur J Public Health study
Sep 12 Bocconi University press release


Global Fund report says 27 million lives saved in 16 years

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced today an estimated 27 million lives have been saved because of the fund's efforts, according to their 2018 annual report. That number represents a cumulative total since the Global Fund, an international public-private partnership based in Geneva, began in 2002.

"The numbers in this report show how far we have come. We have in our sights, but not yet firmly in our grasp, the prospect of freeing communities from the burden of HIV, TB and malaria," said Peter Sands, MPA, executive director of the Global Fund in a press release.

In 2018, the group distributed $4.2 billion in an effort to stop the world's deadliest diseases and said that drug-resistant tuberculosis (TB) was a major threat to curbing TB deaths. Last year, the Global Fund aided 102,000 people in getting treatment for drug-resistant TB.

The Global Fund reported allocations to prevent HIV in key and vulnerable populations rose by nearly 30% for 2017-2019 over the previous funding period. The group said that momentum in the fight against HIV must continue to be harnessed.

"Together, we can end these epidemics, but achieving this goal will require change—increased investment, accelerated innovation, even more effective partnerships and a relentless focus on impact," said Sands.
Sep 12 Global Fund press release
Sep 12 Global Fund report summary


FDA approves Seqirus's new process for cell-based flu vaccine

Flu vaccine maker Seqirus recently announced that the US Food and Drug Administration (FDA) has approved the next generation cell-based manufacturing process for use at its Holly Springs, N.C., facility, a step it says paves the way for more than doubling production of its Flucelvax quadrivalent vaccine for the 2019-20 flu season.

The company acquired the cell-based technology from Novartis in 2015, which at the time was producing about 3 million doses of the vaccine at the Holly Springs facility, which was built in a partnership with the US Biomedical Advanced Research and Development Authority (BARDA) as part of federal efforts to prepare for pandemic influenza threats.

In an Aug 23 statement on the FDA approval, Seqirus said technical improvements helped boost production to about 20 million doses last year.

Preliminary data during the 2017-18 flu season hinted that the cell-based vaccine provided better protection against H3N2, given that the formulation didn't involve the mutation in the egg-based vaccine seed strain thought to be a cause of lower efficacy. In its statement, Seqirus said it has worked with scientific partners to gather more effectiveness data from the 2017-2018 flu season, which it expects to release later this year. "Increased availability of cell-based vaccines in future seasons will provide further opportunities to study their effectiveness," the company said.

Gordon Naylor, Seqirus president, said, "The approval of our next generation process will enable us to meet increasing demand for this innovative vaccine in the US market as well as support its launch in Europe next season."

In its projections for flu vaccine supply for the 2018-19 season, the CDC said 85% will be made using egg-based technology, with the remaining 15% composed of recombinant and cell-based vaccine.
Aug 23 press release
CDC 2018-2019 seasonal flu vaccine supply backgrounder

Stewardship / Resistance Scan for Sep 12, 2018

News brief

Chilean study finds multidrug-resistant gut bacteria in farmed salmon

Chilean scientists have found that extensive use of the antibiotics oxytetracycline and florfenicol leads to the selection of multidrug-resistant (MDR) bacteria in the gut microbiota of farmed salmon, according to a study yesterday in PLoS One.

To demonstrate the impact of antibiotic use in Chile's salmon farms, where more than 5,500 tons of antibiotics have been used over the last 10 years to help prevent and treat infections caused by the bacterium Piscirickettsia salmonis, the scientists selected 15 healthy Atlantic salmon from four salmon farms, then isolated and tested bacteria from fecal matter and intestines. They were particularly interested in oxytetracycline and florfenicol, because those are the two most administered antibiotics in salmon farming, mainly delivered through medicated feed.

In total, 47 bacterial isolates resistant to florfenicol and 44 resistant to oxytetracycline were isolated from the fish, with 38.3% showing a high degree of resistance to florfenicol and 34.1% showing a high degree of resistance to oxytetracycline. In addition, 6 of the 91 isolates were resistant to six other antibiotics—chloramphenicol, tetracycline, erythromycin, ampicillin, ciprofloxacin, and kanamycin—and were characterized as "super-resistant." Molecular analysis of the isolates identified several genes that confer resistance to florfenicol and oxytetracycline, which corroborated the phenotypic resistance that was observed.

"The information collected in the present study clearly indicate that using large amounts of antibiotics to treat industrially farmed animals has the consequence of selecting for multiresistant bacteria in the intestinal microbiota, which then have undeniable advantages when liberated into the environment through the feces," the authors write, warning that the release of feces with antibiotic resistance genes into the marine environment could increase the risk of fish pathogens acquiring those resistance elements and becoming untreatable.
Sep 11 PLoS One study


UK study: Common antibiotics boost risk of drug-resistant E coli in dogs

The use of broad-spectrum antibiotics for the treatment of bacterial infections in dogs can create a reservoir of antibiotic-resistant Escherichia coli within the canine gastrointestinal tract, UK researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.

In the study, the researchers examined fecal samples from 127 dogs before treatment, immediately after treatment, and 1 month and 3 months post-treatment with one of five antibiotics—cefalexin, amoxicillin/clavulanate, cefovecin, clindamycin, or a fluoroquinolone. All confirmed E coli isolates then underwent antibiotic susceptibility testing, and resistant isolates were further analyzed for phenotypic extended-spectrum beta-lactamase (ESBL) and AmpC production and for the presence of resistance genes. The impact of treatment group per point in time and other factors on the presence of resistance were investigated using multilevel modeling.

The results showed that treatment with beta-lactams or fluoroquinolones was significantly associated with the detection of third-generation cephalosporin-resistant, AmpC-producing, MDR and/or fluoroquinolone-resistant E coli immediately after treatment. But at 1 month post-treatment, only amoxicillin-clavulanate was significantly associated with the detection of third-generation cephalosporin-resistant E coli. There was no significant difference at 3 months post-treatment for any of the antibiotics used. The detection of ESBL-producing E coli was not associated with use of any of the antibiotics administered at any time during the study.

The authors say the findings are important because they suggest that treatment with commonly used antibiotics can affect the commensal fecal flora of dogs, causing a shift toward a more resistant population of E coli that could be shared within households and healthcare settings and may cause extra-intestinal infections.

They conclude, "This information can be used to design biosecurity guidelines that limit transfer of such bacteria to in-contact individuals or to the environment, including barrier nursing, appropriate disposal of dog waste, and strict hand hygiene."
Sep 12 J Antimicrob Chemother study


Pharma CEO defends 400% essential antibiotic price hike

Nirmal Mulye, chief executive officer of the small Missouri-based drug company Nostrum Laboratories, said he hiked the cost of bottle of nitrofurantoin, an essential antibiotic, from  $474.75 to $2,392 last month because there was a "moral requirement to sell the product at the highest price."

Mulye was quoted in the Financial Times. Nostrum Laboratories makes a liquid version of the antibiotic, which was first developed in 1953 and used to treat bladder infections. The drug is considered an essential antibiotic by the World Health Organization (WHO).

Mulye said the decision to raise the price was a direct response to a similar raise by Casper Pharma, which prices a bottle of their branded antibiotic at $2,800.

"The point here is the only other choice is the brand at the higher price. It is still a saving regardless of whether it is a big one or not," said Mulye in the Financial Times.

Food and Drug Administration Commissioner Scott Gottlieb, MD, said on Twitter that "there's no moral imperative to price gouge and take advantage of patients," in reference to the story.  He also noted that there is no shortage of nitrofurantoin.
Sep 11 Financial Times story
Scott Gottlieb Twitter account

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