Stewardship / Resistance Scan for Jun 22, 2022

News brief

WHO issues another dire antibiotic pipeline report

The World Health Organization (WHO) today released another disappointing report on the state of the antibiotic development pipeline.

Issued annually since 2017 as part of the WHO's efforts to prioritize and coordinate the global research and development of new antibiotics, the report presents an analysis of antibacterial agents in the clinical and preclinical pipeline. Previous reports have characterized the antibiotic development pipeline as insufficient for tackling the emergence and spread of antimicrobial resistance (AMR), suggesting that most of the antibiotics in development offer little benefit over existing treatments and that too few are novel drugs that target the multidrug-resistant bacterial species the WHO has deemed "critical" and "priority" pathogens.

In the new analysis, the WHO says the pipeline remains stagnant, with only 27 new antibiotics against priority pathogens in development—down from 31 in 2017—and the number of products in the preclinical pipeline constant over the past 3 years. Of the 27 products targeting priority pathogens, only 6 fulfill at least one of the agency's criteria for innovation, and only 2 are active against "critical" pathogens.

Only 12 new antibiotics have been approved by the US Food and Drug Administration or European Medicines Agency since 2017, and 10 of those belong to existing antibiotic classes where resistance mechanisms are established.

The report also notes that, of the 77 antibacterial agents in development, 45 are "traditional" direct-acting small molecules and 32 are "non-traditional" agents, including monoclonal antibodies, bacteriophages, and microbiome-modulating agents. The WHO says these products could provide a new approach to tackling drug-resistant infections, either as adjuncts or antibiotic alternatives, but many are in the early clinical stages and will face major developmental hurdles.

"There is a major gap in the discovery of antibacterial treatments, and more so in the discovery of innovative treatments," Hanan Balkhy, MD, WHO assistant director-general on AMR, said in a press release. "This presents a serious challenge to overcoming the escalating pandemic of antimicrobial resistance and leaves every one of us increasingly vulnerable to bacterial infections, including the simplest infections."  

The WHO says "urgent and concerted" investments in research and development by governments and the private sector are needed to accelerate and expand the pipeline.
Jun 22 WHO press release
Jun 22 WHO
2021 antibiotic pipeline report


New online platform for sharing AMR data launched

Nonprofit health organization Vivli yesterday announced the launch of a new online platform where pharmaceutical and biotech companies can share antibiotic susceptibility data on infection-causing bacterial pathogens.

The Antimicrobial Resistance (AMR) Register will enable companies to securely share AMR surveillance data they collect with researchers, national governments, and multilateral organizations such as the WHO, Centers for Disease Control and Prevention, and the United Nations. Vivli says the aim of the AMR Register is to make the large volumes of raw susceptibility data collected by pharmaceutical and biotech companies all accessible in one place for researchers, who can use it to map patterns of resistance, identify new drug-resistant pathogens, shape policies aimed at halting the spread of AMR, and spur innovation around new antimicrobials.

"Our understanding of how to control antimicrobial resistant infections and how best to protect human health hinges on better access to surveillance data," Marc Mendelson, PhD, chair of the AMR Register scientific advisory board, said in a press release. "Biopharmaceutical company data is a vital missing link in AMR surveillance, making the research enabled by the AMR register critical to mitigating the AMR pandemic and protecting the effectiveness of antibiotics, now and in the future."

Sharing surveillance data, and making it accessible to researchers and public health organizations, was one of the commitments made in 2016 by the more than 100 biopharmaceutical companies and trade organizations that signed on to the Davos Declaration on Antibiotic Resistance and later released the Industry Roadmap for Progress on Combating Antimicrobial Resistance.

Pfizer, GSK, Shionogi, Johnson & Johnson, Merck, Paratek Pharmaceuticals, and Venatorx Pharmaceuticals are among the companies that have already committed to contributing their data to the AMR Register, which was developed by Vivli with a grant awarded by Wellcome.
Jun 21 AMR Register press release

News Scan for Jun 22, 2022

News brief

US, global monkeypox cases climb ahead of WHO meeting

The US Centers for Disease Control and Prevention (CDC) yesterday reported 29 more monkeypox cases, raising the nation's total to 142.

So far 24 states and the District of Columbia have reported cases, up from 21 in the CDC's last update. The most affected states include California, New York, Illinois, and Florida.

Globally, as of Jun 21, a total of 41 countries have reported 3,098 monkeypox cases, according to the CDC's tally. Most are in 5 European countries: the United Kingdom, Spain, Germany, Portugal, and France.

Elsewhere, more countries reported their first cases. South Korea reported its first case, which involved an individual who arrived from Germany on Jun 21, according to Yonhap News. The person had a headache before departing, then had more symptoms, including skin lesions, upon arrival in South Korea.

Also, Singapore reported its first case, involving a man who worked as a British flight steward who flew into the country twice in June, according to the health ministry. He visited a massage establishment and three restaurants while in Singapore, and contact tracing is under way. He is being treated at the National Centre for Infectious Diseases in Singapore, where he is listed in stable condition. Media reports say an 11-person British Airways flight crew has been quarantined in Singapore for 21 days following the case confirmation.

Tomorrow, the World Health Organization (WHO) monkeypox emergency committee meets for the first time to assess if the situation warrants a public health emergency of international concern (PHEIC) and to make recommendations for curbing the spread of the virus.
Jun 21 CDC US update
Jun 21 CDC global update
Jun 22 Yonhap News story
Jun 21 Singapore health ministry statement
Jun 22 Independent story


Meningitis outbreak strikes Florida MSM community

The CDC said today it is helping the Florida Department of Health investigate one of the nation's worst meningococcal disease outbreaks in gay and bisexual men, with 24 cases and 7 deaths reported so far.

In a news release, the CDC recommends that men who have sex with men (MSM) in Florida receive the meningococcal vaccine (MenACWY) or talk to their providers about getting the vaccine if they are planning to visit Florida.

Jose Romero, MD, who directs the CDC's National Center for Immunization and Respiratory Diseases, said the push for vaccination is especially urgent, given the number of Pride events taking place in the state in the coming weeks. "Getting vaccinated against meningococcal disease is the best way to prevent this serious illness, which can quickly become deadly," he said.

The first symptoms are similar to those for flu, but typically worsen quickly and can spread to the lining of the brain and spinal cord, as well as to the bloodstream. The bacteria spread through respiratory secretions, and lengthy contact, such as kissing or being near someone who's coughing, fuels the spread.
Jun 22 CDC news release


UK sounds alarm for polio spread in London

The United Kingdom's Health Security Agency (HSA) today announced poliovirus monitoring of wastewater has found traces of the virus at a London facility multiple times recently, with the investigation suggesting vaccine-derived poliovirus type 2 (VDPV2) is probably spreading among closely linked people in North and East London.

In a statement, the HSA said routine wastewater surveillance typically turns up one to three such detections each year, which can occur when people vaccinated with live oral poliovirus overseas travel to the United Kingdom and briefly shed the virus in their feces.

However, several closely related viruses were found from February to May. They were classified as (VDPV2), which can sometime cause paralysis in people who aren't fully vaccinated. So far, no illnesses have been reported, but investigations are under way to detect any community transmission.

Great Britain reported its last wild poliovirus case in 1984 and was declared free of the virus in 2003.

Jane Clegg, chief nurse for the National Health Service in London, said, "The majority of Londoners are fully protected against Polio and won't need to take any further action, but the NHS will begin reaching out to parents of children aged under 5 in London who are not up to date with their Polio vaccinations to invite them to get protected."

In 2014, the WHO declared that the international spread of polio is a PHEIC, and the emergency committed has met 28 times to assess the latest developments. At their meeting in May when they extended the PHEIC, committee experts said the decision was partly based on the rising risk of international spread of circulating VDPV2.
Jun 22 UK HSA statement
May 21 WHO polio emergency committee statement


Wild bird H5N1 avian flu detections continue, especially in the Midwest

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported 53 more highly pathogenic H5N1 avian flu detections in wild birds found dead, raising the total 1,611.

Most were from Midwestern states, including Michigan, Minnesota, and Wisconsin. However, some were in western states, including Alaska, Washington, and Wyoming, and in eastern states, including Pennsylvania.

Most were waterfowl or raptors, but one was a red-winged blackbird.
Jun 21 USDA APHIS wild bird avian flu update

In a related development, Washington officials recently reported avian flu in a raccoon kit among a group of four found sick or dead, the Tri-City Herald reported, citing the Washington state Department of Game and Fish. Officials said the detection marked the first of its kind in North American raccoons. The animals were found at a state park in Pasco.

The strain has been found in other mammals, including foxes in the United States and Canada, raising concern about the zoonotic potential of the virus.
Jun 1 Tri-State Herald story

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