Stewardship / Resistance Scan for May 23, 2022

News brief

WHO lays out priorities in battle against antimicrobial resistance

The World Health Organization (WHO) last week published its strategic priorities for tackling antimicrobial resistance (AMR).

The document lays out four strategic priority areas that incorporate what the WHO says are the essential components of the AMR response at global, regional, and country levels. It also lists the key achievements and the next steps that need to be taken in those four areas.

The first priority area is strengthening and developing a common vision for the global structures responsible for coordinating a multisectoral AMR response. These include groups such as the Tripartite Joint Secretariat on AMR and the Global Leaders Group on AMR, which were established to lead the global AMR response.

The WHO says one of the next steps for these groups is to establish a panel to define and support evidence-based policies against AMR across the One Health spectrum, which includes human health, animal health, food systems, and the environment.

Priority area number two is addressing the public health impact of AMR in every country by supporting continued development and implementation of National AMR Action Plans (NAPs), which to date have been established in 148 countries but have been implemented and funded in far fewer. Among the next steps to be taken is development of tools to review and assess NAP implementation and funding in countries.

For strategic priority area three—better access to quality AMR prevention and care—the WHO says a key next step will be operationalizing the SECURE initiative, a program developed by the WHO and the Global Antibiotic Research & Development Partnership to expand access to essential antibiotics.

Strategic priority area number four is strengthening surveillance systems and mechanisms for collecting, reporting, and disseminating AMR data. To build on one of the key achievements to date in this area—the creation of the Global Antimicrobial Resistance and Use Surveillance System—the document calls for establishing a WHO AMR dashboard to monitor the global AMR response and developing and implementing national AMR surveys.
May 18 WHO strategic priorities on AMR

G7 Health Ministers commit to addressing antimicrobial resistance

The G7 Health Ministers late last week highlighted the "silent pandemic" of AMR as one of their primary health priorities.

In a communique issued after their May 19-20 meeting in Berlin, the health ministers of the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) called AMR an "urgent public health and socio-economic problem" that will affect the entire globe but have a significant impact on low- and middle-income countries. Acknowledging AMR as a shared responsibility, they committed to "taking further urgent and tangible action" to address the issue.

Among the actions they committed to are establishing new and/or improving existing national integrated surveillance systems on AMR and antibiotic use in the human, animal, plant production, and environmental sectors; promoting prudent and appropriate use of antimicrobials and encouraging antimicrobial stewardship; strengthening implementation of Infection Prevention and Control Programs across the One Health spectrum; and strengthening the research and development pipeline for new antibiotics.

The communique also addressed the economic challenges that have stymied the development of new antibiotics and the need for G7 countries to develop incentives to bolster investment in the antibiotic pipeline.

"We acknowledge that it is essential to ensure a sustainable market for existing as well as new antibiotics," the group wrote. "This includes appropriate steps to address antibiotic market failure and to ensure the commercialisation and provision of existing and new antibiotics for unmet public health needs while taking into account stewardship and equitable access."

They added, "Recognising country-specific circumstances and member state competences, we will explore a range of market incentive options, with a particular emphasis on supporting relevant pull incentives."

The other priorities addressed in the communique and included in the G7 Health Track included working together to overcome the COVID-19 pandemic, strengthening capacities to respond to new pandemics, and addressing the health risks of climate change.
May 20 G7 communique

News Scan for May 23, 2022

News brief

COVID-related thyroiditis still detectable 1 year later in some patients

While COVID-19–related thyroid inflammation usually resolves shortly after the acute illness, about half of participants in a study presented today at the 24th European Congress of Endocrinology still had thyroid abnormalities a year later. The congress is being held May 21 to 24 in Milan, Italy.

University of Milan researchers monitored levels of thyroid-stimulating hormone and examined the gland with ultrasound for 1 year in more than 100 hospitalized patients with thyroiditis and COVID-19, according to a European Society of Endocrinology (ESE) news release,

Uptake of the imaging tracers technetium or iodine, which indicates thyroid function, was still lower than normal in about two thirds of patients at 9 months. After 1 year, the thyroid was still visible on ultrasound—even if reduced in size—in half the patients.

Thyroid function is important to metabolism, growth, and development and helps regulate numerous bodily functions by steadily releasing hormones into the bloodstream, the authors said. And when the body needs more energy during growth, cold temperatures, or pregnancy, the thyroid releases extra hormone.

Thyroiditis is common in patients who have moderate to severe COVID-19, the researchers noted, and has an important role in dysfunction of the hypothalamus-pituitary-thyroid axis. The resulting thyroid hormone imbalance is typically mild but is more pronounced in severe COVID-19.

The researchers said that they don't know if the findings have any long-term clinical consequences.

Lead author Ilaria Muller, MBBS, PhD, said that thyroid dysfunction and COVID-19 are linked. "Knowing that thyroid hormones correlate with the disease severity is important, and the fact that the thyroid gland seems directly involved in SARS-CoV-2 (COVID-19) viral infection needs to be taken into account," she said in the release.
May 21 ESE news release

Salmonella outbreak linked to Jif peanut butter sickens 14 in 12 states

Over the weekend the Centers for Disease Control and Prevention (CDC) announced a Salmonella Senftenberg outbreak linked to Jif peanut butter that has sickened at least 14 people in 12 states. Two people have been hospitalized, and no deaths have been recorded.

Because of potential contamination, on May 20 the J.M Smucker Co. announced a voluntary recall of peanut butter produced at a Smucker's facility in Lexington, Kentucky. Several types of peanut butter were recalled, including creamy, crunchy, natural, and reduced fat, the CDC said. Lot code numbers 1274425 through 2140425, with "425" at the end of the first 7 numbers, should be disposed of immediately.

According to a statement from the Food and Drug Administration (FDA), the peanut butter was distributed to retailers nationwide.

In epidemiologic investigations, all five case-patients interviewed reported eating peanut butter before they got sick, and four of them (80%) reported eating different types of Jif peanut butter. Texas and Georgia each reported two cases, while Washington, Missouri, Arkansas, Illinois, Ohio, Virginia, North Carolina, South Carolina, New York, and Massachusetts each reported a single case.

Symptom-onset dates range from Feb 17 through May 1. "The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella," the CDC said.
May 21 CDC announcement
May 20 FDA announcement

DRC reports fourth Ebola death in Equateur province outbreak

The Democratic Republic of the Congo (DRC) on May 19 reported a fourth case, which was fatal, in its latest Ebola outbreak, which is affecting Equateur province in the country's northwest, the World Health Organization (WHO) African regional office said in a May 20 tweet.

The country had gone about 2 weeks with no new cases, raising hopes that the outbreak was winding down.

The patient is a 12-year-old boy in Wangata, part of Mbandaka, where the outbreak is centered. The boy died from his infection. So far, all four of the people sickened in the outbreak have died from their infections.

Last week the WHO said outbreak responders were monitoring 295 active contacts and that so far, 809 people have been vaccinated.

The outbreak is the DRC's 18th battle with Ebola and is the third since 2018 to hit Equateur province. Genetic analysis suggests that the latest event probably resulted from another jump from animals to humans, rather than persistent virus from a survivor.
May 20 WHO African regional office tweet
May 17 WHO African regional office tweet

UK reports more unexplained hepatitis cases, posts investigation update

The United Kingdom's Health Security Agency (UKHSA) recently reported 34 more unexplained hepatitis cases in children, raising its total to 197 cases as of May 16. Along with the May 20 update it posted its third technical briefing on the investigation. Eleven children needed liver transplants, and so far, no deaths have been reported.

Though researchers are still weighing several potential causes, they noted that adenovirus is the most frequently detected virus in samples tested. Of 170 kids who underwent adenovirus testing, 116 were positive. For 13 others, it wasn't possible to rule out an adenovirus cause. Adenovirus subtyping of 35 available blood samples showed 41F was the most common type present.

Of 169 kids who were tested for COVID-19 on or around the time of hospital admission 15% were positive. SARS-CoV-2 serological testing is underway, as is toxicological testing.

The most common clinical symptom was jaundice, followed by vomiting, pale stools, and other gastrointestinal symptoms such as diarrhea and nausea.
May 20 UKHSA update
May 20 UKHSA technical briefing

High-path avian flu hits more poultry in 3 states

Three states reported more highly pathogenic avian flu outbreaks in poultry, one of which struck another commercial turkey farm in Minnesota, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

In Minnesota, the turkey farm outbreak occurred in Dakota County in the southern Twin Cities area at a facility that housed 57,000 birds. The state also reported another outbreak in backyard poultry, this time at a location in Polk County in the northwest.

In other developments, two western states—Idaho and Wyoming—reported more outbreaks in backyard flocks. Idaho reported the virus in birds at a location in Ada County, which surrounds Boise. Wyoming reported an outbreak in Campbell County, which is in the northeastern part of the state near Gillette.

So far, the APHIS has reported 344 outbreaks, 181 of them involving commercial flocks. The number of birds lost just passed 38 million. So far, 35 states have reported outbreaks in commercial or backyard poultry.
USDA APHIS poultry avian flu updates