Study: Feedback, education reduced antibiotic prescribing in telemedicine
Individualized prescribing feedback and education in a telemedicine practice significantly decreased antibiotic prescribing rates for upper respiratory infection (URI) and bronchitis compared with education alone, US researchers reported yesterday in the Journal of General Internal Medicine.
In a randomized controlled trial conducted at Doctor on Demand, a US telemedicine practice, from Jan 1 to Nov 30, 2018, a team lead by researchers from the Antibiotic Resistance Action Center at the George Washington Milken Institute of Public Health examined the effect of two antibiotic stewardship interventions on antibiotic prescribing for upper respiratory infection (URI), bronchitis, sinusitis, and pharyngitis—four conditions for which antibiotics are inappropriately prescribed or overprescribed. One group of clinicians at the practice (the control group) received education (treatment guideline presentation and an online course), and the intervention group received education plus individualized feedback via an online dashboard with monthly rates of personal and practice-wide prescribing rates.
The primary outcome of the trial was the antibiotic prescription rates for each of the four diagnostic categories.
In the pre-intervention period, the control and intervention groups had different baseline antibiotic prescribing rates for URI (18.4% vs 15.0%), bronchitis (46.8% vs 64%), sinusitis (84.1% vs 87.2%), and pharyngitis (81.3% vs 74.9%). Antibiotic prescriptions for all conditions decreased in the post-intervention period compared with those in the pre-intervention period. Compared with the control group, however, the reduction in antibiotic prescriptions for URI and bronchitis was greater in the group that received education plus individual feedback (interaction term ratio, 0.60; 95% confidence interval [CI], 0.47 to 0.77 for URI and 0.42; 95% CI, 0.32 to 0.55 for bronchitis). There was no significant difference between the two groups for sinusitis and pharyngitis.
The authors of the study note that in December 2018 Doctor on Demand expanded the intervention to provide feedback dashboards to all clinicians at the practice.
"These findings should be used to promote antibiotic stewardship across telemedicine and other ambulatory medical practices," the authors wrote. "Future studies should examine the long-term impact of education and feedback interventions, and maintenance of antibiotic prescription reductions."
Aug 26 J Gen Intern Med study
Ebola sickens 2 more in latest DRC outbreak; 106 cases, 46 deaths
Tests confirmed two more Ebola infections in the Democratic Republic of the Congo (DRC) outbreak in Equateur province, lifting the overall total to 106, the World Health Organization (WHO) African regional office said in a Twitter update today.
Two more deaths were reported, putting the outbreak's fatality count at 46.
The latest outbreak in the DRC began in early June, just as a large outbreak centered in North Kivu province was declared over. Genetic evidence suggests the two outbreaks aren't related, with the new one thought to be the result of a new zoonotic spillover where a similar, short-lived outbreak occurred in 2018.
Illnesses in the new outbreak, the DRC's 11th involving Ebola, are occurring across a wide area that ranges from remote areas that are hard for responders to reach to the provincial capital Mbandaka, which is located on a river and has travel connections to Kinshasa and neighboring countries.
Aug 27 WHO African regional office tweet
Zika virus infection may predispose to future severe dengue disease
Previous Zika virus infection can significantly enhance the risk of severe dengue disease, which could complicate the search for a Zika vaccine, according to a study published today in Science.
Researchers from the University of California at Berkeley studied data from two groups of Nicaraguan children who lived through epidemics with both mosquito-borne viruses: Zika in 2016 and dengue in 2019. They found that some antibodies to the Zika virus, which typically help protect against future Zika infections, may worsen future dengue infections, a phenomenon known as antibody-dependent enhancement.
Lead author Leah Katzelnick, PhD, said in a university press release that the findings raise important questions for Zika vaccine research: "Could a vaccine only targeted at Zika actually put people at increased risk of more severe dengue disease? And how can you design a Zika vaccine that only induces good antibodies that protect you against Zika, but doesn't induce these other, potentially enhancing antibodies that are harmful against disease?"
Dengue disease is caused by four related viruses that can each cause slightly different symptoms and illness severity. A person infected with one type of dengue virus is at higher risk for another, more severe illness when exposed to a second type of dengue virus. But if the person is infected with two types of dengue viruses, they typically are at least partially immune against severe dengue.
While the finding complicates development of safe and effective Zika vaccine, it could can help public health experts prepare for upcoming epidemics, senior author Eva Harris, PhD, said in the release. "So, for instance, if you have a dengue Type 2 epidemic after a big Zika outbreak, you know to prepare your hospitals to treat people who might be more likely to develop a more severe disease."
Aug 27 Science study and commentary
Aug 27 University of California at Berkeley press release
New Hampshire, Massachusetts report rare mosquito-borne illnesses
State officials in New Hampshire confirmed the state's third case of Jamestown Canyon virus (JCV) this week, as officials in Massachusetts confirmed its third human case of eastern equine encephalitis (EEE) virus infection this year.
Both viruses are spread by mosquitoes and relatively rare, but they can be deadly. In Massachusetts, the Department of Public Health (DPH) said the EEE case occurred in a man in his 90s who was exposed in Plymouth County.
"There have already been two other human cases identified this year. In 2019, there were 12 human cases of EEE in Massachusetts with 6 deaths," the DPH said.
In New Hampshire, an adult from Dumbarton was hospitalized with a fever and headache and diagnosed as having JCV.
"This is the third detection of Jamestown Canyon Virus infection in our State this year, and the risk for Jamestown Canyon Virus and other mosquito-transmitted viral infections will only increase until there is a mosquito-killing hard frost in the fall," said Benjamin Chan, MD, MPH, state epidemiologist.
Aug 19 Massachusetts DPH notice
Aug 21 New Hampshire DHHS notice
Avian flu outbreaks strike birds in Australia and Russia
Animal health officials in Australia reported new avian flu outbreaks in commercial birds involving two separate strains, low-athogenic H7N6 and highly pathogenic H7N7, according to notifications from the World Organization for Animal Health (OIE).
The H7N6 outbreak, the country's first involving the strain since 2013, began on Aug 18 at a commercial emu farm in Kerang, Victoria, killing 100 of 8,753 susceptible birds. Clinical signs were seen only in chicks. The source of the virus isn't known but could related to contact with wild birds, according to the report. Culling and disinfection are planned for the site.
Regarding H7N7, the latest outbreak appears to be linked to recent detections at layer farms in Victoria state. The new outbreak began on Aug 23 at a farm in Lethbridge, Victoria, killing 15 of 36,878 susceptible birds. The rest were culled, and the facility is being disinfected.
Australia also recently reported outbreaks from a third strain, low pathogenic H5N2, which turned up on turkey farms, also in Victoria state.
Aug 26 OIE report on H7N6 in Australia
Aug 25 OIE report on H7N7 in Australia
Elsewhere, Russia recently reported three highly pathogenic H5 avian flu outbreaks in village and backyard poultry in Omsk Oblast, located in southwest Siberia, according to an OIE report. The events began on Aug 11, killing 266 of 543 birds. Culling is in progress. So far, the source of the virus isn't known.
Earlier this month, Russia reported two outbreaks involving H5N8 in backyard and village poultry in Chelyabinsk Oblast, located in the Ural Mountains near the border with Europe and Asia.
Aug 25 OIE report on H5 in Russia