News Scan for Oct 03, 2016

News brief

Livestock-associated MRSA found in UK pork products

Samples of UK-produced pork products have tested positive for a livestock strain of methicillin-resistant Staphylococcus aureus (MRSA), according to a report today by The Guardian.

Working in conjunction with the Bureau of Investigative Journalism (BIJ) and the Alliance to Save Our Antibiotics, the paper found that 3 out of 97 samples of minced pork sold in UK supermarkets Asda and Sainsbury's tested positive for MRSA CC398. BIJ reports that the bacterium in all 3 samples was fully resistant to tetracyclines and partially resistant to fluoroquinolones, which are widely used in intensive pig farming. The two Asda samples were also resistant to macrolide and lincosamide antibiotics, while the Sainsbury sample was resistant to trimethoprim.

Officials with the Department for Food, Environment and Rural Affairs (Defra) told The Guardian that if meat is handled and prepared properly, the risk for human infection is low. The main initial effect of MRSA CC398 is a skin infection, but it can have more serious consequences in people with compromised immune systems.

According to Eurosurveillance, CC398 is the dominant MRSA strain in European livestock today, with pigs being the primary host. It's also become a frequent cause of human colonization and disease on the continent, mainly affecting people who have direct livestock contact and members of their household. But studies in Denmark, where the reservoir of MRSA CC398 in pigs has been expanding, have shown some spillover into patients with no direct exposure to livestock. The Guardian and BIJ report that an estimated 12,000 people in Denmark have contracted MRSA CC398 in the past decade.

The Guardian and BIJ also found that, because of a regulatory loophole, live breeding pigs entering the UK from Denmark are not screened for MRSA CC398 because it's not classified as a notifiable disease by Public Health England. That means the UK's pig herd could be at risk of wider contamination.

Defra officials told The Guardian that the government is reviewing options for surveillance.
Oct 3 Guardian story
Oct 3 BIJ report
Sep 17, 2015, Eurosurveillance research article

Investigation reveals antibiotic overprescribing by UK online pharmacies

Britain's General Medical Council (GMC) says it's launching a probe into UK-based online pharmacies after a BBC investigation revealed that some are inappropriately selling antibiotics to customers.

In the BBC investigation, a reporter posing as a 16-year-old patient was easily able to obtain antibiotics for a dental infection, an ear infection, and a urinary tract infection over the course of 3 days after filling out an online questionnaire. The online requests were all approved by the same doctor, and the reporter—who's also a general practitioner—received a selection of antibiotics within 24 hours. Many of the antibiotics were not appropriate to the infection for which they were requested.

Of the 17 online pharmacies investigated, the BBC found that many were not following the guidelines for antibiotic prescribing put forward by Britain's National Institute for Health and Care Excellence.

"Overprescribing of antibiotics risks the health of us all, and it is important that every practising doctor in the UK reflects on current guidance," GMC chief executive Niall Dickson said in a statement. "Although we cannot comment on specific investigations, the BBC has produced serious allegations and we will be looking into them carefully."

The report comes at a time when Britain's National Health Service (NHS) has been urging doctors to curb overprescribing of antibiotics. In May, the NHS announced it would offer funding to hospitals and other providers that reduce inappropriate prescribing.
Oct 2 BBC investigation
Oct 2 GMC statement

Americas countries report 539 more chikungunya cases

Countries in the Americas reported 539 more chikungunya cases over the past week, with just a handful of countries reporting new cases, the Pan American Health Organization (PAHO) said in a Sep 30 update.

The total is down sharply from the 47,931 new confirmed, suspected, and imported cases reported the previous week, but is more in line with the 2 weeks before that, which had 510 and 1,788 new cases. Many locations, however, haven't reported any new cases for several weeks.

A large chunk of the new cases are from Guatemala, which had 210, and Costa Rica, with 107. Other countries reporting a few dozen more infections include Colombia, Ecuador, and El Salvador. The overall number of deaths remained the same, at 108. So far this year the United States has reported 86 imported chikungunya cases.

The Americas' outbreak began in December on St. Martin in the Caribbean. Since then the region has recorded 2,181,961 chikungunya cases.
Sep 30 PAHO update

HHS awards $200 million for next-generation anthrax vaccine development

The US Department of Health and Human Services (HHS) has awarded Emergent BioSolutions of Gaithersburg, Md., almost $200 million to develop its next-generation anthrax vaccine NuThrax, the agency said in a Sep 30 news release.

The 5-year, $198.7 million contract between the Biomedical Advanced Research and Development Authority (BARDA), part of HHS's Office of the Assistant Secretary for Preparedness and Response, funds the remaining development activities required for the company to apply to the US Food and Drug Administration (FDA) for the vaccine's licensure. The work includes a phase 2 study to evaluate the vaccine's safety and whether it interacts with an antibiotic administered as part of the routine treatment following anthrax exposure, as well as a phase 3 clinical study to determine the effectiveness of the vaccine candidate.

The contract also includes a provision about vaccine purchasing and options to buy vaccine for the Strategic National Stockpile. Before FDA licensure, the stockpiled vaccine could be used after an anthrax attack if authorized for emergency use by agency.

"BARDA is sponsoring the development of NuThrax to help better protect our nation from this threat," said Richard Hatchett, MD, acting director of BARDA. "This vaccine could provide protection in fewer doses than the anthrax vaccine currently available, potentially producing better health outcomes if it was needed during a public health emergency."

NuThrax, also known as "AV7909" contains an immune-boosting adjuvant called CPG 7909. Studies involving NuThrax so far indicate that two doses administered 14 days apart appear sufficient to stimulate a protective immune response against anthrax, HHS said.
Sep 30 HHS press release

Yellow fever and dengue vaccine combo OK for toddlers

Administering yellow fever vaccine with tetravalent dengue vaccine in healthy toddlers doesn't affect the immunogenicity or safety of the yellow fever vaccine, according to a study of healthy children in Colombia and Peru.

Researchers recently reported their findings in the October issue of The Pediatric Infectious Disease Journal. The study was funded by Sanofi Pasteur, the maker of the yellow fever and dengue vaccines used in the randomized, observer-blinded, phase 3 controlled trial.

The team enrolled 792 children ages 12 to 13 months from different centers in Colombia and Peru from September 2011 to September 2013. One group received yellow fever vaccine and the first dengue vaccine dose together, followed by the second and third doses of dengue vaccine 6 and 12 months later. The second group received yellow fever vaccine with a placebo, then the first and second doses of dengue vaccine 6 and 12 months later.

Yellow fever seroconversion rates didn't vary much between the placebo and concomitant vaccination group: 100% and 99.7%, respectively. After two injections of dengue fever, the percentage of participants above the targets for titers of the four dengue serotypes was 91.2% to 100% for the group that received the concomitant doses and 97.2% to 100% in the second group. The team didn't find any safety concerns during the trial.

The researchers concluded that combining the two vaccines against the two disease—both flaviviruses—results in a good yellow fever antibody response with no impact on safety, and combining the vaccines at the same office visit could offer public health benefits while conserving health resources.
October Pediatr Infect Dis J abstract

Flu Scan for Oct 03, 2016

News brief

Ivory Coast and Vietnam report new H5N1 outbreaks

Animal health officials in Ivory Coast reported a highly pathogenic H5N1 avian influenza outbreak at a commercial chicken farm in Abidjan district, located in the southern part of the country, according to a report today from the World Organization for Animal Health (OIE).

The event began on Jul 27, striking a facility housing 70,000 pullets and layers and killing 44,634 of the birds. The remaining ones were culled to control the spread of the virus. Other response steps included cleaning, disinfection, and temporarily limiting the trade of poultry and poultry products.

The report said the source of the outbreak isn't known, but it may be linked to the introduction of new animals.

Ivory Coast is among a handful of African countries that have reported a recent resurgence in H5N1 activity after a several-year hiatus.
Oct 3 OIE report

Elsewhere, Vietnam's agriculture ministry reported an H5N1 outbreak in backyard birds in Ca Mau province, in the far south of the country, according to a separate OIE report yesterday.

The outbreak started on Sep 25 and killed 300 of 800 susceptible birds in the flock. The remaining ones were stamped out, and other control measures included vaccination, enhanced surveillance, and establishing a protective zone around the location.

Vietnam reported its last H5N1 outbreak at the end of May.
Oct 2 OIE report

H7N8 from Indiana turkey outbreak can sicken mammals, but spread limited

The H7N8 virus that turned up in commercial turkey farms in Indiana earlier this year—the first time in North America—can infect mammals and cause severe disease, but doesn't transmit effectively, according to experiments using human airway cells and mouse and ferret models. Researchers from the US Centers for Disease Control and Prevention reported the findings Sep 28 in the Journal of Virology.

In the Indiana outbreaks, officials isolated highly pathogenic H7N8 and the closely related low-pathogenic version. Researchers used both in their experiments.

Both versions replicated easily in human cells and in the two animal models, but highly pathogenic H7N8 was more infectious, virulent, and lethal. In ferrets, both viruses replicated similarly, but symptoms such as weight loss, lethargy, and death were seen only with highly pathogenic H7N8.

In direct contact experiments with the ferrets, limited transmission was seen with low-pathogenic H7N8, with no transmission observed for the group infected with the highly pathogenic virus.

The ability of the H7 subtype to transmit to mammals and evolve to a more virulent strain is a cause for concern and sheds light into the potential threat of emerging H7 viruses, which required close monitoring for possible human health risks.
Sep 28 J Virol abstract

Study: Lower flu vaccine use among children who use alternative medicine

Children who use complementary or alternative medicine (CAM) are more likely to skip the seasonal flu vaccine, according to a study today in the journal Pediatrics. The authors suggest educating this population and their CAM providers on the benefits of the flu vaccine.

The rise of pediatric CAM has matched the rise of vaccine hesitancy in parents. One third of American adults used CAM in 2012, while 12% of children did, based on the 2012 National Health Interview Survey (NHIS), the most recent NHIS to include the Child Complementary and Alternative Medicine File (CAL). The authors of the study used the 2012 CAL survey results of 9,000 children to determine how CAM influenced the decision to vaccinate against influenza.

Overall, 43% of sample children received an influenza vaccine in the previous 12 months, but only 33% of children who had used alternative medical systems (acupuncture, chiropractic care, naturopathy) were vaccinated. Alternatively, children who used multivitamins were more likely to get the flu vaccine (45%).

"US children are an extremely important population pertaining to influenza," the authors wrote. "They experience the highest rates of infection and serve as a major source of transmission in the family and community."
Oct 3 Pediatrics study