Stewardship / Resistance Scan for Aug 29, 2016

News brief

MCR-1 found for the first time on the Arabian Peninsula

An international team of researchers is reporting the first case of the colistin-resistance gene MCR-1 on the Arabian Peninsula.

In a study published in the International Journal of Infectious Diseases, the researchers reported that out of 75 colistin-resistant Enterobacteriaceae strains isolated from clinical cases in Bahrain, Kuwait, Oman, Saudi Arabia, and the United Arab Emirates, 4 Escherichia  coli isolates were found to harbor the MCR-1 gene on mobile pieces of DNA known as plasmids. Two of the isolates were from blood samples; the two others were from urine and a bed sore.

The researchers noted that the plasmids on the four isolates all carried various genes that confer resistance to carbapenem and beta-lactam antibiotics, with one of the isolates expressing high levels of carbapenem resistance. Besides colistin—which is considered an antibiotic of last resort—all four strains were uniformly resistant to third-generation cephalosporins, tetracycline, trimetoprime/sulfamethoxasole and gentamicin.

The researchers also said that one of the plasmids identified is the first found in a human E coli isolate to carry both MCR-1 and resistance genes to other classes of antibiotics. The findings are a concern because they suggest antibiotics commonly used in humans could facilitate the spread of MCR-1-carrying bacteria.

The MCR-1 gene was first identified in China in 2015, when researchers detected its presence in E coli samples from food, food animals, and humans. Since then, it's been found in bacteria in more than 30 countries.
Aug 26 Int J Infect Dis study

British scientists warn about drug-resistant fungal infections

UK scientists say that fungal infections are becoming increasingly resistant to the drugs used to treat them and warn that deaths will likely increase with rising resistance.

Fungi can cause a host of illnesses, from minor skin infections such as ringworm to more dangerous conditions like valley fever. While many of these conditions can be treated easily, fungal infections become more of a threat when they occur in people with compromised immune systems, like cancer patients, HIV patients, and premature babies. They're also a bigger problem in developing nations.

The Guardian reports that UK doctors are becoming increasingly alarmed about rising resistance to a class of antifungal agents known as azoles, which are used to treat a variety of fungal infections. Fungal resistance is similar to antibiotic resistance, but experts say it may be even more worrisome because there are far fewer drugs to treat fungal infections than there are antibiotics to treat bacterial infections.

"We cannot afford to lose the few drugs we have—particularly as very little funding is being made available for research into fungi and fungal infections," said Adilia Warris, MD, co-director of the Centre for Medical Mycology at Aberdeen University.

Warris and other experts said the widespread use of fungicides on agricultural crops is one of the factors in rising fungal resistance.

Fungal infections take more than 1.3 million lives each year globally, according to Rutgers University scientists.
Aug 26 Guardian story
Dec 23, 2013 Rutgers news release "Attacking fungal infection, one of world's major killers"

News Scan for Aug 29, 2016

News brief

Survey: 87% of pediatricians face parents who refuse to vaccinate kids

The proportion of pediatricians facing parents who refuse to vaccinate their children has grown markedly in recent years, to 87% according to a new survey from the American Academy of Pediatrics (AAP) published today in Pediatrics.

The AAP surveyed 627 vaccinating pediatricians in 2013 and found that 87.0% reported parental vaccine refusal, a figure that climbed from 74.5% in 2006. Also, 73.1% of respondents said parents are increasingly refusing vaccines because they believe they are unnecessary, which was up from 63.4% in 2006.

A total of 75.0% of pediatricians reported that parents delay vaccines over concern about discomfort, and 72.5% said parents delay because of concern for the children's immune system burden. In 2006, 6.1% of pediatricians reported always dismissing patients for continued vaccine refusal, which climbed to a significant 11.7% in the new survey.

"The perceived rise in refusals and delays does not seem to be solely attributable to any one vaccine, because pediatricians reported increased rates of parents who refused just one vaccine and those who refused more than one immunization," said study author Catherine Hough-Telford, MD, in an AAP news report. This supports previous findings that suggest the public's memory of vaccine-preventable diseases may be fading, she added. "Clearly, though, additional research is needed to evaluate vaccine hesitancy and how it relates to different vaccines," she said.

The AAP also published an accompanying guide today called "Countering vaccine hesitancy," which includes such pointers as remembering that vaccine-hesitant parents are a heterogenous group, and their individual concerns should be respected and addressed.

The guide also noted, "Pediatricians and other health care providers play a major role in educating parents about the safety and effectiveness of vaccines. Strong provider commitment to vaccination can influence hesitant or resistant parents."
Aug 29 Pediatrics study
Aug 29 AAP news release
Aug 29 Pediatrics AAP guidance
AAP vaccine refusal resource page

 

China reports another human H9N2 case

Chinese authorities have reported a new case of H9N2 avian flu in a baby boy, the second human case in as many days.

The Yunnan Provincial Health and Family Planning Commission on Aug 26 said a 10-month-old boy in Mengzi City has tested positive for the virus, according to report translated by FluTrackers, an infectious disease news message board. The case was detected during stepped-up surveillance efforts, and the boy has since recovered, the agency said. No other details were provided, such as whether the boy had contact with live poultry, which is the typical risk factor.

The report said the risk of transmission is very low, with no apparent human-to-human spread.

On Aug 25 local officials reported that a 29-year-old woman in Guangdong province had contracted H9N2, FluTrackers previously noted.
Aug 26 FluTrackers post
Aug 26 CIDRAP News scan on previous case

 

Avian flu found in wild Alaskan duck

The United States Department of Agriculture's (USDA's) Animal and Plant Health Inspection Service (APHIS), confirmed that a wild mallard caught in an animal refuge near Fairbanks, Alaska, tested positive highly pathogenic avian influenza. This the first time H5N2 has been found in the United States since June of 2015.

The duck was identified during routine surveillance and testing of wild birds. "Since July 1, 2016, USDA and its partners have tested approximately 4,000 samples, with a goal to collect approximately 30,000 samples before July 1, 2017," a press release from the USDA stated. The agency tested 45,500 samples in the year before Jul 1, with none testing positive for avian flu.

The risk of infection to humans remains low. According to the USDA, there has never been human infection in the United States with Eurasian H5 viruses. Still, the USDA said that proper handling of birds and eggs, including cooking poultry to an internal temperature of 165°F will kill highly pathogenic avian flu viruses.

Hunters are reminded to wash their hands if they come into contact with wild birds, and dress game birds in the field whenever possible.
Aug 26 USDA press release

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