Stewardship / Resistance Scan for Oct 06, 2016

News brief

CDC funds antibiotic stewardship research focused on the human microbiome

The US Centers for Disease Control and Prevention (CDC) today awarded more than $14 million toward novel approaches to combat antibiotic resistance, including those that address a person's microbiome, or the vast population of microorganisms that live inside and on the body.

The awards, made through the CDC's Broad Agency Announcement, support activities for 34 projects under the agency's Antibiotic Resistance Solutions Initiative, the CDC said in a news release. The initiative, which also provides funding for state health departments and other partners, implements the tracking, prevention, and antibiotic stewardship activities outlined in the White House's National Action Plan for Combating Antibiotic-Resistant Bacteria, developed last year.

The awards will go to 22 universities, 2 nonprofits (The Joint Commission and OpenBiome), and one commercial company—Synthetic Biologics, Inc., of Rockville, Md. Some institutions will be conducting more than one project.

Antibiotics can disrupt the microbiome by changing the balance of good and bad bacteria, which can make patients susceptible to drug-resistant bacteria. Those resistant bacteria can then spread to other people, especially those who also have a disrupted microbiome or compromised immune system.

The research funded by the awards will explore the relationships between antibiotics, the microbiome, and the consequences of widespread antibiotic use. Areas of research include how antibiotics disrupt a healthy microbiome, how a disrupted microbiome puts patients at risk, and how antibiotic stewardship can be improved to better protect the microbiome.

"Understanding the role the microbiome plays in antibiotic-resistant infections is necessary to protect the public's health," said CDC Director Tom Frieden, MD, MPH.
Oct 6 CDC news release

BARDA awards contract for development of rapid diagnostic test

The Biomedical Advanced Research and Development Authority (BARDA) has awarded healthcare technology company DNA Electronics an $8.5 million contract to support development of a next-generation sequencing platform for rapid diagnosis of antimicrobial-resistant infections and influenza, according to news releases from the Department of Health and Human Services (HHS) and the company.

The money will enable the company to support further development and testing of its Genalysis platform, which can sequence and analyze the DNA from blood samples or swabs and identify the pathogen within 2 to 4 hours. The technology would allow doctors to quickly determine the bacteria responsible for infections and their associated level of resistance. It would also diagnose the specific strain of influenza virus in a flu patient. Under current methods, obtaining that information takes several days.

"More rapid diagnoses will allow clinicians to ensure the right treatment is being given, providing faster care for their patients and potentially curbing the spread of pathogens," Richard Hatchett, MD, acting director of BARDA, said in a statement. "This platform could help enable a faster and more accurate public health response to pandemic influenza and antibiotic resistant infections."

The first product will be a rapid blood-to-result diagnostic system for serious bloodstream infections leading to sepsis, which is responsible for 200,000 US deaths a year. Company officials say the device can be operated by users who don't have specific training in sequencing and has the potential to save lives, reduce time spent in critical care, and improve antibiotics stewardship.

The device is currently in late-stage testing and development. If it receives approval from the Food and Drug Administration (FDA), it could be on the market in 2018. The BARDA contract could be extended for up to 4 years and $51.9 million as the company seeks FDA clearance.

BARDA is a division of the Assistant Secretary for Preparedness and Response within HHS.
Sep 30 HHS press release
Sep 30 DNA Electronics press release

News Scan for Oct 06, 2016

News brief

Low-cost interventions result in high HPV vaccination rates

A study yesterday in Pediatrics showed how an urban health system achieved human papillomavirus (HPV) vaccination rates of 89.8% in teen girls and 89.3% in teen boys by using low-cost interventions, including "bundling" the HPV vaccine with other vaccines, and offering vaccines at every healthcare visit.

HPV vaccine rates have lagged behind those for meningococcal conjugate vaccine (MCV4) and tetanus toxoid, among others. This discrepancy is often explained by parental concern and provider misinformation. Denver Health is an urban health system that serves more than 17,000 teens in the Denver metro area annually, including 43% of the Denver Hispanic community and 33% of its African-American community.

From 2004 through 2014, Denver Health targeted teen ages 13 to 17 to get the HPV vaccine by offering the immunization as part of a standard bundle of vaccines, including diphtheria, MCV4, and tetanus. The health system also created standard orders for vaccines via the VaxTrax vaccine registry. Vaccination status was checked through VaxTrax at every doctor's appointment.

By 2014, HPV coverage of more than one dose was 89.8% among teen girls and 89.3% among teen boys, compared with national rates of 57.3% and 34.6%, respectively. Rates of complete three-dose HPV coverage were 66% for girls and 52.5% for boys, versus 37.6% and 13.9% nationally.

"Avoiding missed opportunities for vaccination and providing a strong recommendation for the HPV vaccine were key procedures that likely contributed to high coverage rates," the authors wrote.
Oct 5 Pediatrics study

Almost 400 suspected cases of mumps reported in Arkansas

The Arkansas Department of Health (ADH) said today it is still probing an outbreak of mumps in the northwest part of the state. So far, there are 391 cases under investigation.

The cases first appeared early in September, shortly after school started. As of today, 29 schools in three districts have confirmed cases of mumps.

"ADH is requiring students in the same school with vaccine exemptions for the MMR (Mumps, Measles, and Rubella) vaccine to be excluded from school for 26 days from the date of exposure and until the outbreak has ended. Students with non-medical exemptions, who receive the recommended doses of MMR vaccine, may return to school immediately," the ADH said in an update yesterday.

Mumps is a viral disease that transmits easily among children via respiratory droplets. The Centers for Disease Control and Prevention (CDC) recommends all school-age children receive the MMR vaccine before starting school, but children under the age of 18 who were not previously vaccinated can receive one dose with a follow-up 4 weeks later. The MMR vaccine confers 88% immunity to the disease.
Oct 5 ADH update

Report details 2014 measles outbreak in Ohio Amish communities

Delayed recognition of measles in young Amish adults in Ohio who contracted the virus in 2014 while helping with typhoon relief in the Philippines meant that the outbreak was well under way before the public health response began, according to an investigation of an outbreak, the nation's largest in two decades.

Investigators from the CDC and their partners in Ohio published their findings today in the New England Journal of Medicine.

The outbreak lasted 4 months, sickening 383 people—all but three of them from Amish households—in nine counties. The first two patients started having symptoms a day after returning from the Philippines, with two of their traveling companions developing rashes shortly after. Three sought care at the local hospital, where initial tests revealed thrombocytopenia, and medical teams diagnosed them as having dengue infections.

Measles was recognized after 12 more similar infections surfaced over the following weeks. Health officials took containment steps, stepped up surveillance, met with religious leaders to encourage case reporting, and launched free vaccination clinics, where 10,644 people were vaccinated. Over the course of the outbreak, health officials saw cases shift toward younger patients and from church exposure to home exposure, which they said could reflect social distancing measures.

Religious opposition to vaccination in the wake of the outbreak was less than in the past, and Amish community members were willing to limit attendance at gatherings to help curb the outbreak.

The authors said the outbreak underscores the threat of measles spread in undervaccinated communities, adding that early recognition and prompt launch of control measures can help limit the spread of the disease. They also noted that high vaccination coverage in the wider community is important for containing measles spread.
Oct 6 N Engl J Med abstract

Study: Global infectious disease deaths down, but not with dengue

Deaths from communicable diseases, especially HIV/AIDs and malaria, are on the decline worldwide, while deaths from dengue have increased. Those are some of the findings from the Global Burden of Disease 2015 Study (GBD 2015), which for the first time listed Ebola as a cause of mortality.

The study, published in The Lancet is a comprehensive assessment of mortality from 249 causes in 195 countries and territories from 1980 to 2015. Overall, death due to communicable diseases declined from 2005 to 2015, which the authors attributed to decreased mortality rates among patients with HIV/AIDS (a 42.1% drop), and malaria (43.1%).

Rotavirus was the leading cause of death in children younger than 5 years caused by diarrhea (146,000 deaths) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393,000 deaths). Both the Middle East and southern Asia saw growing mortality rates for these infectious diseases.

Interestingly, in light of the current Zika epidemic, the authors note that another flavivirus, dengue, is causing more deaths than it did in 2010 or 2013. "The increasing geographic range of dengue and, in some areas (eg, Latin America) increasing transmission intensity, contribute to growing concerns about other viruses that are transmitted by Aedes mosquitoes, including the chikungunya and Zika viruses," the authors wrote.
Oct 5 Lancet GBD 2015 report