Stewardship / Resistance Scan for Sep 12, 2019

News brief

Chick-fil-A reached goal of antibiotic-free chicken in all its restaurants

Chick-fil-A today announced it has reached its goal of serving only chicken raised without the routine use of antibiotics, an ambition it set in 2014, according to a company news release.

Chick-fil-A reached its "no antibiotics ever" milestone in May and will be touting the achievement on packaging in its restaurants next month. Matt Abercrombie, director of menu and packaging for the company, said, "Our goal was to pursue the highest standard and partner with the USDA [US Department of Agriculture] to verify it." He added, "We worked with our suppliers to convert our chicken supply to No Antibiotics Ever, which was an industry-changing move, as the supply of No Antibiotics Ever chicken previously did not exist to match our scale."

Other restaurant chains that have reached the same milestone are Chipotle, Panera, McDonald's, Subway, and KFC, according to a blog post today by Avinash Kar and Lena Brook with the New York City–based Natural Resources Defense Council (NRDC).

The pair said, "This reflects a stunning antibiotics success story that has unfolded across the U.S. chicken industry in the last decade," pointing to the fact that 92% of US chicken sold last year was produced without the use of medically important antibiotics.
Sep 12 Chick-fil-A news release
Sep 12 NRDC blog post

Study finds similar antibiotic resistance rates in sewage, clinical samples

A study today in Eurosurveillance suggests analysis of sewage samples has the potential to be used for population-level surveillance of antibiotic resistance, complementing current monitoring systems and providing clinically relevant data for countries where clinical surveillance is lacking.

In the study, a team of Swedish researchers collected hospital and municipal sewage on eight and six occasions, respectively, in 2016, then analyzed 1,252 Escherichia coli isolates from the samples for resistance to eight different antibiotics. The annual mean resistance rates measured in hospital sewage were higher than in the municipal sewage for seven of the eight antibiotics, and a higher prevalence of extended-spectrum beta-lactamase (ESBL) producers was also observed in the hospital sewage. In addition, E coli showing resistance to at least one of the antibiotics were twice as prevalent in the hospital sewage (36.6% vs 17.9%), and 10 of the 11 most resistant isolates were found in the hospital sewage.

Comparison of the resistance rates in the hospital and municipal sewage isolates showed a strong correlation with resistance rates in corresponding clinical isolates from hospital patients and from primary care urine samples, with the stronger correlation observed between resistances rate in hospital sewage and hospital clinical isolates (r² = 0.95 and 0.89 for urine and blood samples, respectively) and a slightly weaker correlation between resistance rates in municipal sewage and primary care isolates (r² = 0.82). The resistance rates in isolates from hospital sewage were overall close to those observed in hospital patient isolates, while the resistance rates from municipal sewage were about half of those measured in primary care isolates.

"In conclusion, this study indicates that resistance data obtained from sewage samples reflects well the resistance situation in the studied populations. However, in order to use sewage monitoring to predict the clinical situation in other populations, including those for which such data are missing, further calibration is needed," the authors of the study write. "This calibration could be extended from E coli to additional important pathogens that can be present in faeces (such as Klebsiella pneumoniae and Salmonella enterica) and possibly from the study of human populations to husbandry animals."
Sep 12 Eurosurveill study

News Scan for Sep 12, 2019

News brief

New confirmed cases raise DRC Ebola outbreak total to 3,099

According to the World Health Organization's (WHO's) online Ebola dashboard, officials in the Democratic Republic of the Congo (DRC) confirmed 8 new cases of the disease today, raising the outbreak's overall total to 3,099. Health officials are also investigating 409 suspected cases.

Three new deaths were also recorded, which moves the fatality count to 2,074, the WHO said.

In an update today from the DRC's multisector Ebola response committee (CMRE) on seven cases identified yesterday, the CMRE said Beni and Mambasa had two cases each, while Kayna, Mabalako, and Mandima each recorded one case.

The CMRE also said vaccinated efforts continue throughout the DRC, with a total of 217,921 people vaccinated with Merck's rVSV-ZEBOV.
WHO Ebola dashboard
Sep 12 CMRE bulletin

Global Vaccination Summit launches in Brussels

In an effort to galvanize global efforts to stop the spread of vaccine-preventable diseases and curb vaccine misinformation, the European Commission (EC) and the World Health Organization (WHO) today hosted the world's first Global Vaccination Summit in Brussels.

In a joint statement, Jean-Claude Juncker, EC president, said it's inexcusable that in a developed world, children still die of diseases that should have been eradicated long ago. "Worse, we have the solution in our hands but it is not being put to full use. Vaccination already prevents 2 to 3 million deaths a year and could prevent a further 1.5 million if global vaccination coverage improved," he said. "Today's summit is an opportunity to address this gap."

Tedros Adhanom Ghebreyesus, PhD, the WHO's director-general, said the world is at a critical turning point, with measles resurging and 1 in 10 children missing out on key childhood vaccines. "We can and must get back on track. We will only do this by ensuring everyone can benefit from the power of vaccines – and if governments and partners invest in immunization as a right for all, and a social good," he said. "Now is the time to step up efforts to support vaccination as a core part of health for all."

Over the past 3 years, seven countries—including four in Europe—have lost their measles elimination status, with new outbreaks resulting from gaps in vaccine coverage, including teens and adults who were never fully vaccinated. The summit's goal is to address vaccination barriers such as rights, regulations, and accessibility, as well as access to vaccination services. Other topics include social and cultural norms, individual motivation, attitudes, and knowledge.

The EC and the WHO also urged strong support for GAVI, the Vaccine Alliance, which plays a critical role in making vaccines available to lower income countries.
Sep 12 WHO press release

Moderna reports promising interim trial results for CMV vaccine

Moderna, Inc., a biotechnology company based in Cambridge, Mass., today announced promising interim findings from a phase 1 trial of its messenger RNA (mRNA) cytomegalovirus (CMV) vaccine (mRNA-1647).

Sallie Permar, MD, PhD, with Duke Medical School, said in a Moderna press release that CMV is the leading infectious disease cause of birth defects, and there is a need for a vaccine that can block transmission from mother to fetus. She said the interim data are exciting, because they show that the vaccine can induce immune response in seronegative individuals that is greater than what is seen in natural CMV infections. That finding is important, because natural immunity doesn't completely protect against congenital CMV transmission.

The phase 1 study enrolled 169 healthy adult volunteers, including those who have and haven't been exposed to CMV. Participants were randomized to receive placebo or one of four different vaccine doses given three times at 0, 2, and 6 months. The interim findings are based on the first three dose levels at 3 months, 1 month after the second dose, and before the third dose.

The safety analysis found that the vaccine was generally well tolerated with injection site pain the most common local adverse event.

Based on the interim phase 1 data, Moderna said it will advance mRNA-1647 to a phase 2 dose-confirming trial that will test the intended phase 3 study formulation.

CMV, a member of the herpesvirus family, infects about 25,000 newborns in the United States every year, and birth defects—many of them neurodevelopmental—occur in about 20% of them.
Sep 12 Moderna press release