News Scan for Aug 29, 2018

News brief

USDA notes BSE case in Florida cow; no threat to humans

The US Department of Agriculture (USDA) today announced a case of atypical bovine spongiform encephalopathy (BSE, or "mad cow" disease) in a 6-year-old beef cow in Florida.

The animal had not entered slaughter channels and does not pose any threat to the food supply or human health, the USDA said. According to a press release, the animal was tested during routine surveillance of cattle that are deemed unsuitable for slaughter.

BSE is not contagious and comes in two forms, classical and atypical. Classical BSE is associated with the outbreak in the United Kingdom in the 1980s and Creutzfeldt-Jakob disease.

"Atypical BSE is different, and it generally occurs in older cattle, usually 8 years of age or greater. It seems to arise rarely and spontaneously in all cattle populations," the USDA said.

This is the sixth detection of BSE in the United States. The first, found in 2003, was a case of classical BSE in a cow imported from Canada. The remaining five have been atypical BSE cases.
Aug 29 USDA press release

CDC: Salmonella in kosher chicken sickens 17, kills 1

The Centers for Disease Control and Prevention (CDC) today issued an outbreak notice for Salmonella illness tied to kosher chicken products in which 17 people in 4 states have been sickened.

Eight people have been hospitalized, including one in New York state who died. New York has reported 11 cases, Pennsylvania 4, and Maryland and Virginia 1 each. The outbreak strain is Salmonella I 4,[5],12:i.

On Aug 24 the USDA's Food Safety and Inspection Service (FSIS) and Empire Kosher Poultry, Inc, first announced the outbreak but didn't specify how people were affected. Empire Kosher has not yet recalled any chicken products, which include whole birds and chicken parts.

"In interviews, ill people reported eating kosher chicken, and when asked about the specific brand eaten, several people reported Empire Kosher brand," the CDC said. "The outbreak strain was also identified in samples of raw chicken collected from two facilities, including one facility that processes Empire Kosher brand chicken."

Illnesses started on dates ranging from Sep 25, 2017, to Jun 4, 2018. Nine of the 11 people infected are female.
Aug 29 CDC notice
Aug 27 CIDRAP News Scan

Congo government warns of growing yellow fever outbreak

Officials from the Congo Republic warned on Monday of at least 70 suspected yellow fever cases, according to a post on ProMED Mail, on online infectious disease tracking message board.

The 70 cases are in five health districts, including a border district with Angola, according to the minister of health and population, Jacqueline Lydia Mikolo. Reuters reported that officials are suggesting there are as many as 186 suspected yellow fever cases, and they warned of "an emerging event of epidemic proportions."

Yesterday, the World Health Organization (WHO) reported one confirmed case of the mosquito-borne diseases in a Congolese man who traveled to and from Angola in July. The man, who was treated at a health center in Pointe Noire, had not been vaccinated against yellow fever.

In 2016, Angola and the Democratic Republic of the Congo, saw a major yellow fever outbreak, which killed more than 400 people, and put a run on the global supply of yellow fever vaccine.
Aug 27 ProMED post
Aug 27 WHO weekly report
Aug 28 Reuters story

Study finds link between congenital defects, maternal Zika infection

A small case-control study conducted during the Zika outbreak in French Polynesia shows an association between congenital defects with both maternal Zika virus seropositivity and symptomatic Zika virus infection during pregnancy. The study was published yesterday in Emerging Infectious Diseases.

The study tracked 21 cases and 102 controls in 2013 and 2014. Of the 21 case-patients, 7 had microcephaly, 5 had brainstem dysfunction characterized by an inability to suck and swallow, and 9 had other central nervous system defects.

"Maternal Zika virus seroprevalence was 95% among case-patients and 76% among controls (P = 0.07)," the authors said.

Thirty-eight percent of mothers of case-patients and 17% of controls had symptomatic Zika virus infection during pregnancy, and mothers of 57% of case-patients and 60% of controls had asymptomatic infection (timing unknown, P = 0.07.)

Among women who reported Zika symptoms in pregnancies for case-patients, 88% (7/8) reported it in the first trimester and 12% (1/8) in the second trimester. For controls, 71% (12/17) of mothers reported symptoms in the first trimester and 29% (5/17) in the second or third trimesters.

The authors conclude, "We found evidence for an association of congenital defects with both maternal Zika virus seropositivity (time of infection unknown) and symptomatic Zika virus infection during pregnancy. Although the early childhood development assessment found no excess burden of developmental delay associated with maternal Zika virus infection, larger, longer-term studies are needed."
Aug 28 Emerg Infect Dis study

Stewardship / Resistance Scan for Aug 29, 2018

News brief

UK health groups publish guidelines for FMT in recurrent C diff patients

The British Society of Gastroenterology and the Healthcare Infection Society have published guidelines for the use and screening of fecal microbiota transplant (FMT) in patients with recurrent or refractory Clostridium difficile infection (CDI).

The guidelines, published yesterday in BMJ Gut and based on a review of randomized trial evidence, recommend that FMT should be offered to patients with recurrent CDI who have had at least two recurrences, or those who have had one recurrence and have risk factors for further episodes. But FMT should only be considered after recurrence of symptoms following resolution of an episode of CDI that was treated with appropriate antimicrobials for at least 10 days. Consideration of treatment with extended/pulsed vancomycin and/or fidaxomicin before considering FMT is recommended.

The guidelines also advise that FMT be considered in cases of refractory, or unmanageable, CDI (although the quality of evidence for its utility is lower than for recurrent CDI), but should not be administered as initial treatment for CDI. FMT is not recommended for treatment of irritable bowel syndrome or other gastrointestinal diseases.

For FMT donations, the guidelines recommend that FMT is best sourced from a centralized bank of frozen stool, but that related and unrelated donors should both be considered acceptable. Potential donors should be screened by questionnaire and personal interview to establish risk factors for transmissible diseases, and blood and stool screening is mandatory.

While FMT has become an accepted treatment for recurrent CDI, the authors of the guidelines say the absence of appropriate, evidence-based protocols that take into account UK clinical practice and FMT regulation has been perceived as a barrier to FMT use in the United Kingdom in Ireland. "These guidelines seek to rectify this problem," they wrote.
Aug 28 BMJ Gut article

General pharmacists might be option for resource-limited stewardship

General pharmacists who underwent a short infectious diseases training course can safety implement an antibiotic approval program, thereby providing an antimicrobial stewardship program option for resource-limited settings, researchers from Thailand reported today in Infection Control and Hospital Epidemiology.

For their study, the investigators compared the effectiveness of antibiotic postprescription review and authorization (PPRA) done by infectious diseases (ID) clinical fellows with that done by trained general pharmacists. The study took place on 6 medical wards of a Bangkok hospital—3 assigned to the clinical fellow group and 3 to the pharmacist group. The researchers focused on patients who received one or more doses of targeted antibiotics: piperacillin/tazobactam, imipenem/cilastatin, and meropenem. There were 303 patients in the pharmacist PPRA group and 307 in the clinical fellow PPRA.

The researchers looked for any differences in favorable response of the patients who received the targeted antibiotics, based on whether PPRA was done by clinical fellows or trained pharmacists.

The authors found no significant difference in favorable clinical response between the two groups, but they couldn't confirm noninferiority of pharmacist PPRA in the consumption of targeted antibiotics. The team did, however, find no significant difference in consumption of targeted antibiotics, antibiotic expenditure, and other treatment outcomes.

They concluded that the strategy of using trained pharmacists appears safe, but it may not be as efficient in reducing antibiotic consumption as antibiotic approval implemented by ID clinical fellows. "Therefore, using trained general pharmacists could be an alternative to ID specialists for antibiotic approval when resources are limited," they wrote.
Aug 29 Infect Control Hosp Epidemiol abstract

Experts tout typhoid conjugate vaccine as an antibiotic stewardship tool

In a commentary yesterday in The Lancet Infectious Diseases, a global group of experts outlined why large-scale, more aggressive typhoid vaccination programs have the potential to reduce antibiotic overuse, a factor that should be incorporated when planning immunization campaigns.

Typhoid fever, caused by Salmonella enterica serotype Typhi bacteria, is responsible for an estimated 12 million to 20 million illnesses and more than 150,000 deaths a year. In March the World Health Organization recommended "programmatic" use of typhoid conjugate vaccines in endemic nations. Officials have formed national vaccination policies based on averted typhoid cases and their associated costs, but this paints only a partial picture, the scientists said.

"For every true case of typhoid fever, three to 25 patients without typhoid disease are treated with antimicrobials unnecessarily, conservatively amounting to more than 50 million prescriptions per year," the authors write. "Antimicrobials for suspected typhoid might therefore be an important selective pressure for the emergence and spread of antimicrobial resistance globally."

The experts propose that large-scale, more aggressive typhoid vaccination programs—including catch-up campaigns in children up to 15 years old and vaccination in lower-incidence settings—may reduce the overuse of antimicrobials and thereby help stem antimicrobial resistance. "Funding bodies and national governments must therefore consider the potential for broad reductions in antimicrobial use and resistance in decisions related to the rollout of typhoid conjugate vaccines," they conclude.
Aug 28 Lancet Infect Dis commentary