News Scan for Jun 03, 2020

News brief

Nondrug measures slowed COVID-19 spread without lockdown, analysis finds

Physical distancing, enhanced screening, and quarantining of people with confirmed or suspected COVID-19—without a lockdown—reduced the spread of the novel coronavirus outside of a hard-hit South Korean province by up to 34%, results of a study published yesterday in Emerging Infectious Diseases suggest.

The researchers analyzed data from local public health authorities from before South Korea implemented enhanced community screening and testing on Feb 23 and mandated physical distancing in mid-March and after they began to relax these measures on Apr 19. The outbreak was deemed contained as of Apr 21.

The authors collected data for 2,023 (98%) of the 2,066 reported COVID-19 cases to estimate the instantaneous effective reproduction number (R_t) outside of Daegu-Gyeongsangbuk province, the site of super-spreading events. R_t is a real-time measure of disease transmission intensity. An R_t of less than 1 means that the outbreak is under control.

Mean R_t was 2.23 the week before Feb 23, declining to 1.48 the following week, corresponding to a 33.6% reduction in transmissibility (95% confidence interval [CI], 23.46% to 43.44%). Likewise, implementation of stringent physical distancing measures was associated with a further reduction in R_t of 9.28% (95% CI, 6.80% to 11.75%).

Mean time from symptom onset to laboratory confirmation of COVID-19 was 4.6 days before public health measures were implemented (95% CI, 0.0 to 12.4), declining to 3.4 (95% CI, 0.0 to 9.0) after. Median incubation period was 4.7 days (95% CI, 0.1 to 15.6).

While non-lockdown measures appeared to suppress spread, the authors noted that South Korea remains vulnerable to future outbreaks. "Because social distancing measures will be relaxed while opportunities for importation of infections from abroad continue, ongoing monitoring of the effective reproductive number can provide relevant information to help policymakers control a potential second wave of COVID-19," they wrote.
Jun 2 Emerg Infect Dis study

India and Taiwan report more high-path avian flu in poultry, other birds

India yesterday reported six more highly pathogenic H5N1 avian influenza outbreaks in poultry and other birds, and earlier this week, Taiwan reported another outbreak involving H5N5, according to separate reports from the World Organization for Animal Health (OIE).

In India, three outbreaks involved poultry, two involved house crows, and one affected birds at a zoo. The poultry outbreaks occurred at farms, in backyards, and at a livestock market in Kerala, Karnataka, and Madhya Pradesh states starting Mar 6 to 15. Taken together, the outbreaks killed 111 of 11,912 birds. The rest were destroyed to curb the spread of the virus. India continues to report sporadic H5N1 outbreaks, and it reported its last event in February, which involved a farm in Odisha state.

Also, the country reported two outbreaks involving wild birds in two different states. One event occurred in Bihar state, with three detections in house crows and one in red-headed trogons. The outbreak occurred between Feb 15 and Mar 19, killing 57 birds, most of them house crows.

In another report, India reported three outbreaks involving house crows at different locations in Madhya Pradesh state, which began between Mar 20 and Mar 22, killing 148 birds. And lastly, an outbreak at a zoo in Jharkhand state that began on Feb 23 killed nine birds, including lesser adjutants, white ibises, and grass owls.

Elsewhere, Taiwan this week reported another H5N5 outbreak in poultry, which occurred at a farm in Yunlin County. The event began on May 21, killing 55 of 24,103 birds. The rest were culled as part of the outbreak response.
Jun 2 OIE report on H5N1 in India (Kerala)
Jun 2 OIE report on H5N1 in India (Karnataka)
Jun 2 OIE report on H5N1 in India (Madhya Pradesh)
Jun 2 OIE report on H5N1 in India (Bihar state wild birds)
Jun 2 OIE report on H5N1 in India (Madhya Pradesh house crows)
Jun 2 OIE report on H5N1 in India (zoo)
Jun 1 OIE report on H5N5 in Taiwan

CEPI announces funding to develop another chikungunya vaccine

The Coalition for Epidemic Preparedness Innovations (CEPI) and its Indian affiliate today announced a new partnership with India-based Bharat Biotech and the International Vaccine Institute (IVI) to advance the development of a chikungunya vaccine.

According to a CEPI statement, the group will give the consortium up to $14.1 million to develop and make a 2-dose live-inactivated vaccine. This part of the award is supported by the European Union's Horizon 2020 program through an existing partnership with CEPI.

A grant of up to $2 million from the Indian government's CEPI initiative will go toward setting up manufacturing facilities in India and producing vaccine for a clinical trial. The money will also fund phase 2 and 3 clinical trials in Colombia, Panama, and Thailand. The vaccine has been through preclinical trials and a phase 1 trial of an adjuvanted version of the vaccine in India.

So far, CEPI has announced more than $80 million for the development of three chikungunya vaccines.
Jun 3 CEPI press release

Stewardship / Resistance Scan for Jun 03, 2020

News brief

US study finds small decline in inappropriate outpatient antibiotics

The proportion of unnecessary antibiotic prescriptions issued by US physicians' offices and emergency departments (EDs) decreased minimally from 2010 through 2015, driven mainly by a decrease in unnecessary prescriptions for children, researchers reported yesterday in Clinical Infectious Diseases.

For the study, researchers from the Centers for Disease Control and Prevention (CDC), the University of Utah, and Boston Children's Hospital used the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys to identify visits to physicians' offices and EDs and antibiotic prescriptions for 2010-11, 2012-13, and 2014-15.

They used a tiered diagnosis system from previous CDC studies to assign a single diagnosis based on the most likely indication for antibiotics, with diagnoses characterized as acute respiratory infections (ARIs) and other conditions. Antibiotic-inappropriate ARIs included asthma, allergy, bronchitis, bronchiolitis, influenza, non-suppurative otitis media, viral upper respiratory infection, and viral pneumonia.

For each period, the researchers calculated the mean annual number of visits and antibiotic prescriptions per 1,000 population. Rates and percentages were calculated overall, for ARIs, antibiotic-inappropriate ARIs, other conditions, and each condition for all ages and by age-group.

They used previous CDC methods to assess the percent of unnecessary antibiotic prescriptions and calculated the mean annual number of unnecessary prescriptions per 1,000 people as the difference between actual and necessary rates.

Overall, there was an 8% decline in antibiotic prescriptions from physicians' offices and EDs from 2010-11 through 2014-15, and a 26% decline in prescriptions for ARIs. The percent of antibiotic-inappropriate visits with antibiotic prescriptions was similar in 2010-11 and 2014-15 overall and in all age-groups.

Thirty percent of antibiotic prescriptions in 2010-11 were unnecessary, compared with 28% in 2014-15. Among children 0 to 19 years of age, unnecessary prescribing declined by 32%, but it did not change among adult age-groups.

"Increased stewardship efforts are needed, especially among clinicians who treat adults, to reach the National Action Plan goal of reducing inappropriate antibiotic prescribing by 50% by 2020," the authors of the study concluded.
Jun 2 Clin Infect Dis abstract

Regulatory period found similar for antimicrobials, non-antimicrobials

An examination of drugs approved by the US Food and Drug Administration (FDA) since 1984 found no evidence that the regulatory approval process for antimicrobials is more time consuming than it is for non-antimicrobials, researchers from Brigham and Women's Hospital and Harvard Medical School reported yesterday in The Lancet Infectious Diseases.

To better understand the array of regulatory pathways the FDA has adopted to expedite the regulatory process for drugs addressing serious unmet needs and how those pathways have impacted drug development and review times, the researchers examined all new drugs and biologics approved by the agency from 1984 through 2018.

They then broke those products down into antimicrobials and non-antimicrobials and recorded each drug's use of the Orphan Drug Act, fast-track, priority review, accelerated approval, and breakthrough therapy programs, as well as dates of investigational new drug application, new drug application, and new drug approval.

The results of the analysis showed that 1,065 new drug products were approved during the study period. Of those, 178 were antimicrobial products, which were more likely than non-antimicrobial products to benefit from priority review (103 [58%] of 178 vs 402 [45%] of 887, P = 0.0023), fast-track designation (58 [37%] of 157 vs 151 [19%] of 814], P < 0.001), and accelerated approval (23 [18%] of 129 vs 67 [9%] of 711, P = 0.0046) and less likely to have Orphan Drug Act designation (25 [14%] of 178 vs 267 [30%] of 887, P < 0.0001).

In addition, median time from investigational new drug application to approval was shorter for antimicrobial than for non-antimicrobial drugs (5.9 years vs 7·6 years, P < 0.001).

"We did not find evidence that antimicrobial development is more time-consuming than non-antimicrobial development or that regulators have been excessively rigid in their approach," the authors wrote.
Jun 2 Lancet Infect Dis abstract