News Scan for Jun 19, 2020

News brief

Study shows high SARS-CoV-2 positivity rate among Latinos

More than 40% of Latinos in the Baltimore-Washington, DC metropolitan region who were tested for SARS-CoV-2, the virus that causes COVID-19, were positive, a rate far higher than for any other racial/ethnic group, researchers from Johns Hopkins University School of Medicine reported yesterday in JAMA.

For the study, the researchers analyzed samples collected via nasopharyngeal swabs from five area hospitals from Mar 11 through May 25 using reverse-transcriptase polymerase reaction and extracted data on patient demographics from electronic medical records. A total of 37,727 patients were tested.

Overall, 16.3% of patients (6,162 of 37,727) tested positive for SARS-CoV-2. The positivity rate for Latinos was 42.6% (95% confidence interval [CI], 41.1% to 44.1%), compared with 17.6% for black patients (95% CI, 16.6% to 18.3%), 8.8% for white patients (95% CI, 8.4% to 9.2%), and 17.2% for those of other race/ethnicity (95% CI, 16.2% to 18.3%). The daily positivity rate was higher for Latino patients than for patients in the other racial/ethnic groups, as well.

Hospital admission rates, however, were lower for Latino patients (29.1%; 95% CI, 27.0% to 32.1%) than for white patients (40.1%; 95% CI, 37.6% to 42.5%) or black patients (41.7%; 95% CI, 39.5% to 43.8%). Hospitalized Latino patients were younger (a greater proportion aged 18 to 44 years), more likely to be male, and had lower rates of hypertension, congestive heart failure, pulmonary disease, and chronic obstructive pulmonary disease than white or black patients.

The authors of the study say that while less access to testing may have contributed to higher rates of positivity, the findings are more likely the result of higher disease prevalence, with the spread of infection among Latinos "driven by decreased opportunity for social distancing in the setting of dense housing and continued work engagement due to essential worker status and economic necessity."

According to reporting by Politico, Latinos account for roughly 34% of reported coronavirus cases nationally, which is currently the highest of any racial and ethnic minority group, and make up a disproportionate share of the cases in nearly every state.
Jun 18 JAMA study

Analysis shows US antibiotic use still heavily tilted toward livestock

A comparison of antibiotic sales data by members of the Natural Resources Defense Council (NRDC) and the Center for Disease Dynamics, Economics & Policy (CDDEP) shows that cattle and swine on US farms consume 44% more of medically important antibiotics than do humans.

Using 2018 Food and Drug Administration data on sales of antibiotics for food-producing animals and 2017 data on sales of antibiotics for use in humans obtained from the IQVIA pharmaceutical database by CDDEP, the analysis found that 65% of medically important antibiotics are being used in food-producing species in the United States, compared with 35% in humans. Cattle and swine together consume roughly 10.8 million pounds of active antibiotic ingredient, while humans consume 7.5 million pounds.

"Even taking into account a large decline from 2015 to 2017, antibiotic sales for use in food-producing animals continue to exceed sales of those same drugs for human medicine by a large margin," authors David Wallinga, MD, and Avinash Kar, JD, of NRDC and Eili Klein, MD, of CDDEP wrote in a blog post on the NRDC website. "Worryingly, those sales rose again in 2018, suggesting that previous declines may only have been temporary."

The authors said that comparable and integrated analyses covering both sales and use of medically important antibiotics—something that's not currently provided by the US government—are urgently needed.

"It's urgent that the leadership of U.S. federal agencies, as well as in Congress, work harder to protect our future by protecting our antibiotics. Providing the public each year with side-by-side comparisons of the use of these precious medicines in human medicine and in food-producing animals, is an important step," they wrote.

They also recommend that livestock producers be required to report annually on their on-farm use of antibiotics, and that the federal government set national targets for reducing medically important antibiotic use in livestock.
Jun 15 NRDC blog post

One new Ebola case confirmed in DRC's Equateur outbreak

The Democratic Republic of the Congo (DRC) today reported 1 more illness in a new outbreak centered in Equateur province, raising the total to 18, according to an update from the DRC's multisectoral Ebola response committee (CMRE).

The patient is a 35-year-old man from Bikoro who wasn't a known contact and who died in the community, a factor known to raise the risk of further spread. Health officials said the man's body has been secured and public health actions are under way. With the new development, the outbreak is spread across five health zones, and, of the 18 cases, 15 are confirmed and 3 are listed as probable. The fatality count is 12, which includes 9 of the confirmed cases and the 3 probable ones.

In the other, much larger outbreak in eastern DRC, no new cases were reported, keeping the total at 3,463 cases, 2,280 of them fatal. As of yesterday, the outbreak has gone 51 days with no new cases.
Jun 19 CMRE report

Afghanistan, Pakistan, Ivory Coast detect more polio cases

Three countries over the past week reported new polio cases, Afghanistan, Pakistan, and Ivory Coast, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

Afghanistan reported 4 more wild poliovirus type 1 (WPV1) cases, 1 each in Farah and Hirat and 2 in Hilmand, lifting the country's total for the year to 16.

Neighboring Pakistan reported 1 more WPV1 case, from Balochistan, putting its total at 51 for 2020. It also reported two circulating vaccine-derived wild poliovirus type 2 (cVDPV2) cases, 1 each in Khyber Pakhtoon and Sindh, raising the country's total to 69.

Ivory Coast, meanwhile, reported 3 cVDPV2 cases, one each in Gbokle-Nawa-San-Pedro, Goh, and Haut Sassandra regions. The country has now reported 10 such cases.
Jun 18 GPEI weekly update

H5N8 avian flu strikes poultry in Bulgaria

Bulgaria's agriculture ministry reported a new highly pathogenic H5N8 avian flu outbreak, which struck a commercial farm in Plovdiv province in the south central part of the country, according to a notification yesterday from the World Organization for Animal Health (OIE).

The outbreak began on Jun 4, killing 68 of 78,943 birds. The rest were destroyed to curb the spread of the virus. The source of the outbreak isn't known.

Some European countries have reported sporadic H5N8 outbreaks over the winter and spring months, and Bulgaria reported its last outbreak in March.
Jun 18 OIE report on H5N8 in Bulgaria

ASP Scan (Weekly) for Jun 19, 2020

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Analysis shows US antibiotic use still heavily tilted toward livestock

Wording change tied to fewer unneeded antibiotics for neonatal sepsis

Originally published by CIDRAP News Jun 17

A change in the wording of antibiotic duration orders for neonatal sepsis led to a substantial decrease in the number of infants who received extra unnecessary antibiotic orders, pharmacists at a hospital in British Columbia reported today in the American Journal of Infection Control.

The intervention implemented at Surrey Memorial Hospital in British Columbia in April 2016 involved a change in the way that clinicians wrote the orders for antibiotic duration in infants with sepsis, from "antibiotics for 48h if blood culture negative" to "antibiotics for 48h unless blood culture positive."

The change in the wording allowed infants to stop receiving antibiotics after they received 48 hours of therapy if the healthcare team had not received notification of a positive culture. The change was made because delays in receiving notification of a negative blood culture can lead to infants receiving extra, unnecessary antibiotic doses.

A medical review of 523 charts (268 prior to the change and 255 after the change) found that unnecessary antibiotic orders (doses beyond 48 hours) were administered to 50% (82 of 164) of infants prior the change and only 7.2% (12/167) after the change. None of the patients included in the review had a blood culture come back positive after the 48 hours of antibiotics were completed. Reductions in pharmacy time and medication waste were also observed.

"The wording and interpretation of antibiotic duration orders, as well as fostering the desired culture shift amongst staff, should be considered as strategies to reduce unnecessary antibiotic administration," the authors of the study wrote.
Jun 17 Am J Infect Control abstract

CARB-X funds rapid test for resistant urinary tract infections

Originally published by CIDRAP News Jun 17

CARB-X today announced that it is awarding India-based Module Innovations a contract worth $702,000 and up to $2.5 million more if it meets certain milestones to develop a rapid diagnostic test for drug-resistant urinary tract infections (UTIs). In a press release, CARB-X said the test would also provide information on which antibiotics would be most useful against the resistant organisms, including common ones such as Escherichia coli, Klebsiella, Pseudomonas aeruginosa, and Enterococci faecalis.

The test has the capacity to take days off the time needed to diagnose a UTI and can detect an infection and provide an antibiotic-resistance profile of the pathogen in about 2 hours. The current process requires advanced microbiology laboratories and personnel, and doctors often prescribe patients broad-spectrum antibiotics while waiting days for a test result. The approach doesn't often work, leading to sepsis, kidney damage, and other complications. CARB-X said the affordable and data-driven approach will be useful, especially in middle- and low-income countries.

Erin Duffy, PhD, chief of research and development at CARB-X, said, "This technology, if successful, could provide health professionals with fast, accurate, and affordable AST [antibiotic susceptibility testing] information for UTIs, accelerating the delivery of effective therapeutics to patients, saving lives, and reducing the risk of contributing to drug resistance."

Since its launch in 2016, CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) has awarded more than $232.1 million to companies developing new treatments and diagnostics for drug-resistant pathogens.
Jun 17 CARB-X press release