Stewardship / Resistance Scan for Jan 21, 2020

News brief

Researchers awarded $25 million for diagnostics based on gene signatures

Imperial College London announced yesterday that it has won a €22.5 million ($25 million US) grant to work with researchers in 15 countries over 5 years to develop a rapid test to diagnose infectious diseases based on personalized gene signatures after taking the next 2 years to develop a library of gene signatures covering common infections and other diseases.

The new approach could speed diagnosis for serious conditions like pneumonia, tuberculosis, sepsis, meningitis, and inflammatory and immune diseases to under 2 hours, the College said in a news release. The researchers believe diagnoses could be made accurately and rapidly on the first blood sample taken when a patient attends a hospital or clinic by identifying the pattern of genes switched on in each patient's blood.

"In the future the whole basis of medical diagnosis could be based on molecular signatures," said Imperial team lead Mike Levin, MBE, PhD. Previous research by Imperial College investigators indicated that using unique gene signatures can predict a bacterial infection with 95% to 100% accuracy. Rapid diagnostics for infections can lower costs, improve patient outcomes, and reduce antimicrobial resistance.

The international group, comprising scientists from 11 European nations and Australia, Gambia, Nepal, and Taiwan, will, in the next 2 years, build a library of gene signatures in which the signatures of all common infectious and inflammatory diseases will be stored and made publicly available.
Jan 20 Imperial College news release

Meta-analysis shows stewardship promise for decision support tools

A meta-analysis demonstrates that clinical decision support systems (CDSSs) may effectively improve antibiotic prescribing, although there is limited evidence available on the use of such tools in primary care, according to a study yesterday in the Journal of Antimicrobial Chemotherapy.

Investigators noted that most of the 57 studies that reported on CDSS effectiveness were non-randomized trials with low methodologic quality, but they were able to separately assess the randomized controlled trials (RTCs), which were of moderate methodologic quality. Overall, 26 studies reported data on the appropriateness of antibiotic therapy, with 23 conducted in hospitals and 2 in primary care.

Of the hospital studies, 20 (including 2 RCTs) yielded sufficient data for the meta-analysis. The researchers found that appropriate antibiotic therapy was twice as likely to occur following the implementation of CDSSs (odds ratio [OR], 2.28, 95% confidence interval [CI], 1.82 to 2.86). Results for the 2 RCTs, however, were less rosy, with a 1.24 OR (95% CI, 0.95-1.62).

The use of CDSSs was also associated with an 18% relative decrease in mortality (OR 0.82, 95% CI, 0.73 to 0.91) among the 18 studies (2 RCTs) that analyzed that metric. CDSS implementation was also tied to less antibiotic use and decreased hospital stays, antibiotic duration, and cost of therapy.

The authors conclude, "Our findings suggest that a focus on system requirements and implementation processes would improve CDSS uptake and provide more definitive benefits for antibiotic stewardship."
Jan 20 J Antimicrob Chemother abstract

News Scan for Jan 21, 2020

News brief

New Ebola patients include vaccinated health worker

A vaccinated health worker is among the 5 new Ebola cases recorded since late last week in the Democratic Republic of the Congo (DRC), which raise the outbreak total to 3,416, including 2,237 deaths. A total of 394 suspected cases are still under investigation, according to the World Health Organization's (WHO's) online Ebola dashboard.

Yesterday, the DRC's Ebola technical committee (CMRE) said one case recorded over the weekend involved a vaccinated health worker from Beni, raising the number of health professionals infected in this outbreak to 167 (5% of all confirmed and probable cases).

The CMRE also said that vaccination uptake in Butembo and Katwa has been successful but vaccination efforts in the Aloya and Bingo health areas in Mabalako in North Kivu have yielded low participation. Most current cases have been traced to a transmission chain from Aloya health area.

"New confirmed cases continue to be reported in Beni, Mabalako and Butembo in North Kivu Province in areas that have not seen new cases for several weeks," the WHO's African regional office said in an update. "Resistance to response activities continues, particularly in North Kivu Province, which continues to hamper response efforts, with resulting resurgence of transmission."

To date, 270,138 people have been vaccine with Merck's rVSV-ZEBOV, and 6,317 have been vaccinated with Johnson & Johnson's Ebola vaccine.
WHO Ebola dashboard
Jan 20 CMRE report
Jan 19 WHO African office weekly bulletin

MERS-CoV infects Saudi healthcare worker

Saudi Arabia's Ministry of Health (MOH) yesterday reported a new MERS-CoV case, involving a 38-year-old female healthcare worker in Abha, located in the southwest.

The report isn't clear about whether she contracted MERS-CoV (Middle East respiratory syndrome coronavirus) in the healthcare setting, because it notes that the source of her illness is primary—meaning she probably didn't contract it from another known patient.

The country reported its last case in Ahba in the middle of December, that of a 66-year-old man. The new cases raises Saudi Arabia's MERS-CoV total for January to five cases.

The WHO said in its latest monthly update that 2,499 cases have been lab-confirmed, including 861 fatalities. The vast majority of the cases have been in Saudi Arabia.
Jan 20 Saudi MOH report

WHO: More than a third of recent global flu cases caused by influenza B

Much of the Northern Hemisphere is reporting high flu activity, according to the latest global flu update from the WHO yesterday, and influenza B accounts for more than a third of recent global cases.

Of lab-tested specimens submitted to the WHO in the last week of December and the first week of January, 62.3% were typed as influenza A and 37.7% as influenza B. Of the characterized B viruses, 99.4% belonged to the B-Victoria lineage, the WHO said.

In Canada and the United States, flu is circulating at levels typically seen at this point in the season, with both countries reporting more influenza B than in recent seasons. In the United States, B/Victoria is the dominant strain. In northern Europe, influenza A strains dominate, with many countries reporting increased detection of H3N2.

Both China and Japan are seeing higher-than-average influenza-like illnesses (ILI), the WHO said.

"In China, ILI activity continued to increase and was greater than that during the same time period in the three previous seasons; influenza activity also increased, with detections of predominately influenza A(H3N2), followed by a smaller proportion of influenza B/Victoria lineage viruses, especially in the southern provinces," the WHO said. "In Japan, the number of influenza cases per sentinel site was higher compared to the same time in the previous three seasons and influenza A(H1N1)pdm09 virus detections predominated."
Jan 20 WHO update

More high-path avian flu outbreaks strike birds in 6 countries

In the latest highly pathogenic avian flu outbreak developments, four European countries reported more detections, while China confirmed the disease in wild birds and South Africa reported more outbreaks at commercial ostrich farms.

In the Czech Republic, an outbreak in backyard birds that began on Jan 17 killed 6 of 15 chickens and ducks, according to a report from the World Organization for Animal Health (OIE). The survivors were culled as part of the outbreak response. The OIE said the outbreak is the country's first involving the H5N8 strain.

Romania, which reported an H5N8 outbreak earlier this month, reported another. The latest event began on Jan 16 at a poultry farm in Maramures County in the northwest, killing 220 of 22,762 birds. The remaining ones were culled to curb the spread of the virus.

Ukraine reported an H5 outbreak that began at a poultry farm in Vinnitsa oblast in the south central region, killing 4,856 of 98,000 birds. The remaining ones were slated for culling.

Meanwhile, Germany reported a highly pathogenic H5N8 detection in a wild goose in Brandenburg state, its first avian flu detection since last winter, Deutsche Welle reported today.
Jan 20 OIE report on H5N8 in the Czech Republic
Jan 18 OIE report on H5N8 in Romania
Jan 20 OIE report on H5 in Ukraine
Jan 20 Deutsche Welle report on H5N8 in German wild bird

In other parts of the world, China reported another H5N6 outbreak in wild swans in Xinjiang province, an area where other recent outbreaks have been reported, according to an agriculture ministry notification reported by Reuters today. And South Africa reported two more H5N8 outbreaks at commercial ostrich farms in Western Cape province, part of ongoing activity there since 2017. The latest events began at the end of October, infecting 10 of 7,577 birds, according to a report yesterday from the OIE. None of the ostriches died.
Jan 21 Reuters story
Jan 20 OIE report on H5N8 in South Africa

Johns Hopkins, Gates Foundation announce pandemic recommendations

A joint effort from the Johns Hopkins Center for Health Security, the World Economic Forum, and the Bill & Melinda Gates Foundation recently made seven key recommendation for pandemic preparedness, based on an exercise conducted in October 2019 that featured a fictional coronavirus—not unlike the new Wuhan coronavirus recently detected in China.

The pandemic exercise tracked how a major pandemic virus would elicit responses from global corporations, key health organizations, and industries. Based on the exercise, the partners wrote seven recommendations for public-private entities, according to a Johns Hopkins news release.

The recommendations include planning for essential corporate capabilities, ensuring that travel and trade routes are maintained during an outbreak, and realizing the financial burden outbreaks place on industries.

The partners also recommended that governments should provide "more resources and support for the development and surge manufacturing of vaccines, therapeutics, and diagnostics that will be needed during a severe pandemic."

According to the Center for Health Security, recent economic studies show that pandemics will cause an average annual economic loss of 0.7% of global gross domestic product—or $570 billion.
Jan 17 Center for Health Security press release