News Scan for Jun 28, 2018

News brief

Monitoring ends for remaining contacts of DRC's last confirmed Ebola case

The Democratic Republic of the Congo's (DRC's) health ministry said today that all contacts of the last confirmed case have completed their 21-day monitoring periods with none showing any signs of illness, marking the beginning of the countdown to the end of the nation's ninth Ebola outbreak. The end of the epidemic will be declared if a total of 42 days pass—two incubation periods—without any new confirmed Ebola cases.

In a statement, health minister Oly Ilunga Kalenga, MD, said the keys to success have been national and international surveillance teams on the ground, which have identified and tracked 1,706 contacts. He also credited the use of the VSV-EBOV vaccine, which has been given to 3,330 people.

Meanwhile, outbreak responders continue to look for potential cases, and the ministry today reported two new suspected cases, one in the remote Bikoro location and one in Wangata health zone, which includes Mbandaka, the provincial capital. Tests on four earlier suspected cases were negative, putting the outbreak total at 55 cases, including 38 confirmed, 15 probable, and 2 suspected illnesses. The number of deaths remained at 29.

Officials said with the final phase of the epidemic now under way, it will replace daily updates with weekly updates, with the next one due out on Jul 6.
Jul 28 DRC daily Ebola update

CDC: Canal water near romaine region contained E coli

The Centers for Disease Control and Prevention (CDC) today issued a final outbreak report on an Escherichia coli O157:H7 outbreak linked to romaine lettuce.

The CDC said laboratory tests identified the outbreak strain in water samples taken from a canal near Yuma, Ariz., a lettuce growing region that's been identified as the source of the tainted romaine. The Food and Drug Administration (FDA) is investigating how the bacteria could have entered the water and how the water contaminated the lettuce.

The outbreak involved a total of 210 ill people from 36 states—13 more since the last report on Jun 1—making it the largest multistate outbreak of E coli O157 since a 2006 event linked to fresh spinach.

Five deaths were reported in the outbreak, along with 96 hospitalizations, including 27 patients who developed a type of kidney failure called hemolytic uremic syndrome. The last reported illness began on Jun 6.

Of the 166 people interviewed, 145 (87%) reported eating romaine lettuce in the week before their illness started, but some patients got sick after coming into close contact with someone who had eaten the lettuce, the CDC said.

"According to the FDA, the last shipments of romaine lettuce from the Yuma growing region were harvested on April 16, 2018, and the harvest season there has ended. Contaminated lettuce that made people sick in this outbreak should no longer be available," the CDC said, adding that it has completed its investigation.
Jun 28 CDC final outbreak update

White House suggests cutting public health corps by 40%

The Washington Post reported yesterday that the Trump administration is proposing to cut the nation's uniformed public health service corps by 40%.

The US Public Health Service Commissioned Corps are the public health professionals deployed during a national disaster or disease outbreak. The uniformed doctors, nurses, and engineers, also provide public health services in some of the country's most remote locations.

The proposal, announced last week in proposed overhaul of the federal government released by the Office and Management and Budget, would reduce the corps from 6,500 officers to "no more than 4,000 officers."

According to the Post, "the proposal would also create a Reserve Corps of government employees and private citizens, similar to that used by other uniformed services, to be mobilized in a public health emergency or to back-fill critical positions left vacant during regular Corps deployment."

Most corps members work at the Centers for Disease Control and Prevention and the National Institutes of Health when not deployed.
Jun 27 Washington Post article

Seqirus joins universal flu vaccine initiative

Seqirus announced today it will be joining the Human Vaccines Project's Universal Influenza Vaccine Initiative (UIVI). Seqirus manufactures the seasonal influenza vaccine under its parent organization, CSL Limited.

UIVI, which began late last year, partners vaccine manufacturers, researchers, and global health organizations to expedite the development of universal flu vaccine, one that would not have to be administered seasonally.

As part of the UIVI, Seqirus will be researching the human immune response to offer new solutions for influenza vaccination.

"While there have been recent advances in the development of better influenza vaccines, we need to continue to work towards more transformational solutions that provide higher levels of protection against multiple strains of influenza for longer periods of time," said Wayne Koff, PhD, president and chief executive officer of the Human Vaccines Project in a press release, adding that collaborating with Seqirus expands the group's partnership with global stakeholders to accelerate the development of a more broadly protective influenza vaccine.
Jun 28 Human Vaccines Project press release

Stewardship / Resistance Scan for Jun 28, 2018

News brief

Financial incentives helped curb unnecessary antibiotic prescribing in NHS doctors

A financial incentive program for United Kingdom National Health Service (NHS) local groups reduced antibiotic prescribing by general practitioners for common respiratory infections by 3%, a research team based at Imperial College London reported today in the Journal of Antimicrobial Chemotherapy.

In 2015, UK officials introduced a quality premium program to improve services at NHS locations that included financial incentives for meeting different criteria, which included measures to reduce antibiotic prescribing by 1% and reduce broad-spectrum antibiotic prescriptions by 10%. Today's report is the first to describe the impact of the plan.

In reviewing data from general practices across England from 2011 to 2017, the authors focused on antibiotic prescribing for uncomplicated respiratory tract infections (RTIs), the majority of which are caused by viruses and don't respond to antibiotics. They saw the expected seasonal peaks and troughs in incidence, but antibiotic prescribing rates decreased over the 6-year period. In April 2015, a time that marked the launch of the antibiotic-prescribing incentive plan, antibiotic prescribing rates declined by 3%, or 14.65 prescriptions per 1,000 RTIs. The team also saw a 2% relative reduction in the broad-spectrum antibiotic prescribing rate.

The greatest reductions occurred in patients who had sore throats and in younger patients, with a 6% reduction in prescribing for children, a group for whom the number of doctor visits for RTIs is higher.

Sabine Bou-Antoun, MSc, the study's first author and an epidemiologist at Imperial College London, said in a press release from the school, "It is important to reduce unnecessary and inappropriate antibiotic prescribing as it is a known driver of antibiotic resistance. It's also important to measure the impact of national interventions targeted at improving the use of antibiotics so we can evaluate and identify what is working."

The group is currently investigating whether reduced antibiotic prescribing has led to any negative impacts, including increased frequency of illnesses. Alison Holmes, MD, MPH, study coauthor who is with the National Institute for Health Research and is professor of infectious diseases at Imperial College London, said, "National-level schemes such as these are important tools in our efforts to reduce antibiotic prescribing, but it is critical that these interventions are objectively and expertly evaluated."
Jun 27 Imperial College London press release
Jun 28 J Antimicrob Chemother abstract

New antibiotic approved for drug-resistant UTIs

The US Food and Drug Administration approved the use of plazomicin as a new treatment for complicated, drug-resistant urinary tract infections (UTIs).

Plazomicin, marketed under the name Zemdri, is not a new antibiotic class, but has been developed to treat drug-resistant Enterobacteriaceae, identified as one of the World Health Organization's top three difficult-to-treat superbugs.

"This new antibiotic will be a vital last-resort treatment for patients with complicated and life-threatening urinary tract infections," said Tim Jinks, head of Wellcome's drug-resistant infections program in a press release. The Wellcome Trust helped fund Zemdri's development.

Zemdri is given as an intravenous infusion, administered once daily, according to Achaogen, Inc, the drug’s manufacturer. Recent phase 3 clinical trials showed that greater than 99% of Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae in US surveillance are susceptible to Zemdri.

Each year, the United States sees approximately 3 million cases of complicated urinary tract infections, many caused by Enterobacteriaceae, a family of gram-negative bacteria that are becoming increasingly resistant to first-line antibiotics.
Jun 27 Wellcome press release
Jun 26 Achaogen press release

IDSA and ASM update lab diagnosis guide for health providers

In an update to recommendations from 2013, the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM) today unveiled their latest guide for using microbiology lab tests to diagnose infectious diseases. The full report appears in the latest edition of Clinical Infectious Diseases.

J. Michael Miller, PhD, the guide's lead author and director of Microbiology Technical Services in Dunwoody, Ga., said in an IDSA press release, "As fast as technology is moving, especially with the genetic and molecular tests, this update was necessary."

The guide details the precise steps for collecting and managing blood, urine, tissue, and other specimens and contains tables that provide detailed information on the use and limitations of tests, organized by type of infections (such as urinary tract or upper respiratory) to help health providers order the best test and collect the appropriate sample. It also includes expanded information on pediatric testing, tests for tick-borne diseases, and information on diagnostic advancements, such as nucleic acid amplification tests that can identify organisms faster and less expensively, the IDSA said.

Melvin P. Weinstein, MD, guide coauthor and chief of infectious diseases at Rutgers Robert Wood Johnson Medical School, said, "Instead of using a shotgun approach and prescribing broad spectrum antibiotics, these new rapid diagnostic tests can help health care providers target the specific organism causing the infection much sooner than traditional microbiologic tests."
Jun 28 IDSA press release
Jun 28 Clin Infect Dis report