News Scan for Nov 14, 2019

News brief

Ebola sickens one more in DRC outbreak, WHO sees positive signs

One more Ebola case was reported in the Democratic Republic of the Congo (DRC) outbreak today, raising the overall total to 3,292 cases, which includes 118 listed as probable, according to the World Health Organization's (WHO's) online Ebola dashboard.

Outbreak responders are still investigating 527 suspected cases. Meanwhile, the number of deaths held steady at 2,192.

The DRC's Ebola technical committee (CMRE) in its latest daily update noted locations for four cases reported yesterday. Two were from Beni and two were from Mabalako.

In its weekly snapshot of the outbreak, the WHO today reported some promising developments. For the week ending Nov 12, all six confirmed cases were from Beni and Mabalako and were known contacts of confirmed patients. All of the cases are linked to the Biakato Mines area in Mandima, which has not reported an illness since Nov 4.

Kalunguta health zone has passed 21 days, one incubation period, with no new cases, and Katwa health zone has passed two incubation periods with no new cases.

The proportion of registered contacts is increasing and was 100% for the last 6 confirmed cases. Health officials are concerned, however, about a shift in cases to Mabalako, where ongoing transmission on Bingo and Ngoyo is challenging due to problems with security and access.
WHO online Ebola dashboard
Nov 13 CMRE update
Nov 14 WHO update

Warming weather patterns tied to increased rate of infectious disease

In the latest update to the Lancet's Countdown, an annual effort to monitor the health effects of climate change, authors say increasingly frequent warming patterns of weather are tied to increasing rates of infectious disease. The report was published yesterday.

"Trends in climate suitability for disease transmission are particularly concerning, with 9 of the 10 most suitable years for the transmission of dengue fever on record occurring since 2000," the authors said. "Similarly, since an early 1980s baseline, the number of days suitable for Vibrio (a pathogen responsible for part of the burden of diarrheal disease) has doubled, and global suitability for coastal Vibrio cholerae has increased by 9.9%."

2018 was one of the hottest on record, with more than 220 million additional exposures to heatwaves compared with a 1986-2005 climatological baseline. Increasing temperatures are linked to rising mortality from dengue fever, particularly in Southeast Asia. Rising temperatures also increase areas of coastline suitable for Vibrio bacteria, which has increased by 31% in the Baltic coastline and 29% in the northeastern coastline of the United States.

In an accompanying editorial in The Lancet, the editors of the journal warn that the link made by individuals between health issues and climate change is weak. They cite a new indicator that uses English-language Wikipedia searches, which show just 0.18% of total health clicks lead to a climate change article, and 1.12% of co-clicks from a climate change article to a health issue.

"With both health and the climate crisis engaging such heightened interest, an opportunity exists for health professionals to bring the inextricable links between them into focus," the authors write.
Nov 13 Lancet study
Nov 13 Lancet editorial

Sterilization program to target Aedes mosquitoes

Today the WHO announced that a program to sterilize male mosquitoes, and control vector-borne disease such as Zika and dengue, will soon be tested.

The sterile insect technique (SIT) uses radiation to make large numbers of male mosquitoes unable to reproduce. The mosquitoes are then released in the wild where they mate with females but cannot produce offspring. Aedes mosquitos will be the first kind to be treated with SIT.

"Half the world's population is now at risk of dengue," said Soumya Swaminathan, MD, WHO's chief scientist. "And despite our best efforts, current efforts to control it are falling short. We desperately need new approaches and this initiative is both promising and exciting."

According to the WHO, diseases transmitted by mosquitoes such as malaria, dengue, Zika, chikungunya, and yellow fever account for about 17% of all infectious diseases globally, and result in more than 700,000 deaths annually.

SIT was developed by the US Department of Agriculture and has successfully reduced the populations of the Mediterranean fruit fly and the New World screwworm fly.
Nov 14 WHO press release

Stewardship / Resistance Scan for Nov 14, 2019

News brief

AHRQ publishes stewardship toolkit for hospitals

The Agency for Healthcare Research and Quality (AHRQ) has released a new toolkit to improve antibiotic use in acute care hospitals.

The toolkit consists of presentations, slides, posters, and other documents that provide guidance on how to develop a culture of safety around antibiotic prescribing, how to develop and improve antibiotic stewardship programs, and how to learn and disseminate best practices for the diagnosis and treatment of common infectious disease syndromes. It also includes an explanation of the "Four Moments of Antibiotic Prescribing," a step-by-step approach that clinicians can use to achieve optimal antibiotic prescribing.

The toolkit is based on the experiences of more than 400 US hospitals that took part in AHRQ's Safety Program for Improving Antibiotic Use, a 5-year project to improve antibiotic prescribing practices across acute care, ambulatory care, and long-term care facilities in the United States.
Nov 13 AHRQ toolkit

New York names hospitals, nursing homes with Candida auris cases

New York has become the first state to release the names of medical facilities that have treated patients with Candida auris, according to a report yesterday in the New York Times.

The list published by the Times includes 64 hospitals and 103 nursing homes (mostly concentrated in Manhattan, Brooklyn, and Queens) that have cared for patients who were either infected or colonized with the multidrug-resistant fungus. New York health officials told the paper they decided to release the names of the facilities to provide transparency to consumers and help curtail C auris, which has spread rapidly in healthcare settings in New York and other states since first being detected in the United States in 2016.

Of the 836 confirmed and probable C auris infections reported to the Centers for Disease Control and Prevention (CDC), 392 have been in New York, with 231 reported in Illinois and 159 in New Jersey. Ten other states have reported cases. An additional 1,624 US patients have been found to be colonized with C auris.

In its updated report on the antibiotic resistance threats in the United States, the CDC added C auris to the list of drug-resistant pathogens it considers to be urgent threats. The fungus has shown resistance to all three classes of antifungal medication, and more than 1 in 3 patients with invasive C auris infections dies.
Nov 13 New York Times story
Oct 29 CDC case count

Study finds antibiotic prescriptions have fallen by nearly a third in Finland

Antibiotic prescriptions have fallen by 29% in Finland over the past decade, according to a study commissioned by pharmaceutical company Pfizer.

Using health insurance data from Kela, the Finnish government agency in charge of social benefits, Pfizer researchers found that nearly 1 million fewer antibiotic prescriptions were filled in Finland in 2018 compared with 2008. Antibiotic prescribing for children ages 0 to 4 fell by 60%, while the number of antibiotic courses prescribed for children ages 5 to 7 fell by 43%. The smallest decline in antibiotic prescribing, 17%, was in adults over 65.

Pekka Honkannen, Emeritus Professor of General Medicine at the University of Oulu, notes in a translated Pfizer press release that the decline in antibiotic prescribing in children is likely linked to the inclusion of a pneumococcal vaccine in the country's national vaccination program.

Recent data from the European Centre for Disease Prevention and Control show that Finland has the ninth lowest antibiotic prescribing rate in Europe.
Nov 13 Pfizer press release