News Scan for Nov 20, 2018

News brief

Another death reported in DRC's Ebola outbreak

In its daily update on its Ebola outbreak, the Democratic Republic of the Congo (DRC) health ministry today reported no new confirmed cases, though it did report one more death in a patient from Beni, the outbreak's main hot spot.

Also, officials said 71 suspected Ebola cases are still under investigation. The latest developments keep the overall case total at 373, which includes 326 confirmed and 47 probable cases. The new fatality raises the number of deaths to 217. The previous 3 days saw 21 new cases.

In other developments, the World Health Organization (WHO) African regional office today, in its weekly outbreak and health emergencies update, said over the past 21 days, Beni, Kalunguta, and Katwa have been the main hotspots. It added that against a backdrop of escalating insecurity, the outbreak remains dangerous and unpredictable.

The agency said there's a critical need to strengthen infection prevention and control in Beni and other areas and to continue collaborating with Mai Mai rebel groups regarding security in the Kalunguta red zone to help with death investigations, follow-up, and vaccination.

The report notes that bed occupancy in Beni's Ebola treatment center is at full capacity. It said 39 healthcare workers have been sickened in the outbreak, 11 of them fatally, signifying an increase of 9 cases and 8 deaths.
Nov 20 DRC update
Nov 20 WHO African regional office report

New York, New Jersey report more measles cases in ongoing outbreaks

Both New York state and New Jersey confirmed more measles cases in ongoing outbreaks, according to updates from health departments in Rockland County, N.Y., and Ocean County, N.J.

In New York, 10 more cases have been confirmed in Rockland County, raising that outbreak total to 76. And 3 more cases of measles have been confirmed in Ocean County, bringing New Jersey's total to 14. An additional 13 cases are under investigation.

The New York outbreak has been traced to an international traveler who visited Rockland County in September. The cases are clustered in eastern Ramapo, but officials warned that the virus could easily spread throughout the small county, which borders New York City.

In New Jersey, the Ocean County health department said it supported and encouraged the exclusion of unvaccinated children from schools, playdates, and daycare in the outbreak area.

Officials said all children 6 months to 11 months old should get their first dose of measles, mumps, and rubella (MMR) vaccine, and all other children should be up to date on MMR vaccination. They warned that unvaccinated children exposed to measles are at great risk of contracting the virus.
Nov 20 Rockland County, N.Y., update
Nov 20 Ocean County, N.J., update

WHO details 4 recent Saudi MERS infections

The WHO today fleshed out more details about four MERS-CoV cases, one of them fatal, reported by Saudi Arabia in the last half of October.

All four of the patients are men ages 53 to 74 who had underlying medical conditions, and none were healthcare workers. None of the men had known contact with an earlier confirmed case.

Three are from Riyadh, two of whom had drunk camel milk before they got sick. Contact with camels or camel products is a well known risk for MERS-CoV (Middle East respiratory syndrome coronavirus). The fatality occurred on Nov 1 in the oldest, a 74-year-old patient from Riyadh who was one of the men who drank camel milk.

The fourth case involves a 62-year-old man from Tabuk in the northwest of the country.

Notification of more cases doesn't change the overall risk assessment, the WHO said, adding that it expects more cases to be reported in the Middle East, with sporadic exported cases involving people who are exposed to animals, animal products, and sick people, such as those in health settings.

Since the virus was first detected in humans in 2012, the WHO has received reports of 2,266 cases, at least 804 of them fatal.
Nov 20 WHO update

Emergent, Valneva report initial results for human Zika vaccine trial

Emergent BioSolutions and Valneva yesterday said initial phase 1 clinical trial results for VLA1601, an inactivated alum-adjuvanted whole-virus vaccine against Zika virus, suggest it is safe and immunogenic.

In a press release, the companies said the first human trial of the vaccine was conducted in 67 healthy flavivirus-naive adults ages 18 to 49 in Knoxville, Tenn. Researchers tested two different doses given either 7 or 28 days apart. The interim safety and immunogenicity results include analyses up to 56 days after the first dose.

VLA1601 was immunogenic in all treatment groups and induced dose- and schedule-dependent neutralizing antibodies against Zika virus as expected for a vaccine of its type. Seroconversion rates reached up to 85.7% on day 35.

Wolfgang Bender, MD, PhD, chief medical officer at Valneva, said in the statement, "The excellent safety profile supports further optimization of the elicited immune response to cover an unmet medical need in the most vulnerable populations."

The companies said a final analysis covering up to day 208 after first vaccination is expected in the first quarter of 2019. VLA1601 is based on Valneva's manufacturing platform for an inactivated whole-virus vaccine against Japanese encephalitis. In July 2017 the France-based company and US-based Emergent BioSolutions announced a deal to codevelop the vaccine.
Nov 19 Emergent BioSolutions statement

Stewardship / Resistance Scan for Nov 20, 2018

News brief

High rate of multidrug-resistant bacteria reported in Ethiopian hospital

In a study yesterday in Antimicrobial Resistance and Infection Control, Ethiopian researchers reported an alarming level of multidrug resistance among patients with healthcare-associated infections (HAIs) at a university hospital.

The cross-sectional study was carried out by researchers at Jimma University Medical Center from May through September 2016. A total of 1,015 patients were admitted during this period, and microbiologic investigation was conducted for 192 patients who were suspected of having an HAI. Investigators collected different clinical specimens (blood, urine, wound swab, pus, and sputum) from the patients, identified the bacterial pathogens, and performed antibiotic susceptibility testing.

Overall, 126 bacterial pathogens were isolated from 118 patients with culture-confirmed HAIs. The most commonly isolated bacteria were Escherichia coli (31 isolates, 24.6%), Klebsiella pneumoniae (30 isolates, 23.8%), and Staphylococcus aureus (26 isolates, 20.6%), all of which showed very high resistance patterns. Among the 126 isolates, 38 (30.2%), 52 (41.3%), and 24 (19%) were multidrug-resistant (MDR), extensively drug resistant (XDR), or pan-drug resistant (PDR), respectively. More than half of the gram-negative bacterial isolates (51%) were positive for extended-spectrum beta-lactamase (ESBL) or AmpC enzymes, and 25% were resistant to carbapenems.

The investigators found that the observed MDR rate was significantly associated with prolonged hospital stays. In addition, all 13 patients who died during the study period were infected with MDR bacteria.

The authors of the study suggest the high rate of XDR and PDR bacteria could be linked to a lack of antimicrobial resistance surveillance or an antibiotic stewardship program at the hospital, as well as to the absence of national antibiotic policies in Ethiopia, where purchasing antibiotics without a prescription is common practice. The country also lacks a system to assess the quality of imported antibiotics, they note, and it is likely that some are sub-standard.

"Coordinated effort is needed from all stakeholders working in [the] health system in Ethiopia to tackle this important public health problem," the authors wrote. "An immediate action should be taken at the hospital to start [an] antibiotic stewardship program to reduce the observed antibiotic resistance and prevent further complications."
Nov 19 Antimicrob Resist Infect Control study

Study finds low adherence to CDC stewardship elements in NICUs

A baseline assessment of a sample of the nation's neonatal intensive care units (NICUs) has found low compliance with Centers for Disease Control and Prevention (CDC) recommendations to improve antibiotic use in newborns and a wide variation in antibiotic usage rates. The findings appear today in Pediatrics.

The one-day cross-sectional quality audit, conducted in February of 2016, involved 143 NICUs enrolled in the Vermont Oxford Network internet-based quality improvement collaborative, an effort to decrease antibiotic overuse during the newborn period. The first part of the audit was a structured, unit-level self-assessment of policies, procedures, and guidelines related to antibiotic stewardship, based on compliance with the CDC's Core Elements of Hospital Antibiotic Stewardship Programs: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.

For the second part of the audit, auditors conducted patient-level assessments, looking at patient demographics, antibiotic use, reason for antibiotic therapy, and what appropriate cultures were obtained before therapy. Results were used to calculate the antibiotic use rate (AUR), defined as the number of infants who were on antibiotic therapy divided by the total census for the day, for each participating NICU.

The results of the unit-level assessment showed that none of the NICUs addressed all seven of the CDC core elements, and only two elements—accountability (55%) and drug expertise (62%)—had more than 50% compliance. Only 15% of NICUs said they tracked AURs, and only 6% said they reported information on antibiotic use and resistance to clinicians.

Of the 4,127 infants audited for antibiotic exposure, 725 received antibiotics, for a median hospital AUR of 17% (interquartile range, 10% to 27%). Of the 412 infants who received antibiotics for more than 48 hours, only 26% had positive culture results, 17% had no culture obtained, and 69% had at least 1 negative culture result.

"There are significant gaps between the CDC recommendations and current antibiotic stewardship capacity and practices in newborns," the authors of the study write. "Systemic quality improvements can be used to address these deficiencies and should be tested for their ability to be used to promote adherence to the CDC core elements and the appropriate use of antibiotics in the newborn period."
Nov 20 Pediatrics abstract