News Scan for Oct 08, 2019

News brief

For second day in a row, only 1 new Ebola case recorded in DRC

Today the World Health Organization's (WHO's) online Ebola dashboard shows 1 new case in the Democratic Republic of the Congo (DRC), which raises the outbreak total to 3,206 cases, including 2,143 deaths. A total of 441 suspected cases are still under investigation.

The past few weeks have witnessed a significant drop in cases, with only five in the past 4 days. The latest update yesterday from the WHO's African regional office noted 16 confirmed cases recorded from Sep 29 to Oct 5.

"The number of new confirmed cases does seem to be declining, but previous experience shows that this trend needs to be interpreted with caution. Notwithstanding this, in areas where robust public health measures have succeeded, no new confirmed cases have been reported, showing that these approaches need to continue," the WHO said.

According to daily reports from the DRC's Ebola technical committee (CMRE), the single case recorded yesterday was in Oicha. In the past 3 weeks, Mambasa, Mandima, and Kalunguta have been the main outbreak hot spots.
WHO Ebola dashboard
Oct 7 CMRE report
Oct 7 WHO African regional office update

Eastern equine encephalitis vaccine enters phase 1 trial

Bavarian Nordic announced the launch of the phase 1 trial of MVA-BN WEV, a vaccine candidate against the equine encephalitis virus—a rare but deadly disease recently in the news.

"The prevalence of Eastern equine encephalitis, which is currently on the rise in the U.S., highlights the importance of a vaccine to help fight these diseases. Again, we are leveraging the unique properties of our MVA-BN platform technology to address unmet medical needs, and we look forward to continuing our work with DOD [Department of Defense] on this important program," said Paul Chaplin, PhD, the president and chief executive officer of Bavarian Nordic.

The trial is funded through the DOD's Joint Project Manager for Chemical, Biological, Radiation, and Nuclear Medical and is part of a program that aims to develop a prophylactic vaccine against three separate strains of the equine encephalitis virus: Eastern (EEEV), Venezuelan, and Western.

According to Bavarian Nordic, the United States is in the midst of its worst EEEV outbreak to date, with more than 30 cases and 9 deaths reported, mostly in northeastern parts of the country. Equine encephalitis viruses are primarily transmitted by mosquitoes, as well as some birds and mammals. The United States considers the virus a potential bioterrorism threat, as the virus could be weaponized.
Oct 8 Bavarian Nordic press release

New US foodborne illness report highlights Salmonella, other pathogens

Federal officials late last week released an annually updated big-picture view of foodborne illness outbreaks, incorporating data from 2017 and highlighting Salmonella as the most common pathogen. The report is geared toward fine-tuning interventions to decrease the number of foodborne illnesses.

The annual Interagency Food Safety Analytics Collaboration (IFSAC) report, which includes surveillance data since 1998, is designed to estimate food responsible for outbreaks involving four pathogens: Salmonella, Escherichia coli O157:H7, Listeria monocytogenes, and Campylobacter. The collaboration includes the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the US Department of Agriculture (USDA).

Data from this year's report comes from 1,329 foodborne disease outbreaks from 1998 through 2017 that were linked to a single food category. Of those, 811 were from Salmonella, 242 from E coli O157, 40 from Listeria, and 89 from Campylobacter (after 147 outbreaks due to dairy were excluded).

The analysis revealed that Salmonella and Campylobacter illnesses were more widely distributed across food categories, and that E coli O157 and Listeria illnesses were mainly related to two food categories. For E coli, 75% of infections were related to row crops such as leafy greens or to beef, and more than 75% of Listeria infections were related to dairy products or fruits.
Oct 4 FDA press release
IFSAC full report

Neonatal ICU program tied to increased infant vaccination coverage

Researchers from the Mayo Clinic describe how a neonatal vaccination program was associated with increased infant vaccination coverage from 56% to 93% in the latest issue of Pediatrics.

The study was based on changes made at the Mayo Clinic's Level IV neonatal intensive care unit (NICU). From January 2015 to June 2017, only 56% of infants were up to date on vaccinations at discharge, well below the ideal 90% coverage rate. The Mayo team aimed to increase that proportion to 80% within 6 months, from Oct 1, 2017, to Mar 31, 2018.

The program identified three major root causes behind the vaccination gap, including lack of provider knowledge of the routine immunization schedule, failure of providers to order vaccines when due, and hesitancy of parents toward vaccination, the authors said.

Intranet information on vaccine schedules and communication guides for talking to hesitant parents were widely distributed among NICU physicians and nurses. By the end of the 6-month improvement phase, the percentage of infants up to date on their immunizations increased to 93.5%.

"We were able to significantly improve the rate of infants fully up to date for immunizations at the time of discharge or transfer from our level IV NICU. We exceeded our original goal and have maintained a fully vaccinated rate of >90% for more than a year," the authors concluded.

NICU infants are at increased risk for vaccine-preventable diseases. But despite being low-weight or premature, the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend that NICU infants adhere to the same chronologic immunization schedule as full-term, healthy infants, with the exception of delayed timing of the first dose of hepatitis B vaccination.
Oct 8 Pediatrics study

Stewardship / Resistance Scan for Oct 08, 2019

News brief

Nationwide US data show high levels of post-discharge antibiotic exposure

An analysis of nationwide Veterans Health Administration data across 3 years finds that a large proportion of antimicrobial exposure among hospitalized patients occurs immediately following discharge, according to a study yesterday in Clinical Microbiology and Infection.

The researchers looked at data from 1,681,701 million acute-care admissions in 122 hospitals from 2014 through 2016 and found that 335,369 patients (19.9%) were prescribed an oral antimicrobial drug at discharge. Fluoroquinolones were the most commonly prescribed drug, accounting for 38.3% of the post-discharge antimicrobials, followed by cephalosporins (14.8%) and beta lactam/lactamase inhibitors (14.4%).

In addition, 39% of the total duration of antimicrobial exposure occurred after hospital discharge. And the investigators found that inpatient use of antimicrobials was only weakly correlated with post-discharge antibiotic use.

The researchers say the study is the first nationwide description of oral antimicrobials prescribed on hospital discharge, making it the largest study on the topic. A study in May involving hospitals in the southeastern United States found prolonged antibiotic courses were common at discharge.

The authors of the current study conclude, "Our findings suggest that standard stewardship metrics, which focus entirely on inpatient antimicrobial use, are providing an incomplete assessment of total antimicrobial exposure associated with an acute-care hospital stay."
Oct 7 Clin Microbiol Infect abstract
May 29 CIDRAP News scan on earlier study

European health officials update resistant gonorrhea response plan

The European Centre for Disease Prevention and Control (ECDC) yesterday published an updated response plan to manage the threat of multidrug- and extensively drug-resistant (MDR and XDR) gonorrhea in Europe.

Noting the rising resistance of Neisseria gonorrhoeae to several antibiotics over the last decade, and the report of an XDR gonorrhea strain in the United Kingdom in 2018, the ECDC said an update to its 2012 response plan was needed to manage the threat of untreatable gonorrhea in Europe. "The present ECDC 2019 response plan strives to further support Member States to develop and implement national strategies and interventions to control the threat of MDR and XDR gonorrhoea in a multidisciplinary approach," the agency said.

The plan calls for European Union/European Economic Activity member states to strengthen surveillance of gonococcal antimicrobial susceptibility so that MDR and XDR strains can be detected and monitored, ensure that appropriate capacity for culture and susceptibility testing is available, implement suitable treatment failure monitoring procedures so that national and international authorities can develop targeted interventions to prevent the spread of MDR and XDR strains, effectively disseminate results from surveillance to increase awareness among healthcare workers and the public, and introduce strategies to reduce the burden of gonorrhea.

The ECDC says other elements of a comprehensive management strategy should include appropriate treatment, diagnostics, and testing algorithms (such as three-site testing in men who have sex with men), test of cure, notification and treatment of partners, and enhanced focus on risk groups and sexually transmitted infection prevention measures.
Oct 7 ECDC MDR and XDR gonorrhea response plan