News Scan for Jan 23, 2019

News brief

Gottlieb: FDA food inspectors reduced by more than half during shutdown

According to a series of tweets made by Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, the agency is trying its best to handle food safety inspections and other critical work during what has become the nation's longest government shutdown.

"Our Office of Human and Animal Food Operations has more than 200 food investigators (not counting support staff and supervisors) out of about 550 total professionals when the agency is fully operational," Gottlieb said. "We're deeply grateful for the FDA professional staff that continue to carry on this mission unpaid, while also incurring expenses on their personal government credit cards for travel. We're doing everything we can to support them as they protect American consumers."

Gottlieb said a number of food safety operations are still under way. They include high-risk domestic food surveillance inspections, foodborne illness surveillance and outbreak investigations, execution of high-risk food recalls, inspection of foreign food facilities, and sampling of imported food samples—including sampling for antibiotic residue contamination and decomposition analysis.

According to Food Safety News, the US Department of Agriculture's Food Safety and Inspection Service (FSIS) continues to deploy most of its workforce of nearly 10,000 during the shutdown. FSIS inspectors must check all meat and poultry sold to US consumers.
Scott Gottlieb Twitter feed
Jan 22 Food Safety News story

 

South Korean study highlights nosocomial SFTS transmission

A new study in Clinical Microbiology and Infection describes the person-to-person transmission of severe fever with thrombocytopenia syndrome (SFTS), which is typically a tick-borne disease.

The study looked at 25 healthcare workers (HWCs) from a South Korean hospital who had contact with an index patient, a 59-year old woman who contracted the disease while chestnut picking. The patient died in the hospital, and 11 days after her death 2 of the HCWs developed symptoms of SFTS.

Among the HCWs who had direct contact with the index patient, 5 were confirmed to have SFTS. Those 5 had contact to blood or bloody respiratory secretions of the index patient without adequate use of personal protective equipment (PPE), the study authors said. Only HCWs who had contact with the patient during the hemorrhagic phase of her disease contracted SFTS at a rate of 33.3%, (5 of 15 HCWs).

SFTS, an emerging infectious disease, is most commonly transmitted through the Haemaphysalis longicornis (longhorned) tick. The study authors said their findings suggest that person-to-person transmission of SFTS may be associated with contact with blood or bloody respiratory secretions of an infected person, and PPE should be used when treating SFTS patients.

Previous instances of likely nosocomial (healthcare-related) spread have been documented in South Korea, including 4 of 27 HCWs in a cluster likely related to respiratory secretions or bodily fluids in 2015 and a case last month potentially involving aerosol transmission.
Jan 21 Clin Microbiol Infect study
Feb 18, 2015, Clin Infect Dis study
Dec 19, 2018, Infect Control Hosp Epidemiol abstract

 

Human-to-human spread suspected in Argentina hantavirus outbreak

Argentina's health ministry has reported an increase in hantavirus pulmonary syndrome (HPS) cases in a southern Patagonian city in Chubut province, the World Health Organization (WHO) said yesterday in a statement.

Since Oct 28, officials confirmed 29 lab-confirmed HPS cases, 11 of them fatal, prompting Argentinian health officials to issue an epidemiologic alert.

The investigation so far suggests potential human-to-human transmission. Though people usually contract hantavirus from rodent habitats, limited human-to-human transmission of HPS due to Andes virus in Argentina has been documented before.

According to the report, the first patient got sick on Nov 2 after environmental exposure and attended a party the next day. Six people who attended the party later began having symptoms from Nov 20 tp Nov 27, followed by 17 more cases in people who had epidemiologic links to the earlier patients. As of Jan 17, officials are monitoring 98 asymptomatic contacts.

One of the confirmed case-patients is a healthcare worker from Chile who had traveled to the outbreak location for 1 day in the middle of November and later hosted and cared for a person with an earlier infection while she was in her prodromal phase. The WHO said the health worker's infection marks the first case of hantavirus in Chile's Los Lagos region in 2019.

Argentina has four endemic regions, and from 2013 through 2018 the country averaged about 100 confirmed HPS cases each year. Health authorities in both counties are implementing several public health measures, including enhanced surveillance and deploying outbreak investigation teams to affected areas.
Jan 23 WHO statement

Stewardship / Resistance Scan for Jan 23, 2019

News brief

CDC experts say US-wide C diff prevention could net $25 billion in benefits

Experts from the US Centers for Disease Control and Prevention (CDC) estimated yesterday in Antimicrobial Resistance & Infection Control that establishing nationwide antibiotic stewardship programs to prevent Clostridioides difficile infections in hospitals would result in an annual net benefit of $25.5 billion.

The investigators used new Department of Health and Human Services guidelines for their cost-benefit analyses of a national in-hospital C difficile prevention program to improve health and preserve antibiotics. They included estimates of antibiotic stewardship staffing and incorporated value-of-statistical-life estimates to derive economic values associated with decreasing morbidity and mortality risk.

They estimated that, if they were to ignore the benefits from reducing the risk of illness and death, net benefits of such a nationwide intervention would range from $300 million to $7.6 billion from 2015 to 2020. But if they include the value of such risk reduction, the net social benefits jump from $21 billion to $624 billion. The authors say the most likely outcome scenario would realize a net benefit of $25.5 billion per year.

The experts conclude, "As the US federal government intensifies its efforts to control antibiotic resistant infections, our results suggest that these ambitious goals can produce very large net societal benefits. As these benefits accrue mostly to patients, policy makers can address how the burden for the additional prevention costs should be shared among patients, third party payers and healthcare providers."
Jan 22 Antimicrob Resist Infect Control study

 

UK study: Antimicrobial resistance strategy linked to drop in prescribing

Researchers with the University of Oxford report today in the Journal of Antimicrobial Chemotherapy that antibiotic prescribing has dropped by 14% in England since the government implemented its 5-year antimicrobial resistance strategy.

Using annual prescription cost analysis data from 1998 to 2017 and monthly prescribing data from 2010 to 2018, the researchers calculated the volume of antibiotic prescriptions and measured the change in prescribing rate after the strategy was implemented in 2013. The strategy, introduced in a report by England's Chief Medical Officer (CMO), included optimizing prescribing practice by reducing unnecessary prescribing and creating a website that provides clinicians with prescribing data by practice and month.

The researchers found that while the annual prescribing rate was stable from 1998 through 2012, there was a downward change after 2013, despite an increase in population. The annual rate dropped from 1,378 per 1,000 Specific Therapeutic group Age-Sex Related Prescribing Units (STAR-PU) per year in 2013 to 1,184 per 1,000 STAR-PU in 2017. Applying the pre-2013 prescribing rate to the period from July 2017 to June 2018, the researchers estimated that an additional 9.7 million antibiotic prescriptions would have been dispensed had the strategy not been implemented.

Though they note that they cannot firmly say that the 5-year antimicrobial resistance strategy caused the reduction in prescribing, the authors of the study say the magnitude and timing of the change are noteworthy.

"National strategic public health interventions are an important and potentially effective way to modify clinical practice," they write. "The CMO report and Antimicrobial Resistance Strategy appears to have had a substantial impact on prescribing of antibiotics at the population level in England."
Jan 23 J Antimicrob Chemother study

 

CDC says 2018 Candida auris cases topped 550

Confirmed and probable Candida auris cases in the United States through Dec 31 rose to 551, an increase of 88 from the end of October, the CDC said in an update yesterday.

Illnesses caused by the deadly, multidrug-resistant fungus have been reported in 12 states, though 90% are in New York (280), Illinois (118), and New Jersey (100). Of the 551 cases, 520 are confirmed and 31 are listed as probable.

In comparison, from when the fungus was first identified in the country in June 2016 through Aug 31, 2017, US states reported 153 clinical cases.

Screening for C auris in six states has found an additional 975 patients who are colonized. The testing is part of efforts to control the spread of the fungus, known to persist on surfaces in healthcare facilities and spread among patients. That total reflects an increase of 174 since the CDC's October update.

Since its first identification in 2009 in Japan, C auris has triggered outbreaks in health facilities in more than 20 countries and has shown resistance to three major antifungal drug classes. The fungus can cause serious invasive infections in patients who have compromised immune systems, and the CDC has estimated that C auris infections are fatal in 30% to 60% of patients.
Jan 22 CDC C auris case count page
Sep 18, 2017, CDC clinical update

This week's top reads