News Scan for Jul 11, 2019

News brief

H1N1 flu vaccine in pregnancy not tied to poor outcomes in young kids

Researchers from Ontario followed more than 100,000 live births for 5 years after the 2009-10 flu season and found no adverse health outcomes in children exposed to prenatal 2009 pandemic (pH1N1) flu vaccination, according to a study yesterday in BMJ.

The researchers looked at 104,249 live births, of which 31,295 (30%) were exposed to pH1N1 influenza vaccination in utero. The monovalent (single-strain) vaccine was developed during the 2009 H1N1 pandemic and was offered to pregnant Canadian women beginning in October of 2009.

During the 5-year follow-up, the investigators saw no evidence of increased upper or lower respiratory infections, otitis media (ear infection), any infectious diseases, neoplasms, sensory disorders, urgent and inpatient health services use, pediatric complex chronic conditions, or mortality, the authors wrote.

"A weak association was observed between prenatal pH1N1 vaccination and increased risk of asthma (adjusted hazard ratio 1.05, 95% confidence interval 1.02 to 1.09) and decreased rates of gastrointestinal infections (adjusted incidence rate ratio 0.94, 0.91 to 0.98)," the authors said, but there was no obvious biological mechanism to explain these findings.

The authors concluded by writing the study was reassuring and consistent with other recent studies on the long-term outcomes of the vaccine.
Jul 10 BMJ study

Various avian flu strains cause outbreaks in 4 nations on 3 continents

The World Organization for Animal Health (OIE) in the past week has confirmed avian flu outbreaks in four countries on three continents, involving three separate strains and birds ranging from chickens to ostriches.

The most recent report, from today, details a highly pathogenic H5N8 avian flu outbreak at an ostrich farm in North Cape province, South Africa. The outbreak began on Jun 21, and the virus sickened 22 ostriches in a flock of 1,440. As is typical for ostrich farms, no birds were destroyed, but measures such as isolation of sick birds and disinfection of the surroundings have been implemented.

On Jul 9 the OIE posted a report on high-path H7N3 causing three poultry outbreaks in Mexico, in backyard flocks in Hidalgo, Jalisco, and Gunajuato states, all in the central part of the country. The outbreaks began in early to mid June, with the largest, in Hidalgo, completely wiping out a flock of 1,000 poultry. Among the three outbreaks, the disease killed 1,035 among 1,260 birds. Authorities euthanized the remainder. They said the states have a low prevalence of avian flu.

Taiwan officials, meanwhile, on Jul 8 reported two outbreaks of low-pathogenic H5N2 that actually happened in 2017, and on Jul 4 they confirmed five recent outbreaks of the highly pathogenic version of H5N2.

The low-path outbreaks involved chicken farms in Pingtung and Yunlin counties and began in April and December of 2017. Retrospective analysis identified the strain recently. Of 44,564 birds in the two flocks, only 64 died. Per protocol, however, all surviving birds were culled.

The high-path H5N2 outbreaks began from Jun 24 to Jun 28 on three farms in Yunlin County and two in Changhua County. The deadlier form of the virus killed 2,629 chickens and geese among flocks totaling 72,573 poultry.

Finally, also last week, Vietnamese animal health officials confirmed high-path H5N6 in a village flock of 1,000 birds in Thai Binh province in the north. The outbreak began Jun 23, killing 35 of the poultry.
Jul 11 OIE report on H5N8 in South Africa
Jul 9 OIE report on H7N3 in Mexico
Jul 8 OIE report on low-path H5N2 in Taiwan
Jul 4 OIE report on high-path H5N2 in Taiwan
Jul 3 OIE report on H5N6 in Vietnam

Stewardship / Resistance Scan for Jul 11, 2019

News brief

Survey: Few countries have established targets for reducing antibiotic use

A survey of antimicrobial use reduction goals for human medicine in 30 countries has found that, as of 2017, less than a third had established targets, according to an article today in Eurosurveillance.

To review planned antimicrobial reduction goals in countries belonging to the Transatlantic Taskforce on Antimicrobial Resistance (TAFTAR), the European Centre for Disease Prevention and Control (ECDC) developed a questionnaire compromising 12 questions addressing whether countries had developed targets for reducing antimicrobial use in human medicine, the rationale for those targets, and how progress would be measured and monitored. The questionnaires were sent to all 28 European Union (EU) countries, plus Norway, Iceland, Canada, and the United States in March 2017. Thirty of 32 countries responded.

The countries that established targets are Belgium, France, Malta, the Netherlands, Norway, Slovenia, Sweden, the United Kingdom, and the United States. The reported targets and corresponding metrics, however, varied greatly among the countries. Of the 21 countries that had not established targets, 17 indicated that work on targets was underway.

"This review of the existing antibiotic targets in EU Member States, Norway, Iceland, Canada and the US is aimed at providing detailed information to countries willing to engage in the reduction of antibiotic use in humans," the authors of the paper write. "Monitoring of countries' progress towards existing targets, possible barriers and facilitators, as well as the assessment of these countries' need to revise their targets, should provide additional key information and may be the objective of a future survey."
Jul 11 Eurosurveill article

Drug-resistant, human-associated E coli clones found in Australian gulls

A study by Australian scientists has found that seagulls carry a wide array of drug-resistant Escherichia coli clones that resemble pathogenic, drug-resistant E coli clones from humans. The findings appeared in the Journal of Antimicrobial Chemotherapy.

In the study, scientists from Murdoch University in Western Australia collected Australian silver gull fecal samples from beaches in all Australian states to look for the presence of E coli with resistance to critically important antibiotics (CIAs). Of the 562 samples tested, 135 (23.8%) were positive for fluoroquinolone-resistant E coli, and 125 (21.7%) were positive for extended-spectrum cephalosporin-resistant E coli.

Whole-genome sequencing of 284 of the CIA-resistant isolates revealed that they belonged predominantly to human-associated extra-intestinal pathogenic E coli clones, including ST131 (17%), ST10 (8%), and ST1193 (6%). In addition, comparative analysis found that the isolates belonging to ST131 and ST1193—which are globally disseminated, highly virulent and drug-resistant E coli strains associated with urinary tract infections in humans—overlapped extensively with human clinical isolates in Australia and overseas.

The analysis also detected a single isolate of carbapenem-resistant and an isolate of colistin-resistant E coli carrying the MCR-1 gene—the first such isolate identified in Australian wildlife.

The authors of the study theorize the gulls, which were from areas with dense human populations, may have acquired the bacteria from leftover human food and garbage.

"The carriage of diverse CIA-resistant E coli clones that strongly resemble pathogenic clones from humans suggests that gulls can act as ecological sponges indiscriminately accumulating and disseminating CIA-resistant bacteria over vast distances," they write.
Jul 9 J Antimicrob Chemother abstract