News Scan for Mar 29, 2018

News brief

Study in pregnant women hints at pertussis protection from flu vaccination

A post hoc study in South African pregnant women who took part in a flu vaccine study in 2011 and 2012 found that flu vaccination may have had a protective effect against Bordetella pertussis. Researchers described their findings today in a letter to the New England Journal of Medicine.

The initial trial involved the trivalent inactivated vaccine, and it included 2,116 women—1,062 who received the flu vaccine and 1,054 who were in the placebo group. Researchers followed the women weekly for any respiratory illnesses from study enrollment, through pregnancy, and through 24 weeks postpartum. In women without HIV, the vaccine was 50.4% effective in preventing lab-confirmed flu.

Given that some studies suggest flu can enhance susceptibility to come bacterial infections, the researchers wanted to explore if there was a relationship between influenza virus and pertussis used archived samples from the earlier study to assess levels of pertussis. Scientists had 3,583 respiratory samples from 1,361 women, and they tested 3,125 (87.2%) samples for pertussis. Specimens from 11 flu vaccine recipients tested positive for pertussis, compared with 26 from placebo recipients. Also, test results were indeterminate for 10 women in the flu vaccine group and 16 in the placebo group.

The researchers acknowledged the limits of a post hoc study, but they said it's not likely that flu vaccination would alter the ability to diagnose pertussis and that their observations warrant further investigation.
Mar 29 N Engl J Med letter

More than 200 new yellow fever cases reported in Brazil

The Brazilian Ministry of Health yesterday noted 211 newly confirmed yellow fever cases, including 38 more deaths.

From Jul 1, 2017, to Mar 28, 2018, officials have confirmed 1,131 cases of yellow fever and 338 deaths. During the same period in 2016-17, the number was much lower, at 660 cases and 210 deaths.

The Ministry of Health said the increase correlates with the arrival of yellow fever in Brazil's biggest cities, where approximately 35.8 million Brazilians have not until recently been recommended to receive the yellow fever vaccine. In the previous season, only 9.8 million Brazilians were at risk for the virus.

An additional 77.5 million Brazilians should be vaccinated against yellow fever this year, as the government is now recommending that every citizen get vaccinated. The move to vaccinate all citizens is preventive and should be completed by April 2019, the ministry said.
Mar 28 Brazilian Ministry of Health update

South African Listeria outbreak tied to processed meat grows

The World Health Organization (WHO) yesterday reported a total of 978 laboratory-confirmed listeriosis cases in a South African outbreak that's been linked to a popular ready-to-eat processed meat product called polony, akin to bologna. The outbreak is now the largest ever reported to the WHO.

Among cases with known outcomes, 183 have died. The case-fatality rate is 27%, comparable to other listeriosis outbreaks worldwide, the agency said. Forty-two percent of patients are newborns who were infected during pregnancy or delivery, the WHO said.

Whole-genome sequencing collected from patients showed that 91% of the Listeria strains belonged to a type found in polony products. The South African Ministry of Health announced this connection on Mar 4, and all implicated polony products have been recalled in 15 African countries.

Listeria has a long incubation period, up to 70 days, so officials said more cases are to be expected.

"Following the identification of the source of this outbreak, WHO is now concerned that the export of implicated products may have resulted in listeriosis cases in other countries," the WHO said. "Detailed information on the implicated product batches exported to each of the identified 15 countries should be shared with WHO and the International Food Safety Authorities Network (INFOSAN) Secretariat."
Mar 28 WHO statement

Case report details possible family meningococcal disease transmission

A team from Colorado and the US Centers for Disease Control and Prevention described a possible instance of meningococcal transmission in a family, despite postexposure prophylaxis (PEP) that occurred within a 15-month interval between the two cases. The report appears today in Morbidity and Mortality Weekly Report (MMWR).

The index patient was a 75-year-old woman who was hospitalized in April 2015, where she was diagnosed as having Neisseria meningitidis serogroup C and recovered after treatment. Seven of her family members were advised to receive PEP to curb nasal carriage and prevent secondary infections, but it's not known if they complied.

Fifteen months later, the woman's 3-month-old grandson, who lived with and was cared for by the woman during the day, was hospitalized with a meningococcal serogroup C infection from which he also recovered. The family was again advised to take PEP.

Whole-genome sequencing revealed that the two isolates were closely related.

The researchers said the cases represent possible family transmission, though the mechanism is unclear. They said the N meningitidis strain could have come from an unidentified family contact, that the strain could have been circulating symptomatically in the community, or that PEP failed to eradicate carriage within the family. The 15-month time lag between related infections is longer than earlier similar reports, but some studies limited their definition of secondary cases to a specific time window.

The authors added that more studies to estimate household attack rates and improve documentation of PEP compliance would help assess the existing public health recommendations, which currently don't include vaccination of close contacts in patients who have sporadic disease.
Mar 29 MMWR report

Finland, Slovakia report H5N6 avian flu in wild birds

Two European countries—Finland and Slovkia—today reported more highly pathogenic H5N6 avian influenza detections in wild bird, according to separate reports from the World Organization for Animal Health (OIE).

The report from Finland marks the country's first detection of the strain, which has turned up in other European countries over the past few months, mainly in wild birds.

The event involves a white-tailed eagled found unable to fly on Mar 20 near the city of Pargas in the far southwest archipelago area. The bird was taken to a wild animal shelter, where tests revealed H5N6. The eagle was euthanized because it was very sick, and the shelter also culled five other wild birds, as well.

In Slovakia, officials detected H5N6 in a black-headed gull found dead in Trnava region in the southwest. The OIE report said the last detection of the virus in Slovenia was in June 2017.
Mar 29 OIE report on H5N6 in Finland
Mar 29 OIE report on H5N6 in Slovakia

Stewardship / Resistance Scan for Mar 29, 2018

News brief

Candida auris cases in Europe on the rise, with 620 since 2013

From 2013 through 2017 European officials recorded 620 cases of Candida auris, mostly from four large outbreaks, and 110 of them (17.7%) involved bloodstream infections, according to a report today in Eurosurveillance.

Almost all the cases were in Spain (388) and the United Kingdom (221). More than 75% (466) cases were reported as colonizations, with no apparent illness. In addition to the 110 bloodstream infections, officials documented 40 other infections, while 4 cases were of unknown status. In addition, the incidence rose in recent years, with 23 cases reported in 2015, 290 in 2016, and 303 in 2017.

The authors of the report write, "The increasing number of sporadic cases, mostly invasive infections, compared with the ECDC rapid risk assessment in 2016 confirms that introduction of C. auris into hospitals in Europe is occurring repeatedly, each time with the potential risk for further transmission and healthcare-associated outbreaks. The reason why some cases of C. auris have caused large outbreaks while other cases were sporadic with no apparent further transmission remains unclear."

The study also noted gaps in European surveillance. The experts report that preparedness and response steps for C auris have been taken in only 20 of the 30 European Union nations. The most common measures were dissemination of laboratory alerts (18 countries), offers for reference identification and antifungal susceptibility testing to hospitals (13), and clinical alerts (10).
Mar 29 Eurosurveillance report

Experimental drug shown effective against recurrent C difficile

A phase 2 trial shows that one dose— but not two — of an experimental drug to prevent recurrent Clostridium difficile infection was more effective than a placebo, according to researchers who published their study today in Clinical Infectious Diseases.

The investigators included in the study 127 C difficile patients from 21 centers in the United States and Canada. Of those, 41 received two doses of the drug, called RBX2660; 44 received two doses of a placebo; and 42 received one dose or RBX2660 and one dose of the placebo.

Efficacy for the one-dose group was 67%, compared with 61% in the two-dose group and 45% in the placebo-only group, but the difference reached statistical significance only for the one-dose group.

Of the 54 patients whose treatment did not succeed in the first (blinded) phase, 5 elected to receive one additional dose of RBX2660 and 49 agreed to two additional doses. For this non-blinded (open-label) portion of the study, treatment success rates were 80% (4/5) and 78% (38/49), respectively. That brought the overall success rate for participants who received at least one dose of RBX2660 in the blinded or open-label phases to 89%.

The authors conclude, "These data provide important insights for a larger Phase 3 trial and continued clinical development of RBX2660."
Mar 29 Clin Infect Dis study