News Scan for Jul 01, 2021

News brief

Global prevalence of vanco-resistant Staph has more than tripled: study

The global prevalence of vancomycin-resistant Staphylococcus aureus (VRSA) has more than tripled in the past two decades, according to a systematic review and meta-analysis yesterday in Antimicrobial Resistance & Infection Control.

The review of 62 published studies on VRSA prevalence rates, conducted by a team of Chinese and Iranian researchers, found that prevalence increased from 2% of 466 isolates before 2006 to 6% of 6,692 isolates from 2006 through 2014 and 7% of 5,798 isolates from 2015 through 2020. Prevalence was highest in Africa (16%) and Asia (5%), followed by North America (4%), South America (3%), and Europe (1%). The frequencies of VRSA isolates from clinical, non-clinical, and mixed samples were 6%, 7%, and 14%, respectively.

Analysis of the genetic backgrounds of VRSA strains found that 71% and 26% were positive for vanA and vanB resistance genes, respectively, and 4% contained the vanC1 gene.

The first case of VRSA, which tends to be multidrug-resistant, was reported in 2002. The study authors suggest the increased prevalence and detection of VRSA could be attributed to more frequent use of vancomycin for treatment of methicillin-resistant S aureus infections, better diagnostics, and a change in vancomycin resistance breakpoints since 2006.

"This study clarifies that the rigorous monitoring of definite antibiotic policy, regular surveillance/control of nosocomial-associated infections and intensive surveillance of vancomycin-resistance are required for preventing emergence and further spreading of VRSA," they wrote.
Jun 30 Antimicrob Resist Infect Control study

CDC issues alert about 3 US melioidosis cases

The US Centers for Disease Control and Prevention (CDC) yesterday warned health providers about three melioidosis cases involving patients in three states that appear to be linked, though investigators are still looking for the source.

In a Health Advisory Network (HAN) notice, the CDC said the patients affected by the rare infections don't have a foreign travel history. They are from Kansas, Texas, and Missouri. Two are adults, and one is a child.

The first illness was identified in March, and the patient—who had underlying risk factors—died. Two others were identified in May, and one is still hospitalized, while the other was discharged to a rehabilitation facility.

Genetic analysis of the Burkholderia pseudomallei samples from the patients suggests a common source, such as an imported product or an animal, but so far the source hasn't been identified.

B pseudomallei is a tier 1 select agent and is most common in tropical and subtropical regions. Most US cases occurred in people who visited areas in which the disease, which can affect animals and people, is endemic. The CDC said the cases stand out because none of the patients had traveled recently outside the United States.

Symptoms can be nonspecific, ranging from fever to joint pain, and people with underlying conditions are at higher risk for contracting the disease. Human-to-human infections are rare, with lab workers thought to be at higher risk. The CDC urged health providers to consider melioidosis patients with similar symptoms, even if they don't have a travel history.
Jun 30 CDC HAN notice

FluGen testing new flu vaccine against H3N2 in older adults

FluGen today announced $11.4 million in US Defense Department funding to support a phase 1b study of its live, single-replication intranasal monovalent flu vaccine that targets H3N2, one of the two circulating strains of influenza A.

The trial will compare how the intranasal vaccine, M2SR, compares to a licensed quadrivalent vaccine that is considered the current standard of care for adults aged 65 and above. This age-group is considered most at-risk for serious complications from seasonal flu infections.

"The current standard of care has not been shown to be widely effective in protecting this population from virus drift, particularly against H3N2," said FluGen President Paul Radspinner in a press release. "We believe M2SR has the potential to be a more effective vaccine option in older adults, as it induces a broad antibody response, including mucosal, humoral, and cellular immunity, even in the presence of pre-existing immunity to the flu."

Three hundred adults will be included in the trial, which is set to begin in the second quarter of 2022, timed for the flu season. The trial design will allow researchers to measure immune responses generated by M2SR and the standard of care vaccine in older adults. In particular, researchers will be looking at the efficacy of the vaccine against drifted influenza strains among study subjects who receive either vaccine alone, both vaccines administered simultaneously, or both given sequentially.
Jul 1 FluGen press release

H5N1 avian flu strikes 2 poultry farms in Niger

Togo reported two highly pathogenic H5N1 avian flu outbreaks in poultry, its first since 2019, according to a recent notification from the World Organization for Animal Health (OIE).

The outbreaks began on Jun 1 and Jun 16 at two layer farms in Maritime region in the far south. Taken together, the virus killed 752 of 2,000 susceptible birds. The surviving poultry were culled to curb the spread of the virus.

A few other African countries have reported H5N1 outbreaks in poultry over the past few months, including South Africa, Mali, and Niger.
Jun 29 OIE report on H5N1 in Togo

COVID-19 Scan for Jul 01, 2021

News brief

COVID spread in households early in the pandemic

COVID-19 transmission was most commonly identified in households early on in the pandemic, but interviews also show an association with healthcare settings, according to a study yesterday in Emerging Infectious Diseases.

In a convenience sample of 202 COVID-19 patients from 16 states, the researchers looked at transmission factors from Jan 14 to Apr 4, 2020. COVID patients ranged from infantile (younger than 1 year) to 95 years. Almost all were symptomatic (96.5%), with symptoms more likely to develop in parents of index case-patients than other members, and one in three were hospitalized for symptoms.

Of the 82 case patients who had a known contact with lab-confirmed COVID-19 14 days prior to symptom onset, the most common exposure was in the household (53.7%) and the second most was healthcare (24.4%, of whom 70% were healthcare workers).

Case patients who didn't have known COVID exposures worked in a variety of different settings. Still, 27.8% of 72 had a known contact in healthcare, and 23.8% of 84 had contact with an "ill person." These patients were also significantly more likely to use public transportation (44% vs 16%), and at insignificant levels, more likely to report travel (38% vs 26%) or attendance at a mass gathering (36% vs 21%).

Sensitivity analysis results showed a plausible range of attack rates from 21% to 39%, with a median serial interval of 3 days, according to the study. Data indicated that transmission was more likely to stem from those 65 and older or from children to those ages 18 to 44.

"Case-patients reporting no known source of infection, travel, or any other exposure risk factor tended to be older and to have more underlying medical conditions—particularly diabetes mellitus," the researchers add. "Persons with concurrent conditions may be not only more susceptible to severe outcomes from COVID-19 but also more susceptible to infection, as suggested by other analyses of SARS-CoV-2 and Middle East respiratory syndrome coronavirus; however, more investigation is warranted."
Jun 30 Emerg Infect Dis study

ICE has worked to address COVID, GAO report says

US Immigration and Customs Enforcement (ICE) has worked to develop responsive COVID-19 protocols around facility intake processes, screening and testing, social distancing, and more, the Government Accountability Office (GAO) said in a report published yesterday.

In 2020, ICE tested 80,200 detainees for COVID-19, identified 8,622 cases (10.8%), and recorded 8 deaths. As part of its COVID response in 2020, the ICE also classified 14,729 detainees as high-risk, of whom 529 (3.6%) developed COVID-19 infections. As of March 2021, ICE confirmed more than 10,000 cases but the same number of deaths.

GAO talked with officials from six of 157 facilities that detained people for at least 72 hours. While COVID protocol was mostly in place, some facilities said it was difficult to quarantine at times and that detainees did not always adhere to mask wearing.

Additionally, the agency looked at recurring survey responses meant to measure COVID protocols. Among the selected facilities, one to six of 74 questions about pandemic response requirements were answered with a no (eg, the facility was not sanitizing detainee personal mail). Notably, one facility's survey results showed that, through November 2020, the site had no policies to adapt social distancing and personal protective equipment use to religious practices.

"According to Detention Service Managers we spoke with, any issues identified with the survey responses were generally addressed informally through phone calls and other communications; however, we observed that several of the 'no' responses in the surveys we reviewed remained consistent over these course of several months," GAO writes.

While Enforcement Removal Operations officials expected that continuing issues would be addressed by November 2020, assessment methods changed with an extensive survey revision in December 2020. Monthly on-site compliance checks also began.
Jun 30 GAO study