News Scan for Oct 10, 2022

News brief

Study finds boosters give good protection against Omicron hospital cases

A US study of almost 17,000 patients finds modest two-dose Pfizer COVID vaccine effectiveness (VE) against hospitalization and emergency department (ED) admission for Omicron BA.1 (the original Omicron variant) and the BA.2 subvariant, but three-dose VE was 79% and 71% for hospitalization, respectively, and 72% and 21% for ED visits.

Also, VE 3 months or more after the third dose remained high except for BA.2 ED admission.

The test-negative case-control study, by Kaiser Permanente and Pfizer scientists, was published in The Lancet Respiratory Medicine and involved 16,994 COVID-19 members of Kaiser Permanente Southern California—a US healthcare system—who were admitted for an acute respiratory infection. Of those, 7,435 (43.8%) had BA.1, 1,056 (6.2%) had BA.2, and 8,503 (50.0%) did not have SARS-CoV-2.

The researchers noted that two-dose Pfizer VE was 40% (95% confidence interval [CI], 27% to 50%) for hospitalization and 29% (95% CI, 18% to 38%) for ED admission against Omicron BA.1 and 56% (95% CI, 31% to 72%) for hospitalization and 16% (95% CI, –3% to 33%) for ED admission against BA.2.

Three-dose VE was 79% (74% to 83%) for hospitalization and 72% (67% to 77%) for ED visit against BA.1 and 71% (55% to 81%) for hospitalization and 21% (1% to 37%) for ED visit against BA.2. VE 3 months or more after the third dose was 76% (69% to 82%) against BA.1-related hospitalization and 65% (56% to 73%) against BA.1-related ED visit. Against BA.2, VE 3 or more months after the third dose was 70% (53% to 81%) for hospitalization and 5% (−21% to 25%) for ED admission.

In a related commentary, two infectious disease epidemiologists write, "Boosters restore vaccine protection to a high level for at least several months, even against the immune-evasive omicron subvariants." But they add, "Strong and durable protection from the current generation of vaccines increasingly appears to be an elusive goal."

They conclude that the newly available bivalent (two-strain) boosters that specifically target Omicron should help.
Oct 7 Lancet Respir Med study and commentary

Vaccinated COVID patients fare better on mechanical ventilation, data show

A new study in JAMA Network Open suggests vaccinated COVID-19 patients intubated for mechanical ventilation had a higher survival rate than unvaccinated or partially vaccinated patients.

The study tracked outcomes among 265 consecutive COVID patients seen in academic intensive care units (ICUs) in Greece who underwent invasive mechanical ventilation due to acute respiratory distress syndrome from Jun 7, 2021, to Feb 1, 2022.

The authors analyzed outcomes in a full vaccination group, who completed the primary COVID-19 vaccination series more than 14 days but less than 5 months prior to intubation. The other patients were either unvaccinated or partially vaccinated or had completed their full vaccination series more than 5 months earlier. The primary outcome was time from intubation to all-cause ICU mortality.

The median age of intubated patients was 66, and 64.2% were men. Twenty-six (9.8%) in the full vaccination group required ventilation. Patients in the full vaccination group were older (72.5 vs 66.0 years) and had a higher rate of significant comorbidities (92.3% vs 66.9%) than the unvaccinated group.

The authors found full vaccination status was significantly associated with lower mortality compared with controls (16 of 26 patients [61.5%] died in the full vaccination group vs 163 of 239 [68.2%] in the control group; hazard ratio, 0.55 [95% CI, 0.32 to 0.94]; P = .03).

"These findings suggest that the total benefits associated with vaccination against COVID-19 may exceed those previously estimated from the prevention of invasive mechanical ventilation alone," the authors concluded.
Oct 7 JAMA Netw Open study

More cases and deaths reported in Uganda's Ebola outbreak

Uganda's health ministry has recorded 4 more Ebola Sudan infections, raising the number of lab-confirmed cases to 48, the group said today on Twitter, marking its first official update since Oct 3. Officials also reported 7 more deaths in confirmed patients, raising that total to 17.

Earlier in the outbreak, officials reported 18 probable cases, all apparently fatal, which would presumably raise the overall totals to 66 cases and 35 deaths.

Fourteen people are currently in medical care for their infections, and 1,049 contacts are listed for follow up.

In a feature story on the outbreak today, the World Health Organization (WHO) African regional office said as of Oct 8, the case-fatality rate was 23% among confirmed cases.

With support from Doctors Without Borders and other health partners, an isolation tent with 12 beds was built in Mubende 5 days after the outbreak was declared. Another tent was added containing 24 beds and medical equipment, bringing the overall Ebola treatment capacity at the Mubende Regional Referral Hospital to 50 beds.

Seventeen health workers are staffing the treatment unit. The WHO has provided three treatment kits, each with enough to treat 100 patients. The WHO is also supporting local authorities, who have deployed health workers and a fleet of 11 ambulances.
Oct 10 Uganda health ministry tweet
Oct 10 WHO African regional office feature story
Sep 26 WHO outbreak notice

Frozen falafel tied to 20 E coli illnesses in 6 states

The US Centers for Disease Control and Prevention (CDC) on Oct 7 announced an Escherichia coli O121 outbreak that has sickened 20 people from 6 states is linked to frozen falafel sold at Aldi stores.

Of 14 people with available information, 5 were hospitalized, including 1 who developed hemolytic uremic syndrome (HUS), a potentially fatal kidney complication. Illness onsets range from Jul 13 to Sep 13. Eleven patients are from Michigan. Other states reporting cases include Wisconsin (4), Florida (2), Iowa (1), Kansas (1), and Ohio (1).

Interviews with 18 patients by state and local public health departments found that 15 had shopped at Aldi stores, and of those, 6 had eaten Earth Grown brand frozen falafel the week before they became ill. Whole genome sequencing showed that the bacteria from samples from the sick people are closely related, suggesting that they got sick from the same food.

On Oct 7, Cuisine Innovations, based in Lakewood, New Jersey, recalled Earth Grown Vegan Traditional Falafel and Garlic and Herb Falafel. Aldi said Cuisine Innovations is the only company that supplies Earth Grown falafel to Aldi stores.

The Food and Drug Administration (FDA) said in its outbreak announcement that two types of falafel from the company are sold exclusively by Aldi, which removed the products from the stores on Oct 6. In its recall notice, the company said the products were sold in Aldi stores in 37 states and in the District of Columbia.

The CDC advises people not to eat, sell, or serve the recalled frozen falafel. The FDA said the product has an 18-month shelf life and that consumers should check their freezers for the products.
Oct 7 CDC outbreak announcement
Oct 7 FDA outbreak announcement
Oct 7 FDA recall notice

H5N1 avian flu confirmed at Arkansas broiler farm

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) on Oct 7 reported the first appearance of highly pathogenic avian flu in the current outbreak in Arkansas. The outbreak struck a broiler breeding facility in Madison County, located in northwest corner of the state.

The outbreak brings the number of states reporting poultry outbreaks since early February to 42.

In a statement, the Arkansas Department of Agriculture (ADA) said testing confirmed the finding as H5N1 after increasing mortality was noted over several days. Officials said the birds were depopulated and that the outbreak is the state's first involving a highly pathogenic strain since 2015.

In related developments, APHIS reported more poultry outbreaks in three states. Kentucky reported an outbreak in backyard poultry in Fayette County. South Dakota reported an event at a commercial gamebird farm in Brule County. And Virginia reported an outbreak at an unspecified facility in Hampton.
Oct 7 USDA APHIS statement
Oct 7 ADA statement
USDA APHIS poultry outbreak updates

Stewardship / Resistance Scan for Oct 10, 2022

News brief

Non-prescription antibiotic dispensing common in Ethiopian pharmacies

A simulated client study in Ethiopia found a high rate of non-prescription antibiotic dispensing at community pharmacies, researchers reported today in the Journal of Antimicrobial Chemotherapy.

For the study, postgraduate and graduate pharmacy students from the University of Gondar were selected to visit community drug retail outlets (CDROs) in the Amhara region of Ethiopia, with a focus on small towns. They visited each CDRO in pairs, with one presenting a pre-prepared clinical case scenario and the other recording the interaction, and they visited each CDRO twice, presenting the case scenario in the first visit and directly requesting antibiotics in the second. The simulated case scenarios were acute childhood diarrhea, acute childhood upper respiratory tract infection, and adult urinary tract infection.

The study had 450 interactions across the two visits. Non-prescribed antibiotics were obtained in 198 of the 225 (88%) clinical case scenario-based visits and in 205 of the 225 (91%) direct antibiotic request visits. Of those CDROs that dispensed antibiotics, 84% provided them at the first level of demand in the clinical case scenario-based visit, and 95% provided them on the first direct antibiotic request. CDRO staff members requested additional information about the patient or the case in 40% of the clinical case scenario-based visits and 30% of the direct antibiotic request visits.

The study authors note that, despite Ethiopia's prescription-only antibiotic dispensing legislation, the rate of non-prescription dispensing found in the study is higher than pooled estimates in sub-Saharan Africa (69%) and a previous simulated patient study conducted in community pharmacies in Addis Adaba, Ethiopia's capital.

"Our findings suggest the need for immediate and sustained measures to address this issue," they wrote. "These could include stricter enforcement of regulations that restrict antibiotics to prescription-only use, imposing heavier penalties for those who contravene the rules, and enhancing regular CDRO supervision."
Oct 10 J Antimicrob Chemother study

Phage therapy clinical trial launches for cystic fibrosis patients

The National Institutes of Health (NIH) announced last week that enrollment has begun on an early-stage clinical trial to evaluate bacteriophage therapy in cystic fibrosis (CF) patients who carry Pseudomonas aeruginosa in their lungs.

The trial will evaluate the safety and microbiologic activity of WRAIR-PAM-CF1, an experimental phage cocktail manufactured by Adaptive Phage Therapeutics of Gaithersburg, Maryland. The cocktail contains four species of bacteriophage—bacteria-killing viruses—that specifically target P aeruginosa, a frequently multidrug-resistant bacterium that colonizes the lungs of CF patients and is the most common cause of CF exacerbations. The hope is that the cocktail will reduce the amount of P aeruginosa in the lungs.

The trial, which will begin as a phase 1b trial and expand to a phase 2 trial, aims to enroll up to 72 adult CF patients, who will receive a single intravenous infusion of the cocktail at three dosage levels. Investigators with the Antibacterial Resistance Leadership Group will assess the safety and microbiologic activity of the cocktail after eight participants have completed each dosage, and that assessment will determine which dosage level will be given in the next stage of the trial. They'll also be looking at how the phages function in the body and how they affect patients' lung activity.

"The prevalence of antibiotic resistance is concerning, and the need for more effective therapeutics for vulnerable populations, such as people with cystic fibrosis, is especially urgent," National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said in an NIH press release. "Although research on bacteriophage therapy may still be in its infancy in the United States, we hope that this study, and others like it, could open the doors to a new type of therapy for difficult-to-treat bacterial infections."
Oct 4 NIH press release

Surveys indicate many French GPs feel pressure to prescribe antibiotics

Telephone surveys of the general public and general practitioners (GPs) revealed that, despite an overall decline in antibiotic use in France over the past decade, more than a third of clinicians report pressure to prescribe antibiotics, researchers reported last week in Antimicrobial Resistance & Infection Control.

To help inform future national awareness campaigns on antimicrobial resistance, researchers with Public Health France conducted two telephone surveys in 2019 and 2020. The first explored antibiotic consumption and knowledge and beliefs about antibiotic resistance among a representative sample of the general public ages 15 years and older. The second explored the evolution of prescribing practices and attitudes toward patient demands for antibiotics among a representative sample of 388 GPs.

In the general public survey, 27% of respondents said they had received antibiotics during the previous 12 months, and 54% of those with a child aged 6 years and under said their child had received an antibiotic during the same period.

In the GP survey, 65% declared they had reduced their antibiotic prescribing over the previous 5 years, and 64% said they did not automatically prescribe antibiotics but advised patients to contact them in 2 or 3 days if symptoms persisted. Among GPs, 33% said they often have patients who insist on having antibiotics, and that elderly patients with comorbidities were among the most demanding. Only 3% of the general public said they put pressure on their GP to prescribe an antibiotic.

The vast majority of respondents in the general public survey expressed trust in their GP regardless of whether they had prescribed them antibiotics (89%) or not (91%). Only half of respondents said they knew antibiotics only act on bacteria, and 38% said they understood exactly what antibiotic resistance is.

A 2020 study by Public Health France found that, from 2009 to 2019, the number of antibiotic prescriptions fell by 18% among all age-groups except the elderly.

The authors say a forthcoming public awareness campaign will take the survey results into account.
Oct 6 Antimicrob Resist Infect Control study