News Scan for Nov 02, 2017

News brief

Madagascar plague total tops 1,800 amid decline in pneumonic cases

Madagascar's number of confirmed and suspected plague infections has climbed to 1,801, including 127 deaths, over the past few days, with the number of new cases from the pneumonic form of the disease continuing to decline, according to the latest situation report from the World Health Organization (WHO) Regional Office for Africa.

Though plague is endemic in Madagascar with the bubonic form most common and the season typically running from September to April, the country has been experiencing an unusual surge in pneumonic plague infections that began with one big cluster, spreading to several regions, including Antananarivo and other urban areas.

So far, 1,100 pneumonic plague illnesses have been reported, accounting for 62% of the cases. The case-fatality rate in Madagascar is holding steady at 7%.

Though Madagascar, the WHO, and health partners have made progress battling the outbreak, the WHO has said more resources are needed to sustain the response over the next several months, given what's known about the span of the annual plague season.

The WHO said it reviewing its risk assessment, given evolving developments. Surveillance activities have expanded to include an emergency and death alert system and an automated data collection tool. A dignified and safe burial protocol has been submitted to national authorities for validation and, once implemented, could help reduce public reluctance to report all deaths. The WHO added that it has asked the country's Red Cross to take responsibility for dignified and safe burials, with training under way for 2,660 volunteers in 22 regions.
Oct 31 WHO situation update

New MERS case confirmed in Riyadh

The Saudi Arabian Ministry of Health (MOH) reported a new case of MERS-CoV infection today in Riyadh.

A 42-year-old Saudi woman from that city is in stable condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus), the MOH announced today. The woman is not a healthcare worker, and her infection is listed as "primary," meaning it's unlikely she contracted the virus from another person.

The new case brings Saudi Arabia's MERS-CoV case count since 2012 to 1,739, including 703 deaths. Eight patients are still being treated, according to the MOH.
Nov 2 MOH report

UK data show 66% effectiveness for inhaled flu vaccine in 2016-17 in kids

New vaccine effectiveness data published in Eurosurveillance today showed that the live-attenuated influenza vaccine (LAIV, or nasal spray vaccine) had a 65.8% vaccine effectiveness (VE) rate during the 2016-17 flu season in UK children ages 2 to 17.

The results confirm provisional VE data reported by Public Health England (PHE) in late August. Today's report, written by PHE and other UK experts, also noted that the inactivated influenza vaccine (flu shot) had a statistically not significant VE of 43.2% in the same age-group. Data for that vaccine were not reported by the PHE in August.

In adults ages 18 to 64, VE was 40.6%, and the vaccine wasn't effective for adults over the age of 65. Those numbers remain unchanged from the provisional report.

The data further support the use in UK children of LAIV4, or four-strain LAIV, which was the version used in the United Kingdom this past season, despite a lack of efficacy demonstrated in US studies among US children.

"Although seasonal influenza vaccine was effective against influenza A(H3N2) infection in younger adults, there was no evidence of significant effectiveness of inactivated vaccine in people aged 65 or older," the authors wrote. "On the contrary, in children there was good effectiveness for LAIV4 against influenza A(H3N2) and a suggestion of effectiveness against influenza B, for which there were only limited detections."

The 2016-17 flu season was dominated in North America and Europe by influenza A strain H3N2.
Nov 2 Eurosurveillance study
Sep 11 CIDRAP News story "Performance of inhaled flu vaccine confounds experts"

IDSA: CHAMPION Act would drain public health protection budget

The US House of Representatives is considering the Community Health and Medical Professionals Improve Our Nation (CHAMPION) Act this week, which proposes to cut 75% ($10.5 billion) of the Prevention and Public Health Fund (PPHF) budget. If the act is passed, the Infection Diseases Society of America (IDSA) said the PPHF would be depleted by 2026.

"The proposed cut would diminish state and local capacities for detecting and responding to disease outbreaks, weaken efforts to combat growing antimicrobial resistance, undermine responses to known and emerging infections, and leave critical immunization programs with insufficient resources." wrote IDSA President Paul Auwaerter, MD, MBA, in a statement made yesterday. "The budgetary impact will compromise both public health and national security. We urge Representatives to vote against the bill as it now stands."

The proposed bill would divert funds from the PPHF to support the Community Health Center Program, the Children's Health Insurance Program (CHIP), and the National Health Service Corps (NHSC).

IDSA supports those programs, but says any cuts to the PPHF will damage public health infrastructure, and will ultimately cost more dollars than it saves.
Nov 1 IDSA statement

Stewardship / Resistance Scan for Nov 02, 2017

News brief

IDSA announces first antibiotic stewardship excellence designations

The Infectious Diseases Society of America (IDSA) today announced the first two recipients to receive its Antimicrobial Stewardship Centers of Excellence (COE) designation: Saint John's Health Center in Santa Monica, Calif., and Summa Health, based in Akron, Ohio.

IDSA unveiled the Antimicrobial Stewardship COE program this month to recognize institutions that meet standards established by the Centers for Disease Control and Prevention for antimicrobial stewardship programs that are led by infectious disease physicians and ID-trained pharmacists.

IDSA President Paul Auwaerter, MD, MBA, said in the statement that IDSA is committed to stewardship programs as a key component in the battle against antimicrobial resistance, which leads to 23,000 deaths each year and costing $20 billion in unnecessary healthcare costs. He added that the COE program is a way to recognize groups that take the lead in establishing highly effective antimicrobial stewardship programs that help clinicians provide optimal anti-infective therapies.

The criteria for the IDSA's Antimicrobial Stewardship COE were developed by a workgroup and builds on guidelines in the CDC's Core Elements of Hospital Antibiotic Stewardship Programs. The IDSA says the COE program emphasizes a facility's ability to implement stewardship protocols using the electronic health record system and providing ongoing education to staff.

Health systems can learn more about and apply for the COE designation on the IDSA's web site. The application deadline is Dec 15, 2017.
Nov 2 IDSA statement
IDSA Antimicrobial Stewardship Center of Excellence information

Rate of longer-term IV antibiotics for UTIs in kids drops dramatically

A study involving hospitalized US children published today in Pediatrics determined that the proportion of infants who receive longer-term intravenous (IV) antibiotic treatment for urinary tract infections (UTIs) decreased markedly from 2005 to 2015 without an increase in hospital readmissions.

US researchers analyzed data from the Pediatric Health Information System database, looking for readmission within 30 days for a UTI. They found that the proportion of infants 60 days old and younger at 46 US children's hospitals who received IV antibiotics for 4 or more days for UTIs decreased from 50% in 2005 to 19% in 2015. They also found that the drop did not correlate with an increased rate of readmission to the hospital.

The authors conclude, "These findings support the safety of short-course IV antibiotic therapy for appropriately selected neonates."
Nov 2 Pediatrics abstract