News Scan for Aug 14, 2014

News brief

Vaccine advisers recommend Prevnar 13 for seniors

A federal vaccine advisory group yesterday recommended that adults age 65 and older receive the Prevnar 13 pneumococcal conjugate vaccine, according to a press release from Pfizer Inc., the vaccine's maker. Using the vaccine alongside the current 23-valent pneumococcal vaccine is thought to provide broader protection.

The Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC), considered the issue yesterday during a 2-hour Webinar.

The vaccine, which protects against pneumonia caused by 13 serotypes of Streptococcus pneumoniae, was approved in 2010 for use in young children, and in 2011 the Food and Drug Administration (FDA) approved its use in adults age 50 and older. In 2012, Pfizer sought an ACIP recommendation for use in seniors, but the panel said it wanted to wait and analyze data from ongoing studies on herd immunity benefits in older people resulting from the vaccine's use in children.

A 23-valent pneumococcal vaccine has been used in seniors for several years. In 2012 ACIP recommended the vaccine for adults age 19 and older who have certain underlying medical conditions.

ACIP voted to recommend Prevnar 13 vaccination in adults 65 and older who have not received a pneumococcal vaccine or whose history is unknown, followed by a dose of 23-valent vaccine. It also advised that adults who have already received one or more doses of 23-valent vaccine should receive a dose of Prevnar 13.

The panel said it would reevaluate the routine use of Prevnar 13 in seniors in 2018 and revise its advice as needed.

Luis Jodar, PhD, Pfizer's' vice president of vaccines, said in the statement, "This additional ACIP meeting recognizes the importance of implementing an adult recommendation for Prevnar 13 in advance of the U.S. influenza season, the time of year when this population is most likely to be considering vaccination."
Aug 13 Pfizer press release
Aug 13 ACIP meeting agenda

Study finds MRSA colonization common in rectal, groin areas

Although the front part of the nasal passages is known as a leading site for colonization of methicillin-resistant Staphylococcus aureus (MRSA), the rectal and groin areas are not far behind, according to a recent study in Infection Control and Hospital Epidemiology.

Researchers obtained swabs from 480 men and 265 women within 72 hours of admission at a Chicago hospital from March 2011 through April 2012. Of the 115 who tested positive for the presence of community-acquired MRSA, 62% had colonization of the anterior nares (nostrils), compared with 58% in the perirectal region, 56% in the groin, 44% in the throat, and 38% in the axilla (armpits).

Also, 43% harbored MRSA in both the perirectal and groin areas. All told, 92% had colonization outside the nose.

Five of the 115 patients colonized had a MRSA infection, and 4 of those colonized had multidrug-resistant strains.

"While people colonized with MRSA may not be sick, the bacteria can become aggressive and lead to infection in the person or others," said lead author Kyle Popovich, MD, MS, in a press release from the Society for Healthcare Epidemiology of America (SHEA), which publishes the journal.

Popovich said the findings "may have important implications [for] MRSA surveillance programs nationwide."
September Infect Control Hosp Epidemiol study
Aug 13 SHEA news release

Analysis finds LAIV more effective than TIV in kids

A meta-analysis of the only two randomized controlled trials of live attenuated influenza vaccine (LAIV) in children showed that LAIV was slightly more effective against moderate-to-severe influenza than against milder flu in children younger than 6 years, according to a study in Vaccine. It was also significantly more effective than trivalent inactivated vaccine (TIV).

The first trial was a 2-year placebo-controlled study of more than 1,300 US children 15 to 71 months old. Overall LAIV efficacy versus placebo was 95.4% in year 1 and 88.5% in year 2 against moderate-to-severe flu and 91.4% in year 1 and 84.2% in year 2 against milder flu.

The second was a 1-year TIV-controlled study involving 4,166 US, European, and Asian children 6 to 59 months old. The relative efficacy of LAIV versus TIV was 52.2% for moderate-to-severe flu and 45.0% for milder flu.
Aug 12 Vaccine study

Fecal transplants may treat more than just C difficile infections

Fecal transplants are known mainly as a treatment for patients with recurrent Clostridium difficile infection (CDI), but studies reported at a conference this week suggest that the approach can help combat other gut diseases as well, according to the American Gastroenterological Association (AGA).

The studies are being presented at the James W. Freston Conference in Bethesda, Md., the AGA said in a press release.

New York City researchers reported some success with fecal microbiota transplantation (FMT) for patients who have irritable bowel syndrome (IBS), with overall symptoms resolving or improving in 9 of 13 patients enrolled. Eight of 11 patients with abdominal pain noted improvement or resolution after FMT.

The treatment was less successful in relieving flatus, but overall well-being improved, the authors reported.
Study abstract

Another report said 10 of 16 patients who received FMT for inflammatory bowel disease (IBD; ulcerative colitis or Crohn's disease) had fewer flares in the ensuing months. Three of the 10 had no flares during an average 21-month follow-up period, while the other 7 had fewer flares than before, and none had more, said researchers from Montefiore Medical Center in the Bronx, N.Y.

Several other disease markers also improved during the follow-up, while medication requirements decreased, according to the abstract.
Study abstract

Still another research team, from Minnesota and Massachusetts, reported that a preparation of gut bacterial spores in pill form was effective in treating CDI, suggesting that this treatment has potential for replacing actual fecal transplantation.

The medication, called SER-109 and described as an "oral Ecobiotic ecology of commensal spores," was used to treat 15 patients who had recurrent CDI that was adequately controlled with antibiotics. Thirteen of the 15 were free of CDI for the 8-week post-treatment follow-up period; the other 2 had transient diarrhea within 9 days after treatment but were free of CDI at 8 weeks. The researchers concluded that the cure rate was 100%.

"The spore ecology worked at low dose and rapidly repaired the dysbiosis caused by chronic antibiotic treatment for C. difficile by inducing the formation of a diverse, healthy microbiome," the abstract states.
Study abstract
Aug 14 AGA press release

Food Outbreak Scan for Aug 14, 2014

News brief

Cyclospora infection total rises to 283, some travel-linked

States reported another bump in Cyclospora cases last week, and health officials are still trying to determine how many are travel-related and if there is a common source for the locally acquired cases. The US Centers for Disease Control and Prevention (CDC) said that as of Aug 12 it had been notified of 283 Cyclospora infections, 48 more than the previous week.

The number of affected states remained at 21, but 57% (160) of the cases were reported in Texas. CDC officials told CIDRAP News that at least 116 Texas patients reported no travel during the 2 weeks before they got sick. Interviews with patients in other states have revealed that 34 of 123 likely acquired their illnesses during travel abroad. So far 64 of the people interviewed said they did not travel before becoming ill.

The CDC said that more patients are being interviewed to determine what percentage of cases were linked to travel and that federal, state, and local officials are collaborating. The agency is working with its partners to see if more people and states are affected.

Nationally, most of the cases were reported in July, and outbreak investigations are underway in Texas and Michigan. The CDC said Maine and Massachusetts are also investigating increases in Cyclospora infections.

The Texas Department of State Health Services (TDSHS) said in an Aug 12 update that the state experienced a surge of Cyclospora infections starting in the middle of June and that a common source has not yet been identified. So far 37 of the state's 254 counties have reported cases, 3 more than the previous week. Counties reporting the most cases are Dallas (35), Tarrant (18), Harris (13), and Collin (10).

Last summer Texas was the hardest-hit state in a Cyclospora outbreak that sickened at least 631 people in 25 states and New York City. Past foodborne outbreaks have been linked to many kinds of imported fresh produce, including raspberries, basil, snow peas, and mesclun.
Aug 12 TDSHS update

US-Canada Salmonella outbreak tied to chia sprouts called over

US and Canadian public health agencies yesterday declared that an outbreak of salmonellosis tied to organic chia sprouts is over after causing at least 63 illnesses in Canada and 31 in the United States.

US cases were reported in 16 states, the CDC said, and six new cases have been confirmed since the CDC's last update on Jul 17. Twenty of the 31 cases involved Salmonella Newport, 7 involvedthe Hartford strain, and 4 involved Salmonella Oranienburg.

Illness-onset dates ranged from Jan 21 to Jul 22. Patients ranged in age from 1 to 81 years, with a median age of 48. Five patients were hospitalized, but no deaths were recorded.

"As a result of this investigation, several recalls of products containing organic sprouted chia powder and chia seeds were issued," the CDC said.
Aug 13 CDC update

In Canada, the 63 cases were confirmed in British Columbia (14), Alberta (10), Ontario (35), and Quebec (4), the Public Health Agency of Canada (PHAC) said. Four of the cases were not previously reported.

Twelve of the 63 patients were hospitalized, 9 of whom have been discharged. No deaths were reported. In addition to the strains infecting US patients, PHAC noted a fourth strain: Salmonella Saintpaul.

"Given that no new cases have occurred since the beginning of July, this outbreak appears to be over and the investigation is now closed," PHAC said.
Aug 13 PHAC notice