News Scan for Oct 10, 2019

News brief

CDC: 21 sick with Salmonella in 13 states in outbreak tied to turtles

The Centers for Disease Control and Prevention (CDC) yesterday announced a 13-state Salmonella Oranienburg outbreak linked to pet turtles that has sickened at least 21 people.

Of the 21 patients, 7 have been hospitalized but none have died, the CDC said. Illness-onset dates vary from May 29 to Sep 3, and patients range in age from less than 1 to 80 years, with a median age of 24.

"Epidemiologic and traceback evidence indicate that contact with pet turtles is the likely source of this outbreak," the CDC said. "In interviews, 12 (71%) of 17 ill people reported contact with a turtle."

California has had the most cases (6), while Illinois, New York, and Washington state have each confirmed 2. The other nine states have each had 1 case.

Turtles can carry Salmonella in their droppings while appearing healthy. The bacteria can then spread to their bodies, tank water, and habitats and also to people who contact the reptiles or their habitats. The CDC urged hand washing after contact with these pets or environs. Because of the Salmonella risk, since 1975 the sale of turtles with shells less than 4 inches long have been banned in the United States.
Oct 9 CDC notice

 

NIH launches strategic plan to combat tick-borne disease

The National Institutes of Health (NIH) today launched a Strategic Plan for Tickborne Disease Research that focuses on five scientific priorities for advancing research and development in the next 5 years, including improved diagnosis and vaccine research.

The priorities, as spelled out in an NIH news release, are:

  1. Improving fundamental knowledge of tick-borne diseases, including transmission to humans and how they can evade human immune systems.
  2. Bolstering detection and diagnosis of tick-borne diseases, including developing rapid tests.
  3. Accelerating research designed to prevent infection, including vaccines, immune-based treatments, and strategies to reduce transmission of tick-borne pathogens to animal hosts.
  4. Advancing research to develop new treatments and methods to reduce disease complications.
  5. Improving scientists' access to biological samples and tick-borne disease genetic data, as well as supporting preclinical development of promising products.

The NIH notes that infections of tick-borne disease rose from 48,610 in 2016 to 59,349, according to CDC data. And although Lyme disease counts for about 82% of total cases, the Lyme count is likely 10 times higher. The NIH also noted new threats, such as alpha gal syndrome, which leaves patients allergic red meat.
Oct 10 NIH news release

 

Study finds no increased risk of neurologic conditions in Lyme patients

Patients with Lyme neuroborreliosis (LNB) do not have an increased long-term risk of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, epilepsy, or Guillain-Barre syndrome (GBS), Danish researchers reported yesterday in Clinical Infectious Diseases.

The team analyzed data on 2,067 patients diagnosed as having LNB, a disorder of the central nervous system in Lyme patients stemming from an infection with Borrelia bacteria, the causative agent of Lyme disease. The patients were identified from national registers and were diagnosed from 1986 through 2016. They matched the LNB patients to 20,679 Danes from the general population.

The investigators observed no long-term increased risk of dementia, Alzheimer's, Parkinson's, motor neuron diseases, or epilepsy. Within the first year, however 8 LNB patients (0.4%) developed epilepsy compared with 20 (0.1%) of the comparison cohort. Also in the first year, 11 LNB patients (0.5%) patients were diagnosed as having GBS compared with none in the matched controls. GBS was not increased, however, after the first year.

The authors determined that overall, though, the LNB patients had no increased risk of any of the neurologic conditions.
Oct 9 Clin Infect Dis abstract

Stewardship / Resistance Scan for Oct 10, 2019

News brief

MSF calls for price cut on multidrug-resistant TB drug

Doctors Without Borders/Médecins sans Frontières (MSF) is calling on drug maker Johnson & Johnson to lower the price of bedaquilin, an oral medication for the treatment of patients with multidrug-resistant tuberculosis (MDR-TB).

Arguing that the drug was developed and tested in collaboration with the TB research community and treatment providers like MSF, using taxpayer money and contributions from other donors, the medical humanitarian organization is demanding that Johnson & Johnson—which owns the patent on bedaquiline—cut the price to $1 a day, roughly half of what the company currently charges.

"Those who contributed to bedaquiline's development should have a say in how the drug is priced," Sharonann Lynch, HIV and TB policy advisor for MSF's Access Campaign, said in a press release. "We will not back down until the price of bedaquiline is brought down." 

Bedaquiline is a core drug in the all-oral treatment regimen currently recommended by the World Health Organization (WHO) for patients with MDR-TB. The previous regimen included injectable drugs associated with serious side effects and increasing treatment failure. In a move that was widely hailed by MSF and other TB advocacy and global health groups, the WHO added bedaquiline as a first-line treatment in 2018, but MSF says fewer than 12,000 people have been treated with a regimen including bedaquiline since that change was made.

MSF says the lowest price Johnson & Johnson  charges for 20 months of bedaquiline is nearly $1,200, or $2 per day, a price the organization believes is preventing scale-up of the drug in countries struggling with MDR-TB epidemics.
Oct 10 MSF press release

 

European report highlights resistance levels in ICU-associated infections

The European Centre for Disease Prevention and Control (ECDC) today issued a new report highlighting the widespread problem of healthcare-associated infections (HAIs) in European intensive care units (ICUs).

The report, based on 2017 data submitted to the European Surveillance System by 14 European Union/European Economic Activity (EU/EEA) countries, shows that 11,787 (8.3%) of the 142,805 patients who stayed in an ICU for more than 2 days presented with at least one HAI.

Documented HAIs included 8,983 cases of pneumonia, 5,298 cases of bloodstream infection (BSI), and 1,274 urinary tract infections (UTIs). Ninety-seven percent of pneumonia cases were associated with intubation, 37% of BSIs were catheter related, and 98% of UTIs were linked to a urinary catheter. The most frequently isolated pathogens were Pseudomonas aeruginosa in pneumonia episodes, coagulase-negative staphylococci in BSIs, and Escherichia coli in UTIs.

Among the bacteria associated with ICU-acquired HAIs, 23.5% of Staphylococcus aureus isolates were oxacillin-resistant; 9.5% of Enterococcus isolates were vancomycin-resistant; 26.5% of P aeruginosa isolates were ceftazidime-resistant; and 15.9%, 39.9%, and 34.3% of E coli, Klebsiella pneumoniae, and Enterobacter isolates, respectively, showed resistance to third-generation cephalosporins. Carbapenem resistance was reported in 15.2% of Klebsiella isolates, 25.9% of P aeruginosa isolates, 63.9% of Acinetobacter baumannii isolates, 1.7% of Enterobacter isolates, and 0.8% of E coli isolates.

"This report confirms the importance of antimicrobial resistance in gram-negative bacteria in ICUs in the EU/EEA in 2017, with resistance percentages being comparable to the levels reported in previous years," the ECDC said in the report. "The high percentages of resistance to carbapenems of P. aeruginosa, A. baumannii and K pneumoniae isolates reflect the challenges of treatment of ICU patients, a highly vulnerable patient population."
Oct 10 ECDC report

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