Stewardship / Resistance Scan for Aug 11, 2022

News brief
Topics
Antimicrobial Stewardship
Tuberculosis

Study: Treatment for drug-resistant TB limited, costly in Europe

A survey of tuberculosis (TB) treatment centers in Europe found the availability of drug susceptibility testing (DST) for new and repurposed TB drugs in Europe is severely limited, drugs and regimens for drug-resistant TB are limited, and treatment costs for drug-resistant TB are very high, according to a study published this week in Clinical Microbiology and Infection.

For the study, a team of researchers with the Tuberculosis Network European Trials group (TBNET) surveyed 43 TB treatment centers in 40 countries in the World Health Organization (WHO) European region, gathering data on DST, TB drug availability, and cost. They focused on treatment regimens for drug-susceptible TB (DS-TB), multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB), extensively drug-resistant TB (XDR-TB), and pre-XDR-TB.

For WHO Group A drugs (levofloxacin/moxifloxacin, bedaquiline, and linezolid) the frequency of countries with availability of phenotypic DST was as follows: 30/40 (75%) for levofloxacin, 33/40 (82%) for moxifloxacin, 19/40 (48%) for bedaquiline and 29/40 (72%) for linezolid. Overall, 36/43 (84%) and 24/43 (56%) of countries had access to bedaquiline and delamanid, which while only 6/43 (14%) had access to rifapentine. Treatment of patients with XDR-TB with a regimen including a carbapenem was available in only 17/43 (40%) of the countries.

The median cost of regimens for DS-TB, MDR/RR-TB (shorter regimen, including bedaquiline for 6 months), and XDR-TB (including bedaquiline, delamanid, and a carbapenem) were €44 ($45.50 US), €764 ($789 US), and €8,709 ($9,004 US), respectively, in middle-income countries, and €280 ($289 US), €29,765 ($30,733 US), and €217,591 ($224,963 US) in high-income countries.

The authors of the study note that the lack of DST for drugs like bedaquiline and linezolid will result in an inability to detect patients with XDR-TB who carry the worst prognosis, while the high cost of the shorter regimen for MDR/RR-TB will have enormous cost implications for countries with a high burden of drug-resistant TB. They say the data provided by the study highlight the need for "urgent action."

"Strong political support and coordinated action from supranational institutions, countries and their TB programmes, non-governmental organizations and civil society is needed to ensure access to the best standard of care to patients affected by TB," they wrote.
Aug 9 Clin Microbiol Infect study

 

TB vaccine only effective in children under 5

The bacille Calmette-Guerin (BCG) vaccine, when given at birth, is effective at preventing TB in children under 5 but ineffective in adolescents and adults, researchers reported in The Lancet Global Health.

To estimate the effectiveness of the BCG vaccine, which is around 100 years old and one of the most widely used vaccines globally, a team led by researchers from Boston University School of Public Health analyzed individual-level data from 26 longitudinal studies that included more than 68,000 participants exposed to TB from 1998 to 2018. The primary outcome was a composite of prevalent (diagnosed at or within 90 days of baseline) and incident (diagnosed more than 90 days after baseline) TB in exposed contacts. Secondary outcomes were pulmonary TB, extrapulmonary TB, and mortality.

Among 68,552 participants, 1,309 (2.6%) of 49,686 BCG-vaccinated participants developed TB, compared with 473 (2.5%) of 18,866 unvaccinated participants. The overall effectiveness of BCG vaccination against all forms of TB was 18% (adjusted odds ratio [aOR], 0.82: 95% confidence interval [CI], 0.74 to 0.91). When stratified by age, BCG vaccination only significantly protected against all TB in children younger than 5 years (aOR, 0.63; 95% CI, 0.49 to 0.81).

BCG vaccination significantly protected against pulmonary tuberculosis among all participants (916 [2.2%] in 41,119 vaccinated participants vs 334 [2.1%] in 16,161 unvaccinated participants; aOR, 0.81; 95% CI, 0.70 to 0.94) but not against extrapulmonary tuberculosis (106 [0.3%] in 40,318 vaccinated participants vs 38 [0.2%] in 15,865 unvaccinated participants; aOR, 0.96; 95% CI, 0.65 to 1.41). In the four studies with mortality data, BCG vaccination was significantly protective against death (aOR, 0.25; 95% CI, 0.13 to 0.49).

The authors say that while the findings affirm the value of BCG vaccination in children in TB-endemic settings, they also highlight the need for new TB vaccines.

"These results suggest that infant BCG vaccination, although important to young children who are at high risk of tuberculosis, does not prevent adult-type cavitary tuberculosis and is therefore insufficient to impede the tuberculosis epidemic, providing further evidence that novel vaccines are urgently needed," the study authors concluded. They also suggest that until new TB vaccines are developed, children over 10 and adults should receive a BCG booster.
Sep 2022 Lancet Glob Health study

News Scan for Aug 11, 2022

News brief
Topics
COVID-19
Avian Influenza (Bird Flu)

Adults with vision and hearing disabilities had lower COVID vaccination rates

Adults with blindness and deafness were less likely to be vaccinated against COVID-19, according to a large study of adults published today in an early online edition of JAMA Ophthalmology.

Researchers examined data from 916,085 adults who participated in a US Census Bureau Pulse Survey from April 2021 through March 2022. They assessed vaccine initiation and completion, as well as determinants of healthcare access.

For adults in general, 82.7% had started COVID vaccination. Controlling for other factors, they found that adults with blindness were 6.3% less likely than those without disabilities to seek vaccination (95% confidence interval [CI], -11.1% to -1.5%; P=.009). Meanwhile, people with deafness were 5.5% less likely to start vaccination (95% CI, -9.2% to -1.9%; P=.003).

The authors, based at the Moffitt Cancer Center in Tampa, Florida, and the University of Florida at Gainesville, said previous to the study, little was known about COVID-19 vaccination rates in adults who have vision and hearing disabilities. They added that their findings can be used to help guide programs to promote equitable and accessible vaccination and that more research may be needed to monitor vaccination disparities in the two groups.
Aug 11 JAMA Ophthalmol abstract

 

California reports first high path avian flu in poultry flock

California has reported its first highly pathogenic avian flu outbreak in poultry related to ongoing activity in the United States and other world regions, bringing the number of affected states to 39, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said today in an e-mail announcement.

The virus was detected in a flock of 10 backyard birds in Sacramento County. California had earlier reported 22 detections in wild birds from nine counties, including Sacramento. So far, the outbreaks, which involve the Eurasian H5N1 strain, have led to the loss of 40.1 million birds.

Also this week, APHIS reported 40 more H5N1 detections in wild birds, raising the nation's total to 2,044. The latest detections were mainly from western states, but there were also more from midwestern and eastern states.
USDA AHPHIS poultry outbreak page
USDA APHIS wild bird page

 

Chinese researchers identify new henipavirus, zoonotic spread

Chinese researchers who were conducting routine surveillance in people with fevers who had recent contact with animals have identified Langya henipavirus (LayV), a distinct henipavirus and relative of Hendra and Nipah viruses, in a throat swab of one patient. In correspondence last week to the New England Journal of Medicine, they said their investigation turned up 35 suspected acute infections in Shandong and Henan provinces. The surveillance for potential zoonotic infections took place in three hospitals, two in Henan province and one in Shandong province, between Apr 2018 and Aug 2021.

The first patient was a 53-year-old woman who sought care at one of the hospitals in December 2018. Patients' symptoms were mainly mild and included fever, fatigue, cough, loss of appetite, myalgia, nausea, and headache. However, a few had more serious illness that included pneumonia and abnormalities in liver and kidney function.

When the researchers investigated potential animal sources, they found serologic evidence of exposure in a few goats and dogs. Of 25 wildlife species they tested, LayV was mainly found in shrews, suggesting that the species might harbor the virus.

They found no evidence of human-to-human spread or common exposures among patients, which they said suggests infections in humans may be sporadic. They concluded that the newly identified henipavirus, which is most closely related to Mojiang henipavirus detected in southern China, warrants more investigation to better understand human infections.
Aug 4 N Engl J Med correspondence

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