News Scan for Jul 05, 2018

News brief

Fractional doses of yellow fever vaccine offer protection for up to 8 years

A study published in Vaccine shows that even small doses of the yellow fever vaccine are likely to offer protection against the virus for up to 8 years after vaccination. The information reassures countries like Brazil, who have used fractional dosing in an effort to stretch supplies of the vaccine during recent outbreaks.

The study was a follow-up to a 2009 Brazilian study comparing the serostatus of vaccine recipients given the full dose of the yellow fever vaccine (27,476 IU) compared to tapered doses (10,447 IU, 3,013 IU, 587 IU, 158 IU, and 31 IU). In that study, seropositivity was maintained for 10 months in all groups, except the group that received 31 IU.

Eight years later, researchers found 85% of 318 participants had antibodies against yellow fever, even in the 587 IU and 158 IU vaccination groups. The groups who had higher doses were more likely to be protected. All participants were male military members and confirmed they had not been revaccinated against yellow fever during the follow-up period.

The findings support the use of the yellow fever vaccine in fractional doses during outbreaks, but each fractional dose should have at least 587 IU. Current recommendations for the yellow fever vaccine from the World Health Organization are at least one dose of 1,000 IU every 10 years.

Though the yellow fever vaccine is one of the oldest, and most effective, vaccines in use, the world is suffering a shortage after outbreaks in the Democratic Republic of the Congo and Angola depleted stockpiles in 2016. In 2017, Brazil announced the use of factional doses in efforts to squelch a growing outbreak in that country.t

In a comment on the study on ProMED Mail, moderator Tom Yuill, PhD, with the University of Wisconsin, Madison, said, "This information will be extremely valuable for decision-making in the face of another yellow fever outbreak. The virus is not going to disappear in Africa nor in South America." ProMed Mail is the online reporting system of the International Society for Infectious Diseases.
Jun 27 Vaccine study
Jul 4 ProMed Mail post

More suspected cases tested as the DRC's Ebola countdown continues

Surveillance activities in the Democratic Republic of Congo (DRC) continue to identify and test new suspected Ebola cases, but no more confirmed cases have been reported over the past few days as the country edges closer to declaring the outbreak over.

In a Jul 3 situation report, the World Health Organization (WHO) said since Jun 26, 13 more suspected cases were identified, 10 from Bikoro, 2 from Iboko, and 1 from Wangata Health Zone in the provincial capital city of Mbandaka. Two rounds of testing have ruled out the disease in 11 of the patients, and second-round test results are still pending for two other people who tested negative in their initial tests.

The total number of cases is 53, which includes 38 confirmed, 15 probable, and 2 suspected cases. The number of deaths remains at 28.

Though the outbreak is largely contained, there is still a risk of flare-ups due to undetected transmission chains and the risk of sexual transmission by some male survivors, the WHO said.

Strengthened surveillance is in place, along with a survivor monitoring program, according to the WHO, which added that the revised risk has been downgraded to moderate for the DRC and low for the regional and global levels.
Jul 3 WHO situation update

**CDC: Needle stick accident led to Brucella exposure**

Today’s Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC) contains a note about a veterinarian in Oregon diagnosed as having brucellosis after an accidental needle stick with the Brucellla abortus strain RB51 vaccine.

The patient administered the vaccine, intended for cattle, 3 weeks before suffering symptoms, including cough, malaise, myalgia, and fever. The patient was initially diagnosed as having pneumonia in the hospital and given doxycycline. After worsening symptoms, the patient was hospitalized and began oral rifampin and intravenous ceftriaxone and azithromycin, and continued oral doxycycline treatments before a brucellosis diagnosis was confirmed.

"This report serves as a reminder that occupational RB51 exposure is a risk among veterinary personnel. Clinicians, laboratory staff members, and public health officials should be aware of RB51 diagnosis and treatment challenges and be prepared to manage RB51 cases and exposure," the report said.

Brucellosis is uncommon in humans, and has been previously linked to veterinary needle sticks and raw milk consumption. The illness requires a positive culture to diagnose.
Jul 5 MMWR report

Stewardship / Resistance Scan for Jul 05, 2018

News brief

Investigation suggests carbapenemase-producing E coli passed from humans to dogs

Finnish researchers are reporting the first transmission of carbapenemase-producing Escherichia coli between humans and dogs.

In an article today in Eurosurveillance, the researchers report that a strain of carbapenemase-producing E coli—ST167 NDM-5—was found in two dogs and one human from the family that owned the dogs. The E coli was originally identified in the ears of the two dogs, both of which had histories of ear infections, and later in rectal swabs from the family member. Molecular analysis and whole-genome sequencing of 10 of the isolates (7 from the dogs, 3 from the human) revealed that the isolates were nearly identical. The dogs and additional family members also carried an identical strain of extended-spectrum beta-lactamase (ESBL)-producing E coli, ST69 CTX-M-9.

These findings suggest interspecies transmission, with the pathogen likely being passed from the humans to the dogs. While carbapenemase-producing E coli is rare in humans in Finland, the authors of the article note that carbapenem-resistant bacteria had not been observed in dogs in Finland before this report. In addition, carbapenems are not authorized for veterinary use in Finland, and the investigation did not reveal any use of carbapenems in the two dogs in the study. But they suggest that the dogs' frequent exposure to other antibiotics to treat their ear infections probably sustained and facilitated the propagation of the NDM-producing E coli after it had been acquired.

"The widespread use of antimicrobials in companion animals could thus enable them to act as reservoirs for CPE [carbapenemase-producing Enterobacteriaceae] isolates and other resistant bacteria," they write.

The authors conclude that veterinary laboratories should remain alert and should screen Enterobacteriaceae for carbapenem resistance, and that the veterinary community should continue to emphasize the importance of prudent antimicrobial use.
Jul 5 Eurosurveill research article

UK groups launch AMR diagnostics collaborative

To help support antimicrobial stewardship efforts in the United Kingdom, health officials today announced the formal launch of the UK Antimicrobial Resistance (AMR) Diagnostic Collaborative.

The group brings together partners from the National Health Service, academic institutions, industry, and other national groups to coordinate the development of guidance and evaluation of interventions to integrate high-quality diagnostics.

Fiona Carragher, MSc, chair of the new UK AMR Diagnostic Collaborative, who is also deputy chief science officer with NHS England, said in post on Global Cause, a global health news site, said diagnostics are a crucial weapon in the battle against antimicrobial resistance, "but they can only deliver their true potential if we get right the what, when, where and how of diagnostic use."

Rapid point-of-care testing has the potential to help guide appropriate treatment decisions, and as new technology, but the new devices need to meet high expectations, she said, adding that effective evaluation will need a coordinated approach at all steps, from innovation to implementation. Carragher also said a structured approach is needed for education and training for staff that will be involved in using the new tests.
Global Cause report