News Scan for Jun 13, 2017

News brief

Congenital Zika infection linked to problems with swallowing

Nine Brazilian infants with congenital Zika infections developed moderate to severe dysphagia, or problems with swallowing, increasing the risk of aspirating liquids and choking, according to a report yesterday in Emerging Infectious Disease.

The infants, all of whom had microcephaly, showed delays in the oral phase, with eight out of nine exhibiting delayed initiation of the pharyngeal phase of swallowing and all showing general oral dysfunction.

Onset of dysphagia began by the age of 3 months, and all the infants had difficulty swallowing, characterized by premature spillage, and marked loss of voluntary activity during the oral phase of swallowing. The authors describe many potential neurologic routes for the dysphagia, including hypertonia, which caused abnormal posture with hyperextension of the neck in six of the nine infants. The children with hyperextensions also displayed more irritability, making swallowing and eating more difficult.

The authors say their study highlights the importance of looking for dysphagia in children who have congenital Zika syndrome.

"The clinical follow-up of children with [congenital Zika] should be conducted by a comprehensive and multidisciplinary team of childhood specialists in neurology, gastroenterology, speech pathology, nutrition, and otorhinolaryngology, using clinical and instrumental swallowing assessments," the authors concluded.
Jun 12 Emerg Infect Dis study

Weekly cholera totals continue to climb in Somalia, Yemen

The World Health Organization's (WHO's) Eastern Mediterranean regional office on Jun 10 released updates on two large cholera outbreaks, one in Somalia and the other in Yemen.

In Somalia for the week ending May 29, the health ministry reported 2,679 cases of acute watery diarrhea or cholera, 23 of them fatal, bringing the outbreak total since the beginning of the year to 45,400 cases, 738 of them fatal. The case-fatality rate of 1.6% is above the emergency threshold of 1%, the WHO said.

In Puntland, one of the hard-hit areas, 59 mobile teams have been deployed to refugee camps, while water purification teams, diarrheal disease kits, and test samples have been sent to other affected areas. The WHO said a second cholera vaccine campaign was completed on May 26, which reached more than 400,000 people age 1 year and older in Baidoa and Jowhar districts.

Severe drought has killed livestock and displaced hundreds of thousands of Somalis, putting nearly 5.5 million at risk of contracting cholera and other waterborne diseases. The WHO said though the rainy season has brought some relief, flooding is expected to increase the number of cholera cases.
Jun 10 WHO update on cholera in Somalia

In Yemen, the country's health ministry reported 13,912 more suspected cholera cases from Jun 3 to Jun 6, raising the number of cases since October 2016 to 96,219, including 746 deaths, the WHO said in a separate statement.

Though the disease is endemic in Yemen, the country has seen a surge in cholera cases since late April, affecting 19 of 21 governorates. The WHO said the case-fatality rate is 0.8%, just shy of the 1% emergency threshold.

The WHO has stepped up response activities, including the establishment of four cholera treatment facilities and 16 oral rehydration centers. However, it said response steps have been hampered by limited capacity for active case finding, population movement and displacement, poor access to health services, and food insecurity.
Jun 10 WHO update on cholera in Yemen

Studies reveal pneumonia pathogen patterns in young children

Two studies recently published in Clinical Infectious Diseases shed new light on what organisms are involved in childhood pneumonia, one describing patterns in child deaths in England and Wales and the other involving illnesses in young children in developing countries.

In the first study, UK researchers looked at invasive pneumococcal disease (IPD) cases and deaths in children younger than 5 years old over an 8-year period. They found 3,146 cases and 150 deaths, for a case-fatality rate of 4.8%. Serotyping of 132 isolates from fatal cases identified 35 different serotypes, none of them predominant. About half of the fatal cases involved meningitis.

Most deaths occurred in children age 1 and younger, and one-third had a risk factor for IPD.

Researchers found that the IPD mortality rate declined after the 7-valent pneumococcal conjugate vaccine (PCV) was introduced in 2006 to 2007, with further reductions seen after 13-valent PCV was introduced in 2010. They concluded that most fatal IPD cases are not vaccine-preventable, and more strategies are needed to reduce child pneumonia deaths in countries that already have vaccination programs.
Jun 12 Clin Infect Dis abstract

In the second study, researchers explored organisms that were involved in childhood pneumonia cases from 2010 through 2014 in centers in eight developing countries: Cambodia, China, Haiti, India, Madagascar, Mali, Mongolia, and Paraguay. The case-control study looked at children younger than 5 years old who were hospitalized with radiologically confirmed pneumonia.

Nasopharyngeal swabs from 888 sick children identified 19 viruses and 5 bacteria. One or more microorganisms were detected in samples from 93% of cases and 74.4% of controls.

Streptococcus pneumoniae, respiratory syncytial virus, and rhinovirus may be the major microorganisms linked to pneumonia in younger children in developing countries, and increasing S pneumoniae vaccination may substantially cut the disease burden in that population, the researchers concluded.
Jun 12 Clin Infect Dis abstract

Autism associated with prenatal maternal fever

A study today in the journal Molecular Psychiatry describes an association between maternal fevers in the second trimester of pregnancy and increased incidence of autism. The prospective study was based on questionnaires given as part of the Norwegian Mother and Child Cohort Study (MoBa), which includes 114,500 children born from 1999 through 2009.

Only children who were born over 32 weeks gestation were included in the study, and autism cases were identified via the Autism Birth Cohort study, a case–cohort study nested within MoBa. Maternal fever was recorded every 4 weeks in pregnancy. After exclusions for certain criteria, the study included 95,754 children (51.4% boys), 583 of whom had a diagnosis of autism.

The researchers found a 40% increase of autism in children whose mothers reported fevers in the second trimester of pregnancy. The risk jumped to 300% if women reported three or more fevers after the 12th week of pregnancy. First-trimester fevers showed a similar, but not statistically significant, association with autism. Taking acetaminophen to lower fevers did not reduce the risk of autism.

"It is also important to bear in mind that causality cannot be definitively established through observational research," the authors concluded. "Nonetheless, we found consistently increased risk with higher levels of fever exposure."
Jun 13 Mol Psychiatry study

Stewardship / Resistance Scan for Jun 13, 2017

News brief

Study: Antibiotic treatment poses 20% risk of adverse events in inpatients

Hospital patients who receive antibiotic treatment may face about a 20% risk of a related adverse event, if the results of a new study from Johns Hopkins University researchers can be generalized.

The authors checked the medical records of 1,488 Johns Hopkins Hospital patients for information about adverse drug events (ADEs) after they received at least 24 hours of parenteral or oral antibiotic treatment, according to their report yesterday in JAMA Internal Medicine.

The investigators looked for gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic ADEs recorded within 30 days after treatment, and for Clostridium difficile or multidrug-resistant infections that occurred within 90 days. The patients had a median age of 59 years, and 51% of them were women.

The team determined that 298 (20%) of the patients had at least one ADE. Fifty-six ADEs, including 7 C difficile infections, were in patients who had received antibiotic treatment that was considered not clinically indicated. The researchers also concluded that every additional 10 days of antibiotic treatment conferred a 3% increase in risk of an ADE.

"The most common ADEs were gastrointestinal, renal, and hematologic abnormalities, accounting for 78 (42%), 45 (24%), and 28 (15%) 30-day ADEs, respectively. Notable differences were identified between the incidence of ADEs associated with specific antibiotics," the report states.

The authors concluded that their findings "underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs."
Jun 12 JAMA Intern Med abstract

Structured allergy history tied to better preoperative antibiotics

A stewardship program that involved a structured allergy history performed by a pharmacist was associated with good results in patients who had beta-lactam allergies and underwent elective surgery at a Toronto hospital, according to a study in the Journal of Antimicrobial Chemotherapy.

The use of alternative second-line antibiotics has been associated with adverse events in patients reporting beta-lactam allergies. The study authors hypothesized that structured allergy histories, without the use of skin testing, could reduce the use of alternative prophylactic antibiotics.

They analyzed data on 485 patients whose allergy histories were detailed by a pharmacist and reviewed by an infectious disease physician. Patients were prescribed cefazolin prophylaxis if they did not describe a history of a type 1–mediated (severe) reaction. Among the total, 117 (24.1%) reported a type 1–mediated allergy history.

Of the 485 patients, 267 (55.1%) were chosen to receive cefazolin before surgery. The researchers reported no increase in serious complications. After the program was implemented, the overall rate of prophylaxis with alternative antibiotics fell from 81.9% to 55.9%.
Jun 10 J Antimicrob Chemother study