May 3, 2010E coli strain in three-state outbreak identified, source notThe strain of non-O157 Escherichia coli that has caused recent illnesses in Ohio, Michigan, and New York has been identified, but the food source remains unknown, according to health officials. The Centers for Disease Control and Prevention (CDC) has identified the strain as O145, which, like O157, produces Shiga toxin, according to Jennifer House, spokeswoman for the Ohio Department of Health. A CDC team arrived in Ohio yesterday to assist in the investigation, House told CIDRAP News. About 15 cases have been confirmed in the outbreak so far. House said Ohio has 6 confirmed, 2 probable, and 5 suspected cases, all in the Columbus area. In Ann Arbor, Mich., Washtenaw County Public Health has reported 8 confirmed cases, with 13 more awaiting confirmation. One case has been reported in New York. College students, including some from Ohio State and the University of Michigan, have been among the patients in all three states, according to press reports.South Korea battles foot-and-mouth diseaseSouth Korea is stepping up quarantine efforts after foot-and-mouth disease (FMD) struck a state livestock research institute and forced the culling of all the animals there, Agence France-Presse reported today. The highly contagious disease hit the Livestock and Veterinary Science Institute, 96 miles south of Seoul, leading to the destruction of 1,549 beef cattle and hogs. The outbreak there—the 10th FMD eruption in South Korea since Apr 9—prompted the establishment of more roadblocks and quarantine posts, the report said. The institute is close to areas that have major cattle farms. On a visit to the institute yesterday, Agriculture Minister Chang Tae-Pyong called for “all-out efforts” to contain the outbreak. About 49,000 animals have already been killed to contain the disease, and the government has paid farmers about $49 million in compensation so far this year. In 2001 a major FMD outbreak in Britain led to the destruction of 7 million cattle, crippling the nation’s livestock industry.Indonesian girl dies of H5N1 infectionA hospital official said a 4-year-old Indonesian girl has died from an H5N1 avian influenza infection, Reuters reported today. The girl, from Pekanbaru, Sumatra, died on Apr 28, Azizman Saad, head of the avian flu unit at Pekanbaru’s Arifin Achmad Hospital, told Reuters. If her illness is confirmed by the World Health Organization, she will be listed as Indonesia’s 164th H5N1 case-patient and 136th fatality. Saad said three other people from an area northeast of Pekanbaru have been hospitalized with suspected H5N1 infections. The patients did not have contact with the girl who died, but came down with high fevers after they touched dead chickens. He said mass poultry deaths had been reported in the area. The suspected cases are in a mother, her 7-year-old child, and a 5-year-old girl from the same district. They were hospitalized on Apr 30, and hospital officials are awaiting the results of H5N1 tests, Saad said.
Two vaccine makers, Sanofi Pasteur and NewLink Genetics, today announced efforts to develop vaccines against Zika virus infection that will springboard off existing technologies.In related news, Honduras yesterday declared a national emergency over an expanding Zika virus infection outbreak, while Thailand confirmed its first locally acquired case.Building on flavivirus vaccine experienceSanofi Pasteur, the vaccines division of Sanofi, based in Lyon, France, already has licensed vaccines for dengue, yellow fever, and Japanese encephalitis, which, like Zika virus (ZIKV) infection, are mosquito-borne diseases caused by flaviviruses, the company said in a news release.Sanofi officials emphasized the company’s dengue vaccine, which was approved for use in Mexico and Brazil in December. “Sanofi Pasteur’s expertise and established R&D and industrial infrastructure for the newly licensed vaccine for dengue, Dengvaxia, can be rapidly leveraged to help understand the spread of ZIKV and potentially speed identification of a vaccine candidate for further clinical development,” the company said in the release.”Our invaluable collaborations with scientific and public health experts, both globally and in the regions affected by the outbreaks of ZIKV, together with the mobilization of our best experts will expedite efforts to research and develop a vaccine for this disease,” said John Shiver, PhD, global research and development director of Sanofi Pasteur.Several groups, mostly small biotech companies, have announced plans to develop a vaccine. The closest prospect thus far could be from a consortium that includes Inovio Pharmaceuticals of Plymouth Meeting, Pa., which hopes to have a candidate ready by year’s end, Reuters reported today.Yesterday, however, Tony Fauci, MD, director of the US National Institute of Allergy and Infectious Diseases, said researchers have two key prospects that won’t be available for several years. And STAT News reported late last week that some experts are predicting it will take from 5 to 15 years for a vaccine to reach people’s arms after regulatory approval.Drug-development initiativeMeanwhile, Ames, Iowa–based NewLink Genetics Corporation, which helped develop the leading Ebola vaccine candidate, said it is using experience gained with other flaviviruses to move rapidly on a Zika vaccine candidate, the company said in a press release.”NewLink Genetics is committed to developing a vaccine solution to the tragedy of the Zika virus disease,” said Thomas P. Monath, MD, CEO and chief scientific officer of NewLink’s Infectious Disease Division. “Our R&D group has decades of experience in developing successful vaccines against closely-related flaviviruses, which we will leverage to accelerate our Zika vaccine program.””Our team gained considerable experience during the Ebola crisis collaborating with national and international partners in a rapidly evolving public health environment,” said Charles J. Link, MD, CEO and chief scientific officer of NewLink Genetics.Latest in Honduras, ThailandIn related news, Honduras has declared a state of national emergency after recording 3,649 suspected Zika cases in less than 3 months, the New York Times reported yesterday.Honduran Health Minister Yolani Batres is urging people to eliminate breeding grounds for the mosquito Aedes aegypti, the leading species that spreads Zika virus. The government has activated its risk management system to coordinate preventive measures, the story said.And Thailand officials said today that a man has contracted the virus without traveling abroad, its first local case. The man, 22, is thought to have caught the same strain as that causing thousands of cases in South and Central America, Agence France-Presse (AFP) reported.The virus was confirmed by blood tests, said Air Vice-Marshall Santi Srisermpoke, director of Bangkok’s Bhumibol Adulyadej Hospital. The man had a fever, rash, and eye redness.”It’s not a new disease in Thailand … we had the first confirmed case in 2012. Since then we have an average of not more than five cases yearly,” said Amnuay Gajeena, MD, director-general of the Disease Control Department of Thailand’s Public Health Ministry. He was referring to imported, not locally acquired cases.”There is no need to panic … we have never had an epidemic of the Zika virus in Thailand all of the cases were one-offs.”In January 2014, a Eurosurveillance report detailed a Zika case in a German traveler who likely contracted the disease in Thailand.See also:Feb 2 Sanofi Pasteur news releaseFeb 2 Reuters reportJan 29 STAT News storyFeb 2 NewLink press releaseFeb 1 New York Times articleFeb 2 AFP storyJan 30, 2014, Eurosurveillance report
Saudi officials confirmed a new fatal MERS-CoV case today, while a study gives a less-than-stellar review of using convalescent plasma for treatment.After 6 days of no new cases, Saudi Arabia’s Arabia Ministry of Health (MOH) reported that a man from Najran has died from MERS-CoV (Middle East respiratory syndrome coronavirus). The case is not related to an outbreak in recent weeks at the King Khalid University Hospital in Riyadh.According to the MOH, a 49-year-old Saudi man with confirmed MERS passed away yesterday. His source of infection is listed as “primary,” meaning not likely contracted from another person. He was not a healthcare worker.On Jul 6, the World Health Organization (WHO) hinted that the recent cases in Najran may be part of a cluster. The last MERS-CoV patient in Najran was a 28-year-old male healthcare who developed symptoms on Jun 24, according to the WHO.The new case brings Saudi Arabia’s MERS-CoV total to 1,439, 606 of them fatal, since 2012.Study casts doubt on use of plasmaIn other MERS news, a study today in Emerging Infectious Diseases explored the feasibility of using convalescent plasma from recovered MERS patients as passive immunotherapy and found the evidence to be lacking.The plasma, which contained MERS-CoV–specific antibodies, could theoretically prevent death or worsening symptoms in patients. Researchers conducted a feasibility trial by obtaining plasma from three sources: 96 patients with suspected or laboratory-confirmed MERS-CoV infection, 230 healthcare workers, and 17 household contacts exposed to the virus, for a total of 443 samples. Using ELISA (enzyme-linked immunosorbent assay), the researchers found only 12 of the samples (2.7%) had adequately high antibody titers.”Our results indicate that it would be possible to obtain quantities of convalescent plasma large enough to use in therapeutic studies or in a large number of MERS-CoV patients,” the authors said. “However, large-scale screening would be required because of the limited availability of eligible potential donors with sufficient levels of antibody.”The authors suggest that their results could be explained by short-lasting antibody response to the virus, and they recommended further ELISA testing with serum samples obtained from recently diagnosed or very ill patients.See also:Jul 20 MOH reportJul 6 WHO statementJul 20 Emerg Infect Dis study
Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scansSenators introduce bill to bolster oversight of antibiotics in food animalsToday Democratic US Senators Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), Dianne Feinstein (Calif.), and Richard Blumenthal (Conn.) introduced the Strengthening Antibiotic Oversight Act to strengthen regulation of medically important antibiotics administered to food-producing animals.If passed, the legislation would require the Food and Drug Administration (FDA), which oversees the drugs in food animals, to review the duration of use of approved indications for medically important antibiotics labeled for animal use and would give the agency authority to withdraw approvals for unjustified durations. The bill also directs the FDA to use funds collected through animal drug user fees to collect and report data on antibiotics delivered to farms, through sampling of veterinary feed directives and feed distribution reports.Current FDA rules do not contain duration limits regulating how much of an antibiotic can be used in an animal for a specified amount of time for all medically important antibiotics, according to a news release on Sen. Warren’s website.”The FDA has taken a number of steps to address the issue of antibiotic resistance, but with two million Americans developing antibiotic-resistant infections every year, it’s clear that more work needs to be done,” said Sen. Warren.”One way to approach this is to reduce the overuse of antibiotics in animals. I’m glad to partner with my colleagues on a bill to help the FDA collect better data and support more careful use of antibiotics.”Sen. Feinstein added, “Our bill will give the FDA greater oversight and ensure medically-important antibiotics are used sparingly.”Matt Wellington, antibiotics program director for U.S. PIRG, said in a release emailed to journalists, “About a third of the medically important antibiotics approved for use in food-producing animals through feed or water have label indications without duration limits. That means meat producers can use these drugs continuously, which would further increase drug-resistant bacteria.”There are few instances in human medicine where such prolonged antibiotic use would be appropriate. We should apply the same standard to animal medicine and farming.”Jun 22 Sen. Warren news release UK awards $16 million for AMR research in low-, middle-income countriesThe UK’s Medical Research Council (MRC) today announced $15.9 million in grants to four universities to study drivers of antimicrobial resistance (AMR) in low- and middle-income countries (LMICs) in Africa and Asia.The AMR in a Global Context Consortia awards, totaling £12 million, are jointly funded by the cross-research council AMR initiative and the National Institute for Health Research’s (NIHR’s) Global Health Research Programme. Teams at the University of Bristol, the University of St. Andrews, the Liverpool School of Tropical Medicine, and the University of Glasgow won the awards.The 3-year awards will connect UK researchers with scientists and policy makers in partner countries. They will use a range of research approaches—from clinical and microbiological studies to geography, modeling, and social sciences—to address various AMR issues in Kenya, Tanzania, Uganda, Malawi, and Thailand.”The NIHR, working in partnership with the cross-research council AMR initiative, is pleased to be supporting four multidisciplinary consortia to identify the factors driving microbial resistance in LMICs and contribute to the development of context-specific interventions to tackle this global health challenge,” said Prof. Chris Whitty, NIHR chief scientific adviser, in an MRC news release.Jun 22 MRC press release Study shows how antibiotic regimen affects resistance in urinary E coliOriginally published by CIDRAP News Jun 19A retrospective multicenter study showed a dose-response relationship between antimicrobial use and resistance in uropathogens in older adults, Belgian researchers reported yesterday in Antimicrobial Resistance and Infection Control.In the study, microbiological results for individual patient samples, retrieved from 15 voluntary participating clinical laboratories in 2005, were linked with individual antimicrobial consumption and sociodemographic data. The purpose of the research was to study the influence of different variables of antimicrobial prescribing on the occurrence of resistance in Escherichia coli isolated from urine samples in Belgian adults over the age of 65.The final data used in the study contained information on resistance status for 7,397 E coli isolates obtained from 5,650 patients. The results demonstrated that resistance in E coli was higher when more antibiotics (more than nine prescriptions) had been prescribed before isolation of the sample, especially in women (significant interaction P = 0.0016).In addition, the effect of route administration interacted with the number of preceding prescriptions, provided that the number of preceding prescriptions is not extremely high. With up to nine prescriptions, when other variables held constant, the probability of resistance decreased by increase in the proportion of preceding parenteral antibiotic prescriptions (significant interaction P = 0.0067).The authors say the findings on route of administration and antimicrobial resistance, which has previously received little attention, should be further explored.Jun 18 Antimicrob Resist Infect Control study Pizza Hut to stop serving chicken raised with medically important antibioticsOriginally published by CIDRAP News Jun 19The nation’s second-largest pizza chain today announced that it would stop serving chicken raised with medically important antibiotics by 2022.In a statement on its website, Pizza Hut said that the commitment comprises all chicken sold by the company, including chicken wings. Pizza Hut, which stopped using chicken raised with antibiotics important to human medicine in its pizza last year, is the first national pizza chain to commit to an antibiotic policy for chicken wings.Matt Wellington, antibiotics program director for U.S. PIRG, praised the decision. “Pizza Hut’s announcement is another step toward preserving life-saving medicines for what they’re meant for, treating illness,” Wellington said in a press release.The move means that all of the Yum! Brands restaurant chains, which also include KFC and Taco Bell, have now pledged to reduce the use of medically important antibiotics in their chicken supply. Jun 19 Pizza Hut statementJun 19 U.S. PIRG statement Triclosan found to induce multidrug resistance in E coliOriginally published by CIDRAP News Jun 19A team of scientists from the University of Queensland has found that an environmentally relevant concentration of the antimicrobial chemical triclosan induces heritable multidrug resistance in E coli.In a study published recently in the journal Environment International, researchers from Queensland’s Advanced Water Management Centre exposed wild-type E coli to varying amounts of triclosan, ranging from a sub-minimum inhibitory concentration (0.02 and 0.2 milligrams per liter (mg/L), which are environmentally relevant concentrations) to a near-lethal concentration of 2 mg/L. After 30 days of exposure, they measured resistance to eight types of antibiotics.The tests revealed that after 30 days, exposure to 0.2 mg/L of triclosan induced resistance to several antibiotics. Further investigation found that the oxidative stress induced by triclosan caused mutations in several key genes—fabL, frdD, marR, acrR, and soxR. These mutations led to resistance by up-regulating genes encoding beta-lactamases and multidrug efflux pumps—two important resistance mechanisms—and down-regulating genes related to membrane permeability.Study author Jianhua Guo, PhD, said the findings suggest the environmental impact of triclosan—a chemical commonly found in consumer products such as soap and toothpaste—should be investigated.”This discovery provides strong evidence that the triclosan found in personal care products that we use daily is accelerating the spread of antibiotic resistance,” Guo said in a University of Queensland press release. In September 2016, the FDA banned the use of triclosan and other antimicrobial ingredients in over-the-counter soaps, saying they were no more effective at killing germs than plain soap and water. Jun 11 Environ Int abstractJun 19 University of Queensland news release
The US COVID-19 death toll officially stands at 60,316 among 1,034,884 cases, according to a tracker maintained by USA Today, but new data from the Centers for Disease Control and Prevention (CDC) shows that death rates in seven hard-hit states are likely much higher, as total deaths in those states were almost 50% higher than normal from Mar 8 to Apr 11.This means as many as 9,000 additional deaths in the country could be attributed to COVID-19.The CDC data tracks deaths coded as “COVID-19” and deaths from all causes. It’s the second category that saw a significant spike in activity in New York, New Jersey, Michigan, Massachusetts, Illinois, Maryland, and Colorado for most of March and the first part of April.Some of these uncounted COVID-19 deaths may have occurred in people who died outside of the hospital setting, a data point New York state has been trying to correct.According to an analysis conducted by the New York Times, the CDC’s numbers are three times the normal deaths in New York City and represent an increase of 121% in Michigan deaths compared with the same period in the past 5 years, which is equivalent to nearly 2,000 more deaths.In Georgia, hospitalized patients with no high-risk conditionsAlso today, new research from the CDC shows that 25% of patients in Georgia hospitalized with COVID-19 did not have any underlying high-risk health conditions. The information comes from the Georgia Department of Public Health and CDC researchers who summarized hospital information from 8 hospitals in Georgia, and tracked 698 hospitalized patients throughout the month of March.Sixty-one percent of hospitalized patients were older than 65, and black patients were more likely to be hospitalized than white peers, with black patients representing 83.2% of patients included in the study.About 74% of patients had underlying health conditions that increased their risk for COVID-19, including diabetes and cardiovascular disease. The case-fatality rate for patients aged 18 to 49 was 3.4%, 9.8% for those aged 50 to 64, and 35.6% for those over 65.Georgia was the first state to reopen its economy last week after 2 weeks of stay-at-home orders. Salons, gyms, tattoo parlors, and movie theaters are now operating in the state, as well as some dine-in restaurants. National Public Radio reports many Georgians are returning to work despite ongoing fear about the virus because if they fail to do so, they risk losing unemployment benefits.Their benefits are currently protected under the federal CARES Act, but if a business chooses to reopen and offer employees their jobs back, they stand to lose those benefits if they refuse.In related news, Politico reports that workers in several industries are demanding protections from employers, including providing protective equipment, in the event of reopening.Illinois sees record deaths; Massachusetts extends stay-at-home orderIllinois recorded 144 COVID-19 deaths yesterday, a new high that propelled the state’s fatality account past 2,000 cases. According to WBEZ Chicago, the high came after 4 consecutive days of lowered case counts. Illinois has seen 2,125 deaths in the past 6 weeks, and 48,140 cases of the virus.In Massachusetts, Governor Charlie Baker extended stay-at-home orders and business closures in his state until May 18. Today that state saw a total case count of 60,265, including 3,405 fatalities.Baker said he has not yet seen a 14-day downward trend in case counts, a recommendation from the CDC that should signal reopening.Tomorrow, federal recommendations on social distancing are set to expire, after being in place for 45 days. President Donald Trump and Vice President Mike Pence have signaled they are not looking to extend the guidelines.
Cefiderocol gets FDA approval for use in nosocomial pneumoniaDrug maker Shionogi & Co. of Osaka, Japan, announced yesterday that the US Food and Drug Administration (FDA) has accepted the company’s supplemental New Drug Application (sNDA) and granted Priority Review designation for the use of cefiderocol to treat adults with nosocomial pneumonia.Cefiderocol, sold under the brand name Fetroja, is a cephalosporin antibiotic with a novel mechanism of penetrating the tough outer membrane of gram-negative bacteria and the ability to overcome resistance mechanisms used by gram-negative pathogens to evade antibiotics. It was approved by the FDA for treatment of complicated urinary tract infections caused by gram-negative pathogens on Nov 12, 2019.According to a company press release, the sNDA is based on results from a phase 3 study that showed cefiderocol met the primary endpoint of non-inferiority compared with high-dose extended-infusion meropenem in treatment of patients with healthcare-acquired and ventilator-associated pneumonia caused by gram-negative pathogens.The results showed that 14 days after initiation of treatment, all-cause mortality in the modified intention-to-treat population was 12.4% for cefiderocol (18 of 145 patients) and 11.6% for meropenem (17/146).The company said cefiderocol also met key secondary endpoints of clinical and microbiologic outcomes at test-of-cure and demonstrated no unexpected safety signals.”We are committed to working with the FDA in order to bring Fetroja to more patients fighting these challenging and life-threatening Gram-negative infections as quickly as possible,” said Akira Kato, PhD, president and CEO at Shionogi Inc., the company’s US-based subsidiary.Jun 1 Shionogi press release Discharge stewardship linked to better antibiotic prescribing, study findsExpanding an antimicrobial stewardship program (ASP) to ensure that hospital patients are discharged with appropriate therapy was associated with improvements in appropriate antibiotic prescribing and fewer days of antibiotic therapy at an Ohio hospital, researchers reported today in Infection Control & Hospital Epidemiology.The study assessed the percentage of patients discharged on appropriate therapy before and after implementation of the discharge stewardship intervention, in which the discharge ASP pharmacist at Northeast Ohio Medical University reviewed patient medical records and anti-infective regimens and provided recommendations on antibiotic therapy to the medical team, if appropriate.Other outcomes included antimicrobial days of therapy (DOT) and the percentage of readmissions of healthcare visits for treatment failure within 30 days. A total of 122 patients were included in the study, with 61 each in the pre-intervention and post-intervention groups.Analysis of the two groups found that the percentage of appropriate therapy on discharge was 47.5% before the ASP expansion compared with 85.2% afterward (relative risk [RR], 0.28; 95% confidence interval [CI], 0.147 to 0.538; P < .001). In the post-intervention phase, 48 recommendations were made across 40 patients upon discharge, with an 81% acceptance rate. Recommendations included change in duration (44%), followed by discontinuation (17%), change in dose (14.5%), and change in drug (10%).The average duration of therapy was 7.8 days in the post-intervention group, compared with 8.9 days in pre-intervention group (P = 0.079). Antimicrobial DOTs were also lower after the intervention than before (555 days vs 626.5 days, respectively). The total 30-day readmission rate was 19.7% in the pre-intervention group versus 11.5% in the post-intervention group (RR, 0.583; 95% CI, 0.246 to 1.38; P = 0.212), a difference not considered statistically significant. "This project demonstrated that the expansion of an ASP significantly improved the rate of appropriate discharge anti-infective prescribing," the authors of the study write. "A larger patient population is necessary to fully describe the effect on readmissions, adverse events, and treatment failure. Time spent on ASP will also be useful to determine the real-world feasibility of expanding to a larger population."Jun 2 Infect Control Hosp Epidemiol abstract