NEWS SCAN: BSE final report, pharmacies offer flu vaccine, soil type and H5N1 spread

first_img Study: Sandy rice-field soil in Cambodia may inhibit H5N1 spreadCertain soil types contaminated with H5N1 avian flu viruses led to chicken deaths when added to their houses, but sandy topsoil collected from area rice fields seemed to resist that pathogen, a Cambodian study in Emerging Infectious Diseases yesterday revealed. Investigators studied sandy topsoil collected from around rice fields in Phnom Penh province, as well as building sand and soil-based compost from a local tree nursery. They contaminated each soil type with low doses of H5N1 (1 infectious unit on day 0, 2 on day 6, 4 on day 12, and 8 on day 18) and high doses (8, 12, 16, and 20 infectious units on the various days, respectively). The soil was then sprinkled on the bottom of an isolator containing 10 to 20 chickens. High-dose building sand and compost both led to a 100% fatality rate after 2 days, whereas high-dose sandy topsoil led to no deaths. Low-dose compost led to a 50% H5N1 seroconversion rate after 24 days, compared with 33% for building sand and 1% for sandy soil. The authors hypothesize that the sandy soil’s acidity inhibits H5N1 spread. They state that about 40% of rice fields in the country have this type of soil and that it is most commonly found in H5N1 outbreak areas. In contrast, “Soil-based compost and building sand, although existing in natural settings, are not the most common substrates found in places where free-ranging poultry are raised in Cambodia,” they write.Aug 6 Emerg Infect Dis letter 3-month probe finds no other sign of BSE in California cow caseA 3-month investigation of the most recent US case of bovine spongiform encephalopathy (BSE), or mad cow disease, showed no other disease in at-risk cows and no problems with feed suppliers, the US Department of Agriculture (USDA) said in a report released last week. The case, which involved a 10-year-old Holstein from a central California dairy and was announced Apr 24, was the first in the country since 2006 and the fourth overall. After an extensive probe into cattle and feed that included the US Food and Drug Administration (FDA) and the California Department of Food and Agriculture (CDFA), officials concluded, “At no time was the US food supply or human health at risk, and the United States’ longstanding system of interlocking safeguards against BSE continues to be effective,” according to a news release from the USDA Animal and Plant Health Inspection Service (APHIS). Inspectors detected no BSE in about 90 other carcasses held at the same rendering station as the index cow, and its two offspring were also cleared, the report said. Investigators also found that 11 feed suppliers were “in compliance with FDA and CDFA regulations and requirements.” The APHIS release underscored the three safeguards in place to keep BSE out of the US food supply: (1) removing targeted animal tissue, (2) a ban on using animal tissue in cattle feed, and (3) ongoing BSE surveillance, as evidenced by this case.Aug 3 USDA reportAug 3 APHIS press releaseApr 24 CIDRAP News story on BSE case Aug 7, 2012center_img Two pharmacy chains begin offering vaccine for new flu seasonTwo pharmacy chains—RiteAid and Walgreens—yesterday announced that flu shots for the upcoming season are now available in their stores. The development follows recent announcements that four of five vaccine makers had begun shipping their first doses for the US market. Companies have said they expect to produce up to 149 million doses of flu vaccine for the 2012-13 flu season. RiteAid said in its press release that customers can receive flu vaccine at any of its 4,600 stores during pharmacy hours without an appointment.  Walgreens said that the vaccine is available at its nearly 8,000 stores, including Duane Reade pharmacies in New York, as well as at more than 360 Take Care Clinics at select Walgreens stores. Robert Thompson, RiteAid’s executive vice president of pharmacy, said in the statement that although it’s hard to predict how any flu season will unfold, getting immunized as soon as the vaccine is available is the best protection strategy.Aug 6 RiteAid press releaseAug 6 Walgreens press releaselast_img read more

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Study: Children, middle-aged most vulnerable to variant H3N2

first_imgAug 10, 2012 (CIDRAP News) – A serologic study from Canada suggests that children and middle-aged adults have little or no immunity to the swine-origin variant H3N2 influenza virus (H3N2v), but about half of adolescents and young adults have some degree of immunity as measured by antibody levels.The researchers also found that seasonal flu vaccines used in the past two seasons did not improve participants’ ability to mount an immune response to H3N2v. Their report was published this week in the Journal of Infectious Diseases.Given the results, “A specific vaccine would be needed in the event A(H3N2)v establishes epidemic spread,” says the study, which was led by Danuta M. Sowronski, MD, of the British Columbia Centre for Disease Control as first author.The H3N2v strain, which contains the matrix gene from the 2009 H1N1 virus, emerged last summer in the United States, causing a dozen cases. But more than 150 cases of H3N2v illness have been reported in the past few weeks, most of them in children who had contact with pigs, often at county fairs. The illnesses have generally been mild and self-limiting.A flu expert with the US Centers for Disease Control and Prevention (CDC) said today that the new findings generally agree with those of previous studies by the CDC and others, but the finding of low antibody levels in middle-aged adults emerged more clearly in the new study than in previous ones.The CDC has prepared a candidate vaccine for the novel virus, and clinical trials are expected this fall.Samples from all agesThe Canadian researchers looked for cross-reactive antibodies to H3N2v, using 1,116 serum samples that had been collected in 2010 from people across the age spectrum. In addition, they tested sera collected from children and adults before and after receipt of the 2010-11 seasonal flu vaccine and from elderly people before and after receipt of the 2011-12 vaccine.Hemagglutination inhibition (HI) and, in a subset of cases, microneutralization were used to assess antibodies to H3N2v.Overall, 25% of the 1,116 participants had an HI antibody titer of at least 40 to the H3N2v strain, the level that’s believed to confer some degree of protection. But no children younger than 5 years and fewer than 20% of subjects 14 or younger or over age 40 had this seroprotective level of antibody.Between the ages of 14 and 40, half of the subjects had a seroprotective level of antibody to the virus, the report says. The proportion peaked at about 60% in adults in their 20s but dropped to about one-third for those in their 30s. Fewer than 10% of those between ages 40 and 69 and about 20% of those older than 69 had seroprotection.The researchers also looked at cross-reactivity to an H3N2 strain called A/Sydney, which circulated in the late 1990s and was the most closely related and readily available human ancestor strain to H3N2v. Overall, they found a seroprotective level of antibody to A/Sydney in 61% of their samples. More than 90% of teens and adults in their 20s had seroprotection, and for adults overall the prevalence was more than 60%.To test whether seasonal flu vaccine enhanced protection against H3N2v, the team looked for at least a fourfold increase in antibodies to the novel virus (seroconversion) after vaccination. They found that seroconversion rates were less than 15% in all age and vaccine groups, with little difference by age-group.Among elderly people who received the 2011-12 seasonal vaccine, 72 received a vaccine containing the MF59 adjuvant. The researchers said the adjuvanted vaccine didn’t enhance response to H3N2v compared with the other formulations.”Our serologic findings suggest substantial protection against A(H3N2)v in late adolescence and young adulthood, but broad susceptibility in children and older adults,” the authors say in summary.The lack of protective antibody levels in middle-aged and older adults contrasts oddly with the fact that there was only one adult among the first 13 H3N2v cases identified, the authors comment. They say this “may reflect limitations in surveillance sensitivity, exposure opportunities or pediatric versus adult hygiene or other protective measures.”The explanation for the age-related variation in seroprotection may have to do with differences in the H3N2 strains that different age-groups were exposed to in childhood, the researchers suggest. They say that the A/Sydney strain circulated a few years after, and is 96.4% similar to, H3N2v’s closest human ancestor, A/Wuhan.Those who were children in the 1990s may have been “primed” by exposure to H3N2v ancestor strains, resulting in robust memory responses to related strains in later years, they write.The authors note several limitations of their data and say the findings need confirmation elsewhere.A CDC expert, Jacqueline Katz, PhD, said the Canadian findings generally agree with previous smaller studies conducted by her agency and a group in Norway. But she said the study is much larger and offers greater insight into the age-related differences in seroprotection against H3N2v. Katz is chief of the immunology and pathogenesis branch of the CDC’s Influenza Division.”Overall, the three studies agree that there is negligible cross-reactive antibody to the H3N2v virus detected in younger children,” Katz said. The work also confirms previous findings that seasonal trivalent flu vaccine containing an H3N2 strain does not trigger much of a cross-reactive response to the novel virus, she added.”What’s novel about Skowronski’s study is it’s the largest to date and had the ability to look more closely at different age groups,” she said. “They have quite an interesting finding that middle-aged adults, ages 40 to 69, show a substantial reduction in the level of cross-reactive antibody compared with younger adults.”The Norwegian study had a similar finding, but in a tighter age-group of adults, she said, adding that further research is warranted to try to find an explanation for the phenomenon.Katz concurred with the Canadian team’s suggestion that different childhood exposures may be a reason for the age-related differences in seroprotection.”It may be that that particular group [middle-aged adults] had a different exposure, that they saw an earlier H3N2 virus for the first time, and didn’t have the same robustness of response to the viruses from the 1990s that are closest to the H3N2v strain,” she said. “We’re interested in looking into that a little more.””When you do genetic and antigenic analysis, you can see that viruses from the early 1990s are genetically most closely related to the hemagglutinin of the H3N2 variant viruses,” Katz said. “So it does make sense that individuals who were of an age to be exposed to those in the early 1990s and made a robust response may have the highest cross-reactive antibody response to the variant strain.”Skowronski D, Janjua NZ, De Serres G, et al. Cross-reactive and vaccine-induced antibody to emerging swine influenza A(H3N2)v. J Infect Dis 2012 (Early online publication) [Full text] [Abstract]last_img read more

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Study: H7N9 highly transmissible by airborne route

first_imgChinese researchers who did extensive work on H7N9 viruses from birds and humans found that one of the human strains was highly transmissible by aerosol droplets in ferrets, fueling more concerns that the new virus could spread between people.The potential for aerosol spread is one of the key factors health officials use in gauging a new virus’s pandemic potential, and the new study follows closely on the heels of two others that also found evidence of respiratory droplet transmission in ferrets.The newest findings were reported today in an early online edition of Science by a team based at the Harbin Veterinary Research Institute, a World Health Organization (WHO) collaborating center.Genetic comparisons produce new cluesScientists ran multiple tests on H7N9 viruses obtained during poultry surveillance and isolated from human cases to get a clearer picture of its pathogenicity, virulence, replication, and transmissibility.They sequenced the genomes of 37 representative H7N9 samples, most of which came from live-poultry markets, and compared them with five human isolates. The hemagglutinin (HA) and neuraminidase (NA) genes were highly similar, but they found more diversity in the six internal genes. They also found that the viruses are still capable of frequent reassortment and rapid evolution.When they examined the basic polymerase 2 (PB2) gene for amino acids associated with flu virulence and transmission in mammals, they found that all of the bird and environment samples had the amino acid combination 627E/701D. The human isolates, in contrast, had either the 627K or 701N mutation, both of which are important for virulence and transmission.The group wrote that the findings suggest the mutations may have occurred during replication in humans.Experiments to explore receptor binding, another factor that plays a role in flu virus replication and transmission, identified a 1243V mutation that—similar to the Q226L mutation—may play a key role in exclusive binding to humanlike receptors for two of the avian isolates and two of the human samples.Tests track aerosol transmission, other factorsVirulence and infection tests in birds confirmed that the H7N9 virus was low pathogenic in poultry and that infected chickens shed the virus for up to 7 days.The researchers said this finding suggests that chickens “may be one of the major carriers and spreaders of H7N9 viruses in the live poultry markets.”In tests on mice that were given lethal doses of H7N9, no signs of disease or death were seen in the ones that received viruses isolated from birds, but the animals infected with human isolates lost weight, got very sick, or died. Similarly, the group’s replication tests on mice infected with human strains found higher viral titers in the nasal passages and lungs when compared with animals infected by the bird strains.Replication experiments in ferrets also showed differences between the bird and human H7N9 strains. The group’s pathology tests on ferret lung samples found severe bronchopneumonia and prominent viral antigen expression in the animals infected with three human strains and one of the bird strains. Ferret lungs, though, appeared normal after infection with a poultry H7N9 strain.Aerosol transmission studies involved placing uninfected ferrets in cages adjacent to those housing infected ferrets. The investigators found H7N9 in one ferret exposed to those infected with one of the bird strains and two human strains isolated from some of the first patients in Shanghai. However, the virus was detected in all three ferrets exposed to animals infected with a human H7N9 strain isolated form a patient in Anhui province (AH/1).To assess reproducibility, they repeated the aerosol transmission test with the AH/1 isolate and got the same result.Senior author Hualan Chen, PhD, told CIDRAP News that there was no significant difference in transmission among four of the five viruses they tested in aerosol transmission testing. “The transmission of AH/1 to all three ferrets suggests that the H7N9 virus has great pandemic potential,” she said.The team noted that it’s difficult to pinpoint which amino acid substitution alone makes the virus highly transmissible, but the amino acid differences between the avian viruses and the Anhui virus range from 1 to 27, suggests that only a few changes are needed to make the virus highly transmissible in mammals.”Moreover, these changes can occur easily during replication in humans,” they added.Overall, the team said their tests found that the H7N9 viruses from poultry and humans can bind to human airway receptors and can replicate efficiently in ferrets, and that one human isolate can transmit efficiently among ferrets by aerosol droplets.Chen said she was surprised that all of the viruses tested are able to bind to humanlike receptors and that the PB2 gene of the virus so easily gains mutations during replication in humans that boost its virulence and transmissibility.Experts weigh pandemic potentialShe said the group’s findings are useful for weighing the threat from the virus. “This study suggests that the H7N9 virus is likely to transmit in humans, and immediate action, not only in China, is needed to prevent a possible pandemic caused by such a virus,” Chen said.The ability of the virus to transmit easily in poultry across a large part of China over a brief period points to the importance of control measures in poultry markets, the group said. But stamping out H7N9 will be a big, long-term challenge, because the virus spreads silently in chickens and also spreads to humans.Ian Mackay, PhD, a virologist at the Australian Infectious Diseases Research Centre at the University of Queensland, told CIDRAP News that the study’s molecular epidemiology component is the largest of its kind to date and adds many more complete H7N9 genomes to the publicly accessible GenBank database.  Mackay also authors the Virology Down Under Web site.He noted that the group’s comparison between the human and avian strains found that they differed by less than 4% at the nucleotide level, “Sometimes there are no differences,” he said, noting that the most divergent strains came from the Shanghai region, where 20% of the samples originated.The team’s infection experiments on chickens confirm that H7N9 is a silent spreader and that the birds shed the virus for about a week before their illness resolves, Mackay said.Findings revealed that major differences between H7N9 viruses are at the amino acid level, with the most divergent segment at the PB1 gene. “But it is the PB2 and HA segment that harbors mutations of particular interest to document the journey from infrequent spillover events to sustained human-to-human pandemic-level transmission,” he said.Mackay added: “We know that pandemic potential does not rest solely on one or other amino acid change, but rather a collection of changes. We also don’t know what we don’t know yet.”The Harbin group showed the potential of H7N9 viruses to bind to both avian and human receptors and that human isolates replicated well in the upper airways, a site for efficient transmission, he noted.”The study reinforces that even ‘lowly’ or inefficient transmission—only 33% of ferrets, for example—is still transmission,” Mackay said. “That proportion would lead to a lot of human cases in densely populated or frequented areas.”Those factors might help explain the wide clinical spectrum that has been seen, as well as difficulties in tracking the source and the proportion of patients who get severely ill and die, he said.Zhang Q, Shi J, Deng G, et al. H7N9 influenza viruses are transmissible in ferrets by respiratory droplet. Science 2013 Jun 18 [Abstract]See also:Jul 10 CIDRAP News story “New studies on H7N9 raise pandemic concerns”Virology Down Under Web sitelast_img read more

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Food Safety Scan for Feb 07, 2014

first_imgFeds mull new measures to limit Salmonella in chickenWith shortcomings in poultry safety highlighted recently by the Foster Farms Salmonella Heidelberg outbreak, the US Department of Agriculture (USDA) has multiple efforts under way to make chicken consumption safer, the Washington Post reported yesterday.The report said it’s not clear how likely the USDA would be to ban certain antibiotic-resistant strains of Salmonella, as it reviews a 2011 petition from the Center for Science in the Public Interest (CSPI) seeking that step. Industry groups have said eliminating the bacteria isn’t feasible, and USDA officials have raised concern that a ban on Salmonella strains would trigger a legal challenge from the industry, according to the story.Meanwhile, the USDA is planning to set new standards to reduce Salmonella contamination in chicken parts, after finding that lowering the acceptable contamination level in carcasses didn’t reduce the frequency of illness in humans, according to the report. Two years ago the agency did a study and found that 24% of chicken parts had Salmonella contamination, nearly four times the frequency of contamination on whole carcasses, the story said.USDA officials said that same percentage was found at the Foster Farms plants tested during the recent outbreak. As part of the outbreak response, Foster Farms has adopted 23 new processes to reduce Salmonella, which involve applying antimicrobial treatments to chicken parts after processing.The USDA is also airing a proposal that would retool its poultry safety inspection system, which it said could drop Salmonella illness rates by 1.9%, a level that the Government Accountability Office has said might not be realistic.Feb 6 Washington Post report New FDA rule aims to ensure safety, quality of infant formulaAn interim final rule and two draft guidance documents for industry on manufacturing standards for infant formula were issued yesterday by the US Food and Drug Administration (FDA) and will be open for public comment shortly, according to a press release from the agency.The new rule, which will become effective Jul 10, implements remaining provisions of the Infant Formula Act of 1980 and the 1986 amendments to the act. It includes changes to current FDA quality-control procedures, notification, and record and reporting requirements, and it requires Cronobacter and Salmonella testing, among other measures.It will be open for comment for 45 days after publication in the Federal Register, scheduled for Feb 10.Companies currently manufacturing infant formula already comply voluntarily with many of the practices and requirements in the new rule and guidance, says the release.One quarter of newborns are not breastfed at all and rely on formula feeding from birth, and two-thirds receive at least some of their nutrition from formula by the age of 3 months, according to the FDA.”The FDA sets high quality standards for infant formulas because nutritional deficiencies during this critical time of development can have a significant impact on a child’s long-term health and well-being. This rule will help to prevent adulteration in infant formula and ensure infant formula supports normal, physical growth,” stated FDA Deputy Commissioner for Foods and Veterinary Medicine Michael Taylor.Feb 6 FDA news release with link for public commentFDA page with links to infant formula documentslast_img read more

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Biosecurity Scan for Dec 17, 2014

first_imgRisk-benefit analysis is next step toward policy on GOF researchIn the wake of this week’s symposium on gain-of-function (GOF) virologic research, the next step is for a federal advisory panel to develop plans for a risk-benefit analysis of such studies, says a spokeswoman for the National Academy of Sciences (NAS).The Obama administration recently suspended funding for GOF research on influenza and two other viruses to allow time to develop a federal policy. To launch the policy development effort, the 2-day symposium earlier this week aired scientific and technical questions related to GOF research. It was hosted by the National Research Council and the Institute of Medicine.The term “GOF” generally refers to experiments that involve enhancing the pathogenicity, transmissibility, or host range of a pathogenic microbe, in the interest of better understanding disease pathways and developing vaccines and drugs.NAS spokeswoman Jennifer Walsh said a summary of the symposium will be provided to the National Institutes of Health (NIH) and the National Science Advisory Board for Biosecurity (NSABB) in January and will also be made available to the public via the National Academies Press Web site.The summary should help the NSABB as it works with a contractor to develop a “risk/benefit analysis structure” on GOF research, Walsh told CIDRAP News. After the NSABB publishes the analysis structure, the NAS will hold a second conference to allow for public comments on it, she added.The estimated timing for the second meeting is July 2015, but it will depend on when the draft plan is released, Walsh said. She also noted that a video recording of this week’s symposium should be available online next week. Dec 12 CIDRAP News item on GOF symposium Oct 17 CIDRAP News item on funding pause Government search turns up more misplaced lab pathogensThe months-long sweep of government labs in the wake of the summertime discovery of security breaches involving anthrax, smallpox, and other disease pathogens has turned up yet more previously unaccounted-for pathogens, including ricin and a deadly form of avian flu virus, the Washington Post reported yesterday.The sweep was ordered after lab workers were potentially exposed to Bacillus anthracis—which causes anthrax—at a Centers for Disease Control and Prevention (CDC) lab in June, followed in July by the discovery of smallpox vials on the campus of the National Institutes of Health and a CDC breach involving highly pathogenic avian flu viruses. The search has involved nearly a dozen federal agencies, 4,000 labs, and more than 40 million samples, the Post noted. The latest findings were released yesterday.On Sep 5 officials said the search at that point had turned up other misplaced microbes, including those that cause plague, tularemia, melioidosis, botulism, and a certain foodborne disease, as well as ricin. In late August officials had asked federally funded labs to suspend all work for about 24 hours to conduct microbe inventories.The pathogens discovered in recent weeks included vials of virulent avian flu virus at US Department of Agriculture labs in Iowa and Georgia and samples of botulinum toxin at a CDC lab. The Post story did not specify the strain of avian flu, but it said those samples and the botulinum toxin were destroyed.It added that other microbe samples were transferred to labs authorized to house them. Officials said all samples of dangerous pathogens were safely stored and there was no evidence to suggest anyone was exposed to them.Dec 16 Washington Post story Sep 5 CIDRAP News scan on previous lab discoverieslast_img read more

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Global officials warn of pan-resistant gonorrhea

first_imgNew data from the World Health Organization (WHO) indicate that resistance to the only remaining treatment for gonorrhea is emerging globally, and that widespread treatment failure is likely in the coming years unless new antibiotics are developed.”It will only be a matter of time,” Teodora Wi, MD, a medical officer with the WHO’s Department of Reproductive Health and Research, told reporters.Wi is the lead author of a study today in PLoS Medicine that details the extent of the problem. In the study, data from 77 countries reporting to the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP) show increasing resistance to azithromycin and emerging resistance to the extended-spectrum cephalosporins (ESCs) cefixime and ceftriaxone—the drugs that make up the last-line treatment for gonorrhea.To date, three countries—Japan, France, and Spain—have reported “superbug” strains of gonorrhea that are resistant to all current forms of treatment.An accompanying commentary in PLoS Medicine by many of the same authors laid out a plan to accelerate the development of new antibiotics for treatment of gonorrhea and evaluate possible treatments using existing drugs.A ‘very smart bug’The WHO estimates there are currently 78 million global cases of gonorrhea, which is caused by the Neisseria gonorrhoeae bacterium. Gonorrhea spreads through unprotected vaginal, oral, and anal sex and can infect both men and women. It generally causes infections in the genitals, rectum, and throat, and pregnant women can pass the infection to their newborns during childbirth. Serious and permanent health problems, including pelvic inflammatory disease and infertility, can result if the disease goes untreated.”There are many consequences of not treating gonorrhea,” Wi said.But treating gonorrhea appropriately has become a challenge, because the bacterium’s DNA has shown the ability to quickly mutate and develop resistance to every antibiotic that’s been used to treat it. “Gonorrhea is a very smart bug,” Wi said. “Every time you introduce a new class of antibiotics to treat gonorrhea, the bug becomes resistant to these antibiotics.”As the data from WHO GASP indicate, that’s what appears to be happening with cefixime and ceftriaxone, the drugs that the WHO currently recommends be used in combination with azithromycin for treatment of most gonococcal infections.According to the data, which cover 2009 through 2014, isolates from 55 of the 77 countries reporting (66%) showed resistance or decreased susceptibility to cefixime or ceftriaxone. In 26 of those countries, the percentage of resistant isolates was at least 5% or higher—the level at which the WHO recommends discontinuing use of an antimicrobial in empiric treatment. In addition, the GASP data showed that 81% of countries reported resistance or decreased susceptibility to azithromycin.Wi called the GASP data the “tip of the iceberg” and noted the extent of the problem could be much greater, since most of the data are from high-income countries with good surveillance systems. In low-income countries in Africa, Central Asia, and the eastern Mediterranean region, where sexually transmitted infection (STI) rates tend to be higher, appropriate laboratory tests and data on drug-resistant gonorrhea are insufficient. Wi said it is likely that cases of untreatable gonorrhea exist in these countries, “and they are not likely being documented at this point.”Emergence of untreatable gonorrheaThis rising resistance to the currently recommended treatment, Wi said, means “we are soon going to be seeing the threat of untreatable gonorrhea in the future,” since drug-resistant gonorrhea can quickly become widespread once it starts getting transmitted. Wi could not say how many years it would take for widespread untreatable gonorrhea to emerge.In June 2016, the New England Journal of Medicine reported on the failure of ceftriaxone and azithromycin therapy in a man from the United Kingdom diagnosed as having gonorrhea. This was the first reported failure of dual therapy in Europe. The N gonorrhea strain identified in the man was identical to a strain spreading in Japan that has shown reduced susceptibility to ceftriaxone and azithromycin.In September 2016, public health officials in Hawaii reported a cluster of N gonorrhea isolates from seven people that showed high resistance to azithromycin and reduced susceptibility to ceftriaxone—the first such cases reported in the United States. All seven patients were successfully treated.The GASP data also showed that 97% of countries reported resistance to ciprofloxacin, a fluoroquinolone that is no longer recommended for gonorrhea treatment but is still being used in some African countries.Wi added that, in addition to gonorrhea’s innate ability to mutate, increasing resistance is also a result of inappropriate antibiotic treatment, which occurs when the wrong dosage of drugs is prescribed, treatment directions aren’t properly followed by patients, or poor-quality drugs are used.Lack of treatment alternativesA lack of alternatives to the currently recommended treatment for gonorrhea makes the issue more pressing. The three antibiotic candidates currently in the pipeline—solithromycin, zoliflodacin, and gepotidacin—are in various stages of clinical development, but none are guaranteed to make it to market, Manica Balasegaram, MRCP, MSc, director of the Global Antibiotic Research and Development Partnership (GARDP), told reporters.”The situation is, actually, fairly grim,” he said.Balasegaram, lead author of a paper that lays out a roadmap for research and development of drug-resistant gonorrhea treatments, said GARDP’s strategy includes four components: Accelerating the development of drugs in the pipeline, evaluating the ability of existing antibiotics to treat gonorrhea (either alone or in combination with other drugs), exploring ways to improve the administration of gonorrhea treatment, and supporting the development of simplified treatment guidelines.As part of this strategy, Balasegaram announced that GARDP had entered into a partnership with biotech company Entasis Therapeutics to accelerate development of zoliflodacin by helping register and conduct public health trials. Balasegaram also said GARDP would also play a role in guiding stewardship efforts for any new gonorrhea treatments. “A critical part of our work will not just be to do the research and development, but also to guide appropriate long-term use, while ensuring access,” he said.Wi said that in addition to finding new treatments for gonorrhea, scientists must focus more on developing affordable, point-of-care tests that can quickly and correctly diagnose gonorrhea. While many people who become infected don’t show any clinical symptoms and as a result go untreated, others may show symptoms (such as vaginal or urethral discharge) but have a different type of infection. Since antibiotic treatment in low-income settings is often based on these visible symptoms, inappropriate antibiotic treatment can result. Prevention is another strategy the WHO is pursuing. That includes development of a preventive vaccine, which Wi said has been hampered by the inability to find the right antigen for preventive immunity, and promotion of safer sex behaviors, including increased condom use. The WHO has set a goal of a 90% reduction in gonorrhea incidence by 2030.See also:July 7 PLoS Medicine studyJuly 7 PLoS Medicine commentarylast_img read more

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First US human bite from worrying longhorned tick noted

first_imgIn a report last week, researchers described the first human in the United States known to be bitten by an Asian longhorned tick, a rapidly spreading invasive species that the US Centers for Disease Control and Prevention (CDC) warned about last year.Though the 66-year-old man did not get sick, scientists know that Haemaphysalis longicornis can harbor bacteria that can cause human and animal diseases—possibly including Lyme disease—and an investigation into areas where the man lived found the tick in locations other ticks aren’t typically found, which could lead to changes in public health risk messaging.A team from the CDC, New York, and New Jersey reported the findings on May 31 in Clinical Infectious Diseases.The tick was found in the United States for the first time in 2017 on a sheep in New Jersey, and since then, the species has been found in at least 10 states, mainly in the eastern states but also Arkansas. It’s still not known how widespread Asian longhorned ticks are in the United States, but health officials are worried, because they are aggressive biters.Females can produce massive numbers of offspring without mating, and in some parts of the world—such as New Zealand and Australia—the species have reduced production in dairy cattle by 25%.Ticks found on sunny lawnsAccording to the new report, a 66-year-old man from Yonkers, New York, removed a tick from his leg in June 2018. He had not traveled outside his home county for the past 30 days, and his only outdoor exposure was his lawn and one other lawn in the same area. His doctor prescribed him a single 200-milligram dose of doxycycline, presuming that the tick was Ixodes scapularis, the most common US Lyme vector.Later that day, the patient took the tick to the Lyme Disease Diagnostic Center in Westchester, New York. He didn’t have any symptoms at the time and didn’t get sick over the next 3 months.Testing in New York identified the tick as an Asian longhorned tick nymph, with genetic sequencing adding more evidence affirming the finding. The National Veterinary Services Laboratory in Ames, Iowa, further confirmed the finding.Tick sampling using corduroy drag cloths found Asian longhorned ticks on the patient’s manicured lawn, some of them in direct sun. More were found in the park across the street from the patient’s house, both in open, cut grass exposed to direct sun and in taller, shaded grass next to the woods. Testing also found ticks on a nearby public trail, in mowed short and midlength grass near the trail edge, both in full sun and partial shade. The discovery of the ticks near the man’s house were the first known collections in New York state.The authors wrote that finding the ticks on manicured lawns and in open sun may be significant, because public education efforts often stress that Ixodes scapularis ticks—the most common biting tick in New York state—are found in wooded areas or shaded grass.Next steps for ongoing threatIn a related editorial in the same issue, Bobbi Pritt, MD, MSC, with the division of clinical microbiology at the Mayo Clinic in Rochester, Minnesota, wrote that though the report of a human bite isn’t surprising, it proves that the invasive longhorned tick continues to bite hosts in its newest location.”This is extremely worrisome for several reasons,” she wrote. One reason is that Asian longhorned ticks can carry several important human pathogens, including the potentially fatal severe fever with thrombocytopenia syndrome (SFTS) virus and Rickettsia japonica, which cases Japanese spotted fever. “While these pathogens have yet to be found in the United States, there is a risk of their future introduction,” she added.Also, Pritt said several other human pathogens have been detected in the ticks, but it’s not clear the Asian longhorned species are able to transmit them to humans. They include Anaplasma, Ehrlichia, Rickettsia, and Borrelia species. Lyme disease is caused by Borrelia burgdorferi bacteria.She warned that the organisms are present in states where longhorned ticks have been found and that it’s possible that the tick—known to be an aggressive biter—might be able to transmit Heartland virus, given its close relationship to SFTS virus.Pritt said it’s clear that the invasive species is here to stay for the foreseeable future, and next steps should include public awareness campaigns that incorporate the new information, easy-to-use resources for labs to identify the tick, and more research to understand the implications of the new findings.See also:May 31 Clin Infect Dis abstractMay 31 Clin Infect Dis commentaryNov 30, 2018, CIDRAP News story “CDC: Worrisome longhorned tick spreading rapidly in US”last_img read more

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Studies diverge on link between early antibiotics, obesity

first_imgTwo new observational studies by scientists in New Zealand provide conflicting evidence on the potential link between early childhood exposure to antibiotics and the risk of developing obesity.In one of the studies, both of which appeared this week in JAMA Network Open, researchers found that children who received multiple courses of antibiotics during the first 4 years of life were more likely to have a higher body mass index (BMI) score than those who received no antibiotics. In addition, children who received more than nine antibiotic prescriptions by age 4 were more than twice as likely to be obese.In the other study, which looked at antibiotic use during the first 2 years of life, researchers also found a small association between antibiotic use and obesity risk by age 4. But when the researchers conducted further analysis in siblings and twins with different outcomes, they found no link between antibiotic exposure and obesity, leading them to conclude that antibiotics are unlikely to be a major contributor to childhood obesity, and that other, unmeasurable factors may be at work.The two studies are in line with other observational studies on the potential association between early antibiotic use and obesity risk in children, a theory based on research showing that antibiotics alter the still-developing gut microbiome of young children in ways that could lead to weight gain. These studies have produced mixed results, with some finding an association and others finding none.Sorting out confounding effectIn the first study, researchers with the University of Auckland and Harvard Medical School measured the weight and height of more than 5,000 children in New Zealand at 54 months of age, then obtained community pharmacy antibiotic dispensing data for the children. They looked at whether or not the children had any antibiotic exposure by age 4, the age of first exposure, and how many prescriptions they received.Of the 5,128 children analyzed, 95% had received an antibiotic by age 4, and 9% had obesity by 54 months. The analysis, which controlled for familial, lifestyle, and economic factors, found that the BMI score for children who received at least four antibiotic prescriptions was higher than for those who hadn’t been exposed, and it increased with the number of prescriptions the children received. The risk for obesity increased as well. Compared with no exposure, children who received more than nine antibiotic prescriptions had more than double the risk of being obese (adjusted odds ratio [aOR], 2.41; 95% confidence interval [CI], 1.07 to 5.41).The analysis also found an increase in BMI associated with receipt of two or more antibiotic prescriptions during pregnancy, and that antibiotic exposure during the first years of life was associated with higher BMI compared with no exposure.”The study findings suggest that repeated antibiotic exposure may be a potentially modifiable risk factor for childhood obesity,” the authors of the study write.In the second study, another team of researchers from the University of Auckland, along with colleagues from Dunedin School of Medicine in New Zealand and Uppsala University in Sweden, looked at antibiotic exposure during pregnancy and the first 2 years of life among 132,000 mothers and 151,000 children in New Zealand. The study, one of the largest undertaken on the topic, included a large cohort of twins and siblings, some of whom had discordant outcomes (ie, one with obesity and one without).”This allowed us to control for a lot of unmeasured and unmeasurable confounding factors, such as genetics (largely), diet, ethnicity, household, stress, sleep patterns, etc.,” corresponding author Wayne Cutfield, MD, of the University of Auckland’s Liggins Institute, said in an email. “These are all corrected for, notably, with twins.”Antibiotic use was common among mothers and children, with at least one course of antibiotics dispensed to 35.7% of mothers during pregnancy and 82.3% of children during the first 2 years of life. Nearly 16% of children were identified as obese. As with the first study, the results showed that both prenatal and early childhood exposure to antibiotics were independently associated with increased BMI and obesity at age 4 in a dose-dependent manner.Across the entire study population, antibiotic exposure during pregnancy yielded a small but increased risk of obesity in children (aOR, 1.06; 95% CI, 1.04 to 1.07), as did antibiotic exposure during the first 2 years of life (aOR, 1.04; 95% CI, 1.04 to 1.05). For children’s exposure to antibiotics, the findings were similar among all siblings (aOR, 1.04; 95% CI, 1.03 to 1.05) and twins (aOR, 1.05; 95% CI, 1.02 to 1.09).  But when Cutfield and his colleagues analyzed 6,249 siblings and 522 twins with different outcomes, these associations disappeared. Among the siblings, there were no associations between antibiotic use and odds of obesity for maternal exposure (aOR, 0.95; 95% CI, 0.90 to 1.00) or children’s exposure (aOR, 1.02; 95% CI, 0.99 to 1.04). The aOR for children’s antibiotic exposure among the twins was 0.91 (95% CI, 0.81 to 1.02).”This initially surprised me, as I was expecting to see a stronger relationship between antibiotic exposure and obesity when background confounding noise was reduced,” Cutfield said.The inability to control for unmeasured family variables, Cutfield explained, likely explains why they found an association between antibiotic exposure and obesity risk in the wider population—and why other studies have found a link between the two.”The weak, dose-related effect of early childhood antibiotics with obesity is probably due to unmeasured/unmeasurable confounding effects, which is always a problem with association studies,” he said. “There are many association studies in the past in which associations have not been borne out when tested in RCTs [randomized controlled trials].”A multifactorial problemIn an editorial that accompanies the two studies, Meghan Azad, PhD, of the University of Manitoba and Arthur Owora, DrPH, of Indiana University write that childhood obesity results from a number of different factors—environmental, socioeconomic, genetic—and that antibiotic exposure is “neither necessary nor sufficient as a cause.”But they argue that it can’t be overlooked, since antibiotics have been used in food-producing animals to promote growth and weight gain, and animal and human studies have documented how antibiotic-induced disruptions of the gut microbiome are linked with metabolism and weight gain.”These 2 studies contribute new data and highlight potential limitations to a growing body of evidence suggesting that antibiotics (among multiple other factors) may contribute to the development of childhood obesity, particularly when repeated exposures occur during the first year of life, a critical time for metabolic programming,” they write.And though it’s unclear whether efforts to reduce unnecessary antibiotic prescribing in children will have an impact on childhood obesity, they say, those efforts are still important.”From a public health perspective, antibiotic stewardship is an urgent priority, regardless of its potential role in obesity prevention,” they write.See also:Jan 22 JAMA Netw Open first studyJan 22 JAMA Netw Open second studyJan 22 JAMA Netw Open editoriallast_img read more

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News Scan for Aug 26, 2020

first_imgDRC Ebola total grows by 2 cases to reach 104, with 44 deathsTwo more people in the Democratic Republic of the Congo (DRC) have tested positive for Ebola, raising the number of cases in the Equateur province outbreak to 104, the World Health Organization (WHO) African regional office said on Twitter today.No new deaths were reported, keeping the fatality county at 44.The outbreak began in early June and affects the same area of a short-lived event in 2018, which resulted in 54 cases, including 33 deaths.Health officials are concerned about the current outbreak, because it is occurring across a broad area, some of it remote, but with a number of cases reported in Mbandaka, the regional capital, which has travel connections to Kinshasa and neighboring countries. Outbreak responders are grappling with the COVID-19 pandemic and scarce resources for battling Ebola.Aug 26 WHO African regional office tweet Study highlights impact of fluoroquinolone restriction initiativeA quality improvement initiative to restrict fluoroquinolone prescribing in high-risk patients reduced fluoroquinolone use without negative impacts, researchers from the University of Wisconsin School of Medicine and Public Health reported yesterday in PLOS One.The initiative was implemented in the intensive care unit (ICU) and solid-organ transplant unit at the University of Wisconsin Hospital in July 2016 in an attempt to decrease the rate of hospital-onset Clostridioides difficile infection (HO-CDI), which is associated with fluoroquinolone use. The restriction required antimicrobial stewardship pre-approval for fluoroquinolone prescribing. In the study, the researchers compared rates of HO-CDI in the 24 months before and after the initiative, along with fluoroquinolone and alternative antibiotic days of therapy (DOT), length of hospital stay, readmissions, and mortality.The results showed that HO-CDI rates did not decrease significantly after the initiative, but fluoroquinolone use fell from 111.6 to 19.8 DOT per 1,000 patient-days without negatively impacting length of stay, readmissions, or mortality.In contrast, use of third-generation cephalosporins, aminoglycosides, and piperacillin-tazobactam increased post-intervention. Interviews with hospital staff (residents, attending physicians, advanced practice providers, and pharmacists) identified the strength of the hospital’s antimicrobial stewardship program (ASP) and pharmacy involvement as key facilitators of the restriction program, and patient complexity and lack of provider education as barriers.”Lessons from our initiative, particularly those learned from exploring the perspectives of front line providers, can be applied to larger-scale ASP interventions,” the authors of the study wrote. “Future studies should confirm safety and efficacy of restriction policies among critically ill and immunocompromised patients with particular attention to the impact on prescribing of alternative agents and explore other opportunities for optimization of antimicrobial prescribing, such as at the time of hospital discharge.”Aug 25 PLOS One study DRC declares end to measles outbreakThe DRC yesterday announced the end of its measles outbreak, a massive event that sickened more than 380,000 people, about 7,000 fatally, over a 2-year period. Health Minister Eteni Longondo, MD, MPH, announced the development yesterday at a news briefing, according to media reports.The country’s outbreak occurred as it was juggling several other health crises, including Ebola, cholera, vaccine-derived polio, and COVID-19. The measles response involved mass vaccination efforts that immunized more than 18 million children, though health officials have warned that coverage is still low in some areas.The WHO African regional office said in its latest weekly outbreaks and health emergencies report that for the week ending Aug 9, officials reported 418 cases and 7 deaths across the country, with most cases reported in Sankuru and South Ubangi provinces. It added that since 2019 a total of 380,766 cases and 7,018 deaths had been reported.Aug 25 Al Jazeera report Aug 25 WHO African regional office weekly reportlast_img read more

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Large trial shows little benefit for remdesivir; pandemic total tops 39 million

first_imgIn the latest international pandemic developments, a closely watched large phase 3 trial of four treatments for COVID-19—including remdesivir—found little or no benefit for survival, and as new spikes accelerated in the United States and Europe, the global total topped 39 million cases.The findings about remdesivir leave doctors uncertain on how to proceed, given that some countries, including the United States, have already granted the drug emergency use authorization. They also leave health authorities, including the World Health Organization (WHO), scrambling to review the latest data to update their treatment guidelines. The findings were published the same day the WHO prequalified remdesivir.Remdesivir and other drugs showed little to no effectThe discouraging news on the COVID-19 treatments came from the 6-month-long multi-country Solidarity trial of repurposed antiviral drugs led by the WHO, and researchers published their initial findings late yesterday in the preprint server MedXriv. Scientists from 30 countries evaluated remdesivir, hydroxychloroquine, lopinavir, and interferon alone and in combination with lopinavir. None of the drugs showed a clear impact on mortality, need for a ventilator, or hospitalization duration.At a media briefing today, the WHO’s Director-General Tedros Adhanom Ghebreyesus, PhD, said that after an early analysis the WHO discontinued the hydroxychloroquine arm of the trial in June, then a month later, announced that it stopped enrolling patients in the lopinavir-ritonavir part of the trial. And now, interim results show little or no effect for remdesivir or interferon at preventing death or shortening hospital stays. He added that full peer-reviewed results will be published soon in a leading scientific journal.The Solidarity trial is still recruiting patients to assess other treatments, such as monoclonal antibodies and new antivirals, but currently, dexamethasone is the only treatment shown to be effective for severe COVID-19 infection.Soumya Swaminathan, MD, the WHO’s chief scientist, said more than 5,000 patients were involved in the remdesivir arm of the randomized controlled trial, which is the gold standard for assessing effectiveness. She said the findings are consistent with recent findings from other similar but smaller trials, such as one published by scientists from the National Institutes of Health (NIH).She said the Solidarity trial findings for remdesivir are robust, with large numbers of patients and tight confidence intervals. Swaminathan noted that the NIH trial showed a benefit for patients who weren’t on oxygen, but that it is difficult to compare studies.Next steps: meta-analysis, treatment guidance decisionsThe next step is for health groups to examine all the evidence for remdesivir to come up with a meta-analysis, which could take a couple weeks, she said. Based on that information, the WHO and other groups will issue guidance about use of the drug.In a statement yesterday, the drug’s maker, Gilead, said it was aware of the preprint findings for remdesivir and said the findings appear to be inconsistent with what it said are more robust findings from other randomized controlled trials. It raised concerns that the findings from the Solidarity trial have not gone through rigorous peer review to allow for constructive scientific discussion, especially given the limitations of the trial design.Global total tops 38 million, partly fueled by Europe surgeThough India and the United States each added more than 60,000 cases to the global total over the past day, cases in Europe continue to surge in the continent’s second wave of activity.But at today’s WHO media briefing, Maria Van Kerkhove, PhD, the group’s technical lead for COVID-19, said the virus isn’t spreading everywhere equally. She said there are 37 hot spots in 13 countries and added that countries need to be able to look at their data to know where to target their interventions. Also, the countries are facing pressure on their hospitals and intensive care unit (ICU) capacity, a concerning development with the flu season approaching, Van Kerkhove said.Many in the Northern Hemisphere are feeling a high sense of anxiety as virus levels rise, with the threat of stronger measures, she said. However, Van Kerkhove emphasized that there are many ways for people to live their lives safely by, for example, wearing masks, washing hands frequently, and avoiding some high-risk situations.A handful of European countries reported record daily high cases today, including Russia with 15,150, with roughly one-third of them from Moscow, Reuters reported. Italy reported more than 10,000 cases, its highest number since the start of the pandemic. The Netherlands, Belgium, and the Czech Republic also reported daily highs.In other international developments:With 17,096 new cases, Argentina reported its biggest single day rise, Asian News International reported.China said the source of a recent hospital outbreak in Qingdao was two dockworkers who had check-ups at the facility, one of whom developed symptoms later, Reuters reported, citing city health officials. In response to the outbreak, the city expects to wrap up testing of all 9 million residents today.The global total today reached 39,126,111 cases today, and 1,101,007 people have died from their infections, according to the Johns Hopkins online tracker.last_img read more

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