Weekly Digest: Malaria vaccine to be piloted in three countries; India’s strides against AMR

28 Apr 2017

A weekly roundup of news on drug resistance and other topics in global health.  

At ECCMID 2017, CDDEP Director Laxminarayan explores differences in rates of AMR. At the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), experts gathered to discuss the landscape of infectious diseases and current research, including bacterial susceptibility and resistance. CDDEP Director Ramanan Laxminarayan spoke about the economic determinants of antimicrobial resistance rates in a symposium organized by the American Society for Microbiology. Laxminarayan’s presentation is available online, along with other presentations from the ECCMID conference. The session on differences in rates of AMR included presentations from Dr. David Fisman on weather and climate, Dr. Evelina Tacconelli on patient-specific factors, and Dr. Peter Colignon on cultural factors that influence resistance rates. [ECCMID Live]

CDDEP Blog: India’s strides against AMR. On the CDDEP Blog, CDDEP-New Delhi communications officer Shalini and Research Associate Molly Miller-Petrie review India’s nearly decade-long path toward the recently-launched national action plan to contain antimicrobial resistance (AMR). They write, “While many of [the NAP’s] priorities echo the Global Action Plan, India added a unique sixth priority: to be a leader in AMR. This indicates a promising level of commitment by the government not only to tackle AMR, but to show the way forward in the region and worldwide.” As the NAP is implemented and progress measured, the newly appointed Interagency Coordination Group on AMR will support India’s efforts. [Cddep.org/blog]

Malaria vaccine to be piloted in three countries. Starting in 2018, Ghana, Kenya and Malawi will conduct large-scale pilots of Mosquirix—known during development as RTS,S—the first commercially available malaria vaccine. Developed by GlaxoSmithKline, the four-dose, injectable vaccine will be rolled out in high-risk areas as part of the WHO’s implementation program. At least 120,000 children 5 to 17 months old will be vaccinated in each country. In phase three trials, the vaccine was shown to reduce severe disease and deaths from falciparum malaria, even though only partially effective. Malaria affects more than 200 million people and causes half a million deaths globally every year, with Africa carrying the greatest burden. The pilot studies will provide information on safety as well as feasibility of use in real-life settings. According to Dr. Matshidiso Moeti, WHO Regional Director for Africa, “Combined with existing malaria interventions, such a vaccine would have the potential to save tens of thousands of lives in Africa.” [WHO, STAT]

The right antibiotic alone effective for most CPE bloodstream infections: Research published in Lancet Infectious Diseases and presented at ECCMID indicates that combination antibiotic therapy may not benefit most patients with bloodstream infections caused by carbapenemase-producing Enterobacteriaceae (CPE). However, treatment with an appropriate antibiotic—consistent with laboratory susceptibility testing and including both monotherapy and combination therapy—resulted in more than a 20 percentage point 30-day mortality benefit over patients treated with an inappropriate agent. Among 437 patients treated for CPE bloodstream infections at hospitals in 10 countries from 2004 to 2013, the difference in mortality between patients getting combination therapy and monotherapy was not significant, except for those at highest risk of death. According to lead author Jesus Rodriguez-Bano, PhD, of the University Hospital Virgen Macarena, "Contrary to present recommendations, combination therapy can be avoided in a substantial proportion of patients with bloodstream infections due to CPE. These patients can be identified using the INCREMENT-CPE score and if they are low risk they can be treated with a single active antimicrobial.” This is good for antimicrobial stewardship, as well patients, who would avoid some adverse effects with monotherapy. [Lancet ID study, Lancet ID commentary, CIDRAP]

High prevalence of multidrug-resistant organisms in asylum seekers: In a study published in PLoS One, researchers in the Netherlands compared the results of bacterial cultures for methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Enterobacteriaceae (MDRE) from asylum seekers who had been referred for medical care upon arrival with screenings and clinical cultures from Dutch patients in the general population. Among 973 asylum seekers and 12,989 members of the Dutch general population screened from January 2014 through December 2015, MRSA carriage was detected in 10 percent of asylum seekers and 2 percent of the general patient population. For MDRE, including extended-spectrum beta-lactamase-producing (ESBL), fluoroquinolone-plus-aminoglycoside-resistant (QARE), and carbapenemase-producing Enterobacteriaceae (CPE), the carriage rate in asylum seekers was 21 percent versus 5 percent in the general population.  The authors suggest that higher rates of MDROs in asylum seekers may reflect high prevalence in their homelands or transmission between asylum seekers. The authors also note that the studied group of Dutch asylum seekers “consists of a heterogeneous group of people originating from many countries with different travel routes and possible hospital admissions before arriving in the Netherlands,” and further investigation of risk factors is needed. [PLoS One, CIDRAP]

New diagnostic test for colistin resistance. Antibiotic susceptibility tests in hospital laboratories routinely take days to produce a result, delaying informed treatment decisions and risking the spread of resistant organisms. Resistance to last-resort antibiotics, like colistin, is of greatest concern. Researchers from Imperial College London have developed a rapid and inexpensive test that can accurately detect plasmid-mediated colistin resistance (which can be passed on to other types of bacteria) using a mass spectrometer—equipment available in most hospitals, at least in high-income countries. It gives results in about 15 minutes and costs less than $1 per sample. The team analyzed 134 Escherichia coli and Klebsiella pneumoniae isolates—pathogens that can cause gastroenteritis, urinary tract infections, pneumonia, and sepsis. The findings were presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). Lead researcher Dr. Laurent Dortet told the congress, "If…we are able to rapidly identify bacteria that have this type of resistance, we can take measures to stop its spread.” The test is now entering commercial development. [ECCMID abstract, CIDRAP]

Report traces evolution of health policy and systems research over two decades. The Alliance for Health Policy and Systems Research has reviewed two decades of health policy and systems research (HSPR), describing funding trends and institutional capacity in LMICs to conduct research. Funding has grown steadily, increasing four-fold between 2000 and 2014. However, in 2014, researchers based in low-income countries (LICs) produced less than 7 percent of all HSPR publications focusing on issues relevant to low- and middle-income countries (LMICs), while researchers based in middle-income countries (MICs) produced 43 percent. The authors indicate the need to bolster research capacity and create an enabling environment of research in LICs, establishing mechanisms for improved networking among LMIC researchers, and more effectively connecting researchers and policymakers. [Alliance for HSPR report, press release]