OFFICES IN Washington D.C. & New Delhi

The Center For Disease Dynamics, Economics & Policy

Weekly Digest: African swine fever continues global spread; HPV vaccine coverage expanded; Promising new Zika vaccine developed.

Weekly Digest: African swine fever continues global spread; HPV vaccine coverage expanded; Promising new Zika vaccine developed.

On-admission CRE colonization, though infrequent, is rarely addressed. Upon admission, 3.9 percent of perirectal swabs from patients in the intensive care unit or transplant unit at Johns Hopkins Hospital (JHH) tested positive for one or more Carbapenem-resistant Enterobacteriaceae (CRE), according to a new study by researchers at John Hopkins University and the Center for Disease Dynamics, Economics & Policy (CDDEP). CRE are bacteria that can cause severe healthcare-associated infections and death in up to half of infected patients. The US Centers for Disease Control and Prevention (CDC) recommends that CRE-colonized or infected patients be placed on contact isolation precautions, but patients are not routinely screened for CRE at the time of hospital admission. The JHH and CDDEP study found that 57 percent of patients with perirectal CRE and 50 percent of patients with carbapenemase-producing CRE were not placed on precautions at time of admission. [Infection Control and Hospital Epidemiology]

EMA recommends restricted use of fluoroquinolone and quinolone antibiotics. The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee (EMA PRAC) has published new recommendations to restrict the use of fluoroquinolone and quinolone antibiotics. These antibiotics have been associated with severe and long-lasting side effects, which may include muscle pain and weakness, fatigue, depression, sleep disorders, and vision and hearing problems. The PRAC recommends that fluoroquinolone antibiotics should not be used to treat mild or moderately severe infections. They should be used with caution among the elderly or patients with a history of kidney problems or organ transplant. Patients experiencing side effects are advised to stop fluoroquinolone treatment. [European Medicines Agency]

African swine fever continues global spread. Ongoing outbreaks of African Swine Fever have caused over 300,000 pig deaths in China and Europe since the virus resurfaced in August 2018. The virus causes hemorrhagic fever and high mortality in pigs. Currently there is no treatment or cure for the disease, and the killing of pigs which have been exposed to the virus is the only way to prevent its spread. Although African Swine Fever Virus does not cause disease in humans it can be carried and spread by humans. The potential financial loss to the swine and agriculture industries posed by the ongoing transmission of the disease is high. Researchers worldwide are calling for enhanced surveillance and early warning systems for animal diseases. [Ministry of Agriculture and Rural Affairs China, Outbreak News Today, Wired, Reuters]

New study maps introduction and spread of multidrug resistant Candida auris in the US. Candida auris, a fungus that causes severe infection and death and is often multi-drug resistant, was first discovered in 2009 and has since spread to over 12 countries. As of September 28, there have been over 400 diagnosed cases in the US, according to the Centers for Disease Control and Prevention (CDC). Genetic analysis of fungal samples collected between 2013 and 2017 revealed that isolates originated from South America, south Asia, east Asia, and Africa. Several cases found in the US were associated with international travel and exposure abroad. Genetic similarity among samples collected from infected patients at the same hospital suggest that domestic transmission in the US is ongoing. [CDC, The Lancet]

“Dual use research” debate continues after publication of controversial virus study. Last year, scientists working at the University of Alberta on the capacity of horsepox to be used as a vaccine against smallpox sparked debate on the ethics of dual use research. This refers to legitimate scientific research that might also be a threat to biosecurity. The debate has highlighted the current lack of regulations or oversight in some areas of scientific research and led some in the scientific community to call for international restrictions on which viruses can be studied in the laboratory. However, in a recent opinion piece, the Alberta researchers argue that more focus should be placed on educating people about the risks of synthetic pathogens. [PLOS ONE, PLOS ONE Opinion, The Atlantic]

HPV vaccine coverage expanded for men and women aged 27 to 45. The US Food and Drug Administration (FDA) recently approved the human papillomavirus (HPV) vaccine, Gardasil 9, for use in men and women ages 27 to 45 years. The vaccine protects against nine strains of HPV which can cause several types of severe diseases, precancer, and cancer including cervical cancer which is estimated to kill around 4,000 women annually. Previously, the vaccine was approved for use in minors and young men and women up to age 26. The FDA’s approval is based on a recent study that showed that Gardasil was safe and 88 percent effective in preventing HPV infection and associated maladies. [FDA, New York Times]

Promising new Zika vaccine that’s cheaper and easier to distribute. Researchers at the University of Texas at Galveston have developed a new Zika vaccine that promises to be cheaper, easier to store and distribute, and effective after a single dose. The new vaccine combines two different vaccine platforms – live attenuated virus and DNA plasmids – to quickly confer immunity with just a single dose while eliminating the need for refrigeration and cell culture techniques which can be challenging in tropical and resource-limited environments. This approach will cut vaccine production and distribution costs by an estimated 80 percent without impacting vaccine safety or efficacy. [EBioMedicine, Science Daily]

New report prioritizes pathogen targets for vaccine development by impact on AMR. In a new report, researchers at the Wellcome Trust and Boston Consulting Group evaluated World Health Organization priority pathogens on a variety of criteria to identify pathogens that would have the greatest impact on AMR. Probability of successful vaccine development, probability of market uptake, and direct and indirect health benefit were among the indicators used. Pathogens with already existing vaccines that would benefit from increased market uptake and vaccination coverage included Haemophilus influenzae, Streptococcus pneumoniae, and Salmonella enterica serotype Typhi. Pathogens such as Escherichia coli, non-typhoidal salmonella, and shigella fell into the “bring to market” category with researchers recommending acceleration of clinical vaccine development. Researchers also recommended investing in early stage research to facilitate the development of vaccines against Mycobacterium tuberculosis, Neisseria gonorrhoeae, Pseudomonas aeruginosa, and Staphylococcus aureus. [Vaccines for AMR Report]

CDC publishes guide for developing, implementing antibiotic stewardship programs. In a new publication, the US Centers for Disease Control and Prevention (CDC) provides strategies for the development and implementation of antimicrobial stewardship programs (ASP) at both the facility- and national-level for countries of varying capacity and resource levels. Basic national-level ASP activities recommended for all countries included creating national ASP committees and developing action plans while intermediate and advanced ASP activities included developing and ensuring access to formularies, measuring antibiotic use, and setting national targets for improvement. At the facility level, educating staff, developing and implementing clinical antibiotic use guidelines, and forming ASP committees were among the recommended ASP activities. [CDC]

An increase in cases of acute flaccid myelitis across the US. Since mid-September, six Minnesota children and nine Illinois children have been diagnosed with acute flaccid myelitis (AFM), state health officials recently reported. AFM is a rare but serious disease that affects the nervous system and is characterized by muscle weakness, neck stiffness, difficulty swallowing, and slurred speech. Nationwide, there has been an uptick in AFM cases; between August 2014 and August 2018, there were a total of 362 cases mostly among children, according to the Centers for Disease Control and Prevention (CDC). AFM may be caused by viruses, environmental toxins, or genetic disorders and can result in paralysis. Currently, there is no vaccine for AFM and treatment is usually aimed at alleviating symptoms.  [Minnesota Department of Health, CDC, CNN, ABC Chicago]

Photo Credit: Suzanne Tucker on Unsplash