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Weekly Digest: CDDEP develops new ASP checklist; Global resurgence of measles; DRC’s Ebola outbreak now second largest and second deadliest ever.

Weekly Digest: CDDEP develops new ASP checklist; Global resurgence of measles; DRC's Ebola outbreak now second largest and second deadliest ever.

CDDEP researchers develop new checklist for hospital antimicrobial stewardship programs. In collaboration with the Qatar Foundation and the World Innovation Summit for Health (WISH), CDDEP researchers developed the Checklist for Hospital Antimicrobial Stewardship (AMS) Programming based on a review of existing checklists and literature. Core components of the checklist addressed senior hospital management and leadership, monitoring and surveillance, reporting and feedback, accountability, education and training, and responsible, evidence-based antimicrobial use. The checklist was tested in 12 Leading Health Systems Network hospitals across nine countries including low-income countries. Overall, participating institutions had between 11 and 29 of the 29 checklist items present. Only one institution, in India, had all components. The most commonly missed checklist items were AMS staffing standards, regular training for AMS staff, and adequate information technology services. Barriers to AMS success included lack of expertise, limited financial resources, and insufficient collaboration. [WISH, Clinical Microbiology and Infection]

Proportion of global population impacted by extreme heat is rising. In 2017, there were 712 extreme weather events worldwide, according to the 2018 report of The Lancet Countdown on Health and Climate Change. It is estimated that 157 million more people were exposed to extreme heat in 2017 compared to the year 2000. In recent years, extreme weather events have resulted in billions of dollars in economic losses, declines in agricultural productivity, and increased prevalence of vector- and water-borne diseases including highest on-record transmission capacity of dengue fever. [The Lancet]

Global resurgence of measles due to gaps in vaccination coverage. Between 2000 and 2017, the total number of reported measles cases and estimated measles deaths worldwide decreased 80 percent, according to the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC). However, between 2016 and 2017, there was a 31 percent increase in measles cases due, in part, to increased surveillance efforts but largely as a result of gaps in vaccination coverage. The Americas, the Eastern Mediterranean Region, and Europe experienced the largest spike in measles cases. [CDC MMWR, WHO, The Daily Beast]

Humanized mice and humans have similar immune response to yellow fever vaccine. Lab mice are an essential tool for researchers investigating the causes of disease and looking for new drug candidates. As many of these diseases affect mice differently, mouse immune systems are ‘humanized’ to make responses more similar to human responses. Researchers from Princeton University used the strong immune response to the yellow fever vaccine, YFV-17D, to develop a new way of comparing how similar these responses are to human immune responses. This will help future researchers to develop better pre-clinical models of disease. [Nature Communications]

Number of uninsured children in the US reaches new high. Between 2016 and 2017, the number of uninsured children in the US rose an estimated 276,000 to 3.9 million, or 5 percent of all children under the age of 19, according to a review of US Census Bureau data. It was the first such increase since 2008. South Dakota, Utah, Texas, Georgia, South Carolina, and Florida had the highest increases. [Center for Children, Medpage Today]

Critical gaps in post-abortion care. The quality of post-abortion care remains low worldwide as critical gaps in care persist, according to an analysis of survey data collected between 2007 and 2017 in ten countries: Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda. In seven of the ten surveyed countries, less than 10 percent of primary-level facilities could provide basic post-abortion care which includes the capacity to remove products of conception, administer antibiotics and uterotonics, and transport patients to referral hospitals. In eight of the ten surveyed countries, less than 40% of referral-level facilities could provide comprehensive post-abortion care which includes the capacity to administer blood transfusions and perform major abdominal surgery. [The Lancet, The Lancet Commentary]

Sanderson Farms to end use of medically important antibiotics. By March 2019, Sanderson Farms, the third-largest chicken producer in the US, will end its use of all medically important antibiotics for the prevention of disease in its livestock. This decision follows guidance from an expert advisory panel who evaluated the company’s antibiotic use procedures. Currently, gentamycin and virginiamycin are the only two medically important antibiotics used by the company. [Sanderson Farms]

Bacillus bacteria prevent Staphylococcus aureus colonization. In a rural Thai population, consumption of probiotic Bacillus bacteria disrupted Staphylococcus aureus colonization. Analysis of stool samples for 200 study participants revealed that 25 (12.5 percent) carried S. aureus, an increasingly common drug-resistant pathogen, in their intestines while 101 (50.5 percent) carried Bacillus species. When Bacillus bacteria were present, S. aureus was not detected. There were no other differences in microbiome composition between S. aureus carriers and non-carriers suggesting Bacillus species directly prevent S. aureus colonization likely through the disruption of the pathogen’s quorum-sensing pathways. [Nature]

Investment in post-exposure prophylaxis for rabies would save nearly 500,000 lives. Researchers with the World Health Organization’s Rabies Modelling Consortium assessed the epidemiological and economic impact of investing in post-exposure prophylaxis for rabies, a viral disease that causes an estimated 60,000 human deaths annually. Between 2020 and 2035, more than one million people will die from rabies, and while current post-exposure prophylaxis use prevents an estimated 56,000 deaths annually, increased access and free vaccination would prevent an additional 489,000 deaths. [The Lancet]

DRC’s Ebola outbreak now second largest and second deadliest ever. As of November 29, 2018, there have been 426 Ebola cases – 379 confirmed and 47 probable – in the Democratic Republic of the Congo (DRC) since the outbreak began in April, according to a statement released by the country’s Directorate General for Disease Control. Ongoing conflict and insecurity have complicated Ebola response efforts, and US government employees are not currently deployed to the outbreak’s epicenter. Despite challenges, the World Health Organization (WHO) and partners continue disease prevention and treatment interventions while experts around the globe call for increased US involvement. [DRC Directorate General for Disease Control, JAMA, NEJM, WHO External Situation Report 17, AP]

First large-scale clinical trial of long-acting PrEP drug starts in Africa. The HIV Prevention Trials Network (HPTN) is enrolling women in the first large-scale, double-blind clinical trial of cabotegravir, a long-acting injectable pre-exposure prophylaxis (PrEP) therapy for the prevention of HIV in uninfected, sexually active women. The five-year study will enroll 3,200 women living in Botswana, Kenya, Malawi, Uganda, and other African nations. [HPTN Press Release, The East African]

Group B streptococcal disease in UK and Irish infants. Between 2014 and 2015, there were 856 cases of group B streptococcus (GBS) in the UK and Ireland. Overall, the incidence rate of GBS was 0.94 per 1000 livebirths while the case fatality rate was 6.2 percent. Early-onset GBS was more common than late-onset with incidence rates of 0.57 and 0.37 per 1000 livebirths, respectively. Authors note the introduction of new guidelines in the UK and Ireland has not achieved expected reductions and suggest new strategies are needed. [The Lancet, The Lancet Commentary]

Photo: Thompson D et al. Checklist for Hospital Antimicrobial Stewardship Programming developed by CDDEP in collaboration with the Qatar Foundation and the World Innovation Summit for Health.