December 14, 2018
Africa CDC’s framework for AMR control in Africa. Africa Centers for Disease Control and Prevention (CDC) with CDDEP’s Ramanan Laxminarayan released a framework for antimicrobial resistance (AMR) control in Africa. The framework will help advance the World Health Assembly’s Global Action Plan on Antimicrobial Resistance and has four objectives: improving AMR surveillance continent-wide, delaying the emergence of resistant pathogens, minimizing the transmission of AMR especially in healthcare facilities, and mitigating harm among patients infected with resistant pathogens. [AJLM]
Global antibiotic use among children. Researchers analyzed wholesale antibiotic sales data for 2015 from 70 middle- and high-income countries and identified child-appropriate formulations to serve as a proxy for antibiotic use among children. The World Health Organization’s Essential Medicines List divides antibiotics into three categories: access (first choice for common infections, should be available in all facilities), watch (for specific indications, high risk of resistance), and reserve (should be held back as a last resort). As a measure for appropriate use, researchers compared the quantity of antibiotics consumed from the ‘access’ category with those from the ‘watch’ category. Access antibiotic use relative to watch antibiotic use varied widely from 94 percent in Slovenia to 27 percent in China, with the median being more than 76 percent. [The Lancet Infectious Diseases, The Lancet Infectious Diseases Comment]
India may ban use of colistin for growth promotion in livestock. India’s National Antimicrobial Resistance Action Plan committee has recommended that the government ban the use of colistin for growth promotion in livestock, the Bureau of Investigative Journalism and The Star Online reported. Colistin is a last-resort antibiotic used to treat drug-resistant infections in humans; its use for growth promotion in animals has already been banned in China, Brazil, the US, and the European Union. According to media reports, the Indian government is currently reviewing the recommendation and drafting a rule on colistin use in agriculture. [Bureau of Investigative Journalism, The Star Online]
Hypervirulent, carbapenem-resistant Klebsiella pneumoniae associated with high mortality rates in India. Researchers at Christian Medical College in Vellore, India identified a hypervirulent carbapenem-resistant Klebsiella pneumoniae strain from an analysis of 86 isolates collected from patients between 2014 and 2015. Overall, 31 percent of isolates were of a strain associated with increased disease severity and mortality among infected patients, and 84 percent of patients infected with this hypervirulent strain died. [Journal of the Association of Physicians of India]
Next generation of malaria drugs. In an effort to develop a malaria drug that prevents disease transmission rather than alleviates symptoms after infection, researchers at the University of California at San Diego used robotic technology to test over 500,000 chemicals for their ability to shut down the malaria parasite at the liver stage. The researchers identified 631 compounds that killed the parasites or blocked their ability to replicate and were non-toxic to human liver cells. These compounds, which are being shared freely with the scientific community, can now be used for further research and drug development. [Science]
The cost of not educating girls. In sub-Saharan Africa, one in three girls is married before her 18th birthday, and only 40 percent of girls complete lower secondary education. Girls who do not complete secondary school have significantly lower earning potential than those who marry later and are more likely to experience child marriage, early childbearing, and gender-based violence. In 12 African countries, child marriage and incomplete education among girls cost $63 million in lost human capital wealth, The World Bank estimated. [The World Bank, The Lancet Editorial]
Livestock-associated MRSA causes severe infection in humans in Australia and China. In 2013 and 2014, two post-surgical patients in China developed severe infections caused by methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398, a clonal type usually associated with livestock. In 2017, a similar strain caused severe infection in a patient in Australia. Patients reported that they had not come into contact with livestock although the patient in Australia had handled raw meat. Genomic analysis of isolates collected in China revealed that the strains had characteristics of human-associated MRSA isolates and lacked virulence factors commonly found in livestock-associated MRSA infections. [Emerging Infectious Diseases- Australia, Emerging Infectious Diseases – China]
Costco commits to reduce use of medically important antibiotics in meat supply chain. Costco, a large US supermarket and wholesale chain, implemented a policy to begin restricting the use of medically important antibiotics in the company’s meat and poultry supply chains. The new policy comes after its shareholders filed a request for such a policy change and will apply to the company’s own poultry processing plant which is currently being developed in Nebraska. [You Sow, Costco Animal Welfare Policy, The Seattle Times]
Maternal immunization to improve the health of HIV-exposed infants. Reductions in mother-child transmission of HIV have given rise to an increasing number of HIV-exposed but uninfected (HEU) infants. Emerging evidence suggests that infectious diseases could be important causes of increased mortality in HEU infants. Maternal immunization may prevent and reduce neonatal infections; however, only three vaccines – for influenza, tetanus, and pertussis – are currently recommended for pregnant women while six others – for hepatitis A, hepatitis B, yellow fever, polio, meningococcal, and pneumococcal – are recommended for consideration during pregnancy, according to a literature review. [The Lancet]
A roadmap for including pregnant women in epidemic vaccine development and deployment. Recent or ongoing outbreaks of Ebola, Zika, and Lassa Fever have exposed gaps in current epidemic vaccine development and deployment practices that often exclude pregnant women. In a new report, researchers at the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group, outline 22 recommendations aimed at global and national policymakers, vaccine manufacturers, clinical trial networks, and other stakeholders for including this population in future outbreak vaccination efforts. Recommendations include prioritizing the development of vaccines suitable for use among pregnant women, developing strategies to encourage vaccination during pregnancy, and encouraging research to better understand immune system function and response among pregnant women and their offspring. [PREVENT Report, Johns Hopkins Berman Institute of Bioethics Press Release]
Antibiotic cycling has little impact on incidence of healthcare-associated infections. Researchers in Northern Ireland reported that implementing an antibiotic cycling strategy – which involved cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin over a two-year period – had little impact on reducing healthcare-associated infections. Over the two-year study period, the number of methicillin-resistant Staphylococcus aureus (MRSA) infections increased significantly while the incidence of Clostridioides difficile infections did not change. Resistance of new extended-spectrum β-lactamase (ESBL) to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly but resistance to piperacillin/tazobactam increased when the antibiotic cycling strategy ended. [Emerging Infectious Diseases]
In Europe, Gonorrhea is becoming less susceptible to ceftriaxone. An analysis of 2,660 Neisseria gonorrhea isolates collected from 25 countries across the European Union and European Economic Area revealed that between 2015 and 2016, there was a significant increase in the number of isolates with decreased susceptibility to the antibiotic ceftriaxone. In 2016, no isolates were resistant to ceftriaxone; however, 14 isolates (0.5 percent) had ceftriaxone minimum inhibitory concentrations of 0.125 milligrams per liter, which is the resistance breakpoint. Azithromycin resistance did not change significantly with overall resistance rates of 7.5 percent in 2016 and 7.1 percent in 2015. [BMC Infectious Diseases]
Polio outbreak in Syria successfully stopped. An outbreak of circulating vaccine-derived poliovirus type 2 which first began in Eastern Syria in June 2017 has been successfully stopped, the World Health Organization (WHO) reported. Overall, there were 74 polio cases in the country, and there was no cross-border or international spread. The risk of future outbreaks of vaccine-derived and wild polio remain high. [WHO]
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