June 01, 2018
Economic and epidemiological impacts of pneumococcal vaccine in India. The British Medical Journal has published a study by CDDEP researchers Itamar Megiddo, Eili Klein, and Ramanan Laxminarayan that examines the effectiveness and cost-effectiveness of introducing a pneumococcal conjugate vaccine, PCV-13, into India’s Universal Immunisation Program (UIP). Results show that an estimated 38,400 deaths annually could be averted if PCV-13 is used across India to prevent Streptococcus pneumoniae infection. The vaccine would also provide protection from catastrophic financial loss to poor families, who would pay out of pocket for treatment or hospitalization of a S. pneumoniae-infected family member. [British Medical Journal]
MRSA and MSSA costs converge. CDDEP researchers Eili Klein and Katie Tseng, with collaborators from Johns Hopkins University and University of Texas Southwestern Medical Center, have published a study which demonstrated that infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are no more expensive to treat than methicillin-susceptible S. aureus (MSSA). The findings are contrary to earlier studies that have found that MRSA was much more expensive to treat than MSSA. [Clinical Infectious Diseases, Precision Vaccinations, Healthcare Finance]
Rohingya refugees face cholera amid monsoons. The global stockpile of oral cholera vaccine (ORV) has been deployed for use in Bangladesh, where a million Rohingya people have sought refuge after fleeing Myanmar. According to a report in the Lancet from the World Health Organization (WHO), the International Centre for Diarrhoeal Disease Research – Bangladesh (icddr,b), and health officials from the government of Bangladesh, administration of ORV provided by the Global Vaccine Alliance began in October, 2017. As the 2018 monsoon season approaches, Devex News reports floods and damaged roads even with light rain, raising concerns that sewage and sanitation measures will fail and lead to further deterioration of conditions in the refugee camps. [Lancet, Devex News]
Disrupted immunization leads to diphtheria outbreak in Yemen, Bangladesh, and Venezuela. Ninety-one people have died of diphtheria out of over 1700 cases reported throughout Yemen since October, 2017. Diphtheria causes outbreaks when routine immunization is interrupted by war, natural disaster, or other humanitarian emergencies. [World Bulletin, Healio]
Pliable genome of Klebsiella pneumoniae readily transfers resistance genes. Among the clinically important pathogens that threaten hospitalized or immunocompromised patients, Klebsiella pneumoniae is responsible for “trafficking” 410 antimicrobial resistance (AMR) genes from their origins in environmental bacteria to infections in humans, where they are they are often difficult to treat. The K. pneumoniae genes are varied and “plasmid-permissive,” and the majority of AMR genes found therein are plasmid-borne. [Current Opinion in Microbiology]
Viral crisis in Aboriginal Australians. The human T-lymphotrophic virus type 1 (HTLV-1) has become widespread in Aboriginal communities near Central and Northern Australia, yet some infectious disease specialists in the country have not heard of the debilitating virus, which is spread through sex, breastfeeding, and blood transfusions. Public health advocates are calling for an awareness and testing campaign that will not scare women in affected communities into abandoning the culturally important practice of breastfeeding, will not encourage discrimination against Aboriginal people, and will yield necessary data in a more timely manner. Currently the time from lab test to result can take up to six months. [Contagion Live, The Guardian Australia, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine]
Health of female Congolese farmers found to improve after hookworm treatment. In a prospective, double-blind, randomized trial of female farmers in the Democratic Republic of Congo, a single oral treatment of 400 mg albendazole resulted in, after seven months, a statistically significant decrease in heart rate of 9.7 beats per minute in women infected with hookworm. Researchers used cardiovascular fitness (heart rate after three minutes of exercise) as a proxy for work capacity using a standardized step test, and controlled for resting pulse rate and age. [Contagion Live, American Journal of Tropical Medicine and Hygiene]
Will drug-resistance doom India’s plan to eradicate TB by 2025? In a long-form article in The Caravan, freelance journalist Menaka Rao outlines the threat of widespread drug-resistance to the Indian Government’s goal of eliminating tuberculosis (TB) by 2025. Rao quotes several spokespeople in the non-governmental sector as saying that the current TB program does not diagnose multi-drug resistant infections quickly enough and will need better diagnostics, more local clinics, access to more TB medicines, and more standardized diagnostic and treatment guidelines for private healthcare providers. [The Caravan]
Probiotic supplement to breastfeeding increases duration of Bifidobacterium colonization in newborns’ intestines. Two studies led by Evolve Biosystems researchers examined the effect of providing newborn babies with a course of the probiotic organism Bifidobacterium longum subspecies infantis during day 7 to 27 of life. The first study reported that, compared to the control group, infants fed B. infantis had significantly higher populations of fecalB. infantis during the three weeks they received supplements, and the difference persisted more than 30 days after supplementation ceased. The second study, presented at the 51st Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, found that infants fed probiotics and breastmilk had, on average, 87.5% fewer antibiotic resistance genes in their microbiome. [mSphere, Healio, EurekAlert, Abstract from Conference Proceedings]
Effectiveness of specific vaccines is essential in routine immunization programs. Programs in 192 countries include Haemophilus influenzae type b (Hib), mostly in combination vaccines. An evaluation of several Hib vaccines in the Dutch program has found no evidence of different serological response or antibody persistence. The findings have implications for lower income countries, which may not have enough data to demonstrate effectiveness via robust case-control studies. [The Lancet Infectious Diseases, Comment in Lancet Infectious Diseases]
Simplified model based on risk-adjusted ratio of observed-to-expected antibiotic use may advance stewardship efforts. Fair interhospital comparisons of antimicrobial use and resistance have long been considered “elusive” due to differences in hospital features and patient populations. Achieving validity by adjusting for risk across such varied institutions is a legitimately challenging problem. The authors of a new study developed a Simplified Antimicrobial Stewardship (ASP) Ratio that incorporated disease burden and compared it to a Complex Ratio and a Facility Ratio. They found that the major predictors of expected antibiotic use were diagnosis-related groups, infection present on admission, patient class, and unit type. [Clinical Infectious Diseases, CID Editorial Commentary]
Image credit: Virus image, modified, from IGI Glossary (License: CC BY-NC-SA 4.0)
