February 01, 2019
WHO highlights AMR and vaccine hesitancy among ten health threats for 2019. The World Health Organization (WHO) reported on ten global health threats that will impact the world in 2019. Air pollution is considered the greatest environmental risk to human health with 90 percent of people breathing polluted air every day. Noncommunicable diseases, namely diabetes, cancer, and heart disease, cause 70 percent of deaths worldwide. Other threats to global health include antimicrobial resistance; vaccine reluctance or refusal; pandemics and outbreaks of influenza, Ebola, and other high-risk pathogens; and weak health systems for displaced populations and in countries impacted by drought, famine, and conflict. [WHO, CNN]
India’s antibiotic-resistance gene found in the Arctic. The New Delhi Metallo-beta-lactamase-1 (blandm-1) gene, which confers multi-drug resistance including to last resort antibiotics such as carbapenems, was discovered in soil samples in the Arctic, researchers reported. The gene was first discovered in India in 2008 and has since been identified in over 100 countries. Arctic soil samples also tested positive for other antibiotic-resistance genes including those associated with aminoglycosides, macrolide-lincosamide-streptogramins, and multi-drug defense systems. The global spread of antibiotic resistance genes including to the most remote places on Earth highlights the urgent need to develop global solutions to an emerging global health emergency. [Environment International, The Independent, The Economic Times]
High antibiotic resistance in Bangladesh. A high prevalence of antibiotic resistance was detected among most tested bacterial pathogens in Bangladesh, according to a review of 46 studies published between 2004 and 2018. Resistance data were available from only 6 of the country’s 64 districts, and over 80 percent of the studies were conducted in the capital, Dhaka. Escherichia coli was the most common cause of urinary tract infection; a median of 94.6 percent of isolates were resistant to ampicillin, 67.1 percent to amoxicillin/clavulanic acid, 65.2 percent to ciprofloxacin, and 72 percent to cotrimoxazole. For Klebsiella species, the median number of isolates resistant to ampicillin, amoxicillin/clavulanic acid, ciprofloxacin, and cotrimoxazole was 100 percent, 58 percent, 67.4 percent, and 72.7 percent, respectively. Similarly, high resistance rates were reported in Pseudomonas spp, Enterococcus spp, and Streptococcus pneumoniae. [International Journal of Infectious Diseases]
GLASS releases second global report on AMR. The Global Antimicrobial Resistance Surveillance System (GLASS) released its second report detailing the status of antimicrobial resistance (AMR) surveillance systems and AMR data for selected human bacterial pathogens in enrolled countries. As of July 31, 2017, 69 countries were enrolled in GLASS; 67 of which reported information on their AMR surveillance systems, and 49 of which provided 2016 AMR data. Country-specific profiles are available online. [WHO]
In China, clofazimine improves clinical outcomes for multidrug-resistant tuberculosis. Between September 2009 and September 2011, 66 patients with multi-drug resistant Tuberculosis (MDR-TB) from 17 hospitals in China were randomly assigned to receive 100 milligrams of clofazimine per day in addition to their standard TB drug therapy regimens. Of these 66 patients, 36 patients were cured and seven completed treatment. This resulted in a favorable outcome rate of 65.1 percent which was significantly higher than the 47.3 percent achieved in the 74 patients who did not receive clofazimine. [Clinical Microbiology and Infection]
New Delhi metallo-β-lactamase-6 identified in Iran. Between March 2014 and February 2017, a total of 120 Klebsiella pneumoniae isolates were collected from hospitalized dialysis patients in Tehran, Iran. Antibiotic susceptibility testing and genetic analysis revealed that 71.6 percent of isolates produced extended-spectrum beta-lactamases, an enzyme that confers resistance to beta-lactam antibiotics, such as amoxicillin, and 10 percent were resistant to carbapenems, which are often referred to as antibiotics of last resort. The blaNDM-6 gene was detected in 3 of 120 isolates which also contained blaCTX-M-15 and blaTEM extended-spectrum β-lactamase genes. [Infection, Genetics, and Evolution]
Prior dengue infection may protect against symptomatic Zika virus infection. Between January 2016 and February 2017, researchers used blood tests to identify 560 children with symptomatic Zika virus infections and 796 children with inapparent Zika virus infections who were part of a long-term cohort study of 3,700 children in Nicaragua. Of children with Zika virus infections, 574 had previously documented dengue infections, and for 134 of those that infection was recent. Children with primary dengue immunity were less likely to have symptomatic Zika infections compared to those who had never been infected with dengue. Researchers concluded that dengue infection may provide immunological protection from symptomatic Zika infections, but further research is needed. [PLOS Med, NIAID Press Release]
KFC and Bon Appetit make strides to reduce antibiotic use. The US fast food chain KFC achieved its 2017 goal of establishing a global supply chain that raises chickens entirely without the use of medically important antibiotics, the company announced. The US food service company Bon Appetit Management Company updated its antibiotics policy to include seafood supply chains. Previously, the company’s policy to only purchase food animals raised without antibiotics unless to treat a veterinarian-confirmed disease only applied to meat and poultry. [KFC Press Release, Bon Appetit Press Release, Forbes, Natural Resources Defense Council]
Infant mortality increasing in Venezuela. Between 1950 and 2000, Venezuela’s infant mortality rate dropped from 108 per 1,000 livebirths to 18.2, but this long-term decline was recently reversed due to the country’s economic crisis and a rise in pediatric infections. In 2016, the infant mortality rate had reportedly increased to 21.1 deaths per 1,000 livebirths. [The Lancet Global Health, Commentary]
Human papillomavirus vaccine effectiveness and herd immunity protection in young women. In the 11-year period following vaccination introduction (2006-2017), human papillomavirus (HPV) vaccination rates increased from 0 percent to 84.3 percent among young women aged 13 to 26 years who sought treatment from hospital-based and community health clinics in Ohio. Detection of four HPV strains, HPV-6, -11, -16, and -18, decreased from 35 percent to 6.7 percent among vaccinated women. HPV detection also decreased among unvaccinated women, from 32.4 percent to 19.4 percent, showing a level of herd protection. Estimated vaccine effectiveness ranged from 80.1 percent to 90.6 percent. [Pediatrics]
Impact of HIV prevention among transgender sex-workers in Peru. In a mathematical model-based analysis, HIV prevention interventions among transgender sex workers in Lima, Peru averted 47 percent of new HIV infections among sex workers and their clients and partners. This equated to an incremental cost-effectiveness ratio of $509 per disability-adjusted life year averted. The interventions included in the model were: a 15 percent increase in condom use with clients, a 10 percent increase with stable partners, an increase in antiretroviral treatment (ART) coverage, and 15 percent pre-exposure prophylaxis (PrEP) coverage. Given implementation of an enhanced scenario would cost 10 per cent ($1·2 million) of the Global Fund’s yearly contribution in Peru, such a program could be a cost effective use of resources. [The Lancet Public Health]
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