April 16, 2018
GARP-Pakistan presents report on antimicrobial resistance. At the 15th Annual Conference on Infectious Diseases in Pakistan, Dr. Ejaz A. Khan, Chair of Global Antibiotic Resistance Partnership (GARP)-Pakistan, launched the Situation Analysis Report on Antimicrobial Resistance in Pakistan: Findings and recommendations for Antibiotics Use and Resistance. The report was written over the past year by Core Group members of GARP-Pakistan through a series of consultations, and was used as the basis of the draft National Action Plan for Containment of Antimicrobial Resistance. The report was presented to GARP dignitaries and other attendees of the 15th Annual Conference on Infectious Diseases, March 17, 2018, in Rawalpindi. GARP is a project of the Center for Disease Dynamics, Economics, and Policy (CDDEP). [CDDEP Website]
Bed nets with added ingredient reduce malaria transmission. A cluster, randomized trial in Tanzanian villages showed that use of bed nets treated with long-lasting piperonyl butoxide (PBO) resulted in 13% fewer malaria infections, compared to groups using standard bed nets. Malaria prevalence was also lowered by 16 percentage points in a group that received indoor residual spraying of the insecticide pirimiphos-methyl. Combining the PBO bed net with the spraying did not provide any additional benefit. Based on this evidence, the World Health Organization (WHO) recommends increasing coverage of PBO-treated bed nets in areas where resistance to pyrethroids is threatening malaria control. [Lancet, Reuters, Medical Xpress]
Preprints are important, especially during time-sensitive outbreaks.While scientists, public health agencies, and publishers of journals have endorsed preprints (research made available publicly before peer review) in principle, utilization of preprints has not increased enough, especially during public health emergencies. According to a PLoS Medicine essay that examined available research during two recent global outbreaks, there was a modest increase (4.5% to 7.9%) in the proportion of preprints to publications in the Zika outbreak (November 2015 to August 2017) compared to the Ebola outbreak (May 2014 to January 2016). However, less than 5 percent of published Ebola and Zika journal articles were made available as preprints prior to publication. [PLoS Medicine, Healio]
Ivermectin-treated blood helps control mosquito vector. A three-day course of the antiparasitic drug ivermectin was well tolerated in humans when added to standard therapy for malaria. A study of mosquitoes fed blood drawn seven days after the humans took ivermectin found that significantly more mosquitoes died compared to untreated blood (risk ratio (RR) of 2.18 at 14 days post feeding, and RR of 1.21 at 28 days post-feeding). Adverse effects were reported in two of the 48 study participants (4%); these safety findings may support the case for using ivermectin via mass drug administration to reduce mosquito populations, thereby reducing malaria transmission. [Lancet, Concise News, Lancet]
Taking steps to facilitate vaccination increases uptake; trying to change beliefs does not. Behavioral interventions such as reminders, prompts, making default appointments and using standing orders lead to higher rates of vaccinations, while efforts to change patients’ beliefs do not, according to a review of scientific literature. School vaccine requirements and stricter criteria for exceptions are likely to increase vaccine uptake. [Medical Xpress, Psychological Science in the Public Interest]
Multidrug resistant A. Baumannii declines from 2010 after nine years of sharp increases. Incidence rates of multidrug resistant Acinetobacter baumanii (MDR-Ab) in the United States saw a ten-fold increase from 2000 to 2009. However, a recent trend analysis by researchers at UCLA found a notable decline in both hospital onset and community onset MDR-Ab infections from 2010 to 2015. With rates of MDR-Ab now below 0.05 cases per 1,000 patient days, compared to its peak incidence of 0.2 cases per 1,000 patient days, researchers attribute the steady decline to a combination of antimicrobial stewardship practices that promote more judicious use of antibiotics, expansion of hand hygiene programs, and increased environmental disinfection. Infection Control and Hospital Epidemiology
C. difficile study: one treatment resolved infection more often than two. A study of Canadian and American patients with recurring Clostridium difficile compared the efficacy of fecal microbiota transplant (RBX2660) to placebo. All patients received two enemas one week apart, with either zero, one, or both doses being placebo. Researchers found that 67% of those who received one fecal transplant followed by one placebo treatment experienced no relapse, compared to 61% of those who received two doses of RBX2660, and 45% of the two-placebo group. The findings are limited by the small study sample size, however. [Contagion Live, Clinical Infectious Diseases]
Mosquito nets provide some malaria protection even when resistance to pyrethroid is present. In a multi-country study coordinated by the World Health Organization, long-lasting insecticide nets proved effective in reducing transmission of malaria. Prevalence in bed net users was lower than in non-users (adjusted odds ratio [OR] 0·63, 95% CI 0·51–0·78), and incidence was also lower in bed net users (adjusted rate ratio [RR] 0·62, 0·41–0·94). The study enrolled 40,000 children in Benin, Kenya, India, Sudan, and Cameroon. [Lancet]
Plan calls for one billion yellow fever vaccinations by 2026. World Health Organization (WHO) director general Tedros Adhanom Ghebreyesus has announced that more than fifty health organizations will collaborate over the next eight years to fight yellow fever in 27 African countries. The Eliminate Yellow Fever Epidemics (EYE) stretegy will include mass and routine vaccinations, rapid containment of outbreaks, and prevention of international spread. The Gavi Alliance will work to ensure that vaccine production keeps up with the demand. Yellow fever outbreaks have become more common since 2000 as a result of increased mosquito populations due to global warming, plus other factors such as urbanization. [Deutsche Welle, United Nations News, Healio]
ANNOUNCEMENT:
A free eBook entitled Antimicrobial Stewardship: From Principles to Practice has been made available to all by the British Society for Antimicrobial Therapies. The book can be downloaded here.
Photo Credit: Dr. Ejaz Khan
