January 26, 2019
New therapy prevents malaria recurrence. Tafenoquine, a single-dose therapy for Plasmodium vivax malaria, significantly reduced the risk of infection recurrence compared to treatment with placebo or primaquine, according to the results of a double-blind, randomized control trial conducted in Ethiopia, Peru, Brazil, Cambodia, Thailand, and the Philippines. At six months, the percentage of patients free from recurrence was 62.4 among those who received tafenoquine, 27.7 percent in the placebo group, and 69.6 percent among those who received primaquine. [NEJM Study One, NEJM Study Two, NEJM Commentary]
Nearly 20,000 measles cases recorded in Madagascar. Health officials in Madagascar have recorded 19,539 measles cases and 39 deaths since an outbreak began in October 2018. Children aged 1 to 14 years account for 64 percent of cases, and cases have been reported across all 22 regions. The estimated measles immunization coverage in Madagascar was 58 percent in 2017, according to the World Health Organization (WHO). Fifty-one percent of infected patients were not vaccinated against the disease or had unknown vaccination status. [WHO]
Measles in Washington state, New Jersey, and New York City. Health officials in Clark County, Washington confirmed 16 measles cases, all among children aged 1 to 18 years, fourteen of whom had not received the Measles-Mumps-Rubella (MMR) vaccine. One patient was hospitalized. In Ocean County, New Jersey, local health officials documented 30 confirmed measles cases between October 2018 and January 2019 with the majority of patients lacking full MMR vaccination. In New York City, health officials have confirmed 62 measles cases as of January 23. The majority of the cases have occurred in an Orthodox Jewish community in Brooklyn where the initial case was an unvaccinated child who traveled to Israel. [Clark County Health Department Press Release, New Jersey Health Statement, NYC Health Statement]
Increase in vancomycin-resistant enterococci in Swiss hospitals. Between January 2015 and March 2018, 46 of 142 health facilities in Switzerland reported vancomycin-resistant enterococci (VRE) cases, according to a national survey. During this period, there were 23 VRE outbreaks nationwide: 4 in 2015, 9 in 2016, 5 in 2017, and 5 in the first three months of 2018. A total of 652 patients had VRE infections, and the number of VRE cases increased from 96 in 2015 to 146 between January and March 2018. The incidence rate increased from 0.26 cases per day in 2015 to 1.58 cases per day in 2018. [Antimicrobial Resistance & Infection Control]
Financial incentives do not lead to lower HIV viral suppression in Uganda. Two hundred and three HIV-positive individuals from four rural parishes in Uganda were randomly selected to receive financial incentives for achieving or maintaining viral suppression, defined as a viral load of less than 400 copies per milliliter, at 6-, 12-, and 24-week timepoints. The median income of all study participants was $0.79 per day. Financial incentives started at $4 US dollars and increased to $12.50. At baseline, 77 percent of all study participants, including 197 control subjects, were virally suppressed. At 24 weeks, there was no significant difference in viral suppression associated with receipt of financial incentive; 84 percent of those receiving financial incentive and 82 percent in the control group were virally suppressed at this timepoint. [The Lancet HIV]
Contextual determinants of antimicrobial stewardship programs worldwide. Researchers interviewed 54 healthcare professionals responsible for implementing antimicrobial stewardship programs (ASP) in hospitals in England, France, Norway, India, and Burkina Faso to identify key contextual and cultural drivers and barriers to ASP implementation and development. In India and Burkina Faso, lack of state involvement to regulate access to antimicrobials or accredit hospitals and laboratories were perceived as barriers to widespread ASP implementation and adoption. In England, budgetary confinements and frequent restructuring of the healthcare system disrupted ASP implementation. Across health systems, hierarchical boundaries within facilities often restricted involvement in ASP activities, which failed to engage the broader health workforce. Authors encouraged interdisciplinary teamwork to develop and implement context-dependent ASP. [PLOS One]
Premature mortality and drug poisoning deaths in the US. Between January 2000 and December 2015, there were 9.5 million premature deaths among Americans aged 25-64 years. The number of premature deaths increased overtime from 2,205,280 between 2000 and 2003 and 2,553,491 between 2012 and 2015. Drug poisoning – including accidents, suicides, and homicides – caused 74,088 deaths between 2000 and 2003 and 159,471 deaths in 2015 alone. Drug poisoning mortality showed the greatest increase in low-income and rural counties. [The Lancet Public Health]
Dermatologists cut overall antibiotic use but increase use after surgery. Dermatologists are among the most frequent prescribers of oral antibiotics across medical specialties, according to researchers. Between 2008 and 2016, almost 12,000 dermatologists prescribed a total of 985,866 oral antibiotic courses, in Minnesota, US. Overall antibiotic prescribing decreased from 3.36 to 2.13 courses per 100 visits driven primarily by reductions in antibiotic therapy for the treatment of acne and inflammation associated with rosacea. Antibiotic prescribing increased nearly 70 percent from 3.92 to 6.65 courses per 100 visits among patients who required surgery despite a low risk of infection following dermatologic procedures and lack of clinical guidelines in support of post surgical antibiotics. [JAMA Dermatology]
Clostridium difficile in pets in Eastern China. Of 175 fecal samples collected from 146 healthy, domesticated dogs and 29 cats residing in Xuzhou City, China, 3 (1.7 percent) – 1 from a dog and 2 from cats – tested positive for Clostridium difficile. All C. difficile isolates were susceptible to the antibiotics chloramphenicol, tetracycline, metronidazole, and moxifloxacin. One isolate was resistant to vancomycin, and all isolates were resistant to ampicillin, clindamycin, and cefoxitin. [BMC Infectious Diseases]
Outcomes for infants born to women with H1N1 infections. Pregnant women admitted to the intensive care unit (ICU) due to influenza infection during the 2009 H1N1 flu season were more likely to deliver preterm and low birth weight babies compared to uninfected women and women with influenza who were not hospitalized. The study assessed outcomes for infants born to 490 women with influenza, 64 of whom were admitted to the ICU, and 1,451 women without reported influenza, using data from five local and state health departments in the US. A babies’ health can be assessed and given a score on the basis of Appearance, Pulse, Grimace, Activity, and Respiration (Apgar). For women hospitalized with influenza, the adjusted relative risk for delivering pre-term infants, low birth weight infants, or infants with Apgar scores of six or less was 3.9, 4.6, and 8.7, respectively. [Birth Defects Research]
Ebola outbreak continues in DRC. In the Democratic Republic of the Congo (DRC), 12 more cases of Ebola have been confirmed, according to the country’s ministry of health. Six of the cases occurred in Katwa and two in Butembo. The other cases occurred in Musienene, Kyondo, Beni, and Kayina. Overall, a total of 631 Ebola cases and 414 deaths have occurred since the outbreak began. [DRC MOH]
The cost of pandemics. Since 2011, an average of 200 epidemics have occurred each year, with local and regional outbreaks becoming both more common and more disruptive to economies. Disease pandemics will cause average economic losses of 0.7 percent of global GDP, approximately $570 million dollars, per year in the coming decades, according to experts at the World Economic Forum (WEF). [WEF]
Pakistan and Nigeria record additional polio cases. As of January 2019, Pakistan health authorities confirmed two cases of wild poliovirus type 1 and five positive environmental samples, according to the Global Polio Eradication Initiative. Nigerian officials also confirmed one case of circulating vaccine-derived poliovirus (cVDPV) type 2 and two positive environmental samples. In 2018, Pakistan reported a total of 10 wild polio cases and Nigeria reported 33 cVDPV cases. [GPEI]
Photo: Measles virus. Credit: Shutterstock.
