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Weekly Digest: UN report urges countries to invest in AMR; Push for US government to finalize antibiotic stewardship policy; FDA approves first dengue vaccine.

Weekly Digest: UN report urges countries to invest in AMR; Push for US government to finalize antibiotic stewardship policy; FDA approves first dengue vaccine.

UN report urges countries to invest in AMR. The United Nations Interagency Coordination Group (IACG) released a report last month addressing the global threat of antimicrobial resistance (AMR) and urged countries to take immediate action. The report calls for a One Health approach from countries across all income levels, focusing on the human, animal, and environmental impacts of AMR. Strategies include prioritizing national action plans, regulatory systems and awareness programs, investing in AMR research and development, and reducing the use of antimicrobials for growth promotion in animals. [WHO]

Experts push US government to finalize antibiotic stewardship policy. Members of the Presidential Advisory Council on Combating Antibiotic Resistant Bacteria (PACCARB) sent a letter to the US Department of Health and Human Services last month urging the finalization of a proposed rule which would require the adoption of Antibiotic Stewardship Programs in hospitals. If not finalized, the rule will expire in June. In the letter, PACCARB warned that without immediate action, the US would be undermining the country’s efforts in the fight against antibiotic resistance. [PACCARB, CIDRAP]

Call for action against the rising threat of drug-resistant TB. The Economist Intelligence Unit has compiled a report outlining the threat of drug-resistant tuberculosis (DR-TB), which currently accounts for one-third of AMR-associated deaths. The report warns that the world is unprepared to address this growing threat. Currently, only one-third of individuals with DR-TB are diagnosed, and one-fourth are treated. DR-TB costs billions of dollars across the world, related to loss of life, worker absences, and reluctance to travel or use public infrastructure due to the risk of TB transmission. The report urges countries to act now by mobilizing resources for the control of TB, learning from the successful elimination of past infectious diseases, and prioritizing engagement in public advocacy around DR-TB. [The Economist Intelligence Unit]

FDA approves dengue vaccine with restrictions after vaccine safety issues in the Philippines. The U.S. Food and Drug Administration approved the first dengue vaccine last week, with strict limitations. Dengvaxia is restricted for use in children 9-14 who live in dengue-endemic areas and have previously been diagnosed with the infection. These restrictions come following controversy over the safety of Dengvaxia in the Philippines. The vaccine was shown to increase risk of hospitalization and severe dengue infection in individuals with no previous dengue diagnosis. [FDA, NPR]

Changes in antibiotic resistant genes in Brazilian poultry. Researchers evaluated the virulence, antibiotic resistance, and genetic diversity of Campylobacter jejuni isolates collected from poultry in Brazil. The overall prevalence of C. jejuni and multi-drug resistant isolates decreased significantly between 2011-2012 and 2015-2016 (p = 0.0007 and p<0.05, respectively). The prevalence of multiple virulence genes and genetic diversity in the isolates increased in the same time period. These findings may be related to the implementation of stricter regulations and pathogen control measures at the agriculture level. [Food Microbiology]

Petting zoos act as a reservoir for multi-drug resistant bacteria. Research presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCIMD) last month revealed that petting zoos could act as a reservoir for transmitting multi-drug resistant bacteria to its visitors. Researchers used genetic sequencing to identify drug resistance genes in fecal and body surface (fur, feathers, or skin) samples from animals in eight petting zoos across Israel. Findings revealed that 77 percent of the MDR bacteria came from fecal samples, and 23 percent came from body surface samples. Highly virulent E.coli strains that cause traveler’s diarrhea and UTIs in humans were both identified from the petting zoos. Petting zoos should consider prioritizing hygiene and infection control procedures as well as rationalized antibiotic use to prevent multi-drug resistant bacteria transmission to visitors. [ECCMIDScienceDaily]

Using whole-genome sequencing for improved prevention and control of hospital-acquired Influenza. Scientists used whole-genome sequencing (WGS) to identify outbreak clusters of Influenza A strains in patients at the Great Ormond Street Hospital in London. Traditionally, Haemagglutinin (HA) and neuraminidase (NA) gene sequencing is used to detect potential outbreak clusters in flu-positive patients, although the effectiveness of this method is unclear. WGS of samples in this study identified one outbreak and one cluster of flu strains, which the HA/NA sequencing had also accurately identified. However, the HA/NA sequencing missed a cluster of two infections and identified unrelated strains in one outbreak cluster. Use of WGS to identify flu outbreaks in hospitals could improve infection prevention and control and decrease disease transmission. [CID]

Factors associated with fluctuating measles vaccination coverage in Madagascar. Researchers used vaccine delivery records, vaccination cards, and a health worker survey to examine the factors associated with temporal fluctuations in measles vaccination coverage in Madagascar between 2013-2016. Results found that more doses of the measles vaccine are given during Supplementary Immunization Activities (SIAs) and Vaccination Weeks (VWs), which are mass vaccine deliveries targeting all children. However, doses decline in the following months, as well as in rainy season. To avoid future measles outbreaks, Madagascar should continue to strengthen SIAs and VWs, while improving health facility organization and vaccine stock during the rainy season. [Vaccine]

Carbapenem resistance associated with poor clinical outcomes in LMICs. Researchers conducted a cohort study across ten low-and middle-income countries to assess clinical outcomes of patients with carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections compared to patients with carbapenem-susceptible Enterobacteriaceae (CSE) bloodstream infections. The crude mortality rate for patients with CRE infection was 35 percent compared to 20 percent for CSE infections. Findings also showed that CRE infections were associated with longer hospital stays and in-hospital mortality (hazard ratio: 1.75). [The Lancet Infectious Diseases]

CDDEP Awards in Antimicrobial Resistance. CDDEP Awards in Antimicrobial Resistance will sponsor two individuals for the best accepted abstracts addressing AMR in low- or middle-income countries for the 19th International Congress on Infectious Diseases (ICID). The awards consist of reimbursement of travel, accommodation, and registration expenses for the 19th ICID in Kuala Lumpur, February 20-23, 2020. Submit your abstract addressing AMR in LMICs by Oct. 25, 2019. [ICID]