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Weekly Digest: New CDDEP research on antibiotic development pipeline; US childhood vaccination rates continue slow decline; H5N6 avian flu outbreak among birds in China.

Weekly Digest: New CDDEP research on antibiotic development pipeline; US childhood vaccination rates continue slow decline; H5N6 avian flu outbreak among birds in China.

No new antibiotics for Gram negative bacteria; most antibiotics fail to penetrate more than a few markets. Only 25 new antibiotics representing 9 different antibiotic classes entered the global market between 1999 and 2014, report researchers at the University of Oslo and CDDEP after reviewing drug registries from Europe, the US, Japan, and India. Overall, 52 percent of new antibiotics were indicated to treat infections caused by drug resistant bacteria, however, none targeted Gram-negative bacteria. Researchers also tracked the distribution of antibiotics through analysis of global drug sales. Within three years of their introduction, antibiotics could reach as many as 30 national markets, and in 10 years as many as 70. However, drug availability was highly variable and only 12 of the 25 antibiotics had registered sales in more than 10 countries. [PLOS One]

Global health aid has prevented almost 700 million deaths since 1990. A surge in global funding for health in the early 21st century helped prevent an estimated 669 million deaths worldwide, according to a new report from ONE, an advocacy organization focused on poverty and preventable diseases. Between 2000 and 2015, maternal mortality rates in sub-Saharan Africa dropped by 15 percent and AIDS-related deaths dropped by almost 40 percent.  Top government donors in the early 21st century were the US, the UK, Germany, and France. However, international donor assistance and domestic funding for important public health initiatives, including immunization and the prevention and treatment of HIV/AIDS, Tuberculosis, and Malaria, has stalled in recent years. If funding does not increase, important global health gains will not continue and many countries are at risk of not meeting 2030 Sustainable Development Goals, ONE warned. [ONE Campaign, Devex]

Despite high coverage, quality of antenatal care remains low in many LMICs. Across 91 low (LIC), lower-middle (LMIC), and upper-middle income countries (UMICs) the availability of antenatal care was high, according to the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Of the more than 600,000 women surveyed, 89.7 percent had at least one visit with a skilled antenatal-care provider between 2007 and 2016 with coverage ranging from 86.6 percent in LICs to 96.1 percent in UMICs. Significant within-country inequalities in antenatal care quality were observed in 70 of the 91 countries. Wealthy women were four times more likely to receive all three services than poor women in the same country. [The Lancet]

Vaccination among children in US is high but slowly declining. The US Centers for Disease Control and Prevention (CDC) published two reports detailing vaccination coverage among children ages 19-35 months and children enrolled in kindergarten during the 2017-2018 school year. More than 90 percent of children ages 19 – 35 months had received recommended doses of the poliovirus; varicella; hepatitis B; and measles, mumps, and rubella (MMR) vaccines, according to data from the 2017 National Immunization Survey-Child. Among this age group, children were least likely to be up-to-date with hepatitis A and rotavirus vaccines, and the proportion of children born in 2015 who had not received a single vaccine by age 24 months was 1.3 percent up from 0.9 percent in 2011. The median percentage of children with an exemption for any state-required vaccine was 2.2 percent up from 2.0 percent for the previous school year. [CDC MMWR Children 19-35 Months, CDC MMWR Children in Kindergarten, Washington Post]

In UK, progress in antibiotic use in animals. Between 2014 and 2016, there was a 27 percent reduction in antibiotic use in food animals in the United Kingdom exceeding the government’s 2018 targets, according to a recent report from the UK Parliamentary Office of Science and Technology (POST). Antibiotic use and reductions in use varied by sector. The pig and poultry meat sectors had the highest antibiotic usage rates but have cut use by 50 percent since 2015 and 82 percent since 2011, respectively. Further reductions will need to be made to meet the nation’s 2020 goals. [POST]

Shorter antibiotic treatment effective for late-onset GBS bacteremia. Current clinical guidelines recommend a prolonged 10-day course of intravenous (IV) antibiotics for the treatment of uncomplicated, late-onset group B Streptococcus (GBS) bacteremia in infants. A retrospective cohort study by researchers at the University of Utah found that shortened IV antibiotic courses were as effective in preventing disease recurrence as prolonged treatment courses. Overall, 612 (79 percent) infants received the clinically recommended 10-day IV antibiotic course while 163 (21 percent) infants received a shortened course of 8 days or less. Of the infants that received a shortened course, only 3 (1.8 percent) experienced a GBS recurrence while 14 (2.3 percent) infants who received the prolonged course experienced recurrence. [Pediatrics]

China reports avian flu outbreak in birds. An ongoing outbreak of highly pathogenic H5N6 avian flu in China’s southern Hunan province has infected 516 birds and caused 385 bird deaths since the outbreak began on September 26, 2018, officials from the World Organization for Animal Health (OIE) recently reported. Over 1,000 additional birds were killed and disposed of to prevent further disease spread. [OIE]

Urbanization and humidity shape intensity of flu epidemics in U.S. cities. The pattern of flu spread varies significantly by city population size, according to an analysis of six years of weekly flu incidence data from 603 US cities. Larger metropolitan areas have greater potential to transmit flu compared to smaller cities which is likely explained by higher densities of people living, working, and commuting together, researchers reported. Consequently, in larger metropolitan areas, flu seasons tend to be longer with cases more evenly distributed throughout the season. Climatic factors, such as humidity, played less of a role in shaping the spread of the flu in larger cities while in smaller cities, lower humidity was associated with prolonged disease spread. [Science, Science Perspective, STAT News]

New vaccine for Lassa fever and rabies shows promise in preclinical trials. Researchers have developed a novel recombinant vaccine, called LASSARAB, that is designed to protect people from both the Lassa fever and rabies viruses. The burden of both Lassa fever, a World Health Organization priority disease, and rabies remains high in some areas of the world, including west Africa. In preclinical trials using mice and guinea pigs, LASSARAB along with a TLR-4 agonist adjuvant elicited long-lasting immune responses to both viruses. Three doses of the vaccine imparted significant protection from Lassa fever in guinea pigs 58 days following vaccination. [Nature Communications, NIH]

Global network of investors raises awareness about risks of intensive livestock production. The Farm Animal Investment Risk and Return (FAIRR) initiative is a global network of investors focused on raising awareness and educating stakeholders in the agricultural industries about the environmental, social, and governance risks and opportunities associated with factory farming. FAIRR is spreading the message that while factory farming may be cheaper for consumers in the short term, it is not a sustainable business model in the long-term due to its severe environmental and human health hazards including high antibiotic use driving resistance. In the last five months the total market value under FAIRR’s management has doubled to $9 trillion, Bloomberg Businessweek reported. [Bloomberg, FAIRR]

DNA sequencing predicts susceptibility to first-line TB drugs. Researchers from the CRypTIC Consortium and 100,000 Genomes Project analyzed whole-genome sequences and associated drug resistance or susceptibility phenotypes of over 10,000 Mycobacterium tuberculosis (TB) isolates to assess whether DNA sequencing could accurately predict pan-susceptibility to first-line TB drugs. The isolate samples represented all major TB strains and originated from 16 countries. Overall, resistance and susceptibility to the first-line TB drugs isoniazid, rifampin, ethambutol, and pyrazinamide were correctly predicted with over 90 percent sensitivity and specificity. Based on the results of this study, public health officials in England, the Netherlands, and New York have decided to stop phenotypic drug-susceptibility testing of certain TB samples. [NEJM, NEJM Comment]

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