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Weekly Digest: Broad antibiotic restrictions in food animals decrease resistance; Masks & respirators equally effective at preventing flu; Resistance rates correlate with country income status.

Weekly Digest: Broad antibiotic restrictions in food animals decrease resistance; Masks & respirators equally effective at preventing flu; Resistance rates correlate with country income status.

Broad antibiotic restrictions in food animals decrease rates of resistance. Researchers in Canada compared the effect of various methods of antibiotic restriction in food animals on rates of antibiotic resistance. They found that single antibiotic and single class restrictions were not associated with reductions in resistance, while complete antibiotic restrictions were linked to a 15 percent reduction in resistance. Restriction approaches that allowed therapeutic antibiotic use were also effective, and were linked to a 9-30 percent reduction in antibiotic resistance. [BMJ Global Health]

 Surgical masks and respirators equally effective at preventing flu in health care workers. In a randomized clinical trial across 137 outpatient sites in the US, researchers found that surgical masks and N95 respirators worn by patients were equally effective in preventing the flu and other respiratory infections among health care personnel. There was no significant difference in the incidence of laboratory-confirmed influenza or laboratory-detected respiratory infections among outpatient health care personnel who encountered patients wearing surgical masks and those wearing respirators (p= 0.18, 0.47).  [JAMA]

Resistance rates correlate with country income status. A surveillance study of 67 countries identified an inverse association between country income status and rates of antibiotic resistance. Rates of infections caused by third-generation cephalosporin-resistant Klebsiella spp., carbapenem-resistant (CR) Acinetobacter spp., and third-generation cephalosporin-resistant (3GCR) Escherichia coli were associated with the highest rates of resistance increase per decrease in gross national income (GNI) per capita (22.5, 19.2, and 15.3 percent respectively). [Journal of Antimicrobial Chemotherapy]

Resistance persists in gut microbiome of antibiotic-exposed premature infants. Researchers at the Washington University in St Louis School of Medicine studied fecal samples from premature infants who were exposed to antibiotics and identified potentially long-lasting effects on the gut microbiome. Premature infants who received an average of eight courses of antibiotics had significantly more drug-resistant bacteria in their gut at 21 months old compared to those who received only one course of antibiotics, as well as compared to full-term babies who did not receive antibiotics.  [Nature Microbiology, WUSTL Medicine]

Risk factors for pneumonia-associated death among Kenyan children. A retrospective study of Kenyan children (5-14 years old) hospitalized for pneumonia identified risk factors for death, which include severe pallor (aOR=8.06), reduced consciousness, age >9 years (adjusted OR= >2), and comorbidities such as HIV and Severe Acute Malnutrition (adjusted OR=2.31, 1.89). Results suggest that the World Health Organization’s (WHO) criteria for defining severe pneumonia among children under 5 is not a valid tool to use in this group of children aged 5-14 and reflect the need for evidence-based clinical guidelines for this group. [BMJ Global Health]

Updated flu prevention guidelines for US children. The American Academy of Pediatrics has updated their recommendations for the prevention and control of influenza in US children for the upcoming flu season. The 2019-2020 guidelines highlight that both the live-attenuated and inactivated influenza vaccines are viable options for children, and both vaccines will now be quadrivalent. A new antiviral flu treatment has also been licensed for children.[Pediatrics]

Flu in hospitalized infants underestimated. An observational study of 3,634 infants across four hospitals in Albania, Jordan, Nicaragua, and the Philippines identified an underestimate of lab-confirmed flu cases in hospitalized infants. The study found that previous estimates of infants hospitalized for the flu could be 2.0-3.6 times lower than the true case count. The results reiterate the benefits of influenza vaccination among mothers and infants. [The Lancet Child and Adolescent Health]

Europe is losing the fight against measles. Based on an assessment by the European Regional Verification Commission for Measles and Rubella Elimination, measles elimination status in Albania, Czechia, Greece, and the United Kingdom has been revoked. In the European Region, the rapid increase of measles cases in 2018 has continued into 2019, with more cases of the disease reported in the first 6 months of 2019 than in 2018 overall. This surge in measles cases is currently classified under WHO Grade 2 emergency response. Although such a designation permits the mobilization of resources to combat the outbreak, further efforts are needed to re-eliminate the virus. [WHO]

USAID to devote $21 million in response to Ebola outbreak in the DRC. The US Agency for International Development (USAID) will devote over $21 million to combat the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC). The funding will support prevention and control measures in health care settings, disease surveillance, training for health care professionals, and the promotion of safe burial practices. The United States represents the largest single country donor to the Ebola response, whose funding amounts to almost $158 million since the onset of the outbreak in August 2018. [USAID]

Price increase on sugary snacks could decrease obesity in the UK. A modeling study estimated that a 20 percent price increase on high sugar snacks (confectionery, biscuits, and cakes) in the UK could decrease overall average body mass index (BMI) by 0.53. This reduction would decrease the overall prevalence of obesity in the UK by 2.7 percent in one year. The study found that the price increase would have the largest effect on the energy purchase/consumption of low-income households that struggle with obesity. [BMJ]

Mortality odds among patients with Gram-negative infections. A CDDEP study examining the association between multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacterial infections and in-hospital mortality in India found that in-hospital mortality was significantly higher among patients infected with MDR or XDR pathogens including Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, compared to non-MDR infections. [CDDEP]

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