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Weekly Digest: MDR Pseudomonas increasing in U.S. children; UNICEF Reports 1.4 million children lost to pneumonia and diarrheal disease each year

Weekly Digest: MDR Pseudomonas increasing in U.S. children; UNICEF Reports 1.4 million children lost to pneumonia and diarrheal disease each year

A weekly roundup of news on drug resistance and other topics in global health.  

Antimicrobial-resistant healthcare-associated infection, Pseudomonas aeruginosa, increased steadily among U.S. children over the last decade. In a study published in The Journal of the Pediatric Infectious Diseases Society, CDDEP researchers and collaborators report increases in multidrug-resistance (MDR) and carbapenem-resistance (CR) in Pseudomonas aeruginosa between 1999 and 2012. The prevalence of MDR P. aeruginosa increased from 15.4 percent in 1999 to 26 percent in 2012, and of CR, from 9.4 percent 20 percent. The proportion of both MDR and CR P. aeruginosa increased each year by 4 percent. The study underscores the need for aggressive prevention strategies, including bacterial surveillance and antimicrobial stewardship programs in pediatric settings. [Journal of PIDS]

World Antibiotics Awareness Week 2016. CDDEP commemorated WAAW this past week with daily blogposts about The Conscience of Antimicrobial Resistance Accountability (CARA) and the Global Antibiotic Resistance Partnership (GARP), including an update on CARA’s progress and a discussion of potential indicators to measure antimicrobial resistance progress post-UNGA. Several GARP partners around the world also staged events, GARP-Kenya organized sessions with civil society groups in health and agriculture. GARP-Nepal held informational meetings, a rally led by professors and medical students to raise community support for safe antibiotic use, and poster and essay competitions. We will be reporting on some of those activities in the coming weeks. [CDDEP Blog]

UNICEF Reports 1.4 million children lost to pneumonia and diarrheal disease each year—more than all other childhood illnesses combined. The overwhelming majority of the deaths occur in low- and middle-income countries. The fact that children continue to die from these diseases is a reflection of deep inequalities. According to UNICEF Deputy Executive Director Fatoumata Ndiaye. “These illnesses have such a disproportionately high impact on child mortality and are relatively inexpensive to treat, yet they continue to receive only a fraction of global health investment…. That’s why we’re calling for increased global funding for protective, preventive and treatment interventions that we know will work to save children’s lives.” [UNICEF]

GlaxoSmithKline tops 2016 Access to Medicine Index. The Access to Medicine Index, launched in 2008, ranks the top 20 pharmaceutical companies on the accessibility of their drugs in low- and middle-income countries (LMICs). GlaxoSmithKline led the index for the fifth time, followed by Johnson & Johnson and Novartis. The report also found that companies increasingly view access to medicine as a way to develop their business in emerging markets, and that collaborative research models (e.g., public-private partnerships) are effective in developing products urgently needed in LMICs, but with low commercial potential. [Access to Medicine Index, STAT]

WHO may declare Zika no longer a public health emergency; multiple viruses can be transmitted in single mosquito bite. The World Health Organization may determine that Zika no longer meets the criteria for a “public health emergency of international concern,” alarming observers that downgrading its status will mean research and detection efforts will wane. According to international law expert Dr. Lawrence Gostin, “The international response to Zika has been lethargic, and if WHO called off the global emergency, it would provide reason for governments and donors to pull back even more. That would be a recipe for the very lack of preparedness the world has seen time and again with infectious diseases.” [STAT]

A study presented at the 2016 American Society of Tropical Medicine and Hygiene (ASTMH) annual meeting confirms that Aedes mosquitoes infected with Zika, chikungunya, and dengue, are able to transmit both Zika and chikungunya in the same bite. It is still unclear whether dengue can also be transmitted simultaneously with one or both of the other viruses. The study also found that co-infection with chikungunya inhibits Zika infection in Aedes mosquitoes, suggesting that one virus may outcompete the other. [ASTMH, CIDRAP]

Minimally symptomatic and asymptomatic Ebola detected, suggests virus was more widespread. A study in PLOS Neglected Tropical Diseases reports evidence of significant unrecorded Ebola infections, determined by measuring Ebola antibody levels in presumed uninfected direct contacts of Ebola patients, who had been quarantined during the outbreak. Their antibody titers were compared with positive controls—recovered Ebola patients—and negative controls—people with a very low likelihood of Ebola exposure. Of the 187 direct contacts tested, 14 were identified as probably having had an Ebola infection. Two admitted that they had a fever while quarantined, but the remaining 12 reported no symptoms. The researchers wrote, “The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection. These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak.” [PLoS NTD, CIDRAP]

Transmission of N. meningitidis along African meningitis belt: A study published in The Lancet Global Health describes transmission patterns of Neisseria meningitidis along the African meningitis belt (Chad, Ethiopia, Ghana, Mali, Niger, Nigeria, and Senegal) in 2010 to 2012. Nearly 1,000 people from 133 households with an identified meningitis carrier were tested, and at least one other family member tested positive in more than half of the households. Children under 5 years were at highest risk of becoming infected. [Lancet GH study, Lancet GH comment]

CDC issues new guidelines for outpatient antibiotic prescribing. The new Core Elements of Outpatient Antibiotic Stewardship, published in Morbidity and Mortality Weekly Report, involve four stewardship pillars: commitment, action for policy and practice, tracking and reporting, and education and expertise. These guidelines build on two reports from a collaboration between The Pew Charitable Trusts and the CDC, which found that that at least 30 percent of antibiotics prescribed in outpatient settings are unnecessary and that only half of the patients treated for three common bacterial infections are treated with the right antibiotic. [CDC, CIDRAP]

The CDDEP Weekly Digest will return in two weeks. Happy Thanksgiving.


Image via HansN. (CC BY-SA 3.0)