Study: Antibody binds to all influenza A subtypes

first_imgJul 29, 2011 (CIDRAP News) – A team of European researchers reported yesterday the discovery of a human monoclonal antibody that binds to all types of influenza A viruses, raising the prospect of a new flu treatment and improving the chances of developing a broadly protective or “universal” flu vaccine.Writing in Science, the team said the antibody, called FI6, recognizes all 16 types of hemagglutinin found in influenza A viruses and that it protected mice and ferrets from lethal doses of two different flu subtypes.A number of researchers in recent years have reported finding human antibodies that target multiple influenza A subtypes, but the new findings are the first report of an antibody that recognizes all of them.”FI6 is the only antibody that has been discovered to date that binds and neutralizes both Group 1 and Group 2 human and animal influenza A viruses,” says a press release issued on behalf of Humabs Biomed, a Swiss company that participated in the research. Humabs, of Bellinzona, Switzerland, collaborated with the Institute for Research in Biomedicine, also of Bellinzona, and the United Kingdom Medical Research Council.Group 1 viruses include H1, H2, H5, H6, H8, H9, H11, H12, H13, and H16 subtypes, while group 2 includes H3, H4, H7, H10, H14, and H15. The type A subtypes that now most commonly infect humans are H1N1 and H3N2, but human are also susceptible to avian flu viruses such as H5N1, H7N7, and H9N2, and to H2, which caused the pandemic of 1957-58.The new findings relate only to influenza A viruses, not influenza B strains, which circulate at varying levels every year.Thousands of cells screenedIn their hunt for exceptional human antibodies, the researchers used a special single-cell culture method to screen or “interrogate” 104,000 plasma cells from eight donors, their report says. Four plasma cells from one donor yielded an antibody that reacted with H1, H5, and H7 viruses.The researchers reproduced this antibody and, using various tests, found that it showed binding and neutralizing activity against all 16 influenza A hemagglutinins. Further, they designed an optimized variant of FI6, called FI6v3, that lacks certain unnecessary mutations, the report says.The team tested the prophylactic effects of the antibody by administering it to mice and then exposing them to normally lethal doses of a lab strain of H1N1 virus. The mice were fully protected when they received an FI6 dose of 4 micrograms per kilogram of body weight.The authors also tested the effects of the antibody when used to treat mice previously exposed to lethal doses of flu virus. When given 1 or 2 days after infection, a dose of 15 mcg per kg protected mice from death. And in other experiments, the antibodyreduced weight loss and prevented death in mice infected with an H3 virusprotected ferrets from a lethal challenge with a 2004 strain of H5N1 virusIn other work, the team used x-ray crystallography to determine that the antibody bound to a particular region in the “F subdomain” of the hemagglutinin. They describe the site as conserved, meaning it is the same in different hemagglutinin types. Their report goes into great detail about how the antibody meshes with the surface contours of the hemagglutinin.Previous reports have noted that the globular head of the hemagglutinin protein, which studs the surface of flu viruses, mutates often to keep the immune system from recognizing it, whereas the stalk or stem of the protein is much more stable.”The results of prophylaxis and therapy that we report identify FI6 as the first example of a neutralizing monoclonal antibody for potential use against all influenza A viruses,” the authors conclude.Study wins praiseGary Nabel, MD, PhD, director of the Vaccine Research Center at the US National Institute of Allergy and Infectious Diseases, praised the report while cautioning that it will take time to translate the findings into something clinically useful.”It’s a very elegant paper,” he said. “It clearly gives a new window on antibody recognition of flu and neutralization of flu, and it offers potentially a better reagent in terms of inhibiting flu. So it’s all good.”He commented that very recent studies have demonstrated sets of antibodies that bound to multiple influenza A viruses in group 1 or group 2, but not both. “So we were going under the assumption that there was some difference between group 1 and group 2 that antibodies couldn’t distinguish, and clearly this report says otherwise,” he said.Nabel said the study offers some insights about the ways the immune system can approach conserved sites on the hemagglutinin. “The more we understand about how antibodies bind to highly conserved sites, the better off we’ll be. . . . Not to mention that if this proves efficacious in treating infection, that would be another nice implication.”He said it would not be too difficult to produce the antibody in quantity for use as a flu treatment, but added, “I think the real question is whether the pharmaceutical industry sees that there’s enough of a market to do that and whether there is a way to do the kind of clinical trial that could show the efficacy of a flu antibody.”To use the discovery to make a broadly protective vaccine, researchers will need to isolate and exploit the hemagglutinin region targeted by the antibody, Nabel said.”Ideally what you do is refine it further to just the stem region that the antibody is seeing,” he said. “You remove that stem region from the rest of the hemagglutinin, which is, in a way, a distraction to the immune system, and then present that in its mot obvious way to elicit the antibody response.”Nabel said this challenge is “not trivial” and will take years: “I think anything less than 5 years would be aggressive, and everything would have to just roll out without complications, which kind of never happens,” he said. “But there are a lot of people working on the problem, there are a lot of different approaches, and universal flu [vaccine] is high on the radar screen, so I think we’ll be seeing a lot of activity there.”Corti D, Voss J, Gamblin SF, et al. A neutralizing antibody selected from plasma cells that binds to group 1 and group 2 influenza A hemagglutinins. Science 2011 Jul 28 (early online publication) [Abstract]See also: Jul 28 EurekAlert press releaseJul 28 UK Medical Research Council press releaseJan 14 CIDRAP News story “Antibodies from H1N1 patients raise hope for more versatile flu vaccines”last_img read more

Study: Few states advance ethics guidelines for pandemics

first_imgSep 26, 2011 (CIDRAP News) – Few US states have addressed ethical issues surrounding pandemic flu preparedness in recent years, according to a new study in the American Journal of Public Health.Also, the study authors found, states that have tackled the issues have focused rather narrowly, typically on allocating scarce hospital resources, while virtually ignoring such issues as community engagement surrounding isolation and quarantine plans.And having high-level support for ethical issues was key in including them in preparedness plans.Researchers James C. Thomas, PhD, MPH, and Siobhan Young, MPH, from the Gillings School of Global Public Health at the University of North Carolina in 2010 scoured plans from all 50 states and the District of Columbia on flu.gov and the Council of State and Territorial Epidemiologists Web site. They searched headings and subheadings for “ethics” and other relevant keywords. They also searched state health department Web sites for ethics-related material.If a state did have recommendations on ethics preparedness, the researchers followed up with phone calls to gather more specifics.They were assessing progress made after a 2007 survey by Thomas and colleagues, reported in the same journal, found states wanting in the area of ethics and pandemic preparedness. Their current study was funded by the Centers for Disease Control and Prevention (CDC).The new study found that six states—Iowa, Indiana, New Mexico, North Carolina, South Carolina, and Tennessee—had their own guidelines for ethical decision making, and three others referred visitors to CDC guidelines: Utah, West Virginia, and Wisconsin.In addition, four states’ Web sites linked to presentations on ethics and pandemic flu: Iowa, Idaho, Minnesota, and North Carolina. Idaho’s site linked to North Carolina’s presentation, and the Minnesota health department’s site linked to materials on the pandemic flu Web site of the University of Minnesota School of Public Health.The researchers also noted that only 1 of 21 recent state-sponsored pandemic flu summits had an ethics discussion on the agenda—that of North Carolina.Thomas and Young also assessed progress after the Indiana State Department of Health and the Association of State and Territorial Health Officials (ASTHO) convened a national meeting in July 2008 on pandemic flu ethics, which resulted in a list of key issues and steps states should take.They found that seven states made recommendations to further develop ethics-related policies or capacities following this summit. Of these, six states—Iowa, Indiana, Minnesota, North Carolina, New York, and South Carolina—created a task force to make recommendations. The most common recommendations made were related to allocating scarce resources in hospitals.The seventh state, California, listed eight legal and ethical recommendations but had not acted on implementing them and had not designated anyone to follow through on them.In the other six states, task force recommendations were being acted upon.In Minnesota and New York, state health department were reviewing the recommendations, while officials in North and South Carolina were working with medical and hospital boards to implement them.In Indiana, meanwhile, the state health department was nearly finished implementing 1 of 15 recommendations.And after Iowa’s task force developed an ethical framework, the state’s epidemiologists were trained in the new policies and then conducted half-day regional workshops for hospital administrators and public health professionals. They also provided follow-up support, such as help in creating ethics panels.The authors found that the key factor in promoting progress on ethics steps was “unambiguous”: support from the top. The main barrier to progress in California, they said, was “a lack of appreciation for, or priority given to, public health ethics among those receiving the recommendations.”In contrast, the authors said that strong cultures of community involvement in Iowa and corporate citizenship in Minnesota fostered advancement on these issues.The authors conclude, “The sense of urgency for pandemic influenza preparation, including ethical considerations, seems to have passed,” but warn, “In a pandemic of highly pathogenic influenza, there will be little time to sort out complicated issues such as the particular values or needs of minority populations.”They recommend as long-term solutions more teaching of ethics in schools of public health and incorporating ethics into health departments’ criteria of accreditation.They also encourage national organizations like the CDC and ASTHO to disseminate best ethics-related practices, coach state health departments on implementing best practices, and help in identifying gaps and addressing, with funds and expertise, how to fill those gaps with comprehensive guidelines.Thomas JC, Young S. Wake me up when there’s a crisis: progress on state pandemic influenza ethics preparedness. Am J Public Health 2011 (published online Sep 22) [Abstract]last_img read more

Flu Scan for Jun 03, 2013

first_imgShanghai man is 38th H7N9 fatalityA 59-year-old Shanghai man died of H7N9 influenza on May 31, becoming the 38th person to succumb to the infection, according to a report from the Chinese state new agency, Xinhua. The man had been sick for nearly 2 months, the story said.Shanghai, where two of the first three H7N9 cases were reported on Mar 31, has had 33 cases, the report said. Fifteen patients have recovered, 15 died, and 3 are still being treated.Before the death was reported, the official World Health Organization (WHO) count for H7N9 stood at 132 cases and 37 deaths.May 31 Xinhua story Officials report Danish, Dutch H7 avian flu outbreaksOutbreaks of low-pathogenicity H7 avian flu on poultry farms in Denmark and the Netherlands have led to the culling of thousands of birds in both countries to contain the virus, officials reported.In Denmark, authorities culled 1,400 mallards and 12,500 pheasants at a game farm near the city of Viborg, according to a Jun 1 report to the World Organization for Animal Health (OIE). Surveillance turned up low-path H7 in mallards on May 31 during routine surveillance. Jun 1 OIE reportDutch authorities, meanwhile, culled 11,000 chickens after avian flu was detected at a farm in that country, Reuters reported Jun 1. The Dutch Economic Affairs Ministry said the chickens “were believed to have the low pathogenic H7 strain,” according to the story.Officials established a 1-kilometer safety perimeter around the farm and banned the transport of poultry, eggs, and farm products. Eleven other area farms would be tested for the virus, the story said.In 2003 an H7N7 outbreak led to the culling of 30 million birds, about a third of the Dutch poultry flock, Reuters reported.Jun 1 Reuters storylast_img read more

Major analysis sees long-term progress on malaria, TB, HIV

first_imgA long-term analysis published in The Lancet shows that the world has made overall progress in the fight against HIV, tuberculosis (TB), and malaria since governments embraced a related development goal in 2000, although malaria deaths may be higher than recent estimates.Christopher Murray, MD, DPhil, of the University of Washington, and a large international team of researchers conducted a “comprehensive and rigorous” analysis of available data on HIV, malaria, and TB for 188 countries between 1990 and 2013, according to a Lancet press release. They used data from all available sources, including vital registration systems and verbal autopsy data.Governments took on the global challenge of combating the three diseases when they adopted Millennium Development Goal 6 in 2000.Malaria, TB advancesRegarding malaria, the team found that new cases and deaths have declined steadily since 2004 as funding has increased. Global annual incidence peaked in 2003 at 232 million cases and fell by about 29% to 165 million cases in 2013.Malaria deaths peaked at about 1.2 million in 2004 and dropped to 855,000 in 2013, but this was somewhat higher than the World Health Organization’s estimate of 627,000 for that year, the release said.Concerning TB, global prevalence has trended downward, but the number of people living with the disease increased from 8.5 million in 1990 to 12 million in 2013. Annual deaths have dropped from 1.6 million in 2000 to 1.4 million last year. “Overall progress for TB is promising,” the statement says.Declining HIV incidenceAs for HIV, the number of people living with the virus has risen steadily to about 29 million in 2012. Global HIV incidence has declined substantially each year since it peaked in 1997 at 2.8 million cases, but 1.8 million people are still getting infected annually. Countries that still have rising HIV incidence number 101, of which 74 are developing, the release says.HIV deaths peaked at 1.7 million in 2005 and have declined each year since, reaching 1.3 million last year. And in the decade that began in 2002, new infections in children were reduced 62%.”We have seen a huge increase in both funding and the policy attention given to HIV/AIDS, malaria, and TB over the past 13 years, and our findings show that a focus on these specific diseases has had a real impact,” Murray said. “However, much remains to be done and all three diseases continue to be major health challenges in 2013.”See also:Jul 22 Lancet abstractJul 21 Lancet press releaselast_img read more

Ebola activity escalates over large part of epidemic region

first_imgWith the case numbers still rising briskly, the Ebola virus disease (EVD) situation in Sierra Leone and Liberia continues to deteriorate, though activity in Guinea appears to have stabilized, the World Health Organization (WHO) said in its latest outbreak update.West Africa’s illness total grew to 6,263 as of Sep 21, while the number of deaths reached 2,917, the WHO said. The numbers reflect an increase of 420 infections and 114 deaths since the ‘WHO’s last update on Sep 22. Health officials have warned that reported cases and deaths underestimate the true burden of the disease, thought to be two to three times higher than official figures.In Sierra Leone, the number of newly confirmed cases has increased over each of the past 5 weeks, a pattern driven by a sharp increase in the number of infections in Freetown, the country’s capital, along with those in three neighboring districts. New cases in two ongoing hot spots—Kailahun and Kenema—seem to have stabilized, but the WHO said more investigation is needed to confirm that trend.The WHO said cases identified during a 3-day house-to-house sensitization campaign recently conducted in Sierra Leone aren’t reflected in its latest update.Sierra Leone today started quarantining three areas in addition to Kailahun and Kenema, which will affect about 1.2 million additional people, Agence France-Presse (AFP) reported today. The new areas include Port Loko and Bombali districts in the northern part of the country and Moyamba in the south. Combined with the quarantines already in place, roughly a third of Sierra Leone’s population will now be under quarantine, according to the report.Though the official numbers from Liberia show a fall in new cases, the WHO said a lack of new confirmed cases from the capital, Monrovia, where a surge of new infections was recently reported, is at odds with reports on the ground from responders, who have said the situation is deteriorating.In other parts of Liberia, the number of new cases is increasing in Grand Bassa county in the west central part of the country and Nimba county, located in north central Liberia.In its assessment of treatment beds, the WHO said there are still significant gaps in capacity in Sierra Leone and Liberia. A new treatment unit opened in Monrovia last week, while a new tent clinic opened in Liberia’s Bong county.Response teams are still meeting resistance from some local populations, the WHO said. For example, it has received reports that communities near Fassankoni, Guinea, have set up roadblocks to screen response teams. It added that social mobilization teams are targeting young people in the region, many of whom resist traditional leaders and government authority.Pleas for help at UN meeting, World Bank ups commitmentA high-level meeting about Ebola today at the United Nations general assembly prompted some new announcements on response commitments, including another large one from the World Bank, and pleas for countries to do more, so the magnitude resources can match the enormity of West Africa’s epidemic.World Bank president Jim Yong Kim, MD, an infection disease specialist, said the World Bank will put $170 million more toward the effort, nearly doubling its contribution, which now stands at $400 million. He warned that the epidemic could roll back the economic growth African countries have experienced in recent years.”It would be a mistake to settle for a response that we are comfortable with, but won’t stop the disease,” he said at the meeting.President Barack Obama also spoke at today’s UN Ebola meeting, repeating his call for other countries to make major commitments to the response. He said recent progress in the region is encouraging, but ‘it’s clear that it’s not enough. “Right now, everybody has the best of intentions, but people are not putting in the kinds of resources that are necessary to put a stop to this epidemic,” he said.”We know from experience that the response to an outbreak of this magnitude has to be fast and it has to be sustained. It’s a marathon, but you have to run it like a sprint,” Obama said. “And that’s only possible if everybody chips in, if every nation and every organization takes this seriously. Everybody here has to do more.”He said he is hosting 44 nations in Washington, D.C., tomorrow to advance the US Global Health Security Agenda and added that the United States is interested in working with any country that shares a commitment to battle biological threats, including Ebola.Yesterday, US Secretary of State John Kerry announced the appointment of Ambassador Nancy Powell to lead the agency’s Ebola Coordination Unit, which is responsible for outreach to international partners to speed epidemic response.WHO Director-General Margaret Chan, MD, MPH, also pressed for urgent actions from the international community at today’s UN meeting but warned that she expects the outbreak to get worse before things improve.”In a human world, we cannot allow the people of West Africa to suffer so much,” she said. “Excellencies, you have the power to turn this horrific epidemic around.”Basic treatment questioned, travel grants for health providers, infected doctor recoversIn other outbreak developments:Basic interventions such as correcting electrolyte imbalances with intravenous therapy can save more lives in West Africa’s Ebola treatment centers but are being underused, according to an international team of doctors who have been serving in the region with teams from the WHO and Doctors Without Borders (MSF). They aired their view today yesterday in a New England Journal of Medicine article. They said volume depletion is a key clinical feature of EVD and that intravenous catheters, fluids, and electrolyte replacement are readily available but are underused. They noted that extreme serum sodium and potassium abnormalities are commonly found in the rare instances where basic blood biochemistry tests are done. The team pointed out that if clinicians can test for Ebola viral loads in care settings, basic biochemical and hematologic testing should be possible. They acknowledged that the number of clinicians is insufficient, but they added that the skills needed to care for Ebola patients are fundamental ones. “We believe we can and must do better in providing supportive care,” they wrote.The International Society for Infectious Diseases (ISID) is offering travel grants for healthcare workers who are attending the 3-day US Centers for Disease Control and Prevention (CDC) Ebola safety training course, with sessions starting Oct 6 at a Federal Emergency Management Agency center in Anniston, Ala. The course is for health providers who will be traveling to West Africa to help care for Ebola patients. The amount of each grant is $500 for US residents and $1,000 for residents of other countries.Rick Sacra, MD, a SIM missionary who was infected with EVD while working in Liberia, is being discharged from Nebraska Medical Center, where he had been treated since Sep 5, according to a statement from the facility. It said tests by the CDC on two blood samples taken 24 hours apart show that the virus is no longer in his bloodstream. During his stay his doctors treated him with an experimental antiviral, TKM-Ebola, and convalescent serum from Kent Brantly, MD, another American doctor who survived EVD. In a statement today, Sacra praised the hospital staff, colleagues in Liberia, and other groups involved in his care and thanked people who prayed for him. He also urged people to keep their focus on West Africa. “Though my crisis has reached a successful end here, unfortunately the Ebola crisis continues to burn out of control in West Africa,” he said. “Please continue to join us in prayer and in providing resources to the people of Liberia, Sierra Leone, and Guinea.”India’s government today announced a $12 million contribution to help battle Ebola, Press Trust of India (PTI) reported. The health ministry said $10 million is earmarked for the UN director-general’s fund for Ebola and $2 million will go toward the purchase of more personal protective equipmentSee also:Sep 24 WHO Ebola roadmap situation reportSep 25 AFP storySep 25 World Bank press releaseSep 25 Obama speech before high-level UN meetingSep 24 US State Department press releaseSep 25 Margaret Chan commentsSep 24 N Engl J Med perspectiveISID statementSep 25 Nebraska Medical Center press releaseSep 25 PTI storylast_img read more

News Scan for Apr 22, 2016

first_imgTests find evidence for MCR-1 transmission between pets and peoplePet dogs and cats can be colonized with the MCR-1 antibiotic-resistance gene and pass it to people, Chinese researchers reported yesterday in a letter to Emerging Infectious Diseases. Their findings came from an investigation into MCR-1–harboring Escherichia coli isolates from three men hospitalized in a Guangzhou facility’s urology ward toward the end of 2015.After learning that one of the men worked in a pet shop, researchers collected fecal samples from dogs and cats at the store. Of 39 samples from dogs, 4 were positive on polymerase chain reaction testing for MCR-1, and of 14 samples from cats, 2 were positive. Further tests showed that all six of the positive samples were resistant to colistin, polymyxin B, cephalosporin, gentamicin, and ciprofloxacin.Genetic sequencing suggested that one of the human strains was related to four of the isolates from dogs, which suggests possible MCR-1 transmission between dogs and the patient.The researchers said the findings hint that aside from food animals and humans, companion animals may be a reservoir of colistin-resistant E coli, adding more complexity to the evolution of MCR-1 in the community.Another Chinese team first described the MCR-1 gene, which confers resistance to the last-line antibiotic colistin, in November. In the wake of that finding, scientists in several countries have found the gene, sometimes alongside other resistance genes, after examining their sample collections.Apr 21 Emerg Infect Dis letter CDC declares Salmonella outbreak tied to supplement over after 33 casesA multistate outbreak of Salmonella Virchow infections linked to a nutritional supplement powder has grown by 6 cases in a month, to 33, but is now considered over, the Centers for Disease Control and Prevention (CDC) said today.”This outbreak investigation is over,” the agency said in a statement. “However, the recalled Garden of Life RAW Meal Organic Shake & Meal products have a long shelf life and may still be in people’s homes.”The number of affected states since the CDC’s previous update on Mar 23 grew by 3, to 23. And among 27 patients with available information, 6 required hospitalization, which is 1 more than reported previously. Minnesota and Utah reported the most cases, 3 each.Illness-onset dates vary from Dec 5, 2015, to Mar 18. Patients range in age from less than a year to 84, with a median age of 35, and are split about evenly by sex.Garden of Life, of Palm Beach Gardens, Fla., recalled several lots of RAW Meal shakes and meal products on Jan 29, and then expanded the recall on Feb 12. Of 30 outbreak patients interviewed, 28 said they had consumed powdered supplements or meal replacement powders in the week before they fell ill, and 27 specifically mentioned RAW Meal products made by the company.Apr 21 CDC statement New details disclosed in first US measles death since 2003A patient from Port Angeles, Wash., who in April 2015 became the first US measles fatality in 12 years was identified by the Seattle Times yesterday as a 28-year-old womanwho had a rare chronic condition.Catherine J. Montantes never developed a rash, and the infection was detected only on autopsy, the story said. Her identity was not released at the tme of her death.Montantes was likely one of more than 30 people exposed to the virus at Lower Elwha Health Clinic on Jan 29, 2015, after possible contact with a 52-year-old man who may have exposed a total of 149 people to measles. She fell ill 6 weeks after the clinic visit, was hospitalized on Mar 26, and died of measles virus giant-cell pneumonia on Apr 8, 2015.Montantes suffered from dermatomyositis, a rare condition that causes muscle inflammation and weakness. Treatment requires the use of medication that suppresses the immune system, the Times said.Montantes’ mother said she was immunized against measles as a child. Speaking of immunocompromised people, the CDC’s Manisha Patel, MD, said, “Even if they’re vaccinated, they may still be susceptible.”The woman’s death highlights the importance of universal measles vaccination as a way to protect people who are especially vulnerable to infection, the Times said. In 2015, 189 people were infected with measles nationally, with 11 cases diagnosed in Washington. Four cases in the United States have been confirmed this year.Apr 21 Seattle Times article Related Jul 6, 2015, CIDRAP News item Plague diagnosed in 3 Wyoming catsThe Wyoming Department of Health (WDH) yesterday confirmed plague infections in three Park County cats.All three cats lived in Cody, Wyo., in the vicinity of South Fork Road. Veterinarians confirmed the plague diagnoses between Apr 12 and Apr 20, the WDH said. The agency didn’t say whether the cats survived.”Plague is a serious bacterial infection that can be deadly for pets and for people if not treated promptly with antibiotics,” said Karl Musgrave, DVM, MPH, Wyoming state public health veterinarian. Cats and dogs can contract Yersinia pestis, the bacterium that causes plague, from flea-infested rodents and transmit the disease to people, though only six people have been diagnosed with plague in Wyoming, where Y pestis is pervasive, since 1978.Symptoms of plague in animals include enlarged lymph nodes, swelling in the head and neck area, fever, chills, lack of energy, cough, vomiting, diarrhea, and dehydration. Plague symptoms in people are similar, with the addition of extreme exhaustion, headache, difficulty breathing, and abdominal pain.Preventive methods include avoiding contact with rodents, using flea repellent, and seeking treatment of animals displaying concerning symptoms, the WDH said.Apr 21 WDH press release Technique for removing malaria parasites from blood shows promiseA technology for reducing parasites in blood may aid in reducing malaria cases transmitted by transfusions, according to a study yesterday in The Lancet.Researchers from the the United Kingdom and Ghana evaluated the effectiveness of the Mirasol system by using it to treat whole blood transfused to 214 anemic patients at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from Mar 12 to Nov 7, 2014. Mirasol uses ultraviolet light and riboflavin to reduce parasite counts in blood.Approximately half of Ghanaian blood donations have detectable levels of Plasmodium falciparum, the parasite that most commonly causes malaria in the region, and 14% to 28% of transfusion recipients in Ghana become infected, the authors said.Of 214 patients who completed the African Investigation of the Mirasol System (AIMS) trial, 107 received Mirasol-treated blood transfusions, and the remainder received untreated blood. One-quarter of all transfusions contained malaria parasites. Malaria was transmitted to 1 of 28 people (4%) exposed to parasites from Mirasol-treated blood and to 8 of 37 (22%) patients exposed to parasites in untreated blood, the authors said.The group receiving Mirasol-treated blood had fewer allergic reactions (5%) than the untreated group (8%), possibly because the technique inactivates white blood cells. Thirteen deaths occurred during the study, though the authors attributed deaths to severe pre-existing illnesses and not to transfusion effects.Parasite reduction technologies for blood transfusions could lead to lower cases and costs related to malaria in sub-Saharan Africa, the authors said.Apr 21 The Lancet studylast_img read more

Stewardship / Resistance Scan for May 29, 2019

first_imgStudy finds prolonged courses of antibiotics common at dischargeA multicenter study looking at total durations of antibiotic exposure related to hospitalization indicates that more than a third of hospital-related antibiotic exposure occurs after patients are discharged from the hospital, researchers from Duke and the Centers for Disease Control and Prevention (CDC) reported yesterday in Infection Control and Hospital Epidemiology.For the retrospective study, researchers collected and reviewed electronic data on inpatient and discharge antibiotic prescribing from three pilot hospitals in the southeastern United States from April to September 2016. The primary metric of total duration was defined as the inpatient length of therapy (LOT) plus postdischarge LOT. Postdischarge prescription durations were calculated from electronic discharge prescriptions (e-scripts).A total of 45,693 admitted patients were evaluated over the 6-month study period. Of these admissions, 23,447 (51%) received inpatient antibiotics and 7,442 (16%) received e-scripts at discharge. E-scripts were prescribed for 348 (5%) admitted patients who did not receive antibiotics as an inpatient. The postdischarge LOT among admissions with discharge antimicrobials was median 8 days, with peaks at 5, 7, 10, and 14 days, and postdischarge days accounted for 38% of antimicrobial exposure days related to hospitalization. And because the estimates of postdischarge antibiotic days were subject to missing data based on avoidance of the electronic system in certain scenarios, the researchers say they could be underestimates.The authors of the study suggest errors in the ordering process, electronic system defaults for outpatient prescriptions, and diagnostic uncertainty are among the reasons for excessive antibiotic durations on discharge.”Our findings suggest that prolonged courses of antibiotic therapy are common at discharge and may contribute to unnecessary antimicrobial exposure in patients,” they conclude. “ASPs [antibiotic stewardship programs] that target discharge prescription duration and appropriateness have an opportunity to reduce unnecessary antimicrobial use and its resultant harms. These activities should be incorporated to hospital quality improvement initiatives focused at improving safety at transitions of care.”May 28 Infect Control Hosp Epidemiol study Carbapenemase-producing Enterobacteriaceae cases rise in Hong KongThe number of patients in Hong Kong hospitals diagnosed with carbapenemase-producing Enterobacteriaceae (CPE) more than doubled from 2017 to 2018, according to a story yesterday in the South China Morning Post.Dr. Raymond Lai Wai-man, chief infection control officer for Hong Kong’s Hospital Authority, told the paper that the number of inpatients diagnosed with CPE, which is resistant to most antibiotics and can cause severe infections, rose from 473 in 2017 to 972 in 2018. To address the increase in cases and a rise in other multidrug-resistant organisms, Lai said the Authority is introducing a 5-point plan that includes more active screening for patients who’ve been hospitalized outside Hong Kong in the last 12 months, patients who’ve spent 14 days or more in the hospital, and patients who have unexplained diarrhea.Lai said Hong Kong hospitals are also using rapid diagnostic tests to detect the superbug more quickly.”This allows for quicker medical responses, such as single room isolation in hospitals, with the room wiped clean of bacteria, and nurses dressed in protective gowns and gloves when entering and leaving it,” he said.The Hospital Authority has also implemented an antibiotic stewardship program to monitor antibiotic prescribing at Hong Kong hospitals.In another story from the same paper, Dr. Ho Pak-Leung, a microbiology professor at Hong Kong University, attributed the surge in CPE infections to overcrowding in the city’s public hospitals. “The greatest challenge is the crowded environment in public hospitals, where during peak hours there can be zero distance between beds,” Ho told the paper.May 28 South China Morning Post main story May 28 South China Morning Post story quoting Ho Study: Only 58% of STI antimicrobial prescriptions for teens filledA research letter yesterday in JAMA Pediatrics says that only 57.7% of antimicrobial drug prescriptions for sexually transmitted infections (STIs) diagnosed in teens visiting emergency departments (EDs) were filled, confirming previous studies that suggest adolescents have an alarmingly low rate of STI treatment adherence.The retrospective study was based on visits to two pediatric EDs affiliated with Children’s National Medical Center in 2016 and 2017. The study included 696 ED visits and 208 teens ages 13 to 19 receiving outpatient prescriptions for antimicrobial treatment for cervicitis or urethritis (31.2%) or pelvic inflammatory disease (68.8%). Of those prescriptions, 57.7% were filled.The only factor associated with prescription filling was hospital admission (73.7% vs 54.1%; adjusted odds ratio, 2.3; 95% confidence interval, 1.0-5.0). “Admitted patients likely experience more severe symptoms and, thus, may have increased motivation to fill their prescriptions and achieve symptom relief,” the authors said.In a press release on the study, Monika K. Goyal, MD, assistant chief of Children’s Division of Emergency Medicine and Trauma Services at Children’s National Hospital said the low fill rate may be related to circumstances.”Teenagers may face a number of hurdles when it comes to STI treatment, including out-of-pocket cost, access to transportation, and confidentiality concerns,” she said.  May 28 JAMA Pediatr letter May 28 Children’s National Hospital press releaselast_img read more

News Scan for May 31, 2019

first_imgCDC: 10 more people infected with Salmonella linked to hedgehogsThe Centers of Disease Control and Prevention (CDC) yesterday announced 10 more cases of Salmonella Typhimurium illness linked to pet hedgehogs, and 6 more states are affected. The new cases raise the outbreak total to 27 cases in 17 states.Two people have been hospitalized in this outbreak, but there have been no reported deaths. Forty-two percent of cases involve children aged 12 or younger, the CDC said. In interviews, 90% of patients said they had contact with a hedgehog prior to symptom onset. Illnesses were reported from Oct 22, 2018, to Apr 8, 2019.”The outbreak strain of Salmonella Typhimurium was identified in samples collected from 10 hedgehogs in Minnesota, including 5 hedgehogs from the homes of five ill patients. A common source of hedgehogs has not been identified,” the CDC said.Minnesota has the most recorded cases, with 5, followed by Missouri (3), and California, Indiana, Virginia, and Wyoming with 2 each. Eleven states have reported 1 case.The CDC recommends good hygiene when handling pet hedgehogs and says to avoid kissing or snuggling the animals. May 30 CDC update CDC records 2 new pediatric flu deaths, 1 variant H1N1 caseToday the CDC recorded 2 new pediatric deaths from influenza in its weekly FluView report, raising the 2018-2019 total to 113. The agency also notes an infection with a variant strain.The rate of influenza-like-illness (ILI) remained at 1.5%, well before the national baseline of 2.2%, signaling flu is circulating at low levels typically seen in summer months. All 10 regions reported ILI activity below their region-specific baseline levels.”CDC continues to recommend vaccination as long as flu viruses are circulating until all vaccine expires at the end of June and prompt antiviral treatment in people with flu symptoms who are very sick or who are at high risk of developing serious flu illness,” the CDC said in a summary statement last week.The CDC said the variant influenza A strain, H1N1v, was recorded in a patient in Michigan. The patient is older than 65, has no history of swine exposure, and has fully recovered. This is the first H1N1v case recorded in the United States in 2019. May 31 CDC FluView report May 24 CDC FluView summary  H1N2 seasonal flu reassortant infects Danish womanEuropean health officials recently reported a novel H1N2 infection in Denmark, a reassortment involving two seasonal flu strains: the 2009 H1N1 virus and H3N2. The original source of the report was the European Union Early Warning and Response System (EWRS), according to a post yesterday on Avian Flu Diary (AFD), an infectious disease news blog.The latest novel H1N2 case marks Europe’s third in just over a year; earlier cases were detected in March 2018 in the Netherlands and in February 2019 in Sweden.In the Danish case, the sample was collected on Apr 11 as part of routine surveillance. The patient is a 74-year-old unvaccinated woman who had traveled by plane to Croatia, then returned home after also visiting Bosnia and Herzegovina. Her symptoms began after returning to Denmark on Apr 7, and she was hospitalized on Apr 11. She was discharged on Apr 13. It’s not clear where she contracted the virus. No other cases have been detected in other contacts or fellow travelers.A genetic analysis of the novel H1N2 virus found that has a hemagglutinin gene from the 2009 H1N1 virus and a neuraminidase gene from H3N2. No evidence of coinfection was found.Last year, the US Centers for Disease Control and Prevention (CDC) said in a risk assessment that the reassortant H1N2 virus is similar to other seasonal flu viruses and that current seasonal flu vaccines are likely to offer some protection. It also said the virus doesn’t show any markers to suggest resistance to neuraminidase inhibitors.May 30 AFD post Feb 6 CIDRAP News scan “Rare H1N2 flu reassortant reported in Swedish adult” Mar 23, 2018, CIDRAP News scan “Dutch officials report reassortant seasonal flu H1N2 infection” Polio cases confirmed in Pakistan, SomaliaPakistan has two more wild poliovirus type 1 (WPV1) cases, and Somalia has one vaccine-derived polio case, according to the Global Polio Eradication Initiative’s (GPEI) latest weekly situation report today.Pakistan has now recorded 19 WPV1 case in 2019, an increase from 2018’s total of 12. The two most recent case-patients, from North Waziristan and Khyber Pakhtunkhwa, experienced symptom onset on May 3 and 5, respectively.In Somalia, the vaccine-derived case of circulating poliovirus type 2 (cVDPV2) was recorded in Togdher, with an onset of paralysis on Apr 22. This is the second cVDPV2 case recorded in Somalia this year.In addition to the three new cases, the GPEI also reported new positive environmental samples collected in Cameroon and Iran, but no associated cases of paralysis in those countries. May 31 GPEI report Almost 7,000 sickened with dengue in Honduran outbreakDoctors without Borders (MSF) is ramping up its efforts in Honduras, as the country has tallied 6,883 cases of dengue fever since the first of the year.Sixty-one percent of cases have been recorded in Honduras’s Cortes department, and the nearly 7,000 cases include 2,111 cases of severe dengue, MSF said in a press release.”The behaviour of this epidemic is unusual compared to previous dengue outbreaks,” says Deysi Fernandez, MD, MSF’s medical activity manager for the dengue response in Honduras. “This epidemic fluctuates, with a high number of cases some weeks and a decrease in other weeks.”MSF said it is engaging in community education and extensive mosquito control. May 29 MSF press releaselast_img read more