Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/10/news-scan-oct-04-2019
News Scan for Oct 04, 2019
Polio in Pakistan, elsewhere; Resistant urinary tract infections; Flu vaccine and serious disease; Global rubella vaccine uptake
Filed Under:
Polio; Antimicrobial Stewardship; Influenza Vaccines; Rubella
Amid more polio cases, WHO says disease is still public health emergency
The World Health Organization said yesterday that ongoing transmission of wild poliovirus in Pakistan and Afghanistan, as well as a rash of new vaccine-derived cases in Africa and Asia, means polio is still a public health emergency of international concern (PHEIC).
"The Committee is gravely concerned by the significant further increase in WPV1 cases globally to 73 in 2019 year to date, compared to 15 for the same period in 2018, with most of the increase due to the ongoing outbreaks in Pakistan," the WHO said a statement on the 22nd international health regulations emergency committee meeting on poliovirus.
The meeting was held last week, and the committee unanimously agreed to the continuation of PHEIC status.
In its latest weekly update, the Global Polio Eradication Initiative (GPEI) said Pakistan recorded three new cases of wild poliovirus this week, and the Democratic Republic of the Congo (DRC), Ghana, and the Philippines each recorded one case of circulating vaccine-derived poliovirus type 2 (cVDPV2).
2019 has had almost triple the number of cases of wild poliovirus than 2018—85 to date, compared with 2018's total of 33. So far this year, officials have confirmed 88 vaccine-derived polio cases; last year, the total reached 104.
Oct 3 WHO statement
Oct 3 GPEI report
US hospital data shows rise in resistant UTIs in older patients
An analysis of US hospital data shows that antibiotic resistance in older patients with urinary tract infections (UTIs) nearly doubled from 2009 to 2016, researchers reported yesterday in PLoS One.
In a retrospective observational study using data from the National Inpatient Sample—Healthcare Cost and Utilization Project, researchers from Queens University Belfast, in Northern Ireland, looked at episodes of care involving patients over 65 with a primary diagnosis of UTI. The primary outcomes were the proportion of admissions with antibiotic resistance (based on ICD-9 and ICD-10 codes), factors associated with higher antibiotic resistance, and the impact of antibiotic resistance on all-cause inpatient mortality, discharge destination, length of stay and hospital expenditures.
Over the 8-year period, a total of 546,305 eligible admissions with a primary diagnosis of UTIs were included in the study. The proportion of antibiotic resistance among inpatient episodes those aged 65+ with a primary diagnosis of UTIs increased from 3.64% in 2008 to 6.88% in 2016 (P < 0.001). Factors associated with higher likelihood of having an antibiotic-resistant UTI included higher age-adjusted Deyo-Charlson Comorbdity Index (ACCI) score (odds ratio [OR], 1.06, 95% confidence interval [CI], 1.06 to 1.07) and admissions to hospitals in urban areas (OR, 1.07; 95% CI, 1.00 to 1.15).
Admissions with antibiotic resistant UTIs were more likely to be discharged to healthcare facilities (e.g. care homes) compared to those without antibiotic resistance (OR, 1.81; 95% CI, 1.75 to 1.86), had increased length of stay (1.12 days longer; 95% CI, 1.06 to 1.18), and had higher hospital costs ($1,259 USD; 95%CI, $1,178 to $1,340). Resistance due to methicillin-resistant Staphylococcus aureus was specifically associated with increased hospital mortality (OR, 1.33; 95% CI, 1.15 to 1.53).
"Our findings indicate a considerable impact of this issue on clinical and economic outcomes," the authors of the study write. "These relationships and their implications for the care homes to which patients are likely discharged warrant further research."
Oct 3 PLoS One study
Two studies demonstrate flu vaccine protection against serious outcomes
Two studies presented today at IDWeek in Washington, DC, demonstrate good protection for the flu vaccine against hospitalization for influenza and other serious outcomes, including death.
The first study found that the vaccine cut the risk of children being hospitalized with the flu by 46%, and the second found a 36% reduction in deaths and a lower risk of other serious conditions like pneumonia in adults infected by one strain of the virus.
For the pediatric study, researchers analyzed data from 3,441 patients in seven US pediatric hospitals in the 2016-17 and 2017-18 flu seasons. They found a 48% vaccine effectiveness (VE) against hospitalization for flu in the early season and 45% VE in the second, for a combined VE of 46%. VE against H3N2, which has been associated with more severe flu, was only 30% over the two seasons.
The other study involved 43,608 US adults identified through the US Influenza Hospitalization Surveillance Network. It covered the flu seasons from 2013-14 through 2017-18.
For the H1N1 strain only, investigators found flu vaccination was tied to a 19% and 28% reduction of intensive care unit (ICU) admission in adults 18 to 64 and 65 and older, respectively, and a 34% and 46% lower risk of mechanical ventilation, respectively, in those two age-groups. In adults 18 to 64 years—and again, for the H1N1 strain—the odds of contracting pneumonia dropped 17%, and death rates were 36% lower, with shorter ICU stays also tied to flu vaccination.
The lower risk of severe outcomes did not hold for the H3N2 strain or for influenza B strains.
"While flu vaccines vary in how well they work and some people who get vaccinated still get sick, this study provides more evidence that getting vaccinated can reduce the severity of the illness," said Shikha Garg, MD, MPH, lead author of the second study, in an IDWeek news release.
Oct 4 IDWeek abstract of pediatric study
Oct 4 IDWeek abstract of adult study
Oct 4 IDWeek news release
Study shows 69% global pertussis vaccine coverage
For the first time in history, more than half the children in the world are protected against rubella ("German measles"), but gaps remain, according to a study today in the Weekly Epidemiological Record.
According to the report, conducted by researchers with the WHO and US Centers for Disease Control and Prevention (CDC), who analyzed 2018 data, scientists are seeing significant progress in rubella vaccination coverage.
In the previous WHO/CDC rubella elimination study, covering 2016 data, an estimated 47% of infants were protected against rubella. In 2018, the figure had risen to 69%.
But 26 countries are yet to introduce the rubella vaccine, leaving 3 in 10 children globally without access. They note that the greatest gaps persist in Africa, where about 6 in 10 countries have not yet made the vaccine routinely available to infants.
"Stopping rubella for good means not only introducing the vaccine, but also building the strong immunization and healthcare systems that will ensure no child misses out on essential vaccinations,” says the head of WHO's immunization programme, said Kate O'Brien, MD, MPH, in a WHO press release. "It will take political and community leadership and commitment to ensure elimination targets are set, achieved, and sustained, so that rubella can become a disease of the past, in every part of the world."
Oct 4 Wkly Epidemiol Rec report
Oct 4 WHO press release
News Scan for Oct 04, 2019
Polio in Pakistan, elsewhere; Resistant urinary tract infections; Flu vaccine and serious disease; Global rubella vaccine uptake
Filed Under:
Polio; Antimicrobial Stewardship; Influenza Vaccines; Rubella
Amid more polio cases, WHO says disease is still public health emergency
The World Health Organization said yesterday that ongoing transmission of wild poliovirus in Pakistan and Afghanistan, as well as a rash of new vaccine-derived cases in Africa and Asia, means polio is still a public health emergency of international concern (PHEIC).
"The Committee is gravely concerned by the significant further increase in WPV1 cases globally to 73 in 2019 year to date, compared to 15 for the same period in 2018, with most of the increase due to the ongoing outbreaks in Pakistan," the WHO said a statement on the 22nd international health regulations emergency committee meeting on poliovirus.
The meeting was held last week, and the committee unanimously agreed to the continuation of PHEIC status.
In its latest weekly update, the Global Polio Eradication Initiative (GPEI) said Pakistan recorded three new cases of wild poliovirus this week, and the Democratic Republic of the Congo (DRC), Ghana, and the Philippines each recorded one case of circulating vaccine-derived poliovirus type 2 (cVDPV2).
2019 has had almost triple the number of cases of wild poliovirus than 2018—85 to date, compared with 2018's total of 33. So far this year, officials have confirmed 88 vaccine-derived polio cases; last year, the total reached 104.
Oct 3 WHO statement
Oct 3 GPEI report
US hospital data shows rise in resistant UTIs in older patients
An analysis of US hospital data shows that antibiotic resistance in older patients with urinary tract infections (UTIs) nearly doubled from 2009 to 2016, researchers reported yesterday in PLoS One.
In a retrospective observational study using data from the National Inpatient Sample—Healthcare Cost and Utilization Project, researchers from Queens University Belfast, in Northern Ireland, looked at episodes of care involving patients over 65 with a primary diagnosis of UTI. The primary outcomes were the proportion of admissions with antibiotic resistance (based on ICD-9 and ICD-10 codes), factors associated with higher antibiotic resistance, and the impact of antibiotic resistance on all-cause inpatient mortality, discharge destination, length of stay and hospital expenditures.
Over the 8-year period, a total of 546,305 eligible admissions with a primary diagnosis of UTIs were included in the study. The proportion of antibiotic resistance among inpatient episodes those aged 65+ with a primary diagnosis of UTIs increased from 3.64% in 2008 to 6.88% in 2016 (P < 0.001). Factors associated with higher likelihood of having an antibiotic-resistant UTI included higher age-adjusted Deyo-Charlson Comorbdity Index (ACCI) score (odds ratio [OR], 1.06, 95% confidence interval [CI], 1.06 to 1.07) and admissions to hospitals in urban areas (OR, 1.07; 95% CI, 1.00 to 1.15).
Admissions with antibiotic resistant UTIs were more likely to be discharged to healthcare facilities (e.g. care homes) compared to those without antibiotic resistance (OR, 1.81; 95% CI, 1.75 to 1.86), had increased length of stay (1.12 days longer; 95% CI, 1.06 to 1.18), and had higher hospital costs ($1,259 USD; 95%CI, $1,178 to $1,340). Resistance due to methicillin-resistant Staphylococcus aureus was specifically associated with increased hospital mortality (OR, 1.33; 95% CI, 1.15 to 1.53).
"Our findings indicate a considerable impact of this issue on clinical and economic outcomes," the authors of the study write. "These relationships and their implications for the care homes to which patients are likely discharged warrant further research."
Oct 3 PLoS One study
Two studies demonstrate flu vaccine protection against serious outcomes
Two studies presented today at IDWeek in Washington, DC, demonstrate good protection for the flu vaccine against hospitalization for influenza and other serious outcomes, including death.
The first study found that the vaccine cut the risk of children being hospitalized with the flu by 46%, and the second found a 36% reduction in deaths and a lower risk of other serious conditions like pneumonia in adults infected by one strain of the virus.
For the pediatric study, researchers analyzed data from 3,441 patients in seven US pediatric hospitals in the 2016-17 and 2017-18 flu seasons. They found a 48% vaccine effectiveness (VE) against hospitalization for flu in the early season and 45% VE in the second, for a combined VE of 46%. VE against H3N2, which has been associated with more severe flu, was only 30% over the two seasons.
The other study involved 43,608 US adults identified through the US Influenza Hospitalization Surveillance Network. It covered the flu seasons from 2013-14 through 2017-18.
For the H1N1 strain only, investigators found flu vaccination was tied to a 19% and 28% reduction of intensive care unit (ICU) admission in adults 18 to 64 and 65 and older, respectively, and a 34% and 46% lower risk of mechanical ventilation, respectively, in those two age-groups. In adults 18 to 64 years—and again, for the H1N1 strain—the odds of contracting pneumonia dropped 17%, and death rates were 36% lower, with shorter ICU stays also tied to flu vaccination.
The lower risk of severe outcomes did not hold for the H3N2 strain or for influenza B strains.
"While flu vaccines vary in how well they work and some people who get vaccinated still get sick, this study provides more evidence that getting vaccinated can reduce the severity of the illness," said Shikha Garg, MD, MPH, lead author of the second study, in an IDWeek news release.
Oct 4 IDWeek abstract of pediatric study
Oct 4 IDWeek abstract of adult study
Oct 4 IDWeek news release
Study shows 69% global pertussis vaccine coverage
For the first time in history, more than half the children in the world are protected against rubella ("German measles"), but gaps remain, according to a study today in the Weekly Epidemiological Record.
According to the report, conducted by researchers with the WHO and US Centers for Disease Control and Prevention (CDC), who analyzed 2018 data, scientists are seeing significant progress in rubella vaccination coverage.
In the previous WHO/CDC rubella elimination study, covering 2016 data, an estimated 47% of infants were protected against rubella. In 2018, the figure had risen to 69%.
But 26 countries are yet to introduce the rubella vaccine, leaving 3 in 10 children globally without access. They note that the greatest gaps persist in Africa, where about 6 in 10 countries have not yet made the vaccine routinely available to infants.
"Stopping rubella for good means not only introducing the vaccine, but also building the strong immunization and healthcare systems that will ensure no child misses out on essential vaccinations,” says the head of WHO's immunization programme, said Kate O'Brien, MD, MPH, in a WHO press release. "It will take political and community leadership and commitment to ensure elimination targets are set, achieved, and sustained, so that rubella can become a disease of the past, in every part of the world."
Oct 4 Wkly Epidemiol Rec report
Oct 4 WHO press release