Posted in wsdttjqajujb

NEWS SCAN: West Nile outbreak grows, widespread dengue in India, yellow fever in Sudan

first_imgNov 7, 2012US West Nile cases top 5,000, including 228 deathsOver the past week the US Centers for Disease Control and Prevention (CDC) received reports of 163 more West Nile virus (WNV) infections along with 5 more deaths, pushing the nation’s total this year to 5,054 cases and 228 deaths, according to an update today. The pace of new infections and deaths is up from the previous week’s, when 116 new cases and 4 new fatalities were reported. So far 2,559 of the WNV cases involved the neuroinvasive form of the disease. The CDC reiterated that this year’s WNV season is the worst since 2003. Nearly 80% of cases have been from 12 states, with Texas bearing the largest burden, reporting a third of all infections.Nov 7 CDC WNV case chartIn a related development, Maine officials recently reported the state’s first-ever WNV case, a patient from Cumberland County who started having symptoms on Oct 1, which included fever, encephalitis, and meningitis, according to an Oct 31 statement from the Maine Department of Health and Human Services (MDHHS). The patient had not traveled during the exposure period, and officials consider the case to be locally acquired.Oct 31 MDHHS press releaseExperts say dengue is widespread and vastly underreported in IndiaDengue virus infections are widespread in India, and extreme underreporting of cases makes the problem worse, according to experts quoted in the New York Times yesterday. The government counts only lab-confirmed cases reported in public hospitals, which totaled 30,002 for this year through October, compared with 18,860 cases for all of 2011. Scott Halstead, MD, a tropical disease expert, estimated the true number of annual cases at 37 million, with 227,500 hospitalizations. Manish Kakkar, MD, MPH, a specialist at the Public Health Foundation of India, said India’s “massive underreporting of cases” has contributed to the disease’s spread. Other experts told the Times that India’s failure to build an adequate dengue surveillance system has hindered awareness of the illness’s vast extent, discouraged efforts to clean up its sources, and slowed the quest for a vaccine. A recent, as yet unpublished study found that dengue is about as prevalent in West Bengal as in Thailand, where almost everyone is infected in childhood, the story said. It noted that up to 80% of dengue infections cause only mild symptoms, but 20% are more serious and 1% are life-threatening. Four strains of dengue viruses exist, and a person who has a second infection with a different strain than the first may suffer a serious illness. “The great danger of having hundreds of millions of people in India with undiagnosed and unacknowledged primary infections is that a sudden shift in the circulating dengue strain could cause a widespread increase in life-threatening illnesses,” the story said.Nov 6 Times storyYellow fever outbreak in Sudan grows to 194 cases, 67 deathsSuspected cases of yellow fever in Sudan have reached 194, including 67 deaths, according to an update yesterday from the World Health Organization’s (WHO’s) eastern Mediterranean regional office. The outbreak has affected 17 localities in Central, South, West, and North Darfur states and now has a case-fatality fate of 34.5%, the office said. The outbreak, which began in late September, has expanded by 91 cases and 25 deaths since the WHO’s last update on Nov 2. About 83% of cases are from Central Darfur. WHO officials are working with Sudanese authorities to vaccinate people and to train more than 225 health workers on surveillance, case management, outbreak investigation, and infection prevention and control.Nov 6 WHO updateNov 2 WHO updatelast_img read more

Posted in qfatsaijsead

Meningitis outbreak investigators say quick work paid off

first_img So far 424 infections and 31 deaths, most of them involving the fungus Exserohilum rostratum, have been linked to three recalled lots of contaminated steroids from NECC, the US Centers for Disease Control and Prevention (CDC) said in an update today. The total reflects an increase of 5 infections and 1 death since the CDC’s last update on Nov 5. The number of affected states remained at 19, and the number of peripheral joint infections stayed at 10. When investigators explored the details of the drugs the patients received, they found that in one clinic, the age of the vials seemed to be associated with the infection rate, and they suggested that contamination could have increased over time, with fungal levels higher in the older vials. The group also found a possible link between higher infection rates and the volume of drug administered. One of the most striking features of the cases was the high incidence of strokes, which were more common early in the outbreak, the group noted. They said that stroke incidence dropped off as fungal meningitis infections were identified earlier, prompting aggressive therapy earlier in the illness course. Nov 7 N Engl J Med abstract The group’s report on the first 66 case-patients in the Tennessee also offers findings about exposure to the contaminated steroids, the clinical course of infections, and treatment. They published the details of the investigation yesterday in an early online report from the New England Journal of Medicine (NEJM). The outbreak’s index patient was a Tennessee man in his 50s who died from Aspergillus fumigatus meningitis after receiving an epidural injection of the steroid methylprednisolone acetate produced by New England Compounding Center (NECC). The doctors who treated that patient described his infection in an Oct 19 NEJM case report. Nov 7, 2012 (CIDRAP News) – A public health investigation into an unusual fungal meningitis death in Tennessee quickly uncovered other related cases and expedited detection and treatment that probably saved lives, while drawing national attention to the problem, according to a report yesterday from some of the state officials who worked on the probe. As of Oct 19, investigators had found 66 patients who met the fungal meningitis case definition. Their median age was 69. While A fumigatus was confirmed in clinical samples from the index patient, E rostratum was identified in 21 of the cases. The median time between injection and symptom onset was 18 days. Authorities found no obvious source of environmental contamination at the clinic, and by Sep 25, they identified a total of eight possible case-patients, all with connections to the clinic. Multiple common products were used for the patients, including preservative-free methylprednisolone acetate from NECC. In hopes of identifying other sick patients, Tennessee officials asked colleagues in Massachusetts to help identify other facilities that had received potentially contaminated steroid injections. “Stroke did not develop in any patients in this report in whom therapeutic doses of antifungal medications were instituted within 48 hours after the initial presentation,” they wrote, adding that all eight of the Tennessee deaths occurred in patients who received minimal, no, or delayed treatment.center_img “Maintaining a strong public health infrastructure is critical to ensuring that there is capacity to investigate such outbreaks quickly and effectively,” the authors concluded. The aggressive public health response to the initial case triggered the identification of the multistate outbreak and a rapid recall of the products, underscoring the importance of close collaboration between public health and the medical community and the need to adequately support public health systems. According to the new NEJM report, a clinician reported the A fumigatus infection to the Tennessee Department of Health (TDH) on Sep 18, and the department launched an epidemiologic investigation that identified other puzzling meningitis cases in healthy adults who had received epidural steroid injections at the same clinic as the first patient. See also: Among 13 patients who had strokes, 8 initially presented with posterior circulation stroke, and strokes were involved in 7 of the 8 deaths in the Tennessee patients. The following day, NECC recalled three lots of methylprednisolone acetate, which had been sent to 76 facilities in 23 states. The TDH activated its emergency operations center and launched a larger investigation to find patients who had been exposed to the drug. Nov 7 CDC fungal meningitis outbreak update Oct 19 CIDRAP News story “Report describes case that launched meningitis outbreak probe”last_img read more

Posted in akidgsvmlsry

With new rules, few public health labs to handle riskiest agents

first_imgDec 13, 2012 (CIDRAP News) – With tougher security requirements set to take effect next April, few state public health laboratories plan to maintain stocks of certain pathogens considered most tempting to bioterrorists, according to the Association of Public Health Laboratories (APHL) and officials with state labs.Pathogens such as Bacillus anthracis, Ebola virus, and several others have been designated “Tier 1″ agents on the Department of Health and Human Services’ (HHS’s) list of select agents and toxins. Come Apr 3, labs that want to keep samples of Tier 1 agents on hand will have to meet special rules for personnel screening and physical security, on top of those already required by the Select Agent Program.Some lab directors describe the extra requirements as burdensome.A recent informal survey by the APHL suggested that only a few labs will take the trouble to register as Tier 1 labs, said Chris N. Mangal, MPH, the association’s director of public health preparedness and response.”We did a quick survey, and what we’ve seen so far is only about six of our labs indicated they’d have an interest in pursuing Tier 1 registration,” Mangal told CIDRAP News. She said all six were state labs.Labs participating in the HHS Select Agent Program were supposed to notify the agency last week whether they planned to seek Tier 1 registration. If they don’t go that route, they will have to get rid of their Tier 1 samples by April.Mangal and some other lab experts say that with only a few labs holding Tier 1 registration, the nation’s lab capacity could fall short in the event of another bioterrorist incident like the anthrax letter attacks of 2001. Others, though, are less concerned.Labs not registered to handle Tier 1 agents will still be able to test for and detect them, with the help of control strains that are not dangerous, Mangal and others said. But if they find one of the agents, they will have only 7 days to either destroy the sample or ship it to a lab with Tier 1 credentials.The 7-day deadline means those labs will have difficulty doing further analysis of Tier 1 agents, such as DNA fingerprinting, which would probably be required if deliberate release of an agent was suspected.”I don’t believe that the Tier 1 select agent requirements will limit their [labs’] ability to perform the initial testing for threat agents,” said Mangal. “Where this new regulation becomes a problem is the additional characterization that is typically needed for evidentiary purposes.”Besides Ebola virus and B anthracis, which causes anthrax, Tier 1 agents are Francisella tularensis (the cause of tularemia), Marburg virus, variola major and minor viruses (smallpox), Yersinia pestis (plague), Clostridium botulinum and botulinum toxin (botulism), Burkholderia mallei (glanders), and Burkholderia pseudomallei (melioidosis).Mangal said that during the 2001 anthrax episode, the Laboratory Response Network (LRN), which then included about 60 labs, ran more 1 million tests. She wonders if, in the event of a similar emergency, the burden of testing would fall mostly on the Centers for Disease Control and Prevention (CDC) in Atlanta and the Department of Homeland Security’s National Biodefense Forensic Analysis Center in Maryland.”Back in 2001 we saw how many samples came through and the vast amount of surge and storage space required,” she said. “What would happen if something like that happened again? . . . A surge in samples could possibly overwhelm the limited labs that would be at Tier 1.”The LRN for Biological Threat Preparedness and Response, which now includes about 165 labs, is designated by the CDC and APHL to respond to potential bioterrorism events and other infectious disease threats. Mangal said the APHL worked successfully to ensure that LRN members would not have to qualify for Tier 1 in order to stay in the network.There have been indications that HHS and the US Department of Agriculture, which administers a separate Select Agent Program, might suspend some of the Tier 1 rules in an emergency, allowing labs to keep agents longer, according to Mangal.CDC spokesman Jason McDonald agreed that that could happen. He said the federal Bioterrorism Act allows the HHS secretary to exempt a facility from the Select Agent Program regulations if the step is judged necessary because of a public health emergency.Rules resentedOne state lab official who resents the new Tier 1 rules is Joanne Bartkus, PhD, director of the Minnesota Department of Health’s (MDH’s) Public Health Laboratory in St. Paul.Bartkus said her lab plans to seek Tier 1 registration. “We felt it was important to maintain the capability to work with these agents,” she said. “We felt that keeping the bugs for a week is not really long enough. If we don’t maintain that capability, it’s gone, possibly forever. So we’ve been assessing the regulations, and we have a project plan in place to fill any gaps. We feel it’s doable.”Referring to the Tier 1 agents, Bartkus said, “These are all naturally occurring diseases that we have to deal with from a public health perspective.”As an example of the kind of problems the new rules might cause, she sketched a hypothetical scenario: Someone in Fargo, N.D., gets sick with anthrax. A week after identifying B anthracis, the North Dakota lab, following the rules, destroys the isolate. Then an anthrax case crops up in Moorhead, Minn., just across the border. With North Dakota’s isolate destroyed, there’s no way to tell if the cases are linked.Bartkus concurred with Mangal that labs need more than a week to do specialized analysis of biological agents. Besides DNA fingerprinting, such work can include steps like antimicrobial susceptibility testing and, in the case of botulism, mouse bioassays to identify the type of botulinum toxin.She believes that forcing labs to get rid of their samples of Tier 1 agents will ultimately diminish their capabilities.”We’ll still have capability and capacity, but to take away the ability to work on agents that are historical isolates because somebody has decided they can be used for bioterrorism” is questionable, she said.”I think it makes much more sense to treat everything the same way, than to focus on a few agents that I have heard someone refer to as ‘your grandfather’s bioterrorism agent.'”Bartkus called the requirement to transfer or destroy Tier 1 agent samples “a fairly onerous, burdensome, and probably unwarranted regulation. And I’m a regulator.”Who needs Tier 1 registration?David A. Butcher, MBA, director of the Laboratory Services Division of the Colorado Department of Public Health and Environment, has quite a different view of the Tier 1 rules. His lab will not seek registration to hold Tier 1 agents.”I don’t think it’s necessary to be a Tier 1 lab,” he said. “You don’t need to store these agents in your lab. Under the rule you have 7 days to confirm them or transfer or destroy them, and that’s easily accomplished in 7 days. You don’t really need a repository of those organisms unless you’re a research facility.””I don’t feel this in any diminishes our capability,” he said. He added that the CDC provides surrogate organisms that are not select agents but mimic them and can be used in testing.Butcher is president-elect of the APHL, but said he was speaking only for himself.”I haven’t heard anyone clearly articulate why they think we do need them [Tier 1 agents],” Butcher said. “I guess they think they need to periodically test against the real organism. Here in Colorado, Yersinia pestis is endemic, so we see it all the time. We occasionally see Burkholderia; we occasionally see Brucella.”He agreed, however, that the 7-day deadline would hamper advanced analysis of agents.Burtcher said the Select Agent Program is “very burdensome” for state labs, and the Tier 1 rules make it even more so.”The biggest burden with Tier 1, and why everyone is upset, is that rule on personnel reliability,” he said. “You have to have a program in place to qualify and do an ongoing assessment of people, essentially their mental capacity. Would they have a propensity to do something illegal involving select agents?”He blames the requirement on the 2001 anthrax attacks and the government’s finding that scientist Bruce Ivins, PhD, was the perpetrator.Butcher voiced doubt that the personnel reliability program required with the Tier 1 rules would be approved by Colorado’s human resources department. “I definitely wouldn’t be able to get it in place by the Apr 3 deadline,” he added.His lab got rid of its Tier 1 agent samples last April, as part of its response to the last inspection by the Select Agent Program, he said. The decision was prompted by the need to reduce the lab’s regulatory burden. “I’ve been an outspoken advocate of not keeping the agents,” he added.North Carolina also opts outAnother state that will not seek Tier 1 credentials for its public health labs is North Carolina.”We’ve decided, based on the changes in the rules, not to pursue Tier 1 status at this time,” said Lou Turner, DrPH, acting public health laboratory director for the state. North Carolina operates one central lab and two regional labs, she noted.The reason for the decision is the “onerous” requirements for personnel reliability and physical security and the resulting costs, she said. A new state lab is about to open, and it would need retrofitting to meet the physical security standards.Turner doesn’t think the lack of Tier 1 registration will hurt the labs’ capabilities. “Our critical point was making sure we’d be able to serve our usual partner groups such as the FBI,” she said. “They’ve told us it was not necessary to be a Tier 1 lab. They would still use the state labs as long as they’re still select agent labs.”We’ll still be able to identify the agents. If we do, we have to refer them to a Tier 1 lab and destroy any materials. We’re perfectly confident of our ability to do that.”Turner said she’s not concerned about a decrease in lab capabilities nationwide as a result of the new rules. But she does wonder if states that don’t have Tier 1 status will eventually receive less CDC lab support through the public health emergency preparedness program.She said there are no signs of such a change, but said, “You never know what the mindset would be later, once these decisions are made and they see the landscape of who is where.”Minnesota’s Bartkus expressed less concern about the extra requirements for Tier 1 labs, compared with Butcher and Turner. She said Minnesota’s lab already meets the physical security requirements, and she doesn’t believe the personnel reliability rules will be a major problem.”One thing a little more vexing is the Internet or IT [information technology] requirements,” she said. The CDC wants certain IT resources protected, and MDH officials are still assessing that.Bartkus said there is some concern about the related costs and the MDH’s ability to meet the standards by April. She said she was hoping that the CDC would promise additional funds for labs that achieve Tier 1 status, which she said is the case for Level 1 labs in the LRN for Chemical Threats.”Those that decide to maintain Tier 1 are pretty much on their own,” she said.See also: Oct 10 CIDRAP News story “Changes in select agent rules concern public health labs”last_img read more

Posted in griffibxxlch

American doctor exposed to Ebola hospitalized at NIH facility

first_imgAn American doctor who was exposed to the Ebola virus while working in Sierra Leone has been airlifted back to the United States and was admitted to the National Institutes of Health (NIH) Clinical Center in Bethesda, Md., for observation.No details were available about the patient. The Associated Press (AP) today published a photograph of a person in head-to-toe white protective gear descending the stairs of a private jet at Frederick (Md.) Municipal Airport, led by an individual who wasn’t wearing any protective gear.Enrolled in clinical trialIn a press release yesterday the NIH said the patient arrived at the center yesterday at about 4 pm Eastern time and will enroll in a clinical protocol. It said that out of an abundance of caution the patient was admitted to the special clinical studies unit that had high-level isolation capabilities and is staffed with infectious disease and clinical care specialists.The NIH said the situation presents minimal risk and it is taking every precaution to ensure the safety of patients, NIH staff, and the public.According to US Centers for Disease Control and Prevention (CDC) guidance, people considered contacts of Ebola virus disease (EVD) patients can travel long distances only by private means during a 21-day interval after last contact. Those exposed to EVD undergo symptom monitoring for 21 days.In late August, the CDC returned a staff member from West Africa by charter flight after he or she had low-risk contact with an international health worker who had tested positive for EVD. The CDC said in an outbreak update today that the staff member was not sick, did not have any disease symptoms, and did not pose a risk to anyone else.All told, four medical workers have been sickened with the disease and were brought back to the United States for treatment. Three have recovered and been released from the hospital, and one remains hospitalized in a high-containment unit at Emory University Hospital in Atlanta.Ivory Coast lifts air travel restrictionMeanwhile, Ivory Coast president Alassane Ouattara announced on Sep 26 that the country would lift its Ebola-related flight restrictions, according to an AP story. He said the initial suspension was made because of uncertainty about the disease threat. The western part of Ivory Coast borders Liberia and Guinea, two of the three hardest-hit countries.Ouattara said the flight and maritime restrictions will end this week, according to the AP. He also announced that Ivory Coast will open a humanitarian corridor so that people seeking to enter the country can be checked.The country banned travel from the three outbreak countries on Aug 11 and ordered its main air carrier to suspend flights to the outbreak region. Global health officials, however, have urged other countries not to close borders and shut down flights, because the measure has hampered the flow of supplies needed for epidemic response.The US State Department on Sep 27 commended Ivory Coast for resuming air travel to the Ebola-affected countries, in line with World Health Organization and International Air Transport Association recommendations. Jen Psaki, State Department spokeswoman, said in a statement that lifting the air travel ban will greatly enhance the international community’s ability to rapidly respond to the outbreak and will help maintain vital trade links in the region.Australia sees airlift logistics roadblocksMeanwhile, in other outbreak developments:Despite calls from groups such as Doctors without Borders for Australia to send medical teams to West Africa, the country has ruled out doing so because of logistical problems of bringing sick workers back to Australia, the AP reported today. Earlier this month the country pledged $6.4 million to assist with the epidemic response.US Navy engineers on Sep 28 took the first steps toward the construction of a $22 million 25-bed mobile hospital donated by the United States to care for infected international health workers, the Globe and Mail, a Canadian newspaper based in Toronto, reported on Sep 28. The report said other US troops are in Monrovia evaluating the runway of the city’s international airport and determining how the tarmac might be strengthened to handle a surge of response flights expected in the weeks ahead.The CDC on Sep 26 posted two new EVD preparedness checklists, one for healthcare coalitions and one for emergency medical services (EMS) providers. The documents were created by the CDC and the Assistant Secretary for Preparedness and Response.Hemispherx Biopharma, Inc., based in Philadelphia, announced five Ebola drug collaborations aimed at developing therapeutic cocktails that have the potential to battle the Ebola virus if it mutates to become resistant to drugs that are under development. The newly announced collaborators include the National Institute of Allergy and Infectious Diseases, the US Army Research Institute of Infectious Disease, the Swiss Department of Defense, Howard University in Washington, D.C., and an unnamed US-based biosafety level 4 lab. The company said in a press release that its two platform drugs, Alferon N and Amplign, have mechanisms that remain bioactive, even in the face of viral mutation.A Liberian doctor said he has seen promising results in EVD patients prescribed an antiretroviral drug, part of a cocktail used to treat HIV/AIDS, AllAfrica news reported today. Dr Gorbee Logan, county health officer at Tubmanburg Hospital, said that when patients seek care early and are treated with lamivudine, they seem to recover in 3 to 5 days. He said he first used the drug on a health worker, who survived the infection.See also:Sep 29 AP storySep 28 NIH press releaseSep 29 CDC outbreak updateSep 26 AP story on Ivory Coast flight restrictionsSep 27 State Department statementSep 29 AP story on Australian announcementSep 28 Globe and Mail storySep 26 CDC healthcare coalition Ebola preparedness checklistSep 26 CDC EMS Ebola preparedness checklistSep 29 Hemispherx Biopharma press releaseSep 29 AllAfrica news storylast_img read more

Posted in zzdbjytrnlts

Study hints at complex interaction of resistant microbes, antibiotics

first_imgDrug-resistant bacteria are a well-documented problem in nursing homes. Residents are frail and prone to infection, and antibiotic use is common. That’s one of the reasons public health officials and infectious disease experts believe nursing homes are a critical target for stewardship programs that promote more prudent use of antibiotics.But a new study from researchers at the University of Michigan suggests that these programs could be hindered by a focus on individual species of multidrug-resistant organism (MDRO) and certain antibiotic classes that may fuel that resistance.The reality, the researchers say, is that nursing homes are likely filled with multiple MDROs simultaneously interacting with antibiotics and with each other in complex ways that can influence the dynamics of patient colonization and increase the likelihood of infection. Their study scratches at the surface of this drug-resistant ecosystem.”One of the major ways these organisms are evolving is through resistance to antibiotics, and we’ve known that,” corresponding author Evan Snitkin, PhD, a microbiologist at the University of Michigan Medical School, said in an interview. “But something else they’re seeing in addition to antibiotics is each other.”They’re all circulating through these facilities simultaneously, and that opens the potential that they might be interacting with one another, whether by coincidence or by evolved mechanism, and our results hint at that.”MDROs ‘ubiquitous’ in nursing homesFor the study, Snitkin and his colleagues retrospectively analyzed data from 234 residents at 12 community nursing homes in Michigan. The data, collected from May 2010 through April 2013, came from a larger study on bacterial colonization and antibiotic exposure in nursing home residents over time.Snitkin and his colleagues focused on patients who had had a urinary catheter for at least 3 days—a population with a high risk of developing urinary tract infections (UTIs). “These are some of the highest risk individuals in nursing homes,” Snitkin said.Focusing on this group allowed the researchers to look at patterns of urinary tract infections and which MDROs might be associated with them.The MDROs most commonly found to be colonizing these patients were vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Proteus mirabilis, Acinetobacter baumannii, and Pseudomonas aeruginosa. Nearly a quarter of the nursing home residents (23.5%) were colonized with at least one of these organisms, while 20.9% were colonized with two species and 20% were colonized with more than two species.Although previous studies have shown that drug-resistant pathogens are prevalent in nursing homes, Snitkin said he was surprised by these results. “I was really surprised that, outside the ICU setting in a hospital, antibiotic-resistant organisms would be so ubiquitous, and to find patients colonized with multiple organisms simultaneously was even more intriguing to me,” he said.Colonization patterns emergeThe team then constructed models to figure out what was influencing acquisition of each of these organisms. The high frequency of multi-MDRO colonization, it turns out, was not random.In fact, the presence of certain MDROs in colonized individuals made it more likely that they would be colonized by another drug-resistant bug. Patients colonized with P mirabilis, for example, had more than two times the risk of also acquiring VRE, MRSA, A baumannii, and E coli, while patients with E coli, A baumannii, and P aeruginosa had an increased risk of acquiring P mirabilis.Snitkin and his colleagues also found that exposure to individual antibiotic classes was associated with increased risk of acquiring certain pathogens, and in some cases multiple species. Over the course of the study, 146 of the residents received at least one course of treatment with 1 of 50 antibiotics. Patients treated with aminoglycosides were found to have more than five times the risk of being colonized with A baumannii, and more than three times the risk of acquiring E coli. Treatment with nitrofurans increased the risk of acquiring VRE threefold and P mirabilis eightfold. And multiple antibiotics were found to increase the risk of a single MDRO.From these findings, the researchers were able to create a map of interactions that showed that all MDRO colonization in the patients, except for MRSA, was positively associated with at least one antibiotic and one other MDRO. Antibiotic exposure increased nursing home residents’ risk of initially acquiring a primary MDRO, which in turn influenced the risk of colonization with another MDRO. This observation led them to ask whether these interactions were influencing risk of infection. Their subsequent analysis of 70 patients with UTIs indicated that co-colonization with certain pairs of species, like P mirabilis and E coli, was linked to increased risk for UTIs, a finding that suggests enhanced pathogenic potential when the two bacteria are both present in a patient. Co-occurrence of E coli and VRE, and P mirabilis and MRSA, was also associated with increased the risk of UTI.Complex web of interactionsSnitkin said all the findings point to a complex web of interactions among drug-resistant organisms and antibiotics. “It’s not just antibiotics but interactions with one another that are driving acquisition and infection,” he said.And what this interconnectivity means, he added, is that stewardship programs in nursing homes and other long-term care facilities will need to take a network-based approach to tackling the underlying MDRO burden, rather than focusing on restricting use of certain antibiotics to reduce individual organisms.”If the objective is to control the overall burden of resistance in a facility, then maybe taking a single-organism view of stewardship might not fulfill that objective,” he said. “The impact of limiting the use of one antibiotic in favor of another will have many downstream influences that could counterintuitively increase the overall burden.”Snitkin notes that for now this is just one study in one set of nursing homes, and that further research will be needed in other nursing homes and other types of healthcare facilities to determine how robust the findings are and understand how these interaction networks might change depending on what organisms are circulating and what antibiotics are being used. “If we see the same patterns over and over again, then we’ll have a basis to start influencing stewardship,” he said.In September 2016, the Centers for Medicare and Medicaid Services finalized a rule that requires more than 15,000 long-term care facilities (nursing homes, skilled-nursing facilities, and assisted-living facilities) to have antibiotic stewardship programs. With the lack of antibiotic stewardship expertise at many of these facilities, developing and maintaining these programs is expected to be a challenge.See also:Sep 12 Proc Natl Acad Sci USA studylast_img read more

Posted in fwzsnvxbnrqu

Study finds high burden of oral HPV, related cancers in men

first_imgHead and neck cancers caused by human papillomavirus (HPV) are dramatically higher in men than in women, with levels in men having already eclipsed the incidence of HPV-related cervical cancer in women, according to a study yesterday in the Annals of Internal Medicine.To sort out the epidemiology behind the cancer trends, US researchers reported new findings on oral HPV prevalence in men and women, shedding light on sexual, lifestyle, and other factors that may help guide public health interventions.The researchers based their analysis on adults who took part in the country’s National Health and Nutritional Examination Survey from 2011 to 2014, which involved oral rinse, penile, and vaginal swab specimens, along with survey questions.One in nine men HPV-infectedAbout one in nine US men are infected with HPV, the group found. The overall prevalence of oral HPV infection was higher in men than in women: 11.5% compared with 3.2%. Cancer-causing HPV strains were more common in men, and the highest-risk type (HPV 16) was six times more common in men.In people with same-sex partners, high-risk HPV infections were more common in men—12.7% versus 3.6%. The rate climbed to 22.2% in men who had two or more same-sex oral sex partners.Oral infection among men with concurrent genital HPV infection was four times higher than in men who had oral but not genital infection. The probability of high-risk HPV infection was greater in black participants, heavy smokers, marijuana users, and those who reported 16 or more lifetime vaginal or oral sex partners.When the investigators looked at patterns by age, they found that HPV 16 was most prevalent in men ages 50 to 69, which they said could suggest that persistent infection from that strain might be driving higher levels of head and neck cancers in that age-group.The authors said the results confirm that oral HPV is common in US men and that the findings will help guide future oropharyngeal cancer prevention efforts. They noted that research priorities should include improved prevention and screening in high-risk groups.Puzzles to solveIn an accompanying commentary, Patti Gravitt, PhD, from the Milken Institute School of Public Health at George Washington University, wrote that despite the new in-depth analysis, it’s still not clear why oral HPV risk increases with age or why the HPV and oropharyngeal cancer burdens are greater in men.She said it’s difficult to tease out independent effects of age and sexual behaviors or differences across birth cohorts. Studies that could shed more light should focus on acquisition of oral HPV from recent sexual partners, autoinoculation from anogenital sites, latent infections, and natural history of sexually active and inactive adults, she said.See also:Oct 16 Ann Intern Med abstractOct 16 Ann Intern Med commentarylast_img read more