July 16, 2016
A weekly roundup of news on drug resistance and other topics in global health.
CDDEP Director Ramanan Laxminarayan and prominent colleagues propose that a four-pronged global action plan on antimicrobial resistance emerge from the upcoming United Nations General Assembly High-Level Meeting of Heads of State. The U.N. General Assembly will discuss measures to ensure access to antimicrobials while maintaining their effectiveness at their September session in New York. In a commentary in The Lancet, Laxminarayan and co-authors propose a U.N. High-Level Coordinating Mechanism on Antimicrobial Resistance (HLCM) with four core functions: advocacy, monitoring and evaluation, resource mobilization, and the coordination of multisectoral action at the national-level in support of the WHO’s Global Action Plan on Antimicrobial Resistance. The proposed HLCM will be similar in scope and ambition to the highly successful UNAIDS, created in 1996 to address HIV/AIDS. [CDDEP, Lancet]
MCR-1.2, a new variant of the colistin resistance gene, was found on multidrug-resistant Klebsiella pneumoniae, according to research published in Antimicrobial Agents and Chemotherapy. Italian researchers found the plasmid-borne resistance element in a multidrug-resistant isolate of the Gram-negative bacterium from a child with leukemia. The gene may have been transferred from Escherichia coli, the main known source of mcr-mediated resistance. [ASM]
Measles outbreak in Arizona traced to an Immigration and Customs Enforcement detention center. Authorities believe the outbreak, which now includes 22 cases, may have started with a migrant, but its spread is being fueled by unvaccinated ICE staffers. State health officials are currently providing free vaccinations and educational outreach, but have met resistance from some ICE employees, who are not required to receive vaccinations. Pinal County health department Director Thomas Schryer said they may ask Governor Doug Doucey to declare a state of emergency to compel ICE employees to receive immunizations. [AP, Fronteras]
One-quarter of adults surveyed would use antibiotics without contacting a medical professional, according to a survey published in Antimicrobial Agents and Chemotherapy. In the relatively small survey of 400 socioeconomically and ethnically diverse adults around Houston, Texas, 14 percent reported storing antibiotics at home, 74 percent of which were saved from previous prescriptions. Of the 14.2 percent of respondents who had used antibiotics without a prescription in the past year, the most common indication was respiratory symptoms, which are most often viral and not responsive to antibiotics. [ASM, Antimicrobial Agents and Chemotherapy]
Neisseria gonorrheae resistance to azithromycin—a key component of the only currently recommended gonorrhea treatment in the United States—rose by more than four-fold from 2013 to 2014, according to the Centers for Disease Control and Prevention (CDC). Resistance to previously effective treatments—tetracycline, ciprofloxacin, and penicillin—remains high. Azithromycin resistance is still low—2.5 percent in 2014—but if the recent increase seen in CDC’s Gonococcal Isolate Surveillance Project signals a continued upward trend, it may not be many years before azithromycin joins those compromised treatments. The lead author, Dr. Robert Kirkcaldy, told Time, “There is this perfect storm where the antibiotic market is going dry and the bacteria continues to develop resistance. Now there is just one remaining treatment option. We want to prevent untreatable gonorrhea from happening.” [CDC, TIME]
Daily use of pre-exposure prophylactic Truvada could dramatically reduce new cases of HIV, according to a study published in The Journal of Infectious Diseases. The modeling study indicates that Truvada used daily for pre-exposure prophylaxis—“PrEP”—could reduce new cases of HIV in men who have sex with men by one-third over the next 10 years in the United States. Truvada, a combination of tenofovir and emtricitabine, was approved for PrEP by the U.S. Food and Drug Administration in 2012. [Infectious Diseases Society of America]
Proximity to super-spreaders was a major driver of 2015 Korean MERS outbreak, according to research published in The Lancet. The study focused on “patient 14,” who spread the Middle East respiratory syndrome coronavirus to 82 people in the Samsung Medical Center’s emergency department over 3 days in May 2015. That one patient accounted for 44 percent of the 186 cases recorded in the 3-month outbreak. This is the first study to demonstrate risk by patient proximity and determine the potential spread from a single infected patient. [CIDRAP, Lancet]
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