August 06, 2016
A weekly roundup of news on drug resistance and other topics in global health.
Antibiotic resistance is a One Health issue. According to CDDEP Director Ramanan Laxminarayan and colleagues, antibiotic resistance is the quintessential One Health issue, involving the health of people, animals, and the environment. Writing in Transactions of the Royal Society of Tropical Medicine & Hygiene, the authors contend that preserving the effectiveness of antibiotics calls for an interdisciplinary approach that includes the three domains. [Royal Society of Tropical Medicine & Hygiene]
A new issue of GARPNet News, the newsletter of the Global Antibiotic Resistance Partnership, is now available online. The issue features a reflection on the inaugural meeting hosted by GARP-Nepal to welcome Pakistan and Bangladesh into the Global Antibiotic Resistance Partnership, as well as an overview of preparations for the upcoming United Nations General Assembly high-level meeting on antimicrobial resistance. Sign up to receive the bi-monthly newsletter here. [CDDEP]
Point-of-care C-reactive protein (CRP) testing in primary health care centers can reduce inappropriate use of antibiotics, according to a study co-funded by the Global Antibiotic Resistance Partnership, appearing in The Lancet. This study, conducted by GARP-Vietnam coordinator Nga TT Do and colleagues, was the first to investigate this subject in a resource-constrained setting. About 2,000 adults and children with respiratory tract infections in 10 primary healthcare centers in northern Vietnam were randomly assigned the CRP test or routine care. The CRP test distinguishes between serious and self-limiting acute respiratory tract infections, giving providers information to guide prescribing decisions. Use of the CRP test reduced antibiotic prescribing significantly. Sixty-four percent of patients in the CRP arm and 78 percent in the routine care arm used antibiotics while clinical recovery time remained the same. The results are similar to results of trials carried out in Europe. [Lancet]
An anthrax outbreak in Siberia, responsible for sickening dozens, is thought to be the result of thawing permafrost on the Yamal Peninsula of Siberia. The likely source of the bacteria is a thawed reindeer carcass, which died in a 1941 anthrax plague. The illness was then likely transferred to humans after butchering and eating infected animals. Seventy-two Yamal nomads have since been hospitalized and the outbreak has claimed more than 2,000 reindeer. Dozens of the indigenous Nenet community have been relocated and herders face a quarantine that may last until September. In 2011, researchers from the Russian Academy of Sciences estimated that anthrax spores can remain viable in permafrost for 105 years. With increasing climate change, long-dormant bacteria may once again become active and threaten nearby populations. [Siberian Times, Washington Post]
Rapid development of a Zika vaccine seems likely, as the virus poses greater threat to United States, especially Puerto Rico. About 5,500 cases of Zika have been confirmed in Puerto Rico, including 672 pregnant women, but the Centers for Disease Control and Prevention (CDC) believe the number is much higher. Officials believe thousands of Puerto Rican residents are infected each day, including up to 50 pregnant women. Miami has confirmed 15 cases of Zika and two babies in California have been born with Zika-related microcephaly. The CDC awarded $16 million in funding to 40 U.S. states and territories while Congress is out of session, diverting funds from other programs in anticipation of the potential approval of greater funding when Congress reconvenes.
A study in Cell Reports demonstrates that the African and Asian lineages of Zika virus actually represent a single serotype, meaning that a single-strain vaccine could protect against all infections. In a study in Science, researchers at Walter Reed Army Institute of Research, Beth Israel Deaconess Medical Center and Harvard Medical School demonstrated that vaccines based on three different platforms provided complete protection in rhesus monkeys, fueling optimism for rapid vaccine development. Clinical trials involving human subjects are planned for this fall. [New York Times, CDC, CIDRAP, Cell Reports, Science]
The first commercial dengue vaccine can lead to more severe disease in subsequent dengue infections. The CYD-TDV vaccine (Dengvaxia, Sanofi Pasteur) is currently licensed in five countries. The vaccine is believed to cause antibody-dependent enhancement (ADE), in which infection with one of the four strains of the virus produces cross-reactive antibodies to the other strains, which are lost over time. When a person is infected with one of the non-vaccine strains later on, the disease is more severe in vaccinated than non-vaccinated individuals. In a study in Vaccine, children less than 5 years old at the time of vaccination were hospitalized for severe dengue five times as often as children in the control groups. According to Scott B. Halstead, a leading figure in dengue research, “Over time, you make and keep protective levels of antibody from the initial infection, but you lose the cross-reactive antibodies. That allows a second dengue infection to cause severe illness, including dengue hemorrhagic fever.” [CIDRAP, Vaccine]
Image via Alexandre Buisse (CC BY-SA 3.0)
