A weekly roundup of news on drug resistance and other topics in global health.

Improving health in a time of austerity. In Finance and Development, a publication of the International Monetary Fund (IMF), CDDEP Director Ramanan Laxminarayan and the IMF’s Ian Parry discuss ways to support good health in settings where there is little capacity to increase government spending on health. Laxminarayan and Parry find that economic incentives, like taxes and subsidies, could improve health beyond the impact of direct spending. They write, “As countries grow, the health needs of their populations will increase. By using economic incentives to modify social determinants of health, countries could bring about significant improvements without breaking the bank.” [Finance and Development]

Antibiotic stewardship efforts may be paying off; antibiotic prescribing and spending in the U.S. is declining. Two independent reports show a decline in the overall use of antibiotics in the United States, both in numbers of prescriptions and in spending on antibiotics. A study by Blue Cross Blue Shield (BCBS) analyzed 173 million patient insurance claims for antibiotic prescriptions in outpatient settings between 2010 and 2016. It found a 9 percent drop in the overall number of antibiotic prescriptions, with a 16 percent reduction in children. The use of broad-spectrum antibiotics also fell by 13 percent. A different study published in Clinical Infectious Diseases found that the overall spending on antibiotics in the US fell by 16.6 percent between 2010 and 2015. Community pharmacies recorded a 37 percent drop in expenditure on antibiotics, but increased use in mail-order, non-retail settings was noted. [BCBSClinical Infectious Diseases]

Shorter duration of antibiotic use is better for treating complicated intra-abdominal infections. A study in Clinical Infectious Diseases finds that in treating complicated intra-abdominal infections, a shorter duration (4 days) of antibiotic therapy had better results than the conventional longer treatment duration (8 days). A recent analysis in The BMJ had sparked controversy on the “appropriate course” of antibiotics to prevent drug resistance. CDDEP Resident Scholar Sumanth Gandra, in a review, suggested that there is a need for “systematic assessment” of regimen lengths for different infections. [Clinical Infectious DiseasesCIDRAP]

Another vector-borne virus spreads in Brazil. Recent reports have highlighted an emerging infectious disease threat that is spreading rapidly in Brazil: the Oropouche virus. Although occasional outbreaks have been reported since it was first identified in 1955, its reach was limited to the tropical areas and the Amazon rain forest. But now, public health experts warn that the virus seems to be fast-adapting and spreading in major urban areas in Brazil. The virus mimics other endemic vector-borne disease predecessors such as dengue, chikungunya, and Zika, both in terms of transmission and symptoms, which would make diagnosis more difficult. Spread via midge bites, the Oropouche virus can cause acute fever, meningitis, and meningoencephalitis. There is no vaccine available. [Science DailyProMed MailNew York Times]

Superbug alert: new, hypervirulent and carbapenem-resistant Klebsiella pneumoniae strain identified in China. A study published in Lancet Infectious Diseases reports a new, fatal strain ofKlebsiella pneumoniae circulating in China. Following an outbreak of ventilator-associated pneumonia cases in a hospital intensive care unit (ICU) in Hangzhou city, Chinese researchers investigated 21 carbapenem-resistant samples from five patients with severe pneumonia who had all died between February and April 2016. All of them were found to be infected with the mostprevalent type of carbapenem-resistant K. pneumoniae strain, ST11, but had poor response to antibiotics, succumbing to multi-organ failure or septic shock. Further testing revealed that the ST11 strain had acquired a virulence plasmid, making it more deadly. A retrospective analysis showed the new strain had already emerged in other parts of China, in 3 percent of cases in 25 other locations across the country. The researchers warn that the new strain is highly transmissible and fatal, underlining the need for global surveillance. [The Lancet Infectious Diseases]

C. diff incidence increasing rapidly in Hong Kong. The incidence rate of Clostridium difficileinfections (CDI) is on the rise in Hong Kong, China, with more than 15,000 cases identified over a 9-year period. A study published in Emerging Infectious Diseases found that the incidence of CDI increased by 26 percent annually between 2006 and 2014, with a threefold increase in cases in the elderly. CDI represents a major burden on health care systems globally, having doubled in the United States from 2001 to 2010. The authors note that there is an urgent need for further surveillance. [Emerging Infectious Diseases]