April 15, 2019
CDDEP researchers identify key barriers that prevent access to antibiotics in LMICs and provide potential solutions to address them. Researchers at CDDEP led stakeholder interviews in Uganda, India, and Germany, and conducted literature reviews to identify key access barriers to antibiotics in low-, middle-, and high-income countries. The report makes several recommendations proposing action on research and development (new antibiotics and rapid diagnostic tests), strengthening regulatory capacity, encouraging the development and diversification of quality local manufacturing, exploring innovative funding to reduce out-of-pocket payments, implementation of improved treatment guidelines, and awareness raising. [CDDEP, EurekAlert!, Homeland Preparedness News]
Task Force on Fiscal Policy for Health examines the health and economic impacts of excise tax policies. The Task Force on Fiscal Policy for Health, which draws attention to the role that fiscal policies can play in the burden of noncommunicable disease, explores evidence (including research from CDDEP) on the health and economic impacts of increased taxation on tobacco, alcohol, and sugary sweetened beverages (SSBs). The task force reported that raising taxes on tobacco, alcohol, and SSBs has the power to save more lives than many other interventions, while substantially increasing country tax revenue. CDDEP’s research, which was cited in the report, found that implementing a tax to increase retail prices of tobacco, alcohol, and SSBs by 50% globally would avert over 50 million deaths and produce a revenue gain of over $20 trillion over a 50-year period. [Bloomberg, CDDEP]
Telemedicine visits associated with high antibiotic prescribing rates in children. In a retrospective cohort study, researchers compared antibiotic prescribing rates among children with acute respiratory infections across three settings: commercial direct-to-consumer telemedicine, urgent care, and primary care provider offices. Antibiotics were prescribed to children significantly more often in the telemedicine setting (52 percent of patients) compared to the urgent care and primary care provider settings (42 percent and 31 percent of the patients, respectively). Telemedicine visits were also associated with lower concordance of antibiotic management guidelines. [Pediatrics]
Identifying strategies to increase AMR investments and programs in LMICs. The WHO AMR Secretariat used a One Health approach to conduct case studies in Ghana, Nepal, and Nigeria, which examine existing antimicrobial resistance (AMR) programs and programs in development. The case studies, “Getting antimicrobial resistance into plans and budgets of government and development partners,” explore options for increasing investments in antimicrobial resistance activities in low-and middle-income countries, and aim to integrate AMR programs into existing budgets and policies. CDDEP worked with the WHO AMR Secretariat in identifying existing and potential funders to interview, coordinating AMR stakeholder interviews in Nigeria, and reviewing existing national action plans and AMR policies in Nepal. [WHO]
Use of whole genome sequencing to investigate MDR Klebsiella outbreak in Beijing. A team of scientists monitored all blaKPC-2-positive carbapenem-resistant Klebsiella pneumoniae (CRKP) infections at Peking University Hospital in Beijing over 14 months, following the death of a patient from a CRKP bloodstream infection in 2016. After performing whole genome sequencing on 100 isolates taken from patients (including those clinically infected with CRKP and carriers identified with screening swabs), and ward environments (including medical equipment and bed rails), a cluster of sequence type 11 isolates (a highly drug resistant strain) was identified that had been circulating in the hospital for at least one year prior to the patient’s death. In some isolates, the number of resistance plasmids present correlated with the level of antimicrobial resistance of the strain. [Microbial Genomics, CIDRAP]
One in four health care facilities lack basic water services according to WASH in Health Care Facilities Report. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) released the first comprehensive global assessment of water, sanitation, and hygiene (WASH) in health care facilities. Although sanitation in health care settings is vital to providing quality care, preventing infection, and controlling antimicrobial resistance (AMR), the report found that one in five health care facilities, serving a total of 1.5 billion people, lack any sanitation service. The report lays out eight recommendations for countries to improve WASH in health care facilities. These include improving infrastructure, establishing national standards, and engaging communities to increase adherence to sanitary practices. [WHO]
HPV vaccine significantly reduces prevalence of cervical disease in Scotland. Researchers in Scotland conduced a retrospective study to explore the effect of the bivalent HPV vaccine on cytology results and associated cervical disease in women at age 20. Smear tests of women born between 1995-1996 were compared to those of unvaccinated women born in 1988. The prevalence of cervical intraepithelial neoplasia (CIN) that was grade 3 or worse in vaccinated women was 89% lower than that in unvaccinated women. Vaccination within the recommended age range (12-13 years) was associated with greater vaccine efficacy for preventing high grade cervical disease compared to late vaccination (at age 17), and herd immunity against cervical disease was also higher among unvaccinated women in the 1995-1996 cohorts than in the 1988 cohort. [BMJ]
Inadequate implementation of antibiotic stewardship programs in French ICUs. In a nationwide cross-sectional survey conducted in France, researchers assessed the implementation of antibiotic stewardship programs across 113 intensive care units (ICUs). According to the survey, local antibiotic use guidelines were only available in 54 percent of ICUs, and diagnostic blood cultures were not processed on nights or weekends in 57 percent of ICUs. Only 26 percent of antibiotic stewardship program leaders, which were reported in 94 percent of ICUs, actually gave advice on antibiotic prescribing. Overall, findings emphasized the need to improve upon inadequate implementation of antibiotic stewardship programs in French ICUs. [Journal of Antimicrobial Chemotherapy]
Cholera spreads throughout Mozambique following Cyclone Idai. Outbreaks of cholera and other diseases are occurring in the wake of Cyclone Idai, which has caused over 800 deaths in Mozambique and neighboring countries since late March. Over 1,000 cholera cases have already been reported, however, aid officials suggest this is an underestimate. International aid groups, including Oxfam, CARE, and Doctors Without Borders, have delivered sanitation supplies and over 900,000 doses of cholera vaccine, and have provided cholera-specific training to local health care workers. Malaria, dengue, and measles outbreaks are also expected, as more than 130,000 Mozambicans currently live in makeshift camps. [New York Times]
Researchers engineer a cost-effective treatment for African sleeping sickness. Through modern techniques in genetic engineering, researchers at the University of Tokyo have modified a strain of the fungus Acremonium egyptiacum to naturally produce high concentrations of a single antibiotic, ascofuranone. The natural antibiotic is a promising treatment for African trypanosomiasis, or African sleeping sickness, a neglected tropical disease that affects thousands of people each year in rural and remote areas of sub-Saharan Africa. If left untreated, the disease can be fatal. Findings from the study identified the gene cluster responsible for ascofuranone biosynthesis, which combined with the suppression of unwanted secondary metabolites via gene deletion, paves the way for cost-effective industrial-scale production of the antibiotic. [PNAS, EurekAlert!]
Multidrug-resistant gene detected in highly polluted urban air samples. In a recent study by scientists at Peking University, analysis of urban air samples from Beijing and Shijiazhuang during times of low and high levels of fine particulate matter (i.e., PM2.5) found antibiotic resistant genes (ARGs) across a diversity of bacteria. Particularly concerning was the detection of NDM-1, a gene encoding resistance to a broad range of β-lactams, which accounted for over 30% of total ARG abundance in highly polluted air. Both NDM-1 and vanB, a gene which confers resistance to vancomycin (a last resort antibiotic), were primarily harbored by Bacillus halotolerans. Although this species is non-pathogenic to humans, it is possible NDM-1 could spread to bacteria of clinical significance, given the gene’s ability to transfer easily between bacteria. [Environment International]
