Weekly Digest: CDDEP research in The Journal of Nutrition; Elizabethkingia outbreak in Wisconsin

Does India’s Integrated Child Development Services (ICDS) program improve educational outcomes of children later in life? ICDS, which provides nutritional, educational and healthcare assistance to young children, was evaluated by CDDEP Fellow Arindam Nandi and colleagues. They found that children from villages where ICDS was in place between 1987 and 1990 were more likely to still be in school in 2003-2005, and had completed, on average, 0.84 more grades of school than children from non-ICDS villages. No difference in test scores between the two groups was found, however. The study appeared in The Journal of Nutrition. .[CDDEP, The Journal of Nutrition]

“Dame Sally Davies is the force elevating antimicrobial resistance into the stratosphere of global policy.” CDDEP Associate Director Hellen Gelband writes on the CDDEP blog about Dame Sally Davies’ keynote address at the 17th International Congress for Infectious Diseases (ICID) in Hyderabad, India. Gelband writes that Davies, in her position as England’s Chief Medical Officer, has raised the profile of antibiotic resistance on the international stage—and that she’s serious about addressing the problem across the globe. [CDDEP]

An outbreak of Elizabethkingia, a rare bacterial infection, has been reported in Wisconsin. As of March 10, 48 people had confirmed infections and 18 of them have died. Most of the affected patients are over 65 and have other serious illnesses. Elizabethkingia is not currently an infection reported to CDC. Although it is commonly found in the environment, human infections are rare and usually serious only in immunocompromised patients. CDC has sent a team of investigators to Wisconsin to track down the source of the outbreak. [Reuters, Chicago Tribune]

A Zika virus vaccine is “years away” according to the World Health Organization (WHO). Global health experts meeting in Geneva outlined three strategies needed to combat Zika: vaccines, diagnostics and vector control tools. Eighteen research groups are currently working to develop a vaccine, the most advanced of which is months away from early-stage human trials. Jorge Kalil, director of a Brazilian research center, called the arrival of a vaccine within three years “optimistic.” At this stage of the outbreak, diagnostic tools are critical, particularly ones that can distinguish Zika from dengue and chikungunya—two similar diseases that are transmitted by the same type of mosquito. [The New York Times]

The U.S. Olympic Committee has created an expert group to evaluate infectious disease concerns, including Zika virus, at the upcoming Olympic Games in Rio de Janeiro, Brazil. The committee will recommend best practices for U.S. athletes participating in the Games. They also plan to develop educational material and provide support services for athletes and staff in the event that they contract an infection. [Reuters]

California-based fast food chain In-N-Out announced this week that it is committed to using beef raised without antibiotics important for human health. In-N-Out, famous for its burgers and commitment to fresh food, bowed to the wishes of more than 50 consumer and environmental groups, who wrote an open letter insisting on the measure. In-N-Out did not announce a deadline for the change, but its Vice President of Quality has “asked our suppliers to accelerate their progress toward establishing antibiotic alternatives.”  [The Guardian, Los Angeles Times]

Measles vaccine coverage in Nepal increased from 81 to 88 percent between 2007 and 2014, and suspected measles incidence decreased 13 percent over the same time period, reports CDC in its Morbidity and Mortality Weekly Report. This represents significant progress, but doesn’t reach the goal of 95 percent to maximize the “herd immunity” effect. The endgame is total measles elimination in Nepal, which could be achieved using four strategies: 1) complete and maintain 95 percent coverage with two doses of the vaccine across all districts; 2) develop and implement a successful measles surveillance system; 3) create and maintain a measles laboratory network; and 4) identify, investigate and respond to suspected measles outbreaks in a timely manner. [MMWR]

The antibiotics frequently given to premature infants to prevent infection have the unwanted effects of impoverishing the gut microbiota, and increasing the share of bacteria that are antibiotic-resistant. A study in Nature Microbiology reported multidrug-resistant Enterobacteriaceae, including Escherichia, Klebsiella and Enterobacter in these infants. The three antibiotics associated with the greatest decrease in gut microbiome diversity were meropenem, cefotaxime and ticarcillin-clavulanate. According to co-author Barbara B. Warner, “The conventional wisdom has been antibiotics can’t hurt and they might help. But our new study demonstrates that wide-scale use of antibiotics in this population does not come without cost.” [Washington University of St. Louis, Nature Microbiology]

Artemisinin-combination therapies (ACTs) are safe and effective for pregnant women to both prevent and treat uncomplicated falciparum malaria, based on trials published in the New England Journal of Medicine The PREGACT trial examined the efficacy of four different ACTs to treat pregnant women with clinical malaria in Burkina Faso, Ghana, Malawi and Zambia, and found cure rates of 95 to 98 percent, highest with.dihydroartemisinin-piperaquine (DHA-P). The second study, from Uganda, studied ACT to prevent malaria during the second and third trimesters, randomly assigning 300 pregnant women to either 1) sulfadoxine-pyrimethamine (the former standard for malaria prophylaxis in pregnancy) three times, 2) a full course of DHA-P three times during the pregnancy or 3) monthly courses of DHA-P. Monthly DHA-P was most effective in preventing placental malaria, symptomatic and asymptomatic malaria in the mother, and in reducing adverse birth outcomes, followed by DHA-P thrice during pregnancy. An accompanying editorial noted the importance of these studies to supporting the use of ACTs in pregnancy. [NEJM PREGACT Study, NEJM Kakuru et al study, NEJM editorial]