Weekly Digest: Malaria drug resistance in Cambodia; New Ebola case in Sierra Leone; Zika virus in the U.S.

Public financing of anti-epilepsy drugs could avert up to 1 million disability-adjusted life-years (DALYs) in India, CDDEP researchers report in a paper published in Epilepsia. The researchers used a simulation model to investigate the health and economic benefits of three scenarios for publicly-financed epilepsy programs, to treat the estimated 6-10 million people in India with active epilepsy: 1) first-line anti-epilepsy drugs (AEDs) only, 2) first- and second-line AEDs, and 3) first- and second-line AEDs and surgery. They found that all three options met standard cost-effectiveness criteria and would avert between 800,000 and 1 million DALYs. Options 2 and 3 would also decrease out-of-pocket expenditure across wealth quintiles and in all states, averting over $80 million annually in the first ten years of the scenarios. Option 1—provision of only first-line drugs—would not decrease out-of-pocket expenditures or provide financial risk protection across all regions, especially in poorer populations. [Epilepsia]

The January issue of GARPNet News, the newsletter of the Global Antibiotic Resistance Partnership, is now available online. The issue features a review of antibiotic resistance-related activities across the globe in 2015, a look back at GARP’s second phase and a look forward to Phase 3. Sign up to receive the bi-monthly newsletter here. [CDDEP]

A death from Ebola was reported in Sierra Leone, one day after the WHO had declared West Africa free of the virus. On Thursday, Liberia was pronounced Ebola-free after going six weeks with no new reported cases, allowing the WHO to declare that “all known chains of transmission have been stopped in West Africa.” On Friday, the Sierra Leone health ministry announced that a woman who died Tuesday tested positive for the virus. According to the ministry, authorities did not follow health protocols during her treatment or burial, potentially exposing more than two dozen people to the virus. [Reuters]

Resistance to piperaquine, the partner drug in Cambodia’s first-line artemisinin combination therapy (ACT) has been confirmed. Researchers reported findings from Pursat, Preah Vihear and Ratanakiri provinces of Cambodia in The Lancet Infectious Diseases. The trial followed 241 patients for nine weeks after treatment with first-line ACT dihydroartemisinin-piperaquine to determine rates of re-emergence after initial clearance of malaria. In Pursat, 46 percent of participants had parasite re-emergence, indicating significant levels of resistance. In Preah Vihear and Ratanakiri, levels were 16 percent and 2 percent, respectively. Resistance to artemisinin has arisen or spread to several countries in Southeast Asia over the last decade, but previous to this study, piperaquine resistance had not been confirmed. An accompanying commentary warned of the possibility of future resistance to artesunate-mefloquine, the replacement first-line therapy in areas where dihydroartemisinin-piperaquine resistance is high. [CIDRAP, Lancet Infectious Diseases, Lancet Infectious Diseases]

For treatment of Clostridium difficile, frozen fecal transplants are as effective as fresh ones, according to research published in JAMA. In a double-blind randomized trial, 219 patients with C. diff infections were treated with either fresh or frozen-and-thawed fecal microbiota transplantation (FMT). The effectiveness of fresh FMT has already been established, but not of frozen FMT, which has practical advantages. The researchers found clinical resolution—no relapse at 13 weeks—in 83.5 percent of the frozen FMT group and 85.1 percent of the fresh FMT group, indicating no significant difference in effectiveness. There were also no differences in adverse events between the two groups. [JAMA, Infection Control Today]

Zika virus, which has been linked by CDC to serious birth defects in Brazil, has been identified in a U.S. patient in Houston, Texas who had been in El Salvador. After the virus spread in Brazil last year, the country recorded more than 3500 cases of microcephaly, the birth defect, in comparison to fewer than 200 microcephaly cases annually in the previous five years. Zika infection can cause fever, rashes and joint pain, and there is currently no vaccine and no specific treatment for the virus. [STAT News, Reuters]

Despite tight budgets and logistical hurdles, a number of U.S. hospitals are moving to antibiotic-free meat. According to a National Public Radio (NPR) report, Hackensack University Medical Center in New Jersey and Overlake Medical Center in Washington state, have prioritized finding antibiotic-free meat sources, even though it is more expensive and involves “a lot of work and a lot of pushing” food distributors to make the changes. However, many large U.S. hospitals are locked in contracts with major food service management companies, like Sodexo, Compass and Aramark, which have very few antibiotic-free meat options and little flexibility in changing their supply chains. According to Chris Linamark, Overlake’s executive chef, “That’s why it’s really important that the food service sector get more involved with this issue, too, since one third of hospitals in the U.S. have food service managed by Sodexo, Compass or Aramark.” [NPR]

Drug regulators in the European Union have launched an investigation into colistin use in agriculture. Following reports of the presence of colistin resistance gene mcr-1 in several European countries, the European Medicines Agency announced plans for an analysis and update of its current advice on colistin use in animals. The investigation will focus on its importance in human and veterinary medicine, levels and impact of resistance, risk management measures and possible alternative treatments. [Reuters]

CDDEP is currently seeking a Communications Intern for the Washington, D.C. office. For more information and to apply, visit cddep.org/jobs. [CDDEP]