Weekly Digest: UK issues new antibiotic stewardship guidance, MERS vaccine success

“Reports of typhoid date back almost 2,000 years, but the disease is still killing people. It is not just the new threats that deserve our attention.” Buddha Basnyat, chair of the Global Antibiotic Resistance Partnership (GARP)-Nepal working group, writing in Nature, urged the global community to pay attention to the risk of a post-earthquake typhoid epidemic in Nepal—and to take action quickly, before the disease spreads. Basnyat calls for a widespread vaccination campaign to limit the spread of typhoid given the current lack of infrastructure for clean water and sanitation in Nepal. He points out that the global health community reveled in the announcement of an Ebola vaccine a few weeks ago, and notes that though a typhoid vaccine has existed for nearly 30 years, widely used by the many trekkers that come to Nepal from the rest of the world, it remains largely unavailable to the local population, which is at much higher risk. [Nature]

The UK’s National Institute for Health Care and Excellence (NICE) published new guidance this week on antibiotic stewardship and use, noting that 10 million unnecessary antibiotic prescriptions are written every year in the country. The guidance covers a wide variety of healthcare professionals, including dentists and pharmacists in addition to physicians, and calls for increased monitoring of antibiotic prescription rates,stewardship plans such as “watchful waiting” and encouraging doctors to discuss the benefits and harms of antibiotic prescribing with patients. [The Guardian]

An experimental vaccine for Middle East Respiratory Syndrome (MERS) produced an immunological response in vitro in camel blood and may have protected macaques from infection.  Professor Andrew Easton, a vaccine researcher not associated with the study, stated that the result is both an important step toward producing a human vaccine and also a potential way to reduce spread of the virus in camels, which could limit transmission to humans. [BBC, Science Translational Medicine]

An outbreak of antibiotic-resistant Pseudomonas bacteria was reported this week at a Los Angeles-area hospital. The hospital, Huntington Memorial, has not released information about the number of people infected or their outcomes, but officials stated that the outbreak is potentially linked to duodenoscopes. Incompletely disinfected duodenoscopes have been linked to two outbreaks of antibiotic-resistant bacteria in Los Angeles earlier this year. [Los Angeles Times]

Thirty-year-old WHO guidelines may be stopping children from receiving necessary antibiotics for diarrheal diseases, writes Donald G. McNeil in a recent New York Times article. McNeil describes research that calls into question current guidelines, which state that pediatric diarrheal infections should be presumed viral—and not treated with antibiotics—unless blood is detected in stool. The research found instead that most children with bacterial diarrheal infections do not have bloody stools, and that bloody dysentery isn’t associated with worse outcomes. What hasn’t yet been extensively studied is whether other treatment options—such as diagnostic testing for diarrheal infections or treatment of all affected children with antibiotics—would be cost-effective in low- and middle-income countries or encourage the spread of antibiotic resistance to a concerning degree, respectively. [New York Times, Journal of the Pediatric Infectious Diseases Society]

The CDC has launched a new interactive tool for tracking antibiotic-resistant foodborne pathogens in the United States over the past 18 years. The web-based database features interactive maps with data from the National Antimicrobial Resistance Monitoring System (NARMS) to track Campylobacter, E. coli O157, Salmonella, and Shigella resistance rates by state. CDC epidemiologists said they hope the tool will be used by state and local health departments as well as anyone in the public who wants to learn more about foodborne pathogens. [CDC, TIME]

The World Health Organization warned this week that vaccine hesitancy—people intentionally delaying or refusing vaccines for themselves or their children—poses a major challenge to global immunization coverage.  A New York Times editorial echoed the WHO warning, arguing that vaccine implementation faces significant barriers even without vaccine hesitancy. Writes the editorial board, “[children have] died globally from a wide range of diseases encouraged by the ignorance of adults who failed to accept immunization for their families.” [WHO, The New York Times]

Toilet waste from international flights may be useful for tracking the global spread of antibiotic-resistant bacteria. Researchers at the National Food Institute and DTU Systems Biology sequenced DNA from toilet waste on 18 aircraft at Copenhagen airport to identify antimicrobial resistance genes in a variety of bacteria, and found the greatest abundance of tetracycline, macrolide and beta-lactam resistance genes. They noted significant geographic differences in resistance patterns, identifying a greater incidence of Salmonella enterica in flights arriving from South Asia, Clostridium difficile in flights from North America and North Asia, and overall greater variation in samples from Asian than from North American flights. [Nature Scientific Reports, Infection Control Today]