June 18, 2018
Adverse events following immunization examined in India study. CDDEP researcher and head, South Asia, Jyoti Joshi has co-authored an original research study analyzing four years of data on serious and severe adverse events following immunization (AEFI) in India. Using the revised Causality Assessment Protocol of the World Health Organization, researchers found 48% (499) of the 1037 AEFI reports were causally associated with immunizations. Of these, 189 were related to vaccine product, 175 to vaccine anxiety, and 135 to immunization error. AEFI reporting has improved in India, and the events are well within the expected rates though overall, AEFI surveillance can be improved further. [Expert Review of Vaccines]
Examining the clinical evidence for shorter antibiotic courses. In an article published by the Alliance for the Prudent Use of Antibiotics (APUA), CDDEP research fellow Sumanth Gandra and co-author Gerardo Alvarez-Uria examined the published outcomes of twelve randomized clinical trials in which patients were exposed to antibiotic therapy of varying durations. The researchers found evidence from the studies suggesting that “in many cases there is a substantial opportunity to limit the duration of antibiotic therapy without compromising the clinical outcome.” The authors also found that of 24,676 clinical trials listed as related to communicable disease on www.clinicaltrials.gov in March 2018, only fourteen were related to duration of antibiotic therapy. [APUA]
Carrying “just-in-case” antibiotics leads travelers to unnecessary antibiotic use. Among Finnish travelers to tropical destinations, the determining factor in the use of antibiotics to treat diarrhea was whether or not they had brought along medicines, rather than the severity of their disease. Thirty-four percent of travelers who had carried the medication from home took antibiotics during their trip, compared to eleven percent of those who did not bring medicines. [Travel Medicine and Infectious Disease]
World Health Organization declares Paraguay is free of malaria. No new cases of malaria have been reported in Paraguay in the last five years, and the World Health Organization (WHO) has declared the country to be malaria-free. Nearby Argentina, as well as Algeria and Uzbekistan, will likely be the next countries to be certified malaria-free by WHO this year. Worldwide, over 200 million cases of malaria occur each year, with over 400,000 deaths caused by the disease. [Thomson Reuters Foundation News, World Health Organization]
Polio ruled out after causing alarm in Venezuela. A suspect case of polio reported in Venezuela has been ruled out, according to the Pan American Health Organization (PAHO). Laboratory specimens from a young child experiencing symptoms of acute flaccid paralysis (AFP) were tested and found to be negative for both wild poliovirus and vaccine-derived poliovirus. AFP can be caused by other diseases besides polio; public health officials investigate 100,000 cases each year worldwide. The child is from Delta Amacuro, an area where gaps in vaccine coverage have been reported. PAHO warns that such gaps should be avoided in order to avoid the re-emergence or reintroduction of polio. [Economist, Pan American Health Organization, PAHO Epidemiological Update]
Two new studies show phage may be effective against harmful gut bacteria. Preliminary results from a small double-blind clinical study examining the safety and effects of bacteriophages on the human gut were presented at the 2018 annual meeting of the American Society for Nutrition in Boston. In the study, thirty-one participants with gastrointestinal distress took four weeks of an oral combination of bacteriophage strains or placebo. Researchers reported reductions in the potentially harmful Clostridium perfringens bacteria and significant decreases in levels of interleukin 4, an inflammatory marker. No adverse events were noted. In an unrelated laboratory experiment, scientists in Copenhagen created a simulated small intestine environment—replete with different E. coli strains—and compared the effects of a cocktail of bacteriophages with the effects of the broad-spectrum antibiotic ciprofloxacin. The phage cocktail and ciprofloxacin both reduced E. coli by 99.5 percent, but the phage bacteria were highly specific in attacking only the E. coli, while the ciprofloxacin reduced all other bacteria that had been present. [Guardian, EurekAlert, American Society for Nutrition, Gut Microbes, EurekAlert]
Research on bacteria in bladder reveals previously unrecognized microbial biome. An Australian research team has cultured 78 of the 149 bacterial strains they isolated from the urine of 77 women according to a study in Nature Communications. Researchers used whole-genome analysis to compare the bacteria colonizing the gastrointestinal, vaginal, and urinary systems, and found the vaginal and bladder (but not the gut) biomes of individual women to be highly similar, suggesting the presence of “interconnected urogenital microbiota.” [IFLScience, Nature Communications, ABC Australia]
Analysis of new California law on food-producing animals. The first law restricting antibiotic use in food-producing animals in the United States was California state law Senate Bill 27, passed in September 2015. In a paper published in the UCLA Law review, legal scholar Emelie Aguirre writes about potential operational difficulties in the law’s implementation and enforcement, as well as possible opposition to the state law from the federal government. The author suggests that California use “democratic experimentalism” as used in the Netherlands—rigorous data collection, custom plans for each farm, increased on-farm transparency, veterinary registration of all prescribed antibiotics, plus the creation of an independent institute to monitor antibiotic use, report it publicly, and set benchmarks—and that successful implementation of the law in California could be a model for federal legislation. [The Regulatory Review, UCLA Law Review]
Alternative treatment could reduce long-term antibiotics for acne. Comparing the effectiveness of long-term tetracycline to spironolactone, a team at University of Pennsylvania School of Medicine found the two treatments have similar effectiveness, measured by examining how many patients taking the medication switched to a different treatment within a year. While the US Food and Drug Administration has not approved spironolactone, a drug used to control high blood pressure, for acne treatment, the prospect of an alternative treatment could reduce antibiotic prescribing among dermatologists, who have among the highest rates of antibiotic prescribing across medical specialties. [Journal of Drugs in Dermatology, EurekAlert, Allure]
Benefits of breastfeeding may disappear by age 16. A follow-up study of the Promotion of Breastfeeding Intervention Trial (PROBIT) in Belarus measured 13,557 of the original 17,046 participants using computerized, self-administered tests. Researchers found no significant differences in neurocognitive behavior between 16-year-olds who were exclusively breastfed as infants for three months or more and those who were not. Previous PROBIT studies had found that the verbal Intelligence Quotient (IQ) of the exclusively breastfed children at age six and a half years was 7.5 points higher. The new results did show a small sustained difference in verbal function. [PLOS, New York Times]
Vaccine for Clostridium difficile is effective in mouse trials. A vaccine in development for C. difficile conferred full protection from a hypervirulent epidemic strain of the bacteria in mice, and significant protection in hamsters, according to Xingmin Sun of the University of South Florida. Dr. Sun discussed the results on video at the annual conference of the American Society for Microbiology (ASM) Microbe 2018 Conference in Atlanta. The vaccine consists of a protein that targets the two toxins—TcdB and TcdA—that make C. difficile virulent. [Contagion Live, USF Health]
Photo Credit U.S. Air Force photo by Airman 1st Class Jonathan Snyder
