Top Infectious Disease News of the Week—August 25, 2019

#5: Duration of Antibiotics Remains Excessive for Many Hospitalized with Pneumonia

Patients hospitalized with pneumonia often receive excess antibiotic treatment, with detrimental outcomes, according to a new study that examined prescribing practices at 43 hospitals in Michigan.

The retrospective cohort study, published in Annals of Internal Medicine, determined excess days of antibiotic treatment by comparing actual treatment with the shortest expected effective treatment based on time to clinical stability, pathogen, and whether the pneumonia was community-acquired or health care-associated.

“After looking at more than 6000 patients hospitalized with community-onset pneumonia, we found two-thirds received longer antibiotic courses than necessary,” lead author Valerie Vaughn MD, MSc, assistant professor of medicine and hospitalist at Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, told Contagion^®. “These long antibiotic courses were harmful: patients were more likely to have side effects for every extra day of antibiotics they received.”

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#4: HHS Funding Backs Additional Year of Ebola Vaccine Manufacturing

The US Department of Health and Human Services (HHS) has announced financial support to continue the manufacturing of the investigational Ebola vaccine from Merck & Co for another year.

According to a statement, the Biomedical Advanced Research and Development Authority (BARDA), which is a component of the HHS Office of the Assistant Secretary for Preparedness and Response, will contribute $23 million to Merck for production of the vaccine over the next 12 months.

Additionally, BARDA will be working with Merck on the development of the experimental Ebola vaccine, rVSV-ZEBOV, including assistance towards obtaining licensure by the US Food and Drug Administration.

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#3: 2 Deaths Recorded in Multistate Listeria Outbreak

The US Centers for Disease Control and Prevention (CDC) is working alongside several health agencies to investigate a multistate outbreak of Listeria monocytogenes.

As of August 23, 2019, there have been 24 cases associated with the outbreak across 13 states. At this time health officials have not identified a particular source of infection.

A statement issued by the CDC reports that cases of Listeria associated with this outbreak were first confirmed in July 2017, with the most recent case confirmed on August 1, 2019. The ill individuals range in age from 35 to 92 years, with a median age of 72. According to available information, 22 of the ill individuals have been hospitalized and 2 patients died from their illness.

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#2: A New Approach to Discontinuing MRSA/VRE Isolation Precautions

Imagine you’re a patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection and, during your hospitalization, you’re in contact isolation precautions. For many, this can be a frustrating, lonely experience, even though it is necessary for the safety of health care workers and other patients. For health care workers, treating a patient under isolation precautions can be cumbersome, time-consuming, and resource-intensive. Contact precautions for those with endemic MRSA are often associated with longer admission wait times, longer length of stay, delays in transfers to long-term care facilities, and more.

For those patients though, with endemic MRSA and/or vancomycin-resistant Enterococcus (VRE) colonization, many health care facilities are considering discontinuing contact precautions. As colonization of MRSA or VRE becomes the new norm, it has left many to question whether these infection prevention efforts are truly effective in light of the impact on the health care worker and the implications for the patient.

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#1: CDC's ACIP Issues Influenza Vaccine Recommendations for 2019-2020 Season

As we approach the start of the 2019-2020 influenza season in the United States, the US Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has issued updated recommendations on the use of the seasonal vaccine.

Published in the August 23rd Morbidity and Mortality Weekly Report, the update urges annual influenza vaccination for all persons ages >6 months who do not have a contraindication, such as history of a severe allergic reaction.

The crux of new information centers around the vaccine virus composition for the 2019-2020 season, and recent labeling changes for previously licensed vaccines.

“2019—20 US trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage),” the committee wrote in the report. “Quadrivalent influenza vaccines will contain HA derived from these 3 viruses and from an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage). This composition includes updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine.”

Since the 2018-19 ACIP Influenza Vaccine Statement was issued, the US Food and Drug Administration (FDA) has issued 2 regulatory actions, including an expanded age indication and a change in dose volume.

In October 2018, the agency approved an expanded age indication for Afluria Quadrivalent, which was previously licensed for persons aged <5 years, and is now licensed for persons aged >6 months. “The dose volume is 0.25 mL per dose (containing 7.5 µg of HA per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years),” the committee noted.

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