June 360: Trending Infectious Disease News of the Month

During the month of June, the editorial team provided coverage on the Association for Professionals in Infection Control and Epidemiology (APIC 2019) annual conference, the 5^th Annual Biodefense World Summit, and ASM Microbe 2019. In addition to conference coverage, the staff published the June issue of Contagion®.

The June issue covers a variety of topics, including a look at what’s in the pipeline for HIV/AIDS and an analysis of the uptick in vector-borne diseases. June’s feature was authored by Christina G. Rivera, PharmD, BCPS, AAHIV-M, and tackles the subject of outpatient antimicrobial stewardship.

Prior to reading the publication, be sure to check out video teasers with editor-in-chief Jason Gallagher, PharmD, FCCP, FIDSA, BCPS; and section editors Monica Mahoney, PharmD, BCPS, AQID, BCIDP; and Ryan K. Shields, PharmD, MS.

In HIV news, the US Preventive Services Task Force issued a ‘Grade A’ recommendation for pre-exposure prophylaxis (PrEP) for HIV prevention. Additionally, investigators on the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study evaluated HIV risk associated with use of 3 types of contraceptives: DMPA-intramuscular; a 3 monthly, progestogen-only, reversible injectable contraceptive; and levonorgestrel implant and found no substantial difference in HIV risk among the methods.

In the final segments of the Contagion® Peer Exchange program on HIV, panelists Joseph Eron, MD; Paul Sax, MD; W. David Hardy, MD; Eric S. Daar, MD; and Ian Frank, MD, addressed important topics in HIV management, including how to treat patients with virological failure or incomplete virological responses, as well as discussed the future of HIV prevention and treatment.

June also saw a stable increase in measles cases across the United States with 1077 cases reported as of May 24, 2019. Although the US Centers for Disease Control and Prevention did not announce any new infectious disease outbreaks in June, the World Health Organization once again convened an International Health Regulations Emergency Committee meeting to evaluate the threat level of the Ebola outbreak in the Democratic Republic of the Congo, following the confirmation of 3 cases of Ebola in neighboring Uganda. Despite expressing “deep concern,” about the outbreak, the committee did not declare it a Public Health Emergency of International Concern. Case counts for the Ebola outbreak and ongoing infectious disease outbreaks can be found on the Contagion® Outbreak Monitor.

News from the US Food and Drug Administration (FDA) included the approval of ceftolozane/tazobactam for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Additionally, the FDA issued a label expansion for Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide). Finally, the FDA accepted a supplemental New Drug Application for delafloxacin for the treatment of community-acquired bacterial pneumonia. A PDUFA action date is scheduled for October 24, 2019.

With July on the horizon, check out a list of the top 5 articles from the month of June below:

#5: Immediate HIV Treatment May Promote Robust CD4 Cell Response

The scientific community understands that when it comes to HIV treatment, earlier initiation is better. Now, a study conducted by investigators at the Ragon Institute of MGH, MIT, and Harvard reveals that extremely early introduction of antiretroviral treatment (ART)—ideally within a day or 2 of HIV diagnosis—may actually alter the course of the disease and enable the preservation of crucial CD4 T cells in infected individuals.

The investigators tapped a group of women enrolled in the FRESH (Females Rising Through Education, Support and Health) study in KwaZulu-Natal, Africa, which emphasizes career and life skills and offers HIV prevention strategies, treatment, and regular testing. Participants were sexually active women between the ages of 18 and 23 years, although all were HIV negative at the time of enrollment in the FRESH study.

The 46 Ragon Institute study participants were grouped into 3 cohorts. Group 1 consisted of 26 women in the FRESH study whose blood tests indicated that they were in the very earliest stages of HIV infection. This group was given ART right away, no more than 24 to 48 hours after diagnosis. Group 2 consisted of 8 participants whose HIV stage was slightly more advanced; this group also received ART immediately. The third group comprised 12 women in various stages of HIV infection who did not begin taking ART until the acute phase of infection had passed and their CD4 cell counts dropped below 350 cells/mm3, which was consistent at the time with South African guidelines for treatment.

Read more about early introduction of ART.

#4: 'If Not Us, Who?': Dr. Drew Urges Clinicians to Speak Up on West Coast Infectious Disease Crisis

Drew Pinsky, MD, is calling on his peers in medicine to help sound the alarm about the abysmal conditions on the Pacific Coast driving the explosion of infectious diseases that have some cities, particularly Los Angeles, teetering on the brink of a humanitarian crisis.

“Speak up and talk about what you’re seeing in the emergency rooms and in the clinics. We are the early detection systems. We know what’s going on before anybody. We see the trends, we know what they are, we see it coming,” Pinsky, an internist and globally recognized addiction medicine specialist, told Contagion® in an exclusive interview.

The problem stems from the homeless population, Pinsky said, and the “gigantic unsanitary accumulations” that go hand-in-hand with thousands of people living on the streets.

Read more of Contagion®’s interview with Pinsky.

#3: Ebola Cases Confirmed in Uganda

The World Health Organization (WHO) in Uganda has announced on Twitter that a confirmed case of Ebola has been detected in Uganda. This case is the first confirmed case of Ebola that Uganda has detected during the ongoing outbreak in the neighboring Democratic Republic of the Congo (DRC).

According to the Twitter thread, the confirmed case is in a 5-year-old Congolese boy who traveled from the DRC into Uganda on June 9, 2019. The family entered the country through the Bwera Border post which is located along the Western border of Uganda which is shared with the DRC.

The child initially sought care at a hospital in Kagando hospital where health workers identified Ebola as a potential diagnosis. At that point the child was transferred to an Ebola Treatment Unit in Bwera. Read more about the detection of Ebola in Uganda.

#2: More Than Surviving Sepsis: Everything Old Is New Again

Because of numerous failed attempts at novel or targeted therapies in sepsis over the past 20 years, investigators have been compelled to step back in time and repurpose old agents, including angiotensin II and ascorbic acid, for the treatment of sepsis and septic shock. Both medications have historically shown promise in animal shock models. However, it was not until the publication of recent clinical investigations in humans that investigators’ interest piqued regarding their use in refractory vasodilatory shock.

ANGIOTENSIN II

Management of distributive shock focuses on early and adequate fluid resuscitation, timely antibiotic administration, and initiation of catecholamine (eg, norepinephrine, epinephrine) and/or noncatecholamine (eg, vasopressin) vasopressor therapy.¹ Given the potential for dose-dependent adverse effects (AEs) from catecholamine-based vasopressor therapy (eg, tachycardia), noncatecholamine therapy has potential clinical benefits.

One promising therapeutic strategy involves using the renin-angiotensin-aldosterone system (RAAS) to generate noncatecholamine vasopressor effects. Angiotensin II binds a number of G-protein coupled receptors, including angiotensin II receptor type 1 (AGTR1), which notably results in vasoconstriction, aldosterone secretion, sodium and water retention, and vasopressin release.² Read more about surviving sepsis.

#1: Number of Reported Polio Cases in First Months of 2019 Up From 2018

The near eradication of poliomyelitis is one of the great public health achievements of the last century, but, in a new report detailing global progress made toward polio elimination, investigators say that the first months of 2019 have seen an uptick in cases of wild poliovirus compared with the same period in 2018.

More than 2.5 billion children have been vaccinated against polio since the start of the Global Polio Eradication Initiative in 1988, and since then the global incidence of polio cases has dropped by 99%. Today polio transmission continues in only 3 countries, and the new report published in the US Centers for Disease Control and Prevention’s (CDC) Mortality and Morbidity Weekly Report details revised emergency action plans for polio vaccination in Afghanistan, Nigeria, and Pakistan, where polio continues to be endemic.

The new report details global cases of wild poliovirus (WPV) and circulating vaccine-derived poliovirus (cVDPV) and progress toward their eradication from January 1, 2017, to March 31, 2019. Since 2015 WPV type 2 (WPV2) has been declared eradicated, and no cases of WPV type 3 (WPV3) have been detected since 2012. There have also been no reported cases of WPV1 in the World Health Organization’s (WHO) African Region in 30 months. For the first time since 2014, however, the number of WPV cases reported in Afghanistan and Pakistan rose, from 22 WPV1 cases in 2017 to 33 cases in 2018. In addition, from January through March 2019 there were 12 cases of WPV type 1 (WPV1) reported worldwide, 4 more than the 8 cases reported during the corresponding period in 2018.

“The increase in WPV1 cases tells us 2 things,” study co-author Sharon A. Greene, PhD, told Contagion®. “First, our surveillance is sensitive enough to detect cases and to succeed in eradicating polio. We must know where the virus is circulating. Second, it tells us that children are not getting vaccinated. Inadequate immunization coverage, either through routine immunization programs or supplemental immunization activities must be strengthened to stop poliovirus circulation.” Read more about the uptick in polio cases.