November 360: Trending Infectious Disease News of the Month

As fall turns to winter and the peak of influenza season is approaching, we are reviewing the infectious disease news which made headlines this November.

For the first time, the Contagion® editorial staff attended the Association of Nurses in AIDS Care (ANAC 2019) conference, this year located in Portland, Oregon. The meeting is the leading conference for nurse practitioners and nurses working in HIV and associated conditions.

At ANAC, the team sat down with Timothy Ray Brown, once referred to as the “Berlin Patient.” Brown who was the first person to be cured of HIV after receiving a stem cell transplant to treat leukemia. We featured our interview with Brown on the fourth episode of our podcast, Contagion® Connect.

At the conference, we conducted video interviews with several experts including Jennifer Cocohoba, PharmD, who discussed polypharmacy and how it impacts people living with HIV. We also spoke to Heather Alt, BSN, RN, ACRN, CPH about research on a nurse-led model for same day initiation of antiretroviral therapy for people newly diagnosed with HIV.

Additional meeting coverage included presentations on pre-exposure prophylaxis (PrEP) implementation strategies for women reporting intimate partner violence as well as on the debate over which providers are responsible for providing PrEP.

US Food and Drug Administration (FDA) approvals this month included cefiderocol for complicated urinary tract infections, which was backed for efficacy by an FDA advisory committee in October. Labeling includes a warning regarding the higher all-cause mortality rate observed in cefiderocol-treated patients compared to those treated with other antibiotics in the CREDIBLE-CR study in critically ill patients with multidrug-resistant gram-negative bacterial infections.

A high-dose quadrivalent influenza vaccine was approved for adults 65 and older, and will be deployed in the 2020-21 flu season.

The FDA also cleared the first duodenoscope with a disposable elevator piece, an innovation which reduces the chances of infection by reducing the number of parts which require cleaning and disinfection between uses.

The FDA announced an E coli outbreak linked to romaine lettuce that occurred over the summer which was not publicized previously. Additionally, the FDA and US Centers for Disease Control and Prevention announced a hepatitis A outbreak linked to blackberries, cases of scombrotoxin fish poisoning related to yellowfin tuna, and another E coli outbreak connected to romaine lettuce from farms in Salinas, California.

As always, check out the Contagion® Outbreak Monitor to learn more about infectious diseases outbreaks in your area.

Let’s take a look at the top 5 web articles from the month of November:

#5 FDA Approves Fluzone High-Dose Quadrivalent Influenza Vaccine for Older Adults

The US Food and Drug Administration (FDA) has approved Sanofi’s Fluzone High-Dose Quadrivalent (Influenza Vaccine) for use in adults 65 years of age and older. The vaccine will be made available for the 2020-2021 influenza season.

The approval of the supplemental Biologics License Application marks a transition from the company’s trivalent influenza vaccine first approved in 2009 that contained 2 influenza A strains and 1 influenza B strain. Fluzone High-Dose Quadrivalent contains an additional influenza B strain.

In a phase 3 immunogenicity and safety trial, the quadrivalent vaccine met its primary end point of non-inferior immunogenicity compared with 2 trivalent formulations of Fluzone High-Dose. Additionally, each B strain in Fluzone High-Dose Quadrivalent induced a superior immune response compared with the trivalent formulation.

Read the full article.

#4 CDC Announces E Coli Outbreak Likely Linked to Romaine

US Centers for Disease Control and Prevention (CDC) officials have notified the public of an ongoing investigation regarding a multistate outbreak of Escherichia coli O157:H7 infections likely connected to romaine lettuce. CDC, US Food and Drug Administration (FDA), and state officials are collaborating to identify illnesses and trace the contamination through the transmission chain.

FDA, CDC, and state health authorities believe their traceback evidence indicates that romaine lettuce from the Salinas, California growing region is the likely source of this outbreak.

As of November 18, 2019, a total of 17 people from 8 states have been reported infected with the outbreak strain. Onset of illness dates range from September 24 to November 8, 2019.

Read the full article.

#3 Contagion® Connect Episode 4: Timothy Ray Brown's Advocacy for HIV Cure Research

Interview transcript (modified slightly for readability):

Welcome to Contagion® Connect. This new podcast will bring you expert perspectives on trending infectious disease topics.

In this episode, we feature a conversation with Timothy Ray Brown recorded at ANAC 2019 in Portland, Oregon. Brown became the first person to be cured of HIV after received a stem-cell transplant to treat leukemia. At first, he desired to remain anonymous and was referred to as the “Berlin Patient.” However, in 2010, Brown came forward and has become an advocate for people living with HIV. He hopes to see the day when all individuals when HIV can be cured safely.

Contagion®: Can you tell me a little bit about your decision to come forward as the “Berlin Patient” and why advocacy is so important to you?

Brown: Leading up to 2010, after my story broke in the New England Journal of Medicine, and then started becoming an important story, I decided I did not really want to be the “Berlin Patient” anymore. I wanted to have people know me by my name and so and I decided that I couldn't be the only person in the world cured of HIV. I was at that point, I didn't want that anymore. I wanted more people to be cured—I wanted everyone with HIV to be cured. And, and so in order to do that, I had to release my name and my image to the public and, and since then, I've become kind of a cheerleader for HIV cure.

Listen to the full podcast.

#2 Changes in Therapy Recommendations in the 2019 ATS/IDSA Guidelines for Community-Acquired Pneumonia

After about 12 years, a joint update of the community-acquired pneumonia (CAP) guidelines was recently published by the American Thoracic Society and the Infectious Diseases Society of America. This article highlights some key updates to the antimicrobial therapy recommendations.

First, the term health care-associated pneumonia (HCAP) was introduced in the 2005 guidelines for hospital-acquired, ventilator-associated, and health care-associated pneumonia as it was thought some patients who acquired pneumonia in the community with certain risk factors for multidrug-resistant bacteria (e.g., living in nursing homes) should be treated similarly to patients with nosocomial pneumonia. In the new guidelines, the term HCAP is clearly eliminated and it is recommended that these patients be treated as CAP patients without covering methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa unless they meet criteria for locally validated risk factors for antibiotic-resistant bacteria.

Read the full article.

#1 Resolved E coli Outbreak Linked to Romaine Lettuce

US Food and Drug Administration (FDA) officials are informing the public of a recent Escherichia coli O157:H7 outbreak likely associated with romaine lettuce. Shiga toxin-producing E coli O157:H7 can sometimes lead to serious complications such as severe diarrhea and kidney damage.

As of November 1, 2019, 23 confirmed illnesses were associated with the outbreak. Illnesses initiated on dates ranging from July 12, 2019 to September 8, 2019. There were no illnesses reported after the US Centers for Disease Control and Prevention (CDC) began its investigation on September 17, 2019. In total, 12 states were affected.

The outbreak was investigated by the US Centers for Disease Control and Prevention (CDC) and FDA, but is believed to be over at this time. CDC notified the FDA of the E coli related illness cluster in mid-September 2019 and a traceback investigation was promptly initiated. The FDA, CDC, and local partners investigated the illnesses associated with the outbreak. Among the 23 illnesses associated with the outbreak, 11 individuals were hospitalized but no deaths were reported.

Public health investigators visited farms located in the central coast region of California which were identified through the traceback investigation. CDC reports collecting many environmental samples from the farms; however, the outbreak strain was not identified.

The investigation did not identify a common source or point where contamination occurred, but investigators believe romaine lettuce is likely the cause of the outbreak. Because the outbreak strain was not detected in environmental samples and no new cases have been identified since September 8, 2019, CDC believes the outbreak to be over.

Read the full article.