Top 5 Contagion® News Articles for the Month of March 2017

Much has happened in the world of infectious diseases in the month of March 2017, from strides in hepatitis C treatment, to proposed changes in the Affordable Care Act. But some news stood out more than others this past month, including the rise of Powassan virus in the United States, infection prevention measures to curb the spread of Clostridium difficile in the hospital setting, and new methods to kill cancer-causing bacteria.

Unsurprisingly, taking the number one spot on the list is news regarding the continued circulation of influenza in the United States after the end of the winter season.

In case you missed them, here are Contagion^®’s Top 5 trending news stories from this past month.

#5: Vitamin May Be Key to Killing Cancer-Causing Bacteria

More than half of the world’s population are carriers of Heliobacter pylori, an infectious bacterium. This bacterium is often found in the gastrointestinal system. The Centers for Disease Control and Prevention (CDC) has confirmed that H. pylori causes nine of 10 ulcers of the small intestine and esophagus, and four of five ulcers elsewhere in the gastrointestinal system. Therefore, eliminating this bacterium is of great importance.

Manual Amieva, MD, PhD, associate professor of Pediatric Infectious Diseases and Microbiology and Immunology at Stanford University, recently published findings that illustrate that, in animal subjects, chronic acid suppression, which is used to treat symptoms of ulcers, may predispose patients to gastric cancers if they are also carriers of H. pylori. What’s more, the constant inflammation linked to chronic ulcers, a symptom of H. pylori, is commonly associated with stomach cancers.

According to study co-author Andrey Kovalevsky, PhD, a macromolecular crystallographer and biochemist at Oak Ridge National Laboratory in Oak Ridge, TN, “Most drugs, including common antibiotics, use a generalized mechanism to bind to their targets which, in turn, eliminates the good bacteria you need to stay healthy as well as the bad bacteria.”

Now, researchers from the US Department of Energy (DOE), Oak Ridge, and the University of Toledo, believe that the enzyme these bacteria use to synthesis vitamin K2 may be the key to the development of drugs that would differentiate between H. pylori and “good” gut bacteria.

Using neutron analysis to study the metabolism of H. pylori, the researchers believe they are one step closer to developing drugs that will only target this bacterium. The researchers found that H. pylori “uses a unique biosynthetic pathway to synthesize vitamin K2.” While K2 is associated with blood clotting in humans, the vitamin plays a key role in essential chemical reactions that keep H. pylori alive. Therefore, obstructing these reactions could weaken or kill the bacteria.

According to the lead researcher, Donald Ronning, PhD, a professor of biochemistry at the University of Toledo, this information “will inform future drug design efforts.” Although this may take years, these findings could accelerate the development of treatment options for H. pylori.

To read more about H. pylori, click here.

#4: Florida Residents at Increased Risk for Zika Virus Infection Since June 2016

In July 2016, the Centers for Disease Control and Prevention (CDC) confirmed active local Zika virus transmission in Miami-Dade County. But what started as a handful of cases in one county quickly progressed to include hundreds of infections throughout Miami-Dade, Broward, Pinellas, and Palm Beach counties.

Last month, the CDC put out a statement confirming that Zika virus has, in fact, been circulating since June 2016. According to the CDC, Florida residents are at an increased risk of acquiring the mosquito-borne infection due to “local travel to areas of active transmission in Florida and challenges associated with defining the sources of exposure.” Adding to this is new information that Zika is known to persist in human semen longer than any other bodily fluid for prolonged periods, which increases the risk of transmitting the virus to sexual partners.

Because Zika can be transmitted through semen by several modes of sexual intercourse, men and women alike are at an increased risk of contracting the virus regardless of mosquito exposure. In light of this and since a vast majority of infected individuals do not become symptomatic, there may be, in fact, be more Zika cases than reported. And so, a Florida resident who has never travelled to a Zika-endemic Florida county may still be at risk of contracting the life-changing infection from an asymptomatic male. The CDC also confirmed that females can infect their male sexual partners with the virus. And, although no female-to-female transmission has been reported as of yet, the CDC states that it is “biologically plausible.”

The Zika virus can also be transmitted through blood transfusions, and so the CDC and other health organizations, such as the US Food and Drug Administration (FDA), have been actively screening blood donations in all 50 US states and Puerto Rico for the virus. Unfortunately, “testing for tissue donors, including semen donors, is not currently available; however, tissue donors are asked travel history questions, and if they have travelled to or live in an area of active Zika transmission, they would be determined ineligible under current FDA guidance.”

To read more about Zika in Florida, click here.

#3: Up-and-Coming Prevention Methods for Clostridium difficile

At the Society for Healthcare Epidemiology of America (SHEA) Spring 2016 Conference, held in Atlanta, Georgia in May 2016, Contagion^® interviewed Robin Jump, MD, PhD, assistant professor in the Department of Medicine at the Case Western Reserve University. Dr. Jump discussed up-and-coming infection prevention strategies to block the spread of Clostridium difficile in the healthcare setting.

During her interview, Dr. Jump talked about how healthcare providers can work to better prevent C. diff in post-acute care facilities. She said that prevention “relies in large part on antimicrobial stewardship, [such as] avoiding unnecessary antibiotic exposure, and also relies upon infection control.” In terms of infection control, Dr. Jump suggested practicing proper hand hygiene, and taking the necessary precautions when interacting with patients infected with C. diff.

One important aspect that she stressed is use of proper language when explaining to a patient or family member why prescribing antibiotics should not be the first measure taken to treat a C. diff infection. “We have to, all of us, not just patients, but all of us in healthcare as well, become more willing to delay starting an antibiotic [regimen] and engage in what some people have called 'watchful waiting.' I like to call [it] 'careful observation,' [because] when we say 'watchful waiting' it sounds like we’re not doing anything and that’s not the case, we actually are carefully observing people, and this is especially true for people who are in long-term care and post-acute care facilities,” said Dr. Jump. The term, ‘watchful waiting,’ she explained, may be translate to the patient as if the provider is simply waiting without taking action, when, in fact, the provider is observing infection progression in the patient. This distinction should be communicated.

To read the full interview transcript, click here.

#2: Another Tick-Borne Disease Growing in the United States: Powassan Virus

In October 2016, at the Infectious Disease Society of America annual meeting, ID Week 2016, held in New Orleans, Louisiana, Contagion^® interviewed Holly Frost, MD, pediatrics physician scientist at the Marshfield Clinic Research Foundation, in Minocqua, Wisconsin, on an emerging infectious disease, Powassan virus.

Powassan virus, she said, is a “tick-borne flavivirus that was first discovered in Ontario in 1956.” This virus can be transmitted through the bite of Ixodes scapularis, also known as the black-leg tick or the deer tick. This tick can also transmit Lyme disease, which may or may not cause chronic Lyme disease.

Because this tick-borne infection is relatively new, said Dr. Frost, researchers are still not 100% sure of on incidence of infection in humans in the United States, until now.

Discussing her research team’s study, which was presented during ID Week 2016, Dr. Frost said during her interview, “This was the first study that looked at the prevalence of Powassan virus in humans. We found that, of patients presenting in the Upper-Midwest with suspected tick-borne disease, about 10% of patients had serologic evidence of Powassan virus. We also looked at patients who were presenting just for routine chemistry screening, and we found that about 4% of those patients had serologic evidence of a past Powassan virus infection. We know that the prevalence in humans is likely to be higher than what we had previously estimated, because the [virus’s] prevalence in ticks is growing."

According to her findings, approximately 7% of Ixodes scapularis ticks in some US regions are carriers of Powassan virus, and around 90% of mammals in New England “have serologic evidence of Powassan virus.”

To read the full interview transcript, click here.

#1: Influenza B Cases Continue to Rise in the United States

Although winter is long over, the Centers for Disease Control and Prevention (CDC) expect “significant flu activity to continue in the coming weeks.”

Influenza activity has been dropping nationwide over the past 5 weeks, according to the CDC. The predominant circulating strain at the beginning of the 2016-2017 flu season was influenza A (H3N2); however, a drop in H3N2 cases towards the end of the season was superseded by influenza B, marking a prolonged flu season that will continue into spring.

According to a CDC FluView report for the week ending March 18, 2017, of the respiratory specimens collected nationwide from individuals positive for the flu, approximately 53% had influenza A, while about 47% had influenza B. In the previous week, these numbers were 61% and 39% respectively.

“Overall the percentage of respiratory specimens that tested positive for flu has declined to 18.3% from the previous week’s rate of 18.6%, though there are indicators that the virus continues to impact many parts of the country.”

At the moment, nine US states are reporting influenza-like illnesses (ILI), while 23 US states are reporting minimal ILI. "Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Oklahoma, South Carolina, and Virginia are still reporting high ILI activity.”

To this end, Alabama recently proposed a new bill that would compel all schools in the state to provide parents and guardians with information on CDC immunization recommendations, the influenza vaccine, symptoms, transmission, and other infectious diseases. This comes on the heels of high flu activity in the state that caused several schools to close down.

In an attempt to increase influenza vaccination rates, a new study from Perelman School of Medicine at the University of Pennsylvania illustrated how a new technique called “active choice” may be able to help physicians increase the rate of patient vaccination for the flu. The study found that by informing patients that they are eligible for a flu vaccine and asking them to either accept or decline vaccination, there was a 6% increase in vaccination rates in comparison to vaccination rates at clinics not using the method, and a 37% relative increase in comparison to vaccination rates from the previous years.

Lead author Mitesh S. Patel, MD, MBA, MS, said, “Our results indicate that this simple intervention could be an effective and scalable approach to use the design of electronic health records to increase the rate of flu vaccinations, which are estimated to prevent millions of flu cases and tens of thousands of related hospitalizations every year.”

To read more about influenza B, click here.