Top Infectious Disease News of the Week—February 3, 2019

#5: More Exemptions and Less Vaccination: The 2 Factors Driving US Measles Outbreaks

The recent measles outbreak in New York City is a textbook example of a travel-associated outbreak. Health investigators in the city have determined that the first case was identified in an unvaccinated child who was exposed to measles during travel to Israel.

Legislation in the state of New York permits vaccine exemptions for individuals who have religious beliefs against immunization. As such, cases in this particular outbreak have spread among unvaccinated individuals in Orthodox Jewish communities, but have yet to affect those outside of the religious group, according to the New York City Health Department.

However, New York legislation opposes philosophical exemptions for vaccinations, meaning that children must be up-to-date on required vaccinations in order to attend school unless they have a religious or medical exemption.

Read about vaccine exemptions during a measles outbreak.

#4: Quality of Life Steady for New PrEP Users

Pre-exposure prophylaxis (PrEP) has been a game changer for people at risk of contracting HIV, particularly men who have sex with men (MSM). The medication, which combines tenofovir and emtricitabine in the form of a single pill to be taken daily, reduces the chance of transmission significantly.

However, investigators have questioned whether PrEP affects the quality of life of its users in the same way the burden of antiretroviral therapy can impact the quality of life of people living with HIV. The results of a recent study published in PLOS ONE show relatively high quality of life scores that rival those of the general population and barely budged during 48 weeks on PrEP.

Investigators at Weill Cornell Medicine in New York, the Fred Hutchinson Cancer Research Center in Seattle, and other centers reviewed data from 591 participants (186 women and 405 men) enrolled in an existing study comparing 3 different PrEP regimens with the standard tenofovir/emtricitabine combination (the control group). All participants completed a baseline quality of life assessment measured with the EQ-5D-3L, which covers questions on self care, mobility and movement, pain, anxiety, and depression.

Read about the quality of life in PrEP users.

#3: 'Victorian-Era' Diseases on the Rise in the UK, but Why?

Hospital visits for so-called “Victorian-era” diseases are on the rise in the United Kingdom, and experts there believe public health budget cuts may be behind the upswing.

According to UK National Health Service data analyzed by the opposition Labour party, hospital visits for scarlet fever, gout, whooping cough, and malnutrition rose by 3000 admissions since 2010-11, a 52% increase.

Admissions for a primary diagnosis of scarlet fever spiked more than 200% (429 hospital admissions in 2010-11 to 1321 in 2017-18), gout admissions rose 38% (4935 in 2010-11 to 6824 in 2017-18), whooping cough admissions rose 59%, and malnutrition admissions rose 54%.

“It’s very concerning that these conditions, associated with a bygone era, seem to be on the resurgence,” Helen Donovan, professional lead for public health at the Royal College of Nursing, said in a statement to Contagion®. “Nurses are central to educating people about what they can do to better look after their own health, however the very nurses that deliver public health interventions around diet, [behavior], and lifestyle have seen their numbers plummet—last year, the number of health visitors fell by 22 percent. As a result, people at risk of diseases we thought were a thing of the past will continue slip through the cracks.”

Read about the rise of Victorian-Era Diseases?

#2: FDA Accepts Regulatory Review Filings for 2 of Merck's Antibacterial Agents

The US Food and Drug Administration (FDA) has accepted for review 2 regulatory filings for antibacterial agents being developed by Merck.

A New Drug Application (NDA) was accepted for the Priority Review of the combination of relebactam with imipenem/cilastatin for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) caused by susceptible gram-negative bacteria in adults with limited or no alternative therapies available.

A supplemental NDA (sNDA) was accepted for the Priority Review of ceftolozane/tazobactam (ZERBAXA) to treat adult patients with nosocomial pneumonia, including ventilator-associated pneumonia caused by particular susceptible gram-negative microorganisms including Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Bacteroides fragilis, Streptococcus anginosus, Streptococcus constellatus, and Streptococcus salivarius.

Read about Merck's antibacterial agents.

#1: Concerns for Flu-Drug Resistance Grow

We’re in the middle of influenza season and flu activity is still high in the United States, with the proportion of outpatient visits for influenza-like illness at 3.8%—above the national baseline of 2.2%— for the week ending January 26, 2019. The US Centers for Disease Control and Prevention (CDC) reported that influenza A(H1N1)pdm09 continues to be the predominant flu virus this year across the country.

Although many individuals might reach for anti-viral medications in the face of an influenza infection, there is growing concern about resistance to flu medication stemming from a recent finding by Japanese researchers.

Microbial resistance is not reserved solely for bacteria and antibiotics; the truth is that viruses are wholly capable of mutating to become resistant against medications. Consider HIV—the virus has the ability to mutate and continue viral production in the presence of the antiretroviral drugs that are used to kill it. The same concerns exist for influenza viruses, which already mutate quite rapidly.

In late January, investigators published findings that a new influenza antiviral drug may not be as effective as originally anticipated. Marketed as a competitor for existing medications Tamiflu (oseltamivir) and Relenza (zanamivir), this new medication is called Xofluza (baloxavir marboxil) and is recommended for flu treatment. Although Xofluza doesn’t prevent the flu like the vaccine, if taken within 48 hours of becoming sick with symptoms, such antiviral drugs can help lessen the symptoms and shorten the duration of sickness. The driving point of Xofluza is that it is offered as a single dose while Tamiflu requires twice daily doses for 5 days.

Read about the concern for flu-drug resistance.