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Some details emerge on coronavirus cases, but many gaps remain

first_imgSep 26, 2012 (CIDRAP News) – A European report has filled in some details about the two severe illnesses linked to a novel coronavirus, but most of the major questions, such as where it came from and how it spreads, remained unanswered today.A 49-year-old Qatari man remained in a London hospital’s intensive care unit with a severe respiratory illness accompanied by renal failure. A 60-year-old Saudi Arabian man who had a similar illness and was infected with a virtually identical coronavirus died in June in his home country. No new confirmed or suspected cases were reported today.A risk assessment released by the European Centre for Disease Prevention and Control (ECDC) offered some new details on the cases, including that the Qatari patient had returned from a trip to Saudi Arabia more than 10 days before he fell ill on Sep 3, which seems to suggest that he wasn’t infected while in that country.A case definition released by the World Health Organization (WHO) yesterday lists a history of travel to Saudi Arabia within 7 days before illness onset, or close contact with a probable or confirmed case-patient in that same time frame, as a possible clue to the virus in a person who is hospitalized with an acute respiratory infection accompanied by fever and cough.A Sep 25 letter from the head of the United Kingdom Department of Health to UK health workers said the incubation period for the new virus is assumed to be 7 days, given what is known about other human coronavirus infections. The letter to UK National Health Service workers was written by Dame Sally C. Davies, chief medical officer.A then-novel coronavirus sparked the SARS (severe acute respiratory syndrome) outbreak in 2003, which involved more than 8,422 cases globally and killed 916 people, according to the ECDC risk assessment. Aside from the outbreak, human coronaviruses are mainly known for causing colds. Health officials have stressed that the new coronavirus is clearly different from the SARS virus.Both the Davies letter and the ECDC risk assessment said no suspected cases have been found among contacts of the Qatari patient or elsewhere. “Many of these contacts are already likely to be beyond the incubation period . . . when symptoms would have developed had they been infected,” Davies wrote.The ECDC said that as of yesterday it was not aware of “any increase in the number of patients with acute respiratory infections of unknown cause in intensive care units in Saudi Arabia or Qatar.”The ECDC statement filled in some new details on the 60-year-old Saudi Arabian who died. It said he fell ill on Jun 6, was hospitalized with severe pneumonia on Jun 13, and died on Jun 24.The fact that the two cases occurred 3 months apart and that time spent in Saudi Arabia is the only known link means that “independent non–human-to-human transmission must be considered” and that an animal source can’t be excluded, the ECDC said.In addition, it is likely that the novel virus caused both cases, but more evidence is needed to prove this, the agency said. It added, “It is not clear which laboratory tests are most applicable for detection of the novel coronavirus, and there is therefore an urgent need to validate the existing tests and to develop more specific ones.”Meanwhile, the UK Health Protection Agency (HPA) said today that the WHO “has convened relevant European laboratories to work collaboratively to produce clinically validated assays for real-time detection of the novel coronavirus.” The HPA also said that Ron Fouchier, PhD, of Erasmus Medical Center in the Netherlands, is expected publish the full genome of the virus from the Saudi Arabian man within a day or two.In other developments, the Hong Kong Centre for Health Protection (CHP) published some guidance related to the new coronavirus, including advice to schools and recommendations on personal protective equipment for helathcare personnel. Hong Kong served as the launching pad for the international spread of the SARS virus in 2003, after it emerged in mainland China in late 2002.See also: ECDC risk assessmentSep 25 Davies letter to NHS staffSep 26 UK HPA statement about development of molecular diagnostics for new virusHong Kong CHP guidance for schools and recommendations for healthcare workerslast_img read more

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ASP Scan (Weekly) for Dec 15, 2017

first_imgOur weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scansStudy: No benefit from adding rifampicin to S aureus bacteremia treatmentThe results of a large randomized trial show that adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with Staphylococcus aureus bacteremia, UK researchers reported yesterday in The Lancet.For many years, the researchers explain, it’s been hypothesized that adding rifampicin to the standard treatment for S aureus bacteremia (either an anti-staphylococcal penicillin or a glycopeptide if the bacteria are resistant to methicillin) might improve outcomes for the infection, which is one of the most common and serious community- and hospital-acquired infections worldwide. That belief has led to widespread use of rifampicin for treatment of S aureus bacteremia, even though the evidence to support the benefit is weak.To test the hypothesis that adjunctive rifampicin is beneficial for S aureus bacteremia patients, the researchers conducted a multicenter, randomized, double-blind, placebo-controlled trial of adults with S aureus bacteremia treated at 29 UK hospitals from December 2012 through October 2016. The participants were randomized 1:1 to receive either rifampicin or a placebo for 2 weeks, plus standard antibiotic therapy as chosen by the attending physician. The primary outcome was bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomization to 12 weeks.Of the 758 eligible participants, 370 received rifampicin and 388 received a placebo in addition to standard therapy. Standard antibiotics were given for a median duration of 29 days, and 619 participants (82%) received flucloxacillin. By week 12, bacteriologically confirmed treatment failure or disease recurrence, or death, had occurred in 62 participants (17%) in the rifampicin group compared with 71 patients (18%) in the placebo group (absolute risk difference -1.4%, hazard ratio 0.96). While there was a small but significant reduction in disease recurrence associated with rifampicin, that effect had no impact on short-term or long-term mortality. In addition, patients treated with rifampicin had more adverse events than those treated with placebo (17% vs. 10%) and were more likely to have drug interactions that complicated their treatment (6% vs. 2%)”In summary, adjunctive rifampicin did not improve outcomes from S aureus bacteraemia, with the exception of a modest reduction in disease recurrence,” the authors conclude. Dec 14 Lancet studyDec 14 Lancet commentary Irish study finds VRE contamination common in the ICUIrish researchers report that intensive care unit (ICU) environmental contamination with vancomycin-resistant enterococci (VRE) in areas near patients is common, even in non-outbreak settings, according to a study yesterday in Infection Control and Hospital Epidemiology.In the single-center study, conducted in the ICU of an 820-bed teaching hospital in Dublin, investigators took samples from the ICU environment and patients during seven sampling periods from October 2012 through June 2014. The aim of the study was to identify potential reservoirs of VRE, investigate the clinical and molecular epidemiology of VRE outside of outbreaks, and assess the role of active surveillance cultures (ASCs) in identifying VRE patients in this setting. Ireland has the highest rate of VRE bloodstream infections in Europe at 45.8%.Of 289 sampling occasions involving 157 patients and their bed spaces, VRE isolates were recovered from patient bed spaces, clinical samples, or both on 114 of 289 sampling occasions (39.4%). The patient and their bed space were positive for VRE on 34 of 114 VRE-associated sampling occasions (29.8%). Thirty of the 157 patients (19%) were VRE-colonized.Of 1,647 environment samples, 107 sites (6.5%) were VRE positive, with significantly greater VRE recovery from isolation rooms than from the open-plan area (9.1% vs 4.1%). The most frequently VRE-contaminated sites were the drip stand, bed control panel, and chart holders, which together accounted for 61% of contaminated sites. The use of ASCs resulted in a 172% increase in identification of VRE-colonized patients. Molecular typing revealed two environmental clusters, one involving three patients and generally greater heterogeneity of patient isolates compared to environmental isolates.The authors conclude that better infection control policies that limit environmental transmission of VRE in the ICU are needed. Dec 14 Infect Control Hosp Epidemiol study Palestinian study finds good response to ICU stewardship interventionA prospective audit-and-feedback antimicrobial stewardship program (ASP) in a Palestinian ICU found a high acceptance rate for the ASP team’s recommendations, according to a study this week in the British Journal of Clinical Pharmacology.The ASP program was begun at the Palestinian Medical Complex in September 2015. The investigators analyzed data from the 4 months before and the 4 months after implementation.They found that, of 176 recommendations made by the ASP team, 78.4% were accepted. The most often accepted interventions were dose optimization (87%) and de-escalation based on culture results (84.4%). In addition, interventions were associated with a 24.3% reduction in antimicrobial use, shorter length of stay, and significantly reduced duration of therapy. Dec 13 Br J Clin Pharmacol study More cases of puppy-linked Campylobacter reported in several statesOriginally published by CIDRAP News Dec 13The Centers for Disease Control and Prevention (CDC), in an update on an ongoing outbreak of multi-drug resistant Campylobacter infections linked to puppies sold in pet shops today, confirmed 30 new cases reported since the last outbreak update published on Oct 30.As of yesterday, officials have reported that 97 people in 17 states have laboratory-confirmed infections or symptoms consistent with Campylobacter infection. A total of 22 people have been hospitalized, but no deaths have been reported. The first cases were reported to the CDC in June.The vast majority of patients (98%) reported contact with a puppy in the week preceding illness. Ninety percent of people interviewed said they had contact with a puppy from a Petland store, or had contact with a person who became sick after contact with a puppy from a Petland store. Twenty-one ill people worked at a Petland store.Using whole genome sequencing, the CDC identified multiple antimicrobial resistance genes and mutations in most isolates from 35 ill people and 9 puppies, including resistance to azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline.Dec 13 CDC update Clinicians call for more inclusive trials for new antibioticsOriginally published by CIDRAP News Dec 12A letter today in the Journal of Infectious Diseases argues for relaxed criteria for patient exclusion in randomized controlled trials (RCTs) for new drugs to treat multidrug-resistant infections.The letter, written by two Israeli clinicians, describes three patients with severe infections caused by carbapenem-resistant bacteria that presented during a single day at a hospital in Haifa. None of the three patients, the authors note, was eligible for an ongoing RCT at the hospital to assess the antibiotic cefiderocol—a novel siderophore cephalosporin in late-stage development—versus the best available therapy for bloodstream and other severe multidrug-resistant infections. All were treated with colistin as the only covering antibiotic.These cases, the authors argue, point out a paradox. While it’s estimated that more than 700,000 patients die each year from infections caused by multidrug-resistant pathogens, and plenty of patients with carbapenem-resistant infections are described in epidemiologic studies, finding patients for drug approval RCTs is difficult. That’s because RCTs are often biased toward uncomplicated patients with a low risk of death, and the patients with the types of conditions described in their letter—neutropenia, severe sepsis, and organ failure—are often excluded from such studies. Yet these are the patients who may have the greatest need for new treatments.While efforts to improve testing and approval requirements of new drugs for unmet needs have been commendable, the authors write, “We would like a discussion about the changes in regulatory guidance to the industry that would relax criteria for patient exclusion to ensure that the patients in [an] RTC resemble a bit more the patients in need of the antibiotic under study.”Dec 12 J Infect Dis letter Commentary: Vaccines needed in the fight against AMROriginally published by CIDRAP News Dec 12Vaccines could and should play a key role in stemming the antimicrobial resistance (AMR) crisis, according to a commentary today in Nature.The commentary, co-authored by the chief scientist at GlaxoSmithKline Vaccines and professors from Harvard T.H. Chan School of Public Health and Cincinnati Children’s Hospital, calls for a global strategic effort to prioritize development of a portfolio of vaccines to target AMR.Their reasoning is based on several factors. For one, they argue, vaccines almost never prompt bacteria to develop resistance. In addition, scientists have had much more success over the last 30 years developing new vaccines than they’ve had discovering new antibiotics. Since the 1980s, 22 new vaccines have been deployed in the clinic, while no new truly new class of antibiotics has been discovered or engineered. And vaccine technology continues to evolve.Given this reality, and the fact that several current vaccines—such as the pneumococcal and influenza vaccines—have already helped directly and indirectly reduce the need for antibiotics, the authors say vaccines must be considered an essential element of the fight against AMR, along with new antibiotics, diagnostics, surveillance, and stewardship. Launching an effort to develop a portfolio of vaccines against AMR, they say, will require policymakers and stakeholders to raise awareness about the potential of vaccines to combat AMR, to persuade governments and drug companies of the cost-effectiveness of investing in vaccines, and to prioritize which bacterial strains should be targeted.”Over the past few years, key institutional stakeholders — notably the [World Health Organization], the [United Nations General Assembly], the World Bank, the G20 group of countries, the European Union and the UK and US governments — have called for researchers to develop new antibiotics to expand our arsenal in the war against superbugs,” the authors write. “We appeal to these organizations to call now for a multi-layered strategy that prioritizes the development of vaccines to target resistant strains.”Dec 12 Nature comment Interventions to reduce overtreatment of asymptomatic bacteriuria notedOriginally published by CIDRAP News Dec 11A paper today in JAMA Internal Medicine proposes an evidence-based implementation guide to help reduce inappropriate treatment of asymptomatic bacteriuria (ASB).Despite efforts to reduce the practice, treatment of ASB—defined as isolation of bacteria in an uncontaminated urine specimen in the absence of urinary tract infection symptoms—remains prevalent across settings and frequently leads to inappropriate antibiotic prescribing. A multicenter retrospective review of three US hospitals found that 38% of in patients with ASB were treated with antibiotics the day of a positive urine culture report, and 43% were treated by the fourth day.To come up with an implementation guide that could help clinicians reduce ASB overtreatment, a team of researchers from Johns Hopkins, Sinai Health System, and the University of Toronto first reviewed the evidence behind supporting reduced treatment of ASB. Based on that evidence, they determined that efforts to reduce inappropriate treatment of ASB in low-risk populations (excluding pregnant women and patients undergoing invasive urologic procedures) can reduce preventable harm from unnecessary antibiotic exposure.The team then looked at safety and quality outcomes data for different interventions aimed at reducing ASB treatment. From those data, they determined that the most successful interventions used a multimodal approach that combined the following elements: education, audit and feedback, withholding routine urine culture reports, and clinical decision support tools and protocols.”While the interventions described in this guide have proven efficacy in certain settings, we acknowledge the importance of context and encourage teams to select and adapt specific interventions that best suit the needs and resources specific to the institution,” the authors write. “In reality, a bundle of interventions may be needed to address different contributors to the problem specific to the local setting.”Dec 11 JAMA Internal Med paper New National Academies publication details AMR workshop proceedingsOriginally published by CIDRAP News Dec 11The National Academies of Sciences, Engineering, and Medicine (NAS) have released a new document summarizing the presentations and discussions at a 2-day workshop on antimicrobial resistance (AMR) held earlier this year.The workshop, held Jun 20 and 21 in Washington, DC, brought together experts in infectious disease, microbiology, and human and animal health to explore the issue of AMR through the One Health lens, which views the health of humans, animals, and the environment as interconnected. The workshop was convened to examine short-term actions and research needs that are feasible and cost-effective and will have the greatest effect on reducing AMR.Among the topics explored were the implications and effects on human health of the movement of resistance genes across different ecosystems; the expected effect of new US regulatory policies regarding the use of antibiotics in food animals; the role and effectiveness of antibiotic stewardship programs in reducing and preventing AMR, and the importance of data availability and data sharing for evaluating stewardship strategies; strategies for maintaining the effectiveness of existing drugs, for developing new drugs and diagnostics, and for implementing disease prevention steps; and the need for national and international collaboration.The document contains the opinion of the presenters, but it does not reflect the conclusions of the Health and Medicine Division of the NAS.Dec 8 National Academies proceedings of AMR workshoplast_img read more

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McPhy and Atawey join forces

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Review: ‘If Beale Street Could Talk’ is lyrical and lovely

first_img 1 of 3 This image released by Annapurna Pictures shows Stephan James, left, and Brian Tyree Henry in a scene from “If Beale Street Could Talk.” (Tatum Mangus/Annapurna Pictures via AP) This image released by Annapurna Pictures shows Regina King in a scene from “If Beale Street Could Talk.” (Tatum Mangus/Annapurna Pictures via AP) This image released by Annapurna Pictures shows Stephan James, left, and KiKi Layne in a scene from “If Beale Street Could Talk.” (Tatum Mangus/Annapurna Pictures via AP)center_img “Every black person born in America was born on Beale Street…whether in Jackson, Mississippi, or in Harlem, New York,” reads the title card that begins director Barry Jenkins’ “If Beale Street Could Talk .”The quote is from a 1974 James Baldwin novel, which Jenkins has adapted himself for his first film since 2016’s “Moonlight.” The story is, loosely, about a pregnant woman, Tish (KiKi Layne, a phenomenal breakout) and her partner Fonny (Stephan James), who has been wrongly jailed for a crime he didn’t commit. Tish and Fonny are both achingly young and beautiful, full of promise and hope even amid all the institutional obstacles and injustices that they face in daily life in 1970s Harlem, like not being able to rent their own apartment, or buy groceries at the local mart without being reassessed by a police officer. Their future, however, is dashed when Fonny is jailed because a woman across town has wrongly identified him as her rapist. Tish has to tell Fonny she’s pregnant through a glass window. Somehow, at least at first, the circumstances aren’t enough to break their spirits, although there is the sense that both are just putting on a brave face for the other.Back at home, Tish’s family celebrates their daughter. Mom, Sharon (Regina King in a powerful performance), sister, Ernestine (Teyonah Parris) and dad, Joseph (Colman Domingo), open up the sherry, put on a record and call Fonny’s family over to continue spreading the news.There are three wholly unforgettable scenes in “If Beale Street Could Talk,” and the electric showdown between Fonny’s religious and snobbish mother (Aunjanue Ellis) and Tish’s family is one of them. Another is a stirringly haunting monologue from Brian Tyree Henry, which unfortunately is really his only significant scene in the film, and the third is Sharon’s heartbreaking talk with Fonny’s accuser. All are well-worth the price of admissionNot everything works totally, in between these barnburners there is a lot of sleepy down time (still gorgeously shot and scored) and a few moments that just don’t quite work the way they probably should, like Dave Franco as an empathetic Jewish landlord who just loves love.The film plays more like a free verse poem than a traditional narrative, jumping back and forth between moments chronicling the origins of Tish and Fonny’s relationship, and Tish’s struggle to prove Fonny’s innocence in the present.Jenkins and cinematographer James Laxton (“Moonlight”) use close ups, and straight on shots of his actors looking right into the camera as though they are speaking to the audience and daring them to notice. It’s startlingly impactful and bold, like the perfectly bright clothes costumer Caroline Eselin has chosen to help flesh out this world and its characters. Does anyone use colors as perfectly as Jenkins does? Whether it’s a red leather booth or a yellow coat, everything in his frame is there for a reason, and every shot is like its own beautiful painting come to life.The whole production makes the film a transporting experience, heady and intoxicating, but perhaps the most important ingredient in bringing it all together is Nicholas Britell’s elegantly subtle and heartrending score.“Moonlight” is a hard act to follow, and while “Beale Street” might not quite reach the heights of Jenkins’ instant classic of a best picture-winner, it is its own kind of marvel, lovely, transcendent, heartbreaking and as smooth as its jazzy soundtrack.“If Beale Street Could Talk,” an Annapurna Pictures release, is rated R by the Motion Picture Association of America for “language and some sexual content.” Running time: 119 minutes. Three and a half stars out of four.MPAA Definition of R: Restricted. Under 17 requires accompanying parent or adult guardianFollow AP Film Writer Lindsey Bahr on Twitter: www.twitter.com/ldbahrlast_img read more

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