A Randomized Trial Comparing Extended-Release Injectable Suspension and Oral #Naltrexone, Both Combined With #Behavioral Therapy, for the #Treatment of #Opioid Use Disorder (Am J Psychiatry, abstract)

[Source: American Journal of Psychiatry, full page: (LINK). Abstract, edited.]

A Randomized Trial Comparing Extended-Release Injectable Suspension and Oral Naltrexone, Both Combined With Behavioral Therapy, for the Treatment of Opioid Use Disorder

Maria A. Sullivan, M.D., Ph.D., Adam Bisaga, M.D., Martina Pavlicova, Ph.D., Kenneth M. Carpenter, Ph.D., C. Jean Choi, M.S., Kaitlyn Mishlen, M.A., Frances R. Levin, M.D., John J. Mariani, M.D., Edward V. Nunes, M.D.

Published Online: 19 Oct 2018 / DOI: https://doi.org/10.1176/appi.ajp.2018.17070732




The oral formulation of the opioid antagonist naltrexone has shown limited effectiveness for treatment of opioid use disorder due to poor adherence. Long-acting injection naltrexone (XR-naltrexone), administered monthly, circumvents the need for daily pill taking, potentially improving adherence, and has been shown to be superior to placebo in reducing opioid use over 6 months of treatment. This open-label trial compared the outcomes of patients with opioid use disorder treated with XR-naltrexone or oral naltrexone in combination with behavioral therapy.


Sixty opioid-dependent adults completed inpatient opioid withdrawal and were transitioned to oral naltrexone. They were stratified by severity of opioid use (six or fewer bags versus more than six bags of heroin per day) and randomly assigned (1:1) to continue treatment with oral naltrexone (N=32) or XR-naltrexone (N=28) for 24 weeks. The first dose of XR-naltrexone (380 mg) was administered prior to discharge, with monthly doses thereafter, and oral naltrexone was given in a 50-mg daily dose. All participants received weekly behavioral therapy to support treatment and adherence to naltrexone.


A Cox proportional hazards model adjusting for race, gender, route of use, and baseline opioid use severity indicated that significantly more patients were retained in treatment for 6 months in the XR-naltrexone group (16 of 28 patients, 57.1%) than in the oral naltrexone group (nine of 32 patients, 28.1%) (hazard ratio=2.18, 95% CI=1.07, 4.43).


Patients receiving XR-naltrexone had twice the rate of treatment retention at 6 months compared with those taking oral naltrexone. These results support the use of XR-naltrexone combined with behavioral therapy as an effective treatment for patients seeking opioid withdrawal and nonagonist treatment for preventing relapse to opioid use disorder.

Keywords: Opioids; Naltrexone; Psychiatry.



#Epidemiology and predictors of #survival of #MERS-CoV #infections in #Riyadh region, 2014-2015 (J Infect Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Public Health. 2018 Oct 16. pii: S1876-0341(18)30148-5. doi: 10.1016/j.jiph.2018.09.008. [Epub ahead of print]

Epidemiology and predictors of survival of MERS-CoV infections in Riyadh region, 2014-2015.

Al-Jasser FS1, Nouh RM2, Youssef RM3.

Author information: 1 Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia; Department of Family & Community Medicine, College of Medicine and King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: dr.f.j@hotmail.com. 2 Field Epidemiology Training Program (FETP), Department of Public Health, Ministry of Health, Riyadh, Saudi Arabia. 3 Department of Family & Community Medicine, College of Medicine and King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia; Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.




MERS-CoV emerged as a zoonotic disease in Saudi Arabia with 1437 cases as of July 2016. This study aimed at describing the epidemiology of MERS-CoV infection, clinical aspects of the disease and the determinants of survival.


The medical records of Prince Mohamed Bin Abdulaziz Hospital were reviewed between April 2014 and December 2015 to identify admission and discharge with MERS-CoV. Patient’s characteristics, epidemiologic and clinical data and laboratory results were extracted and described. Logistic regression analyses were used to model the determinants of the survival of these patients. Significance of the results were judged at the 5% level.


249 confirmed cases were admitted mostly in August (20.48%) and September (14.86%) of the year 2015. A third (39.36%) reported contact with an index case, developed the disease after 6.2days and continued to shed the virus for 13.17days on average. The case fatality rate was 20.08%. Independent predictors of being discharged alive among confirmed cases were younger age (ORA=0.953), breathing ambient air (ORA=8.981), not being transferred to the ICU (ORA=24.240) and not receiving renal replacement therapy (ORA=8.342). These variables explain 63.9% of the variability of patients’ status at discharge.


MERS-CoV spread from human-to-human as community acquired and nosocomial infection. The study identified high risk patients in need for special medical attention in order to improve patients’ outcome.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS: Determinants of survival; Epidemiology; MERS-CoV; Saudi Arabia

PMID: 30340964 DOI: 10.1016/j.jiph.2018.09.008

Keywords: MERS-CoV; Saudi Arabia.


Highly pathogenic #avian #influenza #H5N8 Clade virus in #Uganda, 2017 (Infect Genet Evol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infect Genet Evol. 2018 Oct 17. pii: S1567-1348(18)30508-2. doi: 10.1016/j.meegid.2018.10.010. [Epub ahead of print]

Highly pathogenic avian influenza H5N8 Clade virus in Uganda, 2017.

Ndumu D1, Zecchin B2, Fusaro A2, Arinaitwe E1, Erechu R1, Kidega E1, Kayiwa J3, Muwanga E1, Kirumira M1, Kirembe G1, Lutwama J3, Monne I4.

Author information: 1 Directorate of Animal Resources, Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), P.O. Box 513, Entebbe, Uganda. 2 Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell’Università, 10, 35020, Legnaro, Padova, Italy. 3 Uganda Virus Research Institute (UVRI), P. O. Box 49, Entebbe, Uganda. 4 Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell’Università, 10, 35020, Legnaro, Padova, Italy. Electronic address: imonne@izsvenezie.it.



In early January 2017, outbreaks of H5N8 highly pathogenic avian influenza (HPAI) were reported for the first time in wild and domestic birds along the shores and on some islands of Lake Victoria, in central-southern Uganda. Our whole-genome phylogenetic analyses revealed that the H5N8 viruses recovered from the outbreak in Uganda belonged to genetic clade group-B and clustered with viruses collected in 2017 in the Democratic Republic of the Congo and in West Africa. Our results suggested that infected migratory wild birds might have played a crucial role in the introduction of HPAI H5N8 into this region.

KEYWORDS: H5N8 subtype; Influenza A virus; Migratory wild birds; Phylogeny; Uganda

PMID: 30342095 DOI: 10.1016/j.meegid.2018.10.010

Keywords: Avian Influenza; H5N8; Poultry; Wild Birds; Uganda.


Quantifying the #risk of local #Zika virus #transmission in the contiguous #US during the 2015-2016 ZIKV #epidemic (BMC Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Med. 2018 Oct 18;16(1):195. doi: 10.1186/s12916-018-1185-5.

Quantifying the risk of local Zika virus transmission in the contiguous US during the 2015-2016 ZIKV epidemic.

Sun K1, Zhang Q1, Pastore-Piontti A1, Chinazzi M1, Mistry D1, Dean NE2, Rojas DP2, Merler S3, Poletti P3, Rossi L4, Halloran ME5,6, Longini IM Jr2, Vespignani A7,8.

Author information: 1 Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, 02115, USA. 2 Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, 32611, USA. 3 Bruno Kessler Foundation, 38123, Trento, Italy. 4 Institute for Scientific Interchange Foundation, 10126, Turin, Italy. 5 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, 98109, USA. 6 Department of Biostatistics, University of Washington, Seattle, 98195, USA. 7 Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, 02115, USA. a.vespignani@neu.edu. 8 Institute for Scientific Interchange Foundation, 10126, Turin, Italy. a.vespignani@neu.edu.




Local mosquito-borne Zika virus (ZIKV) transmission has been reported in two counties in the contiguous United States (US), prompting the issuance of travel, prevention, and testing guidance across the contiguous US. Large uncertainty, however, surrounds the quantification of the actual risk of ZIKV introduction and autochthonous transmission across different areas of the US.


We present a framework for the projection of ZIKV autochthonous transmission in the contiguous US during the 2015-2016 epidemic using a data-driven stochastic and spatial epidemic model accounting for seasonal, environmental, and detailed population data. The model generates an ensemble of travel-related case counts and simulates their potential to have triggered local transmission at the individual level in the 2015-2016 ZIKV epidemic.


We estimate the risk of ZIKV introduction and local transmission at the county level and at the 0.025° × 0.025° cell level across the contiguous US. We provide a risk measure based on the probability of observing local transmission in a specific location during a ZIKV epidemic modeled after the epidemic observed during the years 2015-2016. The high spatial and temporal resolution of the model allows us to generate statistical estimates of the number of ZIKV introductions leading to local transmission in each location. We find that the risk was spatially heterogeneously distributed and concentrated in a few specific areas that account for less than 1% of the contiguous US population. Locations in Texas and Florida that have actually experienced local ZIKV transmission were among the places at highest risk according to our results. We also provide an analysis of the key determinants for local transmission and identify the key introduction routes and their contributions to ZIKV transmission in the contiguous US.


This framework provides quantitative risk estimates, fully captures the stochasticity of ZIKV introduction events, and is not biased by the under-ascertainment of cases due to asymptomatic cases. It provides general information on key risk determinants and data with potential uses in defining public health recommendations and guidance about ZIKV risk in the US.

KEYWORDS: Computational modeling; Risk assessment; Zika virus

PMID: 30336778 DOI: 10.1186/s12916-018-1185-5

Keywords: Zika Virus; USA; Mathematical models.


#Avian #Influenza in the #US Commercial Upland #Game #Bird #Industry: An Analysis of Selected Practices as Potential Exposure Pathways and Surveillance System Data Reporting (Avian Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Avian Dis. 2018 Sep;62(3):307-315. doi: 10.1637/11814-021518-Reg.1.

Avian Influenza in the U.S. Commercial Upland Game Bird Industry: An Analysis of Selected Practices as Potential Exposure Pathways and Surveillance System Data Reporting.

St Charles KM1, Ssematimba A1,2, Malladi S1, Bonney PJ1, Linskens E1, Culhane M3, Goldsmith TJ3, Halvorson DA1, Cardona CJ1.

Author information: 1 A Secure Food Systems Team, University of Minnesota, Veterinary and Biomedical Sciences, 301C Veterinary Science Building, 1971 Commonwealth Avenue, St. Paul, MN 55108. 2 C Department of Mathematics, Faculty of Science, Gulu University, P.O. Box 166, Gulu, Uganda. 3 B Secure Food Systems Team, University of Minnesota, Veterinary Population Medicine, 1365 Gortner Avenue, St. Paul, MN 55108.



Producing a smaller yield of higher-value birds compared to conventional poultry production, the U.S. commercial upland game bird industry deals primarily in the sale of live birds for recreational hunting. In this study, our aims were to gain insights into the occurrence of avian influenza (AI) in the U.S. commercial upland game bird industry in comparison to other poultry sectors, to identify the presence of the specific AI risk factors in the practices of raising ducks on site and having connections to live bird markets (LBMs), and to assess how AI surveillance systems may have played a role in the reporting of the presence of exposure pathway-related information. We found that 23 AI epizootics involving upland game bird premises were reported, compared to 485 epizootics in the other poultry industries, and 86% of epizootics involving upland game birds were limited to only one premises. Regarding specific AI risk factors, 70% of upland game bird epizootics involved one of the two examined practices. In assessing the impact of surveillance systems, data framed around the implementation of surveillance systems revealed that the introduction of active surveillance coincided with the more thorough reporting of both the raising of ducks on site and premises having connections to LBMs. Our results suggest the need for more thorough data collection during epizootics and the need to assess additional exposure pathways specific to the commercial raise-for-release upland game bird industry.

KEYWORDS: United States; avian influenza; exposure pathways; surveillance; upland game birds

PMID: 30339513 DOI: 10.1637/11814-021518-Reg.1

Keywords: Avian Influenza; Poultry; USA.


#Phylogenetic classification of #hemagglutinin gene of #H9N2 #avian #influenza viruses isolated in #China during 2012-2016 and evaluation of selected candidate #vaccine strains (Poult Sci., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Poult Sci. 2018 Sep 1;97(9):3023-3030. doi: 10.3382/ps/pey154.

Phylogenetic classification of hemagglutinin gene of H9N2 avian influenza viruses isolated in China during 2012-2016 and evaluation of selected candidate vaccine strains.

Xu C1,2,3, Ye H4, Qiu W4, Lin H1, Chen Y1, Zhang H1, Liao M1,2,3.

Author information: 1 National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China. 2 Key Laboratory of Veterinary Vaccine Innovation of the Ministry of Agriculture, China. 3 Key Laboratory of Zoonosis Prevention and Control of Guangzhou Province, China. 4 Guangzhou South China Biological Medicine Co., Ltd., Zengcheng, China.



H9N2 subtype avian influenza virus (AIV) was the highly contagious pathogen which has caused severe losses in the poultry industry throughout China in recent years. Using current epidemic viruses as vaccine was an effective way to prevent infection of H9N2 subtype AIV. In this study, a total of 23 H9N2 subtype AIV strains were isolated in 200 samples from 13 provinces of China during 2012-2016. The sequencing and phylogenetic analysis of the hemagglutinin gene sequence of the isolation strains showed that 22 isolation strains were clustered to h9.4.2.5 lineage, while only 1 belonged to h9.4.2.6. The data of cross-HI, neutralization and cross-immune protection shown that the A/chicken/Hunan/HN/2015 (HN) and A/chicken/Shandong/SD/2014 (SD) strains as vaccine could effectively protect present viruses infection compared with other strains. These results indicated that current epidemic viruses were mainly belong to h9.4.2.5 lineage and HN and SD strains as candidate vaccine strains were potentiality for the protection of present H9N2 subtype AIV infection.

PMID: 29931183 DOI: 10.3382/ps/pey154 [Indexed for MEDLINE]

Keywords: Avian Influenza; H9N2; Poultry; Vaccines; China.


Novel partners with #colistin to increase its in vivo therapeutic effectiveness and prevent the occurrence of colistin #resistance in #NDM- and #MCR-co-producing #Ecoli in a murine infection model (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Novel partners with colistin to increase its in vivotherapeutic effectiveness and prevent the occurrence of colistin resistance in NDM- and MCR-co-producing Escherichia coli in a murine infection model

Yang Yu, Timothy R Walsh, Run-Shi Yang, Mei Zheng, Meng-Chao Wei, Jonathan M Tyrrell, Yang Wang, Xiao-Ping Liao, Jian Sun, Ya-Hong Liu

Journal of Antimicrobial Chemotherapy, dky413, https://doi.org/10.1093/jac/dky413

Published: 20 October 2018




The emergence of NDM- and MCR-1-co-producing Escherichia coli has compromised the use of carbapenems and colistin, which are critically important in clinical therapy, and represents a severe threat to public health worldwide. Here, we demonstrate synergism of colistin combined with existing antibiotics as a potential strategy to overcome XDR E. coli co-harbouring NDM and MCR-1 genes.


To comprehensively evaluate their combined activity, antibiotic combinations were tested against 34 different E. coli strains carrying both NDM and MCR-1 genes. Antibiotic resistance profiles and molecular characteristics were investigated by susceptibility testing, PCR, MLST, S1-PFGE and WGS. Antibiotic synergistic efficacy was evaluated through in vitro chequerboard experiments and dose–response assays. A mouse model was used to confirm active combination therapies. Additionally, combinations were tested for their ability to prevent high-level colistin-resistant mutants (HLCRMs).


Combinations of colistin with rifampicin, rifabutin and minocycline showed synergistic activity against 34 XDR NDM- and MCR-1-co-producing E. coli strains, restoring, in part, susceptibility to both colistin and the partnering antibiotics. The therapeutic effectiveness of colistin combined with rifampicin or minocycline was demonstrated in a mouse model. Furthermore, colistin plus rifampicin showed significant activity in preventing the occurrence of HLCRMs.


The synergism of colistin in combinations with rifampicin, rifabutin or minocycline offers viable therapeutic alternatives against XDR NDM- and MCR-positive E. coli.


© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Research; Abstracts; Antibiotics; Drugs Resistance; Colistin; E. Coli; Rifampicin; Rifabutin; Minocycline; MCR; NDM.