#Synergistic #combinations and repurposed #antibiotics active against the #pandrug #resistant #Klebsiella pneumoniae #Nevada strain (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Synergistic combinations and repurposed antibiotics active against the pandrug-resistant Klebsiella pneumoniae Nevada strain

Thea Brennan-Krohn [MD], James E. Kirby [MD]

DOI: 10.1128/AAC.01374-19



In early 2017, the Centers for Disease Control and Prevention issued an alarming report describing a woman in Nevada who died in the setting of infection with a pan-resistant Klebsiella pneumoniae isolate that harbored an NDM-1 enzyme (AR-0636) and was colistin resistant as a result of inactivation of the mgrB regulator gene (1, 2).…

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Klebsiella pneumoniae; USA; Nevada.



#Emergency #Declarations for #PublicHealth Issues: Expanding Our #Definition of Emergency (J Law Med Ethics, abstract)

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

J Law Med Ethics. 2019 Jun;47(2_suppl):95-99. doi: 10.1177/1073110519857328.

Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency.

Sunshine G1, Barrera N1, Corcoran AJ1, Penn M1.

Author information: 1 Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona’s Office of the Attorney General, where she practices public health law. Aubrey Joy’s practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O’Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC’s Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control’s Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia.



Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration.

PMID: 31298138 DOI: 10.1177/1073110519857328

Keywords: USA; Public Health.


Activity of #cefepime / #zidebactam (WCK 5222) against #Enterobacteriaceae, #Pseudomonas aeruginosa and #Acinetobacter baumannii endemic to #NYC #medical centres (J Antimicrob Chemother., abstract)

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

Activity of cefepime/zidebactam (WCK 5222) against Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii endemic to New York City medical centres

Zeb Khan, Alejandro Iregui, David Landman, John Quale

Journal of Antimicrobial Chemotherapy, dkz294, https://doi.org/10.1093/jac/dkz294

Published: 11 July 2019




The combination of cefepime and zidebactam (WCK5222), a novel β-lactam enhancer, has demonstrated activity against a wide variety of Gram-negative pathogens and is currently under clinical evaluation.


To examine the activity of cefepime/zidebactam against: (i) a contemporary collection of Gram-negative isolates from New York City; (ii) a collection of carbapenem-resistant clinical isolates; and (iii) a collection of isolates with characterized resistance mechanisms.


Susceptibility tests were performed using broth microdilution for cefepime, zidebactam and cefepime/zidebactam (1:1).


More than 99% of a contemporary collection of Escherichia coli, Klebsiella pneumoniae and Enterobacter spp. had cefepime/zidebactam MICs ≤2 mg/L, the susceptibility breakpoint for cefepime. For K. pneumoniae, the acquisition of blaKPC resulted in increased MICs, although MICs remained ≤2 mg/L for 90% of KPC-possessing isolates. Overall for Pseudomonas aeruginosa, 98% of isolates had MICs ≤8 mg/L and MICs were affected by increased expression of ampC. For carbapenem-resistant P. aeruginosa, 78% of isolates had cefepime/zidebactam MICs ≤8 mg/L. The activity of cefepime/zidebactam against Acinetobacter baumannii was lower, with 85% of all isolates and 34% of carbapenem-resistant isolates with MICs ≤8 mg/L (cefepime interpretative criteria).


Cefepime/zidebactam demonstrated excellent activity against Enterobacteriaceae and P. aeruginosa, although activity was reduced in carbapenem-non-susceptible isolates. The activity against A. baumannii was reduced and studies examining the therapeutic efficacy in strains with high cefepime/zidebactam MICs are warranted.

Topic:  pseudomonas aeruginosa – cefepime – enterobacter – enterobacteriaceae – new york city – acinetobacter baumannii – bacterial carbapenemase resistance blakpc gene – malnutrition-inflammation-cachexia syndrome – carbapenem resistance


© The Author(s) 2019. 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: Antibiotics; Drugs Resistance; Carbapenem; Enterobacteriaceae; Pseudomonas aeruginosa; Acinetobacter baumannii; Cefepine; Zidebactam; USA; NYC.


Effect of #age on relative #effectiveness of high-dose versus standard-dose #influenza #vaccines among #US #Medicare beneficiaries ages 65 years and older (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Effect of age on relative effectiveness of high-dose versus standard-dose influenza vaccines among US Medicare beneficiaries ages 65 years and older

Yun Lu, PhD, Yoganand Chillarige, MPA, Hector S Izurieta, MD, Yuqin Wei, MS, Wenjie Xu, BA, Michael Lu, BS, Heng-Ming Sung, MPH, Arnstein Lindaas, MA, Michael Wernecke, BS, Thomas MaCurdy, PhD, Jeffrey Kelman, MD, Richard A Forshee, PhD

The Journal of Infectious Diseases, jiz360, https://doi.org/10.1093/infdis/jiz360

Published: 09 July 2019




Studies have found that the high-dose influenza vaccine has higher relative vaccine effectiveness (RVE) compared to standard-dose vaccines in some seasons. We evaluated the effect of age on the high-dose versus standard-dose RVE among Medicare beneficiaries.


A six-season retrospective cohort study from 2012 to 2018 among Medicare beneficiaries ages ≥65 years. Poisson regression was used to evaluate the effect of age on high-dose versus standard-dose RVE in preventing influenza hospitalizations.


The study included >19 million vaccinated beneficiaries in a community pharmacy setting. The Poisson models indicated a slightly increasing trend in RVE with age in all seasons. The high-dose vaccine was more effective than standard-dose vaccines in preventing influenza hospital encounters (influenza inpatient stays and emergency department visits) in the 2012–13 (RVE 23.1%, 95% CI 17.6–28.3%), 201314 (RVE 15.3%, 95% CI 7.8–22.3%), 201415 (RVE 8.9%, 95% CI 5.6–12.1%), and 201617 (RVE 12.6%, 95% CI 6.3–18.4%) seasons, and was at least as effective in all other seasons. We also found that the high-dose vaccine was consistently more effective than standard-dose vaccines for people ages ≥85 years across all seasons. Similar trends were observed for influenza inpatient stays.


The high-dose versus standard-dose influenza vaccine RVE increases with age.

influenza vaccine, relative vaccine effectiveness, high-dose vaccine, effect of age, Medicare

Topic:  influenza – influenza vaccines – inpatients – medicare – vaccines

Issue Section: Major Article

This content is only available as a PDF.

Published by Oxford University Press for the Infectious Diseases Society of America 2019.

This work is written by (a) US Government employee(s) and is in the public domain in the US.

Keywords: Seasonal Influenza; Vaccines; USA.


#Mandatory #Measles #Vaccination in #NYC — Reflections on a Bold Experiment (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Mandatory Measles Vaccination in New York City — Reflections on a Bold Experiment

Julie D. Cantor, M.D., J.D.


Though a vaccine has been available for more than 50 years, measles has recently reemerged as a public health threat in the United States. Outbreaks have arisen where vaccination rates have waned, and local governments have responded.

In Detroit, officials and religious leaders of an affected community collaborated, encouraging vaccination to control an outbreak. Los Angeles quarantined people exposed to the virus. New York City and Rockland County have seen the most cases, and their extensive vaccination efforts have included free clinics, meetings with community leaders, and email messages to clinicians. They also issued orders restricting the liberty of people who neither had nor were exposed to the virus.



Disclosure forms provided by the author are available at NEJM.org.

This article was published on June 5, 2019, at NEJM.org.

Author Affiliations: From the UCLA School of Law, Los Angeles.

Keywords: Measles; USA; NYC; Society.


#Pseudomonas poae–Associated #Fatal #Septic #Transfusion #Reaction, Peoria, #Illinois, #USA, 2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 8—August 2019 / Synopsis

Pseudomonas poae–Associated Fatal Septic Transfusion Reaction, Peoria, Illinois, USA, 2017

Therese S. Woodring and John J. Farrell

Author affiliations: University of Illinois College of Medicine, Peoria, Illinois, USA (T.S. Woodring, J.J. Farrell); OSF System Laboratory, Peoria (J.J. Farrell)



In the United States, fatal transfusion-transmitted infections from red blood cell units are rare. Although this pattern mostly reflects how inhospitable refrigerated red blood cell units are to contaminant growth, fatalities caused by microorganisms that can grow at storage temperature (4°C), but not in standard clinical blood cultures at 37°C, are probably underestimated. We analyzed a fatal red blood cell transfusion in Peoria, Illinois, USA, that occurred in 2017. Samples from the patient’s whole blood and the red blood cell unit remained culture-negative during the investigation, despite direct visualization of gram-negative bacilli within the unit immediately after transfusion. We identified the bacteria as Pseudomonas poae, a nonpathogenic pseudomonad carrying multiple cold-shock domain protein genes, and confirmed its cold tolerance and inability to grow at 37°C. Our work indicates transfusion reaction workups need to include testing for psychrophilic organisms, which could explain the cause of other apparently culture-negative transfusion reactions.

Keywords: Blood safety; Pseudomonas poae; USA; Illinois.


Vital Signs: #Surveillance for #AFM — #USA, 2018 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018

Early Release / July 9, 2019 / 68

Adriana Lopez, MHS1; Adria Lee, MPH1; Angela Guo, MPH1; Jennifer L. Konopka-Anstadt, PhD1; Amie Nisler, MPH1; Shannon L. Rogers, MS1; Brian Emery1; W. Allan Nix1; Steven Oberste, PhD1; Janell Routh, MD1; Manisha Patel, MD1

1 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.

Corresponding author: Adriana Lopez, alopez@cdc.gov, 404-639-8369.

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Lopez A, Lee A, Guo A, et al. Vital Signs: Surveillance for Acute Flaccid Myelitis — United States, 2018. MMWR Morb Mortal Wkly Rep. ePub: 9 July 2019. DOI: http://dx.doi.org/10.15585/mmwr.mm6827e1external icon.



  • What is already known about this topic?
    • Biennial U.S. outbreaks of acute flaccid myelitis (AFM) have been recognized since 2014. Most cases occur in children during late summer and early fall.
  • What is added by this report?
    • During 2018, 233 confirmed AFM cases were reported, the largest number since surveillance began in 2014.
    • Upper limb involvement only was more prevalent in confirmed cases (42%), as was report of respiratory symptoms or fever (92%) within 4 weeks preceding limb weakness onset.
    • Median intervals from onset of limb weakness to hospitalization, magnetic resonance imaging, and reporting to CDC were 1, 2, and 18 days, respectively.
  • What are the implications for public health practice?
    • Prompt recognition, early specimen collection, and rapid reporting will expedite public health investigations and help characterize AFM.




Acute flaccid myelitis (AFM), a serious paralytic illness, was first recognized as a distinct condition in 2014, when cases were reported concurrent with a large U.S. outbreak of severe respiratory illness caused by enterovirus D-68 (EV-D68). Since 2014, nationwide outbreaks of AFM have occurred every 2 years in the United States; the cause for the recent change in the epidemiology of AFM in the United States, including the occurrence of outbreaks and a biennial periodicity since 2014, is under investigation. This report updates clinical, laboratory, and outcome data for cases reported to CDC during 2018.


Clinical data and specimens from persons in the United States who met the clinical criterion for AFM (acute onset of flaccid limb weakness) with onset in 2018 were submitted to CDC for classification of the illnesses as confirmed, probable, or non-AFM cases. Enterovirus/rhinovirus (EV/RV) testing was performed on available specimens from persons meeting the clinical criterion. Descriptive analyses, laboratory results, and indicators of early recognition and reporting are summarized.


From January through December 2018, among 374 reported cases of AFM, 233 (62%) (from 41 states) were classified as confirmed, 26 (7%) as probable, and 115 (31%) as non-AFM cases. Median ages of patients with confirmed, probable, and non-AFM cases were 5.3, 2.9, and 8.8 years, respectively. Laboratory testing identified multiple EV/RV types, primarily in respiratory and stool specimens, in 44% of confirmed cases. Among confirmed cases, the interval from onset of limb weakness until specimen collection ranged from 2 to 7 days, depending on specimen type. Interval from onset of limb weakness until reporting to CDC during 2018 ranged from 18 to 36 days, with confirmed and probable cases reported earlier than non-AFM cases.


Identification of risk factors leading to outbreaks of AFM remains a public health priority. Prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention recommendations.

Keywords: Acute Flaccid Myelitis; Enterovirus; Rhinovirus; EV-D68; USA.