Second lab-worker CJD case prompts lab moratorium in France
Five research institutions in France are under a 3-month moratorium on prion research after a retired lab worker who handled prions was diagnosed as having Creutzfeldt-Jakob disease (CJD), according to a report today in Science.
An investigation is under way to see whether the worker was exposed to prions on the job, and the diagnosis follows the 2019 CJD death of a French lab worker who contracted the illness after pricking her thumb while conducting an experiment with prion-infected mice.
CJD is an incurable and fatal brain disease triggered by the misfolding of proteins. Symptoms typically occur up to 10 years after exposure, resulting in rapid-onset dementia and death, often within months.
The moratorium affects nine labs at the five institutions and has the goals of exploring an infection link between the lab work and the second patient’s illness and identifying more prevention measures.
The second patient is a woman who works at a National Research Institute for Agriculture, Food and Environment lab in Toulouse and is still alive. French officials learned of her infection last week, a scientist familiar with the situation told the journal. So far, it’s not clear if the patient has classic CJD or variant CJD.
Jul 28 Science report
Oxford launches early clinical trial of plague vaccine
Oxford University this week announced the phase 1 trial launch of a vaccine against plague, based on the same adenovirus platform that researchers used to develop the AstraZeneca-Oxford COVID-19 vaccine.
The trial will take place in 40 healthy adults ages 18 to 55 and will assess safety and how well the vaccine triggers protective antibody and T-cell responses, Oxford said in a press release. Volunteers will be followed for 12 months.
Andrew Pollard, MD, who directs the Oxford Vaccine Group, said plague has threatened the world over several millennia, and even today, outbreaks continue to disrupt communities. “A new vaccine to prevent plague is important for them and for our health security,” he said. Cases continue to be reported in Africa, Asia, and the United States. A 2017 outbreak in Madagascar resulted in 2,119 suspected cases and 171 deaths.
Christine Rollier, PhD, an associated professor with the Oxford Vaccine Group, said antibiotics can be used to treat plague, which is caused by Yersinia pestis, but many areas that experience outbreaks are in remote locations, and an effective vaccine would be useful for preventing infections in those settings.
Jul 26 Oxford University press release
Study: Nursing home intervention led to fewer antibiotics for UTIs
A tailored intervention implemented at nursing homes in Denmark reduced antibiotic prescriptions and unnecessary interventions for urinary tract infections (UTIs) without substantially increasing hospitalizations and mortality, Danish researchers reported last week in The Lancet Infectious Diseases.
In a cluster-randomized trial involving 22 nursing homes, 11 were randomized from June 1, 2017, to June 1, 2018, to receive interactive educational sessions on how to distinguish between a UTI and asymptomatic bacteriuria and evaluate non-specific symptoms, along with an algorithm to determine whether a UTI is likely. The remaining nursing homes continued standard UTI management.
While nursing home staff in Denmark (unskilled workers, nurses, healthcare assistants, and healthcare helpers) don’t prescribe antibiotics, the theory behind the intervention was that diagnosis and treatment of UTIs are directly influenced by the staff’s knowledge and communication skills.
The primary outcome of the trial was the number of antibiotic prescriptions for acute UTI per residents per days at risk in the intervention and control groups. Secondary outcomes included the appropriateness of antibiotic treatment for UTIs, all-cause hospitalizations, and all-cause mortality.
A total of 1,470 nursing home residents (765 in the intervention group and 705 in the control group) were analyzed for the primary endpoint. The number of prescriptions for UTI per resident was 134 per 84,035 days at risk in the intervention group, compared with 228 per 77,817 days at risk in the control group, for an unadjusted rate ratio (RR) of 0.51 (95% confidence interval [CI], 0.37 to 0.71) and an adjusted RR of 0.42 (95% CI, 0.31 to 0.57).
In terms of secondary outcomes, the risk of receiving appropriate antibiotic treatment (RR, 0.65; 95% CI, 0.41 to 1.06) and inappropriate (RR, 0.33; 95% CI, 0.23 to 0.49) treatment was lower in the intervention group. All-cause hospitalization increased in the intervention group (adjusted RR, 1.28; 95% CI, 0.95 to 1.74), but all-cause mortality was lower (adjusted RR, 0.91: 95% CI, 0.62 to 1.33).
“Our results imply that a broader range of health professionals should be engaged in antibiotic stewardship and that programmes should be tailored to address potential barriers to implementation and should focus on education, reflection, and a structured professional dialogue,” the study authors wrote.
Jul 22 Lancet Infect Dis abstract