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ECDC: Response plan to control and manage the threat of multi- and extensively drug-resistant gonorrhoea in Europe

ECDC has published Response plan to control and manage the threat of multi- and extensively drug-resistant gonorrhoea in Europe. The executive summary:

Gonorrhoea is the second most notified sexually transmitted infection in the European Union and European Economic Area (EU/EEA) after chlamydia. The overall trend between 2008-2017 among 20 of the 28 EU/EEA countries consistently reporting, showed an increase in the number of notified gonorrhoea cases. In addition, over the past decades, Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to several antimicrobial classes. 

Six years after the initial ECDC Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe, the threat of untreatable gonorrhoea remains. ECDC reviewed the response plan and the 2019 update strives to further support EU Member States to develop and implement national strategies and interventions to control the threat of multidrug-resistant and extensively drug-resistant gonorrhoea in a multidisciplinary approach by outlining the suggested public health response to this threat with several vital components. 

Preventing the emergence and spread of AMR in N. gonorrhoeae is just one aspect of gonorrhoea control: as part of comprehensive management strategies including appropriate treatment, diagnostics and testing algorithms (e.g., three-site testing in men who have sex with men), test of cure, notification and treatment of partners, enhanced focus on risk groups and STI prevention measures, including advocating for increased condom use.

ECDC CDTR, week 8

ECDC has published Communicable disease threats report, 17-23 February 2019, week 8.

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 17-23 February 2019 and includes updates on Middle East respiratory syndrome coronavirus (MERS-CoV), chikungunya virus disease and dengue, Ebola virus disease, influenza, Neisseria gonorrhoeae, Salmonella Poona and influenza A(H9N2).

Eurosurveillance: Special issue on advanced diagnostics to inform public health policy

An editorial in this week's Eurosurveillance: Note from the editors: Special issue on advanced diagnostics to inform public health policy.

This issue features the first three articles of the Eurosurveillance special issue on advanced diagnostics to inform public health policy. The second set of articles for the special issue will follow in mid-January.  

Acknowledging the impact of advances in laboratory technology—including the application of qualitative and quantitative molecular diagnostics, proteomics (e.g. MALDI-TOF MS) and genomics, particularly whole genome sequencing (WGS) and metagenomics—on clinical and public health microbiology and consequently on public health, we issued a call for contributions for this special issue in late 2017. 

Here we present the first part of the special issue, with three articles that exemplify proof of concepts and novel applications of laboratory methods that have potential to impact public health and surveillance. In their study, van der Veer et al. applied Neisseria gonorrhoeae multi-antigen sequence typing (Ng-MAST) directly to urogenital and extra-genital samples, allowing for diagnosis of N. gonorrhoeae even in cases where culture failed, thus overcoming an important limitation of culture-dependent approaches. Moreover, the authors were able to detect concurrent infections with distinct strains in the same patient, which would have been missed if they had followed the resistance surveillance guidelines that recommend culture of only one anatomical site.  

An article on diagnostics of Legionnaires’ disease (LD) by researchers from Italy also demonstrates the advantages of a molecular, culture-independent method over the more time-intensive diagnostic approaches based on culture. In this paper, Ricci et al. applied real-time PCR directly on respiratory specimens for the detection of LD and, based on their experiences, propose the adoption of PCR as routine laboratory testing to diagnose LD, as well as to consider the inclusion of PCR positivity in the case definition of a confirmed LD case. 

In a proof of concept, Kafetzopoulou et al. demonstrate that metagenomic sequencing using Illumina MiSeq and the portable Oxford Nanopore MinION was able to recover whole genome sequences of chikungunya and dengue viruses directly from serum or plasma samples. Authors inferred that the applied technique may also be used to detect other RNA viruses, thereby supporting front-line public health investigations during outbreak situations.  

The research in these three articles provides novel ideas and opens new public health perspectives. We are confident that our readers will find them interesting and we look forward to presenting the second part of the special issue in mid-January 2019.

Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018

Via Eurosurveillance: Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018. The abstract:

We describe a gonorrhoea case with combined high-level azithromycin resistance and ceftriaxone resistance. In February 2018, a heterosexual male was diagnosed with gonorrhoea in the United Kingdom following sexual intercourse with a locally resident female in Thailand and failed treatment with ceftriaxone plus doxycycline and subsequently spectinomycin. Resistance arose from two mechanisms combining for the first time in a genetic background similar to a commonly circulating strain. Urgent action is essential to prevent further spread.

ECDC: Public health guidance on active case finding of communicable diseases in prison settings

ECDC has published Public health guidance on active case finding of communicable diseases in prison settings. Excerpt from the executive summary:

Compared with the general public, people in prison in the EU/EEA have a higher burden of communicable diseases such as human immunodeficiency virus (HIV), hepatitis B, hepatitis C, syphilis, gonorrhoea, chlamydia and tuberculosis (TB). Increased disease prevalence in this population is recognised as a significant public health concern, both for people living and working in prisons and for the general population at large because the vast majority of people held in prisons eventually return to their communities. 

Yet, incarceration may represent a unique opportunity to make adequate healthcare services available to people and target groups that are usually hard to reach when in the community. Active case finding is one of the key measures for the prevention and control of communicable diseases that should be considered for broader implementation in prison settings. It supports early diagnosis, ensures that infected people can receive early treatment and care, and thus contributes to prevent onward disease transmission. The successful implementation of evidence-based interventions in prison settings requires an in-depth knowledge of structural hurdles, individual barriers, and the characteristics and behaviours of the prison population. 

To this aim, the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have joined forces to develop a common evidence-based guidance for the prevention and control of communicable diseases in prison settings in the EU/EEA. 

This document provides EU/EEA Member States with evidence-based scientific advice on active case finding options. These options can be applied to the planning and implementation of interventions that promote the early diagnosis of communicable diseases in prison settings.

Understanding drug-resistant gonorrhoea: An ECDC whole genome sequencing study

ECDC has published Understanding drug-resistant gonorrhoea: an ECDC whole genome sequencing study. Click or tap through to download the study this report is based on. Excerpt:

Can whole genome sequencing illustrate changes in drug susceptibility of gonorrhoea to antimicrobials used for treatment and so help to define more effective treatment regimens? The first study of this kind within an international surveillance programme for sexually transmitted infections shows distribution of drug-resistant gonorrhoea strains across Europe. The study results are published in an ECDC report and summarised in The Lancet Infectious Diseases. 

With more than 75 000 reported cases in 2016, gonorrhoea is the second most commonly notified bacterial sexually transmitted infection (STI) in Europe. But over the past decades, Neisseria gonorrhoeae, the bacterium causing gonorrhoea, has been developing resistance to several antimicrobial classes as shown by the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP). This programme is co-ordinated by ECDC and annually monitors emerging resistance trends by testing susceptibility of the recommended antimicrobial agents for gonorrhoea treatment.  

Previous Euro-GASP results indicate that susceptibility to antimicrobials and resistance patterns have changed over the years in the European Union and European Economic Area (EU/EEA). Resistance to cefixime decreased since 2010 and while resistance to azithromycin dropped between 2010 and 2012, it subsequently increased again from 2013 onwards.  

In the light of limited alternatives to the current recommended combination therapy with ceftriaxone and azithromycin (introduced in 2012), and recent reports of extensively drug resistant gonorrhoea strains, it is vital to understand if changes in resistance prevalence are the consequence of modifications in treatment, sexual behaviour in different sexual networks, the gonococcal strain distribution or due to other reasons.

ECDC Rapid Risk Assessment: Extensively drug-resistant (XDR) Neisseria gonorrhoeae in the United Kingdom and Australia

ECDC has published Rapid Risk Assessment: Extensively drug-resistant (XDR) Neisseria gonorrhoeae in the United Kingdom and Australia. Click or tap through to download the PDF. The abstract:

The first three cases of infection with XDR Neisseria gonorrhoeae resistant to ceftriaxone and with high-level resistance to azithromycin (HLAziR; minimum inhibitory concentration of ≥256 mg/L.) on a global scale were reported in the United Kingdom (one) and Australia (two). 

These extensively drug-resistant isolates (see footnote* and ref for definition) were not susceptible in vitro to the empiric first-line dual antimicrobial therapy recommended in the EU/EEA (ceftriaxone 500 mg intramuscularly together with azithromycin 2g orally as a single dose), or in Australia (ceftriaxone 500mg IM plus azithromycin 1g orally) and showed resistance to most commonly used antibiotics. Ceftriaxone and azithromycin in varying doses is widely recommended as the first-line treatment for N. gonorrhoeae and these strains are also resistant to most alternative available treatments. 

There are currently very limited treatment options for such cases and the spread of ceftriaxone-resistant and HLAziR N. gonorrhoeae would have a significant public health impact. In its list of priority antibiotic-resistant bacteria to guide research, discovery and development of new antimicrobials, the World Health Organization (WHO) has identified N. gonorrhoeae as a high priority.

The full RRA says that efforts to trace the cases' sexual contacts in Southeast Asia are "ongoing." Given the popularity of sex tourism to Asia, we can expect many more XDR cases before long.

ECDC: Communicable disease threats report, 22-28 April 2018, week 17

ECDC has published Communicable disease threats report, 22-28 April 2018, week 17. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 22-28 April 2018 and includes updates on dengue, chikungunya, seasonal influenza, yellow fever, gonorrhoea and cholera.

CIDRAP: In world first, UK reports high-level gonorrhea resistance

Via CIDRAP, Lisa Schnirring writes: In world first, UK reports high-level gonorrhea resistance. Excerpt:

Health officials in the United Kingdom announced today that they are investigating a gonorrhea infection contracted abroad that marks the first global detection of high-level resistance to recommended dual-antibiotic treatment as well as to other commonly used drugs. 

Gwenda Hughes, PhD, consultant scientist at Public Health England (PHE) and head of its sexually transmitted infection section said in a statement that the patient's Neisseria gonorrhoeae infection is very resistant to first-line treatment, a combination of two antibiotics—azithromycin and ceftriaxone.  

"We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimised," she said, adding that the PHE actively monitors the spread of antibiotic resistance in gonorrhea and potential treatment failures. 

In 2017, the World Health Organization (WHO) released new data on the global rise in multidrug-resistant gonorrhea, warning that widespread treatment failure is likely in the years ahead unless new antibiotics are developed. At the time of the report, three countries had reported strains of gonorrhea resistant to all current treatment: Japan, France, and Spain. 

WHO data also showed that N gonorrhea, known for its ability to quickly mutate and develop resistance, is becoming resistant to cefixime and ceftriaxone, the drugs the WHO recommends for use in combination with azithromycin for treatment of most gonococcal infections.

See also this report in The Guardian.

Infectious diseases kill 2,198 in China in December

Via the National Health and Family Planning Commission: Infectious diseases kill 2,198 in China in December.

A total of 2,198 people died as a result of infectious diseases on the Chinese mainland in December 2017, official data showed. 

According to the National Health and Family Planning Commission, there were 699,850 cases of infectious diseases reported on the mainland in December.  

One person died from plague while no cases of cholera were reported in December. 

Plague and cholera are classified as Class A infectious diseases, the most serious classification on China's Law on the Prevention and Treatment of Infectious Diseases. 

A total of 294,397 cases were classified as Class B infectious diseases, resulting in 2,187 deaths. Viral hepatitis, tuberculosis, syphilis, gonorrhoea as well as scarlet fever accounted for 93 percent of these cases. 

Category C diseases caused 10 deaths in December. Infectious diarrhea, influenza, foot and mouth disease were the most prevalent in this category, accounting for 93 percent of cases.