Search

In 2016, the World Health Organization (WHO) released the Global Health Sector Strategy (GHSS) setting goals for global hepatitis elimination. To inform new or revised viral hepatitis national strategic action plans (NSAPs) for 2022–2030, NSAPs developed during 2016–2021 were assessed for alignment with the WHO GHSS. Country NSAPs were assessed to determine if they included components in the 2016 GHSS. Of 55 country NSAPs, 19 (35%) did not include hepatitis B and C virus elimination goals, only 18 (33%) included targets for needles and syringes for persons who inject drugs, and 21 (38%) had a national budget or financing plan for hepatitis activities. Gaps identified indicate need for technical support in NSAP development. [ABSTRACT FROM AUTHOR]

During January 2017–March 2020, approximately 2.2 million noninstitutionalized civilian US adults had hepatitis C; one-third were unaware of their infection. Prevalence was substantially higher among persons who were uninsured or experiencing poverty. Unrestricted access to testing and curative treatment is needed to reduce disparities and achieve 2030 elimination goals. [ABSTRACT FROM AUTHOR]

Access to recommended second-line treatments is limited for patients who fail initial hepatitis C virus (HCV) therapy in low- and middle-income countries. Alternative regimens and associated outcomes are not well understood. Through a pooled analysis of national program data in Egypt, Georgia, and Myanmar, we observed SVR rates >90% for alternative retreatment regimens. [ABSTRACT FROM AUTHOR]

Using national pharmacy claims data for 2014–2020, 843 329 persons were treated for hepatitis C at least once. The proportion treated increased annually among persons aged <40 years, insured by Medicaid, and treated by primary care providers. Monitoring hepatitis C treatment is essential to identify barriers to treatment access. [ABSTRACT FROM AUTHOR]

Background and Aims: As obtaining adequate tissue on biopsy is critical for the detection of residual and recurrent intestinal metaplasia/dysplasia in Barrett's esophagus (BE) patients undergone Barrett's endoscopic eradication therapy (BET), we decided to compare the adequacy of biopsy specimens using jumbo versus standard biopsy forceps. Methods: This is a two-center study of patients' post-radiofrequency ablation of dysplastic BE. After BET, jumbo (Boston Scientific©, Radial Jaw 4, opening diameter 2.8 mm) or standard (Boston Scientific©, Radial Jaw 4, opening diameter 2.2 mm) biopsy forceps were utilized to obtain surveillance biopsies from the neo-squamous epithelium. Presence of lamina propria and proportion of squamous epithelium with partial or full thickness lamina propria was recorded by two experienced gastrointestinal pathologists who were blinded. Squamous epithelial biopsies that contained at least two-thirds of lamina propria were considered 'adequate'. Results: In a total of 211 biopsies from 55 BE patients, 145 biopsies (29 patients, 18 males, mean age 61 years, interquartile range [IQR] 33–83) were obtained using jumbo forceps and 66 biopsies (26 patients, all males, mean age 65 years, IQR 56–76) using standard forceps biopsies. Comparing jumbo versus standard forceps, the proportion of specimens with any subepithelial lamina propria was 51.7% versus 53%, P  = 0.860 and the presence of adequate subepithelial lamina propria was 17.9% versus 9.1%, P  = 0.096 respectively. Conclusions: Use of jumbo forceps does not appear to have added advantage over standard forceps to obtain adequate biopsy specimens from the neo-squamous mucosa post-ablation. [ABSTRACT FROM AUTHOR]

Editors-in-Chief of Diseases of the Esophagus REFERENCES 1 Matsuda S, Takeuchi M, Kawakubo H, Kitagawa Y. Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer. In the current issue of Diseases of the Esophagus, we have the pleasure of publishing the first new series of premium-invited review articles. Professor Kitagawa's group have pioneered research on lymph node metastatic patterns in esophageal cancer, first by exploring the sentinel node concept in gastric and esophageal cancer, and then by performing prospective studies mapping the patterns of lymph node metastasis in esophageal cancer of both histological subtypes. [Extracted from the article]

Nineteen Serratia marcescens bloodstream infections, including 9 deaths, were linked to contaminated parenteral nutrition prepared by a compounding pharmacy. The investigation identified several deficiencies in sterile compounding procedures, reaffirming the need for improved adherence to sterile compounding standards.Background. Compounding pharmacies often prepare parenteral nutrition (PN) and must adhere to rigorous standards to avoid contamination of the sterile preparation. In March 2011, Serratia marcescens bloodstream infections (BSIs) were identified in 5 patients receiving PN from a single compounding pharmacy. An investigation was conducted to identify potential sources of contamination and prevent further infections.Methods. Cases were defined as S. marcescens BSIs in patients receiving PN from the pharmacy between January and March 2011. We reviewed case patients’ clinical records, evaluated pharmacy compounding practices, and obtained epidemiologically directed environmental cultures. Molecular relatedness of available Serratia isolates was determined by pulsed-field gel electrophoresis (PFGE).Results. Nineteen case patients were identified; 9 died. The attack rate for patients receiving PN in March was 35%. No case patients were younger than 18 years. In October 2010, the pharmacy began compounding and filter-sterilizing amino acid solution for adult PN using nonsterile amino acids due to a national manufacturer shortage. Review of this process identified breaches in mixing, filtration, and sterility testing practices. S. marcescens was identified from a pharmacy water faucet, mixing container, and opened amino acid powder. These isolates were indistinguishable from the outbreak strain by PFGE.Conclusions. Compounding of nonsterile amino acid components of PN was initiated due to a manufacturer shortage. Failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs. Improved adherence to sterile compounding standards, critical examination of standards for sterile compounding from nonsterile ingredients, and more rigorous oversight of compounding pharmacies is needed to prevent future outbreaks. [ABSTRACT FROM AUTHOR]

Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Infections caused by CRE have limited treatment options and have been associated with high mortality rates. In the previous year, other carbapenemase subtypes, including New Delhi metallo-β-lactamase, have been identified among Enterobacteriaceae in the United States. Like KPC, these enzymes are frequently found on mobile genetic elements and have the potential to spread widely. As a result, preventing both CRE transmission and CRE infections have become important public health objectives. This review describes the current epidemiology of CRE in the United States and highlights important prevention strategies. [ABSTRACT FROM AUTHOR]

Purpose. Specific deviations from United States Pharmacopeia standards were analyzed to investigate the factors allowing an outbreak of Serratia marcescens bloodstream infections in patients receiving compounded amino acid solutions. Methods. Filter challenge experiments using the outbreak strain of S. marcescens were compared with those that used the filter challenge organism recommended by ASTM International (Brevundimonas diminuta ATCC 19162) to determine the frequency and degree of organism breakthrough. Disk and capsule filters (0.22- and 0.2- µm nominal pore size, respectively) were challenged with either the outbreak strain of S. marcescens or B. diminuta ATCC 19162. The following variables were compared: culture conditions in which organisms were grown overnight or cultured in sterile water (starved), solution type (15% amino acid solution or sterile water), and filtration with or without a 0.5-µm prefilter. Results. Small-scale, syringe-driven, disk-filtration experiments of starved bacterial cultures indicated that approximately 1 in every 1,000 starved S. marcescens cells (0.12%) was able to pass through a 0.22-µm nominal pore-size filter, and about 1 in every 1,000,000 cells was able to pass through a 0.1 - µm nominal pore-size filter. No passage of the B. diminuta ATCC 19162 cells was observed with either filter. In full-scale experiments, breakthrough was observed only when 0.2- µm capsule filters were challenged with starved S. marcescens in 15% amino acid solution without a 0.5- µm prefiltration step. Conclusion. Laboratory simulation testing revealed that under certain conditions, bacteria can pass through 0.22- and 0.2- µm filters intended for sterilization of an amino acid solution. Bacteria did not pass through 0.2-µm filters when a 0.5-µm prefilter was used. [ABSTRACT FROM AUTHOR]