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Weekly Digest: Anti-ageing drugs could boost COVID vaccines in older people; Herd immunity approaches to COVID-19 control are a ‘dangerous fallacy’; Drug-resistant TB – Global Tuberculosis Report 2020; Antimicrobial stewardship: a COVID casualty?

Weekly Digest: Anti-ageing drugs could boost COVID vaccines in older people; Herd immunity approaches to COVID-19 control are a ‘dangerous fallacy’; Drug-resistant TB - Global Tuberculosis Report 2020; Antimicrobial stewardship: a COVID casualty?

COVID-19

How anti-aging drugs could boost COVID vaccines in older people. Scientists agree that aging immune systems make people more vulnerable to infections and reduce vaccine efficacy; in older adults, chronic, low-grade inflammation makes the immune system less responsive to external stimuli. While it is not clear yet if COVID-19 vaccines will perform as well in older adults, many researchers are suggesting that anti-aging and anti-inflammatory drugs may lower inflammation, boost immunity, and improve vaccine responses. Candidate drugs involve those that act on cell growth pathways such as mTOR inhibitors, and a type 2 diabetes drug (metformin), already associated with reduced COVID-19 mortality. Understanding and compensating for the weakness of the immune system has implications for a variety of other diseases and represents a better strategy than the development of vaccines specifically for the elderly. [Nature]

Herd immunity approaches to COVID-19 control are a ‘dangerous fallacy. As many European countries are grappling with the realities of the second wave of COVID-19, recommendations from a large group of scientists, based on what is known on the disease so far, convey a clear message: mitigation strategies should be in place and transmission should be controlled. Measures advocated by the WHO in the early stages of the pandemic such as physical distancing, use of face coverings, hand and respiratory hygiene, avoidance of poorly ventilated spaces, are still as important today in fighting transmission. Considering the lack of scientific evidence that supports herd-immunity, scientists oppose strategies that promote uncontrolled transmission among those at low risk; in addition to increased mortality and morbidity across all ages, those strategies could have profound impacts on the workforce and overwhelm the ability of health-care systems to provide acute and routine care. Instead, continuing restrictions in the short term, may reduce transmission and compensate for ineffective pandemic response systems, ultimately preventing future lockdowns. [The Lancet]

Effect of hydroxychloroquine in hospitalized patients with Covid-19. A team of investigators from the UK conducted a randomized, controlled, trial to compare usual care with hydroxychloroquine, as treatment options for hospitalized patients with COVID-19. The study revealed that the 1561 patients receiving hydroxychloroquine did not have lower 28-day mortality than the 3155 patients receiving usual care (rate ratio, 1.09; 95% CI, 0.97 to 1.23; P=0.15). Additionally, patients in the hydroxychloroquine group experienced longer hospitalization (median, 16 days vs. 13 days), and were at a greater risk for needing invasive mechanical ventilation when it wasn’t required at baseline. The findings indicated that hydroxychloroquine may not represent an effective treatment for hospitalized patients with severe Covid-19. [NJEM]

Excess Deaths from COVID-19 and Other Causes, March-July 2020. In a research letter to JAMA, a team of researchers updated the estimate of excess deaths associated with direct and indirect impacts of COVID-19 in the United States and explored temporal relationships with the lifting of related restrictions. They found that between March 1 and August 1, 2020, the US saw a 20% increase over expected deaths. The states with the highest death rates (New Jersey, New York, and Massachusetts) accounted for 30% of excess deaths, but had the shortest epidemics, while states that lifted restrictions earlier experienced extended increases in excess deaths throughout the summer. Only 67% of excess deaths were documented COVID-19 deaths, although other excess deaths may include undocumented COVID-19 cases or deaths otherwise related to disruptions from the pandemic.[JAMA]

Outcomes of neonates born to mothers with Severe Acute Respiratory Syndrome Coronavirus 2 infection at a large medical center in New York City. A retrospective cohort study based on medical records for maternal and newborn data for 101 neonates born to 100 mothers positive for, or with suspected SARS-CoV-2 infection,  revealed that only 2 infants (2%) tested positive for SARS-CoV-2, all the while having no clinical COVID-19 symptoms. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1 to 38.4] vs 39.1 [IQR, 38.3 to 40.2] weeks; P = 0.02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = 0.04) compared with newborns of mothers with asymptomatic/mild COVID-19. In light of findings indicating low rates of testing-based vertical or perinatal transmission and no clinical evidence for neonatal SARS-CoV-2 infection, researchers suggest retaining evidence-based newborn care and that separation or avoidance of direct breastfeeding may not be warranted to prevent SARS-CoV-2 transmission. [JAMA Pediatrics]

 

Drug Resistance and Global Health

 

Drug-resistant TB – Global Tuberculosis Report 2020. The recent WHO Global Tuberculosis report reveals that about half a million people developed rifampicin-resistant TB (RR-TB) in 2019, with 78% of the cases consisting of multidrug-resistant TB (MDR-TB).  India, China, and the Russian Federation shared the biggest burden with 27%, 14%, and 8% of the reported cases, respectively. Despite some progress in testing and detecting of rifampicin resistance in bacteriologically confirmed TB (61% in 2019  vs 51% in 2017), only 38% of those estimated to have developed MDR/RR-TB were enrolled in treatment in 2019; ten countries accounted for 77% of the global gap and China and India alone accounted for 41%, warranting for urgent expansion of testing and treatment coverage in countries with a high MDR-TB burden. [WHO]

Caregiver willingness to vaccinate their children against COVID-19. A recent cross-sectional study evaluated factors associated with caregivers’ intent to vaccinate their children against COVID-19 in 16 pediatric Emergency Departments across six countries. Researchers found that 65% of caregivers reported that they intend to vaccinate their child, once a COVID-19 vaccine becomes available. Intended uptake was associated with older children, children with no chronic illness, when fathers completed the survey, children receiving other vaccinations in a timely manner, and caregivers concerned their child had COVID-19. While the most common reason reported by caregivers intending to vaccinate was to protect their child (62%), the main reason to refuse vaccination was the vaccine’s novelty (52%). Providing evidence about the vaccine’s safety may convince more caregivers to have their children vaccinated. [Vaccine]

Antimicrobial stewardship: a COVID casualty? In an editorial letter to the Journal of Hospital Infection, researchers discuss the profound effect that the COVID-19 pandemic has had on antimicrobial stewardship (AMS) programs. As countries cope with waves of COVID-19, antimicrobial resistance continues to pose an ever-increasing threat globally, its magnitude being affected by recent disruptions in AMS programs and global antibiotic supply chains, as well as, a tendency to over-treat hospitalized COVID-19 patients. The researchers imply that the WHO World Antimicrobial Awareness Week could represent a much-needed opportunity to bring AMR into the spotlight and that innovative solutions to limit AMR in the context of the pandemic, could strengthen AMR in the post-pandemic era.  [Journal of Hospital Infection]

A Quality Improvement Initiative To Optimize Antibiotic Use in a Level 4 NICU. A children’s hospital in Rochester, New York implemented an internet-based learning collaborative, where health care professionals participated in periodic webinars with the specific target of reducing unnecessary antibiotic use. Following a two year intervention, from 2016-2018, the antibiotic use rate decreased from 27.6% at baseline to 15.5%, equating to an overall 43% reduction. Interventions that contributed most to this reduction included the implementation of a sepsis risk calculator, adoption of a 36-hour rule-out period for sepsis evaluations, a 36-hour antibiotic hard stop, and novel guidelines for early-onset sepsis evaluation among infants <35 weeks. The decrease in antibiotic use led to an increase from 15.8% to 35.1% in the percentage of infants discharged without antibiotic exposure. [Pediatrics]

Multicenter prevalence study comparing molecular and toxin assays for Clostridioides difficile surveillance. A multicenter prevalence study of toxigenic C. difficile detected in stool samples routinely collected from hospitalized patients with diarrhea assessed surveillance by PCR and enzyme immunoassay (EIA), and revealed that C. difficile prevalence was greater when the PCR test method was used.  Among samples collected in 76 hospitals from two days (one in winter and one in summer) EIA detection rates were 6.4 cases/10,000 patient bed-days in winter and 5.7 cases/10,000 patient bed-days in summer, whereas PCR detection rates were 11.4 cases/10,000 patient bed-days in winter and 7.1 cases/10,000 patient bed-days in summer. The findings emphasize the need for uniform recommendations on diagnostic approaches in order to enable meaningful inter-institutional and nationwide comparisons [Emerging Infectious Diseases]