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Weekly Digest: Subsidies for infection control can reduce infection rates; Thai government reports high antibiotic consumption among humans and animals; WHO launches new global flu strategy.

Weekly Digest: Subsidies for infection control can reduce infection rates; Thai government reports high antibiotic consumption among humans and animals; WHO launches new global flu strategy.

Subsidies for infection control could reduce infection rates in healthcare facilities. In a paper published in the Proceedings of the National Academies of Sciences (PNAS), researchers at CDDEP and Princeton University used a game-theory model to assess the impact of financial subsidies on healthcare facilities’ infection control measures. A dollar-for-dollar matching subsidy, in which policymakers match hospital spending for infection control measures, was the most effective at reducing the number of hospital-acquired infections when compared to a fixed subsidy and a subsidy tied to the number of uninfected patients, which is equivalent to a tax on infected patients. In hospitals with high transmission and/or high levels of patients with on-admission infections, a matching subsidy resulted in a hospital increasing its own spending. The study provides an actionable policy to reduce infection levels in healthcare institutions. [PNAS, CDDEP Press Release]

Thai government reports high antibiotic consumption among humans and animals. Antibiotic consumption among humans in Thailand in 2017 was 75.68 daily defined doses (DDD) per 1,000 inhabitants per day, a rate higher than Mongolia (64.41 DDD per 1,000 inhabitants per day), which has the highest per capita consumption rate according to the latest World Health Organization report on antibiotic consumption in humans. Antibacterials were the most highly consumed class of antimicrobials, accounting for almost 70 percent of consumption, followed by antivirals and antifungals, according to a review of data from the Thailand Surveillance of Antimicrobial Consumption program. Antibiotic consumption among animals in Thailand in 2017 was 4,688 tons. [Consumption of antimicrobial agents in Thailand in 2017]

AMR genes are abundant and diverse in global sewage samples. Metagenomic analysis of bacteria in untreated sewage from 79 sites across 60 countries revealed that countries in Africa, Asia, and South America had higher concentrations and more diverse types of antimicrobial resistance (AMR) genes compared to countries in Europe, North America, and Oceania. Across all sample sites, a total of 1,625 different AMR genes belonging to 408 gene groups were identified; genes encoding resistance to macrolides, tetracyclines, aminoglycosides, beta-lactams, and sulfonamides were the most abundant. There was a significant increase in the abundance of AMR genes belonging to a specific antimicrobial class with increasing usage of that antimicrobial class, but total antimicrobial usage did not correlate to overall AMR gene abundance. Between country variability was better explained by Human Development Index scores, sanitation, and general health. [Nature Communications]

Neighborhood antibiotic consumption associated with personal E. coli infection risk. Increased levels of personal and community fluoroquinolone consumption were associated with increased personal risk of acquiring fluoroquinolone-resistant Escherichia coli infections among adults aged 22 years or older in Israel, according to a review of over two million electronic medical records representing 1,733 neighborhoods. Community-level fluoroquinolone consumption levels were classified into quintiles. Odds ratios for the quintiles with higher neighborhood antibiotic consumption, compared with the lowest quintile, were 1.15, 1.31, 1.41, and 1.51, respectively, for women, and 1.17, 1.24, 1.35, and 1.50 for men. The association between community-level consumption and personal infection remained significant even when analysis was restricted to patients who had not consumed fluoroquinolones themselves. [The Lancet Infectious Diseases]

High rate of inappropriate antibiotic use in VA outpatient setting. Forty percent of antibiotics prescribed to outpatients seeking care at a facility in the Veterans Affairs Western New York Healthcare System were not indicated by standard treatment guidelines, according to a review of 1,063 patient visits between June and September 2017. Amoxicillin clavulanate, azithromycin, ciprofloxacin, and cephalexin accounted for 80 percent of unnecessary drug use. Urinary tract infections, bronchitis, skin structure infections, and sinusitis were the most common causes of inappropriate antibiotic use. [American Journal of Infection Control]

WHO launches new global flu strategy. The World Health Organization (WHO) released a comprehensive Global Influenza Strategy for 2019 through 2030. The strategy focuses on strengthening country-level capacity for disease surveillance and response, prevention and control, and preparedness and developing better tools to prevent, detect, control, and treat influenza such as more effective vaccines and antivirals. [WHO Press Release, WHO Flu Strategy]

Lassa fever outbreak in Nigeria. There have been 420 confirmed cases of Lassa fever across 21 states in Nigeria in an ongoing outbreak that began in January 2019, according to the World Health Organization (WHO). Ninety-three cases resulted in death giving a case fatality ratio of 22.1 percent. Edo and Ondo states are the most affected and account for 65 and 46 percent of all cases, respectively. [WHO]

WHO’s latent TB screening guidelines minimally effective in preventing incidence in Canada. The application of the World Health Organization (WHO) End TB Strategy’s latent tuberculosis (TB) screening and treatment recommendations minimally impacted TB incidence in a low-risk population of over one million people who immigrated to British Columbia (BC), Canada as permanent residents between 1985 and 2012, according to a retrospective cohort study. 1.5 percent of the study population met the criteria to be strongly recommended for screening; criteria included those who encountered a TB-positive person, were diagnosed with HIV, received dialysis, took immunosuppressive medications, or migrated from a high-TB burden country, among other factors. However, of the 2,814 people with active TB, only 118 (4.0 percent) cases were considered preventable by the current screening recommendations. [Clinical Infectious Diseases, WHO End TB Strategy]

Democracies more likely to be associated with lower non-communicable disease mortality. Researchers assessed political, economic, and cause-specific mortality data for 170 countries for 1970-2016 to assess the impact of democracy on health. Countries with democratic governments enforced by free and fair elections were more likely than those with autocracies to experience progress in reducing mortality due to cardiovascular disease, transport injuries, cancer, and other non-communicable diseases. HIV-free life expectancy at age 15 years also improved significantly for countries that transitioned to democracies during the study period, on average by 3 percent after 10 years of political transition. A country’s democratic experience, characterized by indicators such as electoral fraud, multi-party elections, freedom of civil association, and media freedom, among others, explained more of the variation in mortality than per capita GDP. [The Lancet]

Clinical predictors of mortality in MERS patients. Continuous renal replacement therapy and the use of corticosteroids were the most significant risk factors that contributed to mortality in patients infected with Middle East Respiratory Syndrome (MERS) with odds ratios of 3.85 and 4.95, respectively, according to a retrospective analysis of 314 symptomatic patients, of which 78 died, admitted to a tertiary health facility in Saudi Arabia between April 2014 to March 2018. Older age, higher initial white blood cell, and lower hemoglobin and serum albumin levels were also associated with increased mortality risk. [Travel Medicine and Infectious Disease]

Changes in adolescent health between 1990 and 2016. Researchers evaluated 12 previously defined Lancet Commission health indicators to understand global changes in adolescent health between 1990 and 2016. Health indicators covered health risks, health outcomes, and social determinants of health, and data for 195 countries and territories were collated primarily from the Institute of Health Metrics and Evaluation. In the 26-year period, the global proportion of adolescents living in multi-burden (high burden of communicable, maternal, and nutritional conditions) or non-communicable disease-predominant locations increased while the number living in injury-excess countries decreased. Between 1990 and 2016, the number of adolescents with obesity increased by 176.9 million and those with anemia by 74.2 million. [The Lancet]

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