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Center For Disease Dynamics, Economics & Policy

Weekly Digest: U.S. livestock antibiotic use is rising, while medical use falls; Release of African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes.

A side view of calves eating indoors on a farmA side view of calves eating indoors on a farmU.S. livestock antibiotic use is rising, while medical use falls. CDDEP and the Natural Resources Defense Council (NRDC) collaborated to fill a critical data gap, presenting a side-by-side comparison of antibiotic use in animals and humans in the United States over time. The use of antibiotics in human medicine has remained consistent since 2009, while use in livestock has increased over 10% from 2017 to 2019. Livestock sales of antibiotics nearly double use in humans. More surveillance of animal use is needed to combat the threat of antibiotic resistance, as well as spillover infections from animals to humans [NRDC]

Release of African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes. An interdisciplinary panel of infectious disease clinicians and public health experts led by CDDEP and the Africa Centres for Disease Control and Prevention (CDC) have released a first edition of the African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes. The guidelines fill a critical gap in providing healthcare workers across the African continent with expert recommendations for antimicrobial selection, dosage, and duration of treatment for common bacterial infections and syndromes [CDDEP]

Antimicrobial resistance in common food animals has shifted in the past two decades. The bacterial genomes listed in public databases can give insights into changes in antimicrobial resistance. One such analysis examined 22,102 genomes to explore antimicrobial resistance of nontyphoidal Salmonella in American bovines, poultry, and swine. In 2018, genes conferring resistance to an average of 2.08 poultry, 1.74 bovine, and 1.28 swine antimicrobial classes were identified. This represents a 70% decline in bovine and swine and a 13% increase in poultry AMR levels from 2000. For specific antimicrobials, 3rd-generation cephalosporin resistance decreased by 9.97%, 4th-generation cephalosporin increased to 12.53%, and quinolone resistance increased to 3.87%. [Microbiology Spectrum]

Quarantine elimination for K-12 students with mask-on-mask exposure to COVID-19 does not increase secondary transmission rates. A study focused on a public school district in Omaha, Nebraska explored rates of secondary COVID-19 transmission as the policy for student quarantine following mask-on-mask exposure moved from mandatory to voluntary. Despite widespread COVID-19 transmission in the area, only two cases of secondary transmission, both of which occurred in unmasked individuals, were identified during the fall and spring semesters. When youth are masked and social distancing is in place, secondary transmission rates of COVID-19 are low, making mandatory quarantines for K-12 students of questionable benefit. [Pediatrics]

Children exposed to invasive Group B Streptococcal Disease (iGBS) are at increased risk of developing motor impairments. An assessment of vision, hearing, cognition, behavior, language, and motor skills was performed to identify neurodevelopmental impairments in South Indian children exposed to iGBS. Approximately half of iGBS-exposed children had impairment in at least one of these neurodevelopmental domains, while 26% had multi-domain impairment. In comparison, 38% of non-iGBS-exposed children had impairment in one domain, while 15.4% had multi-domain impairment. Language was the most common impairment across both groups, but iGBS-exposed children had more motor impairments compared to their non-iGBS-exposed peers. [Clinical Infectious Diseases]

GPS navigation software allows for a closer-to-reality assessment of healthcare inequity. An assessment of geographical accessibility and coverage of comprehensive emergency obstetric care facilities was conducted in Lagos, Nigeria. Travel time for women seeking care ranged from 2 to 320 minutes. Longer travel times were more likely for women who traveled to facilities during morning, afternoon, or evening hours, as well as those referred to care. Additionally, four hotspots where the majority of women traveled for over an hour were notably affected by infrastructure issues or were the primary point of care for an underserved part of the state. [Health Policy and Planning]

Moderna COVID-19 vaccine safe and effective in solid tumor cancer patients. Cancer patients are known to be at increased risk of complications from COVID-19. However, limited data is available on the administration of mRNA vaccines during cancer treatment. A prospective, multicenter, noninferiority trial was performed to assess the impact of immunotherapy, chemotherapy, and chemoimmunotherapy on the Moderna vaccine’s immunogenicity and safety. The majority of patients were able to develop an adequate antibody response post-vaccination comparable to healthy individuals, and no notable side effects were reported. A third dose may be necessary for suboptimal responders. [The Lancet]

Doctors may experience persistent mental health repercussions due to the COVID-19 pandemic. A repeated multi-country analysis was performed to assess the prevalence of anxiety and depression among medical doctors working in Catalonia (Spain), Italy, and the UK during the COVID-19 pandemic. A high prevalence of self-reported anxiety and depression was identified, with rates highest in Italy and lowest in the UK. Women, individuals under 60, those reporting normal or below-average health, and those with concerns about workplace safety had a higher risk of anxiety and depression symptoms. No systematic differences were identified, implying that mental health repercussions may be persistent and ongoing. [PLoS One]

The global media is not educating the public on their role in antimicrobial resistance (AMR). Researchers analyzed English and Chinese news representations of AMR risk between 2015 and 2018. An increasing trend in the reporting of AMR issues was identified between 2015 and 2017, but attention declined in 2018. Media attention was primarily centered on official reports or the discovery of AMR risks or solutions, with a temporal increase in educating the public on microbial evolution. However, the media did not discuss preventative, actionable changes individuals can make or the multifaceted consequences of AMR. [Antimicrobial Resistance and Infection Control]

The COVID-19 pandemic has harmed the productivity and mental health of researchers worldwide. Surveys assessing the productivity and mental health of researchers across Europe and the United States reveal notable declines in new article submissions, publications, and collaborations. Women, people of color, and parents of young children have been disproportionately affected by the pandemic. Comparatively, white men and researchers with COVID-19-related projects seem to be the least affected. [Nature]

No changes in fatality rates among critical COVID-19 patients with pneumonia. A multicenter retrospective cohort study explored the mortality of critical COVID-19 patients with pneumonia admitted to hospital ICUs. Assessed patients were admitted to hospitals in Spain, Andorra, and Ireland during the three COVID-19 waves from February 2020 to March 2021. Despite substantial changes in care and disease management, no significant change in ICU fatality rates was found. However, during the second and third waves, the mortality of adults aged 61-75 decreased by 4.7% and there was a significant reduction in the length of survivors’ hospital stays. [The Lancet]

Most severe COVID-19 patients have complex immune dysregulation (CID), not cytokine storm syndrome (CSS). Patients with severe COVID-19 were initially thought to have CSS, also known as macrophage activation syndrome (MAS). However, it seems patients are much more likely to have CID. COVID-19 patients with CID see more favorable outcomes when the ratio of IL-6/mHLA-DR (human leukocyte antigen DR molecules on CD14-monocytes) is decreased and inflammation is reduced. This explains the benefits of dexamethasone and tocilizumab for patients with severe respiratory failure and highlights the importance of the IL-6/mHLA-DR ratio in COVID-19 immunotherapy. [EBioMedicine]

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