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Weekly Digest: Drug resistant parasites and fungi may aggravate antimicrobial resistance; India faced multiple challenges with conducting clinical trials during the COVID-19 pandemic.

Helminths isolated from stool

Highly pathogenic avian influenza viruses can survive for several days on raw chicken. A highly pathogenic avian influenza (HPAI) virus strain (H7N9) was found to remain viable for 9, 7, and 4 days at −20°C, 4°C, and 25°C, respectively. HPAI virus strains were inactivated at room temperature within 2 minutes of application of household bleach, ethanol, peracetic acetic acid, or acetic acid. However, they were unaffected by hand soap and lactic acid. Highly pathogenic avian influenza viruses have been repeatedly detected on raw poultry, and their viability and potential spread must be managed as products move through the supply chain. [The Lancet Microbe]  

Research suggests Omicron is totally or partially resistant to all monoclonal antibody treatments. This resistance is attributed to mutations concentrated on Omicron’s spike protein where antibodies bind. Only two antibodies – sotrovimab and DXP-604 – seem to have retained the ability to fight this SARS-CoV-2 variant. However, triple the concentration of sotrovimab is required to halve viral replication of Omicron. Therefore, sotrovimab is currently being rationed based on the prevalence of Omicron-associated infections and hospitalizations in certain regions. Given the limited diagnostic and treatment tools available, experts fear this may deepen COVID-19 treatment inequity in many countries. [Nature] 

Lack of access to COVID-19 diagnostic tools keeps low- and middle-income countries vulnerable. By September 2021, when 3.2 billion COVID-19 tests had been performed worldwide, only 0.4% had been performed in low- and middle-income countries. Similarly, when 5.82 billion vaccines had been administered, just 1.9% of individuals from these countries had received a single dose. Enhanced access to COVID-19 testing could improve surveillance and identification of variants, generate vaccine efficacy data, and help guide treatment strategies. Continued lack of access to diagnostics will perpetuate the major healthcare inequities between rich and poor countries. [EClinicalMedicine] 

Antibiotic use and knowledge in Bangladesh increased during the COVID-19 pandemic. A mobile phone survey of 1,854 individuals in Bangladesh was conducted between January and March 2021 to determine antibiotic knowledge and recent use of antibiotics. Over 86% of participants were familiar with the names of antibiotics, particularly azithromycin, cefixime, and ciprofloxacin, compared to 48% of participants surveyed in other studies prior to the pandemic. However, only 12.1% of individuals were aware of potential harmful effects, and only 3.5% were familiar with antibiotic resistance. Regarding antibiotic use, 32.7% of people who had experienced recent illness reported using antibiotics, compared to 21% pre-pandemic. [Antibiotics] 

Strengthening oxygen systems can reduce pneumonia-associated mortality in low-resource settings. A systematic review estimated the impact and cost-effectiveness of oxygen interventions on preventing pneumonia-related children’s deaths in low- and middle-income countries. Strengthening oxygen systems were found to reduce hospital-based pneumonia deaths by approximately 50%, while hospital-based children’s deaths were reduced by 25%. The median cost-effectiveness was $68 USD per disability-adjusted life year averted. However, the authors cautioned of the biased nature of the findings due to the non-randomized design of the studies included in this review. [BMJ Global Health]   

India faced multiple challenges with conducting clinical trials during the COVID-19 pandemic. These country-specific challenges included delays in ethics and regulatory agencies’ approvals, infrequently scheduled committee meetings, and the lack of familiarity with the guidelines for trials conducted in pandemic times. Several site-level issues were also identified, including problems with set-ups and their management, scope limitations due to travel restrictions, and lack of participation by remote units. Additionally, misinformation was a major issue, with premature recommendations on treatments lacking scientific data causing trial funding issues and reluctant clinician participation. [The Lancet Global Health]   

Multiple factors drive COVID-19 breakthrough infections among vaccinated individuals. Protection associated with the two-dose COVID-19 AstraZeneca vaccine wanes after 21 weeks, regardless of the circulating variants of concern, and can be a major contributing factor to severe disease among vaccinated populations. However, other factors such as new variants of concern and relaxation of social measures are also contributors. Gaining an understanding of contributing variables and how different vaccine protection changes over time can support vaccination policy in low- and middle-income countries where vaccine coverage is still limited.  [The Lancet]   

Drug resistant parasites and fungi may aggravate antimicrobial resistance. Anti-parasitic and antifungal resistance may occur following their use in animals and the environment, respectively. However, parasitic and fungal diseases are as much of a major health issue for humans as bacterial diseases. Increasing levels of drug resistance are being documented for parasites like Plasmodium, Giardia, Leishmania, and Trypanosoma, as well as antifungals including Aspergillus and Candida.  A One Health approach is needed to create policies that can combat drug resistance of these pathogens. [One Health]   

Scaled-up test-and-treat can support the global fight against COVID-19. Test-and-treat strategies employ early detection and treatment to prevent disease progression and transmission. Treatments should occur immediately upon symptom onset, but to do so, there must be equitable access to COVID-19 therapeutics and increased use of rapid diagnostics in community-based and self-testing settings. Furthermore, promising therapeutics that have completed phase three clinical trials should be rapidly evaluated and given approval to increase access to treatment options. Immediate action is needed to enable the necessary changes in primary care-associated supply chains, staff, training, test-and-treat literacy, and referral pathways. [The Lancet Global Health] 

Vietnam’s One Health approach can provide insights to countries seeking to improve public health. Several emerging infectious diseases impacted Vietnam in the last two decades, including SARS, H5N1, H1N1, Zika virus, COVID-19, Streptococcus suis, and avian influenza A (H5N6). However, the country’s One Health approach to policy and action created the foundation for multiple sectors to communicate and collaborate to improve public health outcomes. This multi-sectoral approach to capacity building and managing zoonotic diseases, animal pathogens, and antimicrobial resistance has enabled disease preparedness and allowed Vietnam to successfully control disease outbreaks. [One Health] 

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