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Center For Disease Dynamics, Economics & Policy

Weekly Digest: COVID-19 leads to increased rates of hospital antibiotic prescribing; Safely reopening UK schools will require comprehensive COVID-19 testing & tracing; Vaccine programs provide high financial benefits for LMICs.


COVID-19 leads to increased rates of hospital antibiotic prescribing. A cross-sectional analysis of a hospital in Spain found that antibiotic prescribing increased significantly during the COVID-19 pandemic compared to the same time period last year, from 73.3 and 69.8 defined daily doses (DDDs) per 100 patient-days in March and April 2019 to 87.8 and 93.2 DDDs per 100 patient-days in March and April 2020. The use of amoxicillin/clavulanate and broader-spectrum antibiotics increased during the hospital’s first and second peaks of COVID-19, respectively, corresponding with the hospital’s early recommendations for empiric antibiotic prescribing and an increase in severe patients at risk for nosocomial infections. Findings support the need for standardized antimicrobial stewardship programs for COVID-19 patients to prevent inappropriate antibiotic use during the pandemic. [Infection Control & Hospital Epidemiology]

Safely reopening UK schools will require comprehensive COVID-19 testing & tracing. A modeling study in the UK suggests that preventing a second wave of COVID-19 once schools reopen and distancing guidelines are relaxed will require comprehensive testing, contact tracing, and isolation of positive cases. The model estimated that if 68 percent of contacts were traced, then 75 percent of symptomatic individuals would need to be tested and isolated should schools resume at full capacity in September. Without testing, tracing, and isolation when schools reopen, the second wave of COVID-19 will likely peak in December 2020, at double the size of the first wave. [The Lancet Child & Adolescent Health]

US school closures tied to reduced COVID-19 incidence and mortality. Findings from a time series analysis suggest that statewide school closures in the United States were temporally associated with decreased COVID-19 incidence (62 percent reduction each week between March 9th and May 7th, 2020) and mortality (58 percent reduction per week). Relative reductions were largest in states that closed schools early on in the pandemic, when incidence remained low. Authors note that other public health interventions may have contributed to these decreased rates of COVID-19 cases and deaths as well. [JAMA]

Novel coronavirus infection rate disproportionately impacts US minority children. In a cross-sectional analysis of 1,000 US children tested for the novel coronavirus, racial/ethnic minorities and children from lower-income families had disproportionately higher rates of infection. The study found that Black and Hispanic children had 2.3 and 6.3 times higher odds of testing positive for SARS-CoV-2 compared to their White counterparts, respectively. Infection rates were also significantly higher among children with a median family income in quartiles 1, 2, and 3, compared to those in the highest income quartile. The researchers note that these disparities may be related to structural factors, lack of access to healthcare, scarce resources, and discrimination that minority groups face. [Pediatrics]

New COVID-19 vaccine candidate shows early promise in phase I trial. In a press release, Novavax, Inc. reported that their recombinant COVID-19 vaccine candidate was safe, well-tolerated, and induced a strong antibody response among participants in a phase I trial. NVX-CoV2373 induced neutralization titers in all 131 participants, and a Matrix-M™ adjuvant added to the vaccine induced CD4+ T cell responses among recipients. No severe adverse events were reported. [Novavax]


Drug Resistance, Vaccines, and Global Health

Vaccine programs provide high financial benefits for LMICs. Findings from a study by researchers at the WHO, Johns Hopkins, and the Bill and Melinda Gates Foundation suggest that immunization programs provide a high return on investment in low- and middle-income countries (LMICs). The study analyzed the economic benefits and costs associated with immunization programs targeting ten pathogens across 94 LMICs. Researchers estimated that under a cost-of-illness approach, return on investment for every one dollar invested in immunization programs was $26.1 and $19.8 between 2011 and 2020 and 2021 and 2030, respectively. Under a value-of-a-statistical-life approach, return on investment was $51.0 and $52.2 per every one dollar invested. Results emphasize the economic benefits of continued investment in immunization programs in LMICs. [Health Affairs]

Study reports trends in antibiotic-resistant pneumococcal serotypes in US. Researchers in the US reported a downward trend in antimicrobial-resistant Streptococcus pneumoniae among adults with suspected pneumonia between 2009 and 2017, although resistance trends varied by serotype. S. pneumoniae isolates resistant to penicillin and ceftriaxone declined by 72.3 and 73.8 percent respectively over the study period, and the proportion of serotype 19A isolates decreased from 17.4 to 3.9 percent, corresponding with the introduction of the 13-valent pneumococcal conjugate vaccine (PCV) in 2014. Resistance rates remained stable for S. pneumoniae serotype 19A, declined for serotype 19F, and increased for certain antibiotics for serotype 3, likely reflecting serotype-specific resistance mechanisms.[Journal of Infection]

Clinician training reduces antibiotic prescribing for kids with respiratory illness. An online antimicrobial stewardship training for pediatric clinicians in Chicago was associated with a 7 percent reduction in antibiotic prescribing rates for children with acute respiratory tract infections (ARTIs). The program consisted of three modules over 11 months with tutorials, webinars, vignettes, and antibiotic prescribing feedback reports for each clinician. Overall antibiotic prescribing for viral ARTIs decreased as well, by approximately 40 percent, indicating that the program is successful in preventing inappropriate antibiotic prescribing among children. [Pediatrics]

UK and India to research the impact of antimicrobial waste on AMR. The UK and India are contributing $10.5 million USD towards five new projects aimed at tackling antimicrobial resistance (AMR). UK Research and Innovation and the Government of India Department of Biotechnology will lead the collaboration set to begin in September 2020, assessing how waste from antimicrobial manufacturing may be contributing to a rise in AMR. Specific projects will measure the impact of water release on resistance selection, increasing rates of environmental AMR, the burden of manufacturing and pharmaceutical waste, and the spread of antimicrobials and resistance from waste to humans. [British High Commission]

Antibiotic with low resistance potential approved for community-acquired pneumonia in Europe. Lefamulin, a new antibiotic with low resistance potential has been approved for the treatment of adults with community-acquired pneumonia (CAP) in Europe. Lefamulin is the first class of antibiotics approved to treat adults with CAP in Europe in nearly 20 years; The drug was approved for use in the United States in August 2019. [Nabriva]