OFFICES IN Washington D.C. & New Delhi

Center For Disease Dynamics, Economics & Policy

Weekly Digest: Azithromycin course ineffective at reducing the risk of rehospitalization or death in Kenyan children under five; Risk factors linked to vaccine hesitancy among children and adolescents in England

Azithromycin course ineffective at reducing the risk of rehospitalization or death in Kenyan children under five. A recent double-blind, placebo-controlled, randomized trial in Kenya revealed no significant benefit from a five-day azithromycin course at hospital discharge for death or rehospitalization among children under five (adjusted hazard ratio 0.91, 95.5% CI 0.64 to 1.29). Azithromycin resistance in E.coli isolates was higher at three months but not six months following discharge. The critical post-discharge period among children under five warrants more research into interventions to reduce mortality and rehospitalization. [The Lancet]

Risk factors linked to vaccine hesitancy among children and adolescents in England. An investigation into vaccine hesitancy among children and adolescents in England showed that among the 27,910 students who responded to a survey between May 14th and July 21st, 2021, 50.1% indicated they would take the vaccination, 37.0% were undecided, and 12.9% indicated they would not. Students in the vaccine-hesitant group were more likely to come from deprived socio-economic backgrounds, smoke, spend time on social media, and lack a sense of belonging in their school communities. [Lancet]

COVID-19 pandemic has caused life-expectancy losses in many countries. Life expectancy at birth has decreased between 2019 and 2020 in 27 out of 29 countries, based on findings from a study including countries in Europe, Chile, and the United States. Males in the US and Lithuania experienced the most significant losses of 2.2 years and 1.7 years, respectively. These losses in life expectancy matched those from World War II in countries like Spain, Italy, and Belgium. In many Central and Eastern European countries, the losses exceeded those observed after the dissolution of the Eastern Bloc. [International Journal of Epidemiology]

Monoclonal antibody treatment prevents COVID-19 in exposed individuals. REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab prevented COVID-19 infection in people at high risk of infection from exposure to an infected household contact. Symptomatic COVID-19 developed in 1.5% of people receiving REGEN-COV within 96 hours of exposure and 7.8% among the placebo group. Furthermore, recovery time was shorter for those with symptomatic infections in the REGEN-COV group (1.2 weeks vs. 3.2 weeks). [NEJM]

School masking policies linked to lower COVID-19 cases in the community. Three studies from the US Center for Disease Control and Prevention show that school districts without strong universal masking policies were more likely to have COVID-19 outbreaks. One study in Arizona showed that schools were 3.5 times more likely to have outbreaks if they did not have universal masking in place at the start of the school. In another study, COVID-19 case rates were lower in counties with school mask requirements than those who did not (16.32 vs. 34.85 per 100,000/day). [CDC]

High antimicrobial prescription rates for nonbacterial acute infectious diarrhea. To address evidence on the misuse of antimicrobials for acute infectious diarrhea, researchers in Japan conducted a retrospective observational study on the antimicrobial prescription trends for acute infectious diarrhea among patients ages 0-65. Among the 482,484 analyzed healthcare visits, 94.6% were diagnosed with nonbacterial acute infectious diarrhea. However, antimicrobial prescription rates were high, with the most prescribed antimicrobials being fosfomycin (37.7%) and fluoroquinolone (30.5%). [BMC Infectious Diseases]

Cefixime more effective than tetracycline at treating acute respiratory tract infections. A recent study suggests that cefixime may be superior to tetracycline for treating acute respiratory tract infections (ARTIs). The analysis of 466 single isolates from previous ARTI research, consisting of Staphylococcus (35%), Streptococcus (29%), Bordetella (15%), Hamophyllus (12%), and Corynobacterium (9%), showed that 38.0% were resistant to cefixime and 92.86% were resistant to tetracycline. [Nature]

Geographic and age-based vaccination distribution strategies are more equitable than age-based strategies alone. While the risk for severe COVID-19 infection is high for elderly individuals, it is also high for Black, Indigenous, and People of Color (BIPOC) of younger ages in the United States. A US study evaluating four different schemas for vaccine prioritization strategies found that age-based strategies alone do not benefit the entire population of the United States. Instead, geographical prioritization through risk assessment in local contexts could protect those at high risk who are excluded from the age-based strategies. [Science]

Impact of the COVID-19 pandemic on outpatient antibiotic prescriptions trends in the United States. Findings from a US study investigating outpatient antibiotic prescriptions trends during the COVID-19 pandemic suggest contrasting changes in prescription trends. An initial reduction in the prescription of commonly used antibiotics (amoxicillin, azithromycin, amoxicillin-clavulanate, doxycycline) in April 2020, was followed by a significant increase and a reverse in the 5-year trend of consistent reductions in the use of ciprofloxacin. While the reasons for these changes are unclear, the authors suggest that COVID-19 preventive measures have led to fewer respiratory infections and, as a result, less antibiotic use. [JAMA]

Photo: Shutterstock