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Weekly Digest: CDDEP partners with WHO on Action Framework on using vaccines to prevent AMR; Attributes and predictors of long COVID; Azithromycin for community treatment of suspected COVID-19; Antenatal screening of asymptomatic bacteriuria can reduce pre-term and low birth weight

CDDEP partners with WHO on Action Framework on using vaccines to prevent AMR. In addition to averting morbidity and mortality, vaccines can help combat antimicrobial resistance (AMR) by preventing infections and reducing antibiotic use. In a recent paper, researchers from the World Health Organization (WHO), Wellcome Trust, Bill & Melinda Gates Foundation, and CDDEP have developed an Action Framework to guide vaccine stakeholders in using vaccines to prevent AMR. The framework underscores the importance of prioritizing Hib, PCV, TCV, and influenza vaccines and the development of vaccines against malaria, HIV, RSV, and group A Streptococcus to reduce antibiotic useOther recommendations include accelerating data collection and analysis to quantify the role of vaccines against AMR from the research, health, and economic perspective, and use targeted communication to catalyze much-needed action.  [Clinical Infectious Diseases]

 Moderna vaccine may reduce transmissibility of SARS-CoV-2 by 61%. Randomized controlled trials (RCTs) have reported high efficacy for several vaccines against SARS-CoV-2 disease; however, little is known on the vaccination’s impact on infection, shedding, and transmission of the virus. Reported vaccine efficacies represent a measure of how effective the vaccine is at preventing someone from developing symptoms but do not indicate the role of vaccines in preventing disease transmission. Researchers from the Harvard T.H. Chan School of Public Health investigated an approach where viral positivity in a cross-section of the population, irrespective of symptoms, was analyzed separately from the outcome of a positive test triggered by symptom development. Based on this approach, researchers estimated that one dose of the Moderna vaccine reduces the transmissibility of SARS-CoV-2 by 61%. [medRxiv]

Pfizer COVID-19 vaccine 94% effective in “real life” settings. Researchers in Israel matched 596,618 people vaccinated as part of a nationwide campaign with an unvaccinated ‘twin’ of the same age, sex, ethnicity, and neighborhood of residence. They found that Pfizer’s vaccine was 94% effective at preventing COVID-19 and 92% effective against severe disease seven days or more after the second shot. The vaccine’s efficacy was similar to that reported in the randomized control trial, strengthening the expectation that newly approved vaccines could help mitigate the profound global effects of the Covid-19 pandemic. [The New England Journal of Medicine]

Attributes and predictors of long COVID. Researchers from the UK assessed long-lasting COVID-19 symptoms in terms of prevalence, risk factors, and predictability using data from the COVID Symptom Study app. Of the 4,182 study participants, symptoms were reported to last more than 28 days by 13.3%, more than eight weeks by 4.5%, and more than 12 weeks, by 2.3%. Long-lasting symptoms included fatigue, headache, difficulty breathing, and loss of smell, with older adults, women, and individuals with a higher BMI being more likely to experience long-lasting symptoms. Using data from this study, and including parameters such as the number of symptoms in the first week, age, and sex, the researchers built a model to predict short (<10 days) and long (≥28 days) duration of COVID-19. [Nature Medicine]

Alcohol and tobacco sales in the United States increased during the COVID-19 pandemic. Alcohol and tobacco sales have increased during the pandemic. In a study assessing household retail sales in the United States, researchers compared data from a longitudinal household cohort from April 1 to June 30, 2020, with those from the same months in 2017-2019. Sales for alcohol increased from $7.10 billion in 2019 to $9.55 billion in 2020 (+34%) and for tobacco from $3.12 billion to $3.53 billion (+13.2%), with a higher increase among higher-income households, young adults, larger households, households with children under 18, and ethnic minorities. [Annals of Internal Medicine]

Global effect of the COVID-19 pandemic on pediatric cancer care. In an international collaborative effort led by researchers from St. Jude Children’s Research Hospital in Memphis, TN, US, 213 medical institutions across 79 countries were surveyed to assess the impact of the COVID-19 pandemic on childhood cancer care. They revealed that 34% reported failure or delays of 4 weeks of more in treatment initiation. Institutions reported changes in cancer care that included reductions in surgical care (72%), blood product shortages (60%), chemotherapy modifications (57%), and interruptions to radiotherapy (28%). The findings illustrate the pandemic’s considerable impact on pediatric disease management worldwide, and especially in low-income and middle-income countries where reporting of disruptions was most frequent. [The Lancet Child & Adolescent Health]

Short-course antimicrobial therapy was comparable to standard care in the treatment of pediatric, community-acquired pneumonia. Researchers in Canada conducted a 2-center, blinded randomized clinical trial to investigate whether short-course antibiotic therapy (5 days of high-dose amoxicillin) was inferior to standard care (5 days of high-dose amoxicillin) for children 6 months to 10 years diagnosed with community-acquired pneumonia (CAP) in an outpatient setting.  Among the 281 participants with a median age of 2.6 (IQR 1.6-4.9) years outcome was obtained from 252. Clinical cure at 14-21 days after enrolment in the study was observed in 108/126 (85.7%) in the intervention group and 106/126 (84.1%) in the control group, indicating that short-course antimicrobial therapy was comparable to standard care. This has implications for treatment guidelines on antibiotic therapy, as an evidence-based reduction in treatment duration can reduce unnecessary antibiotic use and emerging resistance. [JAMA Pediatrics]

Antenatal screening of asymptomatic bacteriuria can reduce pre-term and low birth weight. Asymptomatic bacteriuria (ASB) can induce pre-term labor, leading to higher mortality and life-long disabilities in premature babies. Researchers at a tertiary care hospital in India conducted a randomized controlled trial to assess the effect of rapid test screening for ASB on pre-term birth and low birth weight (LBW) incidence. Among 240 asymptomatic pregnant women, 21 women tested positive for ASB and were prescribed pathogen-specific antibiotics. The incidence of pre-term birth/ LBW in the intervention arm was 14.7% lower than in the control arm, indicating that rapid-test-guided treatment for ASB can reduce preterm birth/ LBW incidence.  [The Lancet]

AMR profile of Streptococcus pneumoniae after PCV10 introduction in Brazil. The pneumococcal conjugate vaccine (PCV10) was introduced into Brazil’s immunization program in 2010. Researchers in Brazil assessed antimicrobial susceptibility in Streptococcus pneumoniae (Spn) before and after the introduction of PCV10, using data from 11,380 isolates.  The study revealed that non-susceptible Spn infections declined three years after vaccination but then subsequently increased in the following years, particularly in 2017-2019;  in 2017, multidrug-resistance reached 25%. Serotypes 19A, 6C, and 23A, not connected to the PCV10 vaccine, were most associated with antimicrobial non-susceptibility, underscoring the importance of continuous AMR surveillance in guiding antibiotic therapy policies. [Vaccine]

 Azithromycin for community treatment of suspected COVID-19. To explore the potential of azithromycin as a treatment for COVID-19, the PRINCIPLE Trial Collaborative Group conducted a randomized clinical trial of patients with suspected COVID-19 (aged 50 or older and 65 years or older) with at least one comorbidity. Treatment involved 500 mg of azithromycin once daily for three days in addition to usual care for COVID-19. Outcomes were similar between the treatment and control groups, with 80% of participants in the azithromycin plus usual care group and 77% of participants in the usual care group recovering after 28 days. Differences in median time to first reported recovery and hospitalization rates were also statistically insignificant between the two groups. These findings suggest that azithromycin should not be used routinely to treat COVID-19, particularly given implications for antibiotic stewardship and antimicrobial resistance. [The Lancet]