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Weekly Digest: Economic, regulatory & societal challenges impede antibiotic development; AMR poses threat to child health; Eighty percent of adolescents worldwide are not physically active.

Weekly Digest: Economic, regulatory & societal challenges impede antibiotic development; AMR poses threat to child health; Eighty percent of adolescents worldwide are not physically active.

Economic, regulatory, and societal challenges impede antibiotic development. In a Nature Reviews Microbiology Viewpoint article, seven experts including CDDEP director Ramanan Laxminarayan discuss the myriad of challenges that impede the discovery and development of new antibiotics, as well as current initiatives that are aimed at these barriers. Challenges include economic, regulatory, and societal factors, such as the lack of research and development investments from the pharmaceutical industry, and the increasing regulatory costs and economic risks of bringing a new antibiotic to market. [Nature Reviews Microbiology]

Antibiotic resistance poses threat to child health and survival. The United Nations Children’s Fund (UNICEF) released a report noting antimicrobial resistance (AMR) as one of the biggest generational threats to childhood health and survival. The technical note emphasizes that children’s immune systems are not yet fully developed, which puts them at high risk for resistant pathogens. UNICEF outlined three areas of AMR response efforts, which include reducing the rate of infection, promoting access to and optimal use of antimicrobial agents, and increasing awareness and understanding of AMR. [UNICEF]

Eighty percent of adolescents worldwide are not sufficiently physically active. The World Health Organization (WHO) analyzed reports from 1.6 million students (11-17 years old) across the world between 2001 and 2016 and found that 80 percent were not sufficiently physically active. A worldwide gender gap existed in all but four countries studied, with boys reporting more physical activity than girls. Approximately 85 percent of girls and 78 percent of boys failed to meet current activity guidelines, which recommend at least one hour of physical activity per day. The results suggest that urgent policy action and increased opportunities for activity among adolescents are needed to prevent health compromises. [WHO]

CDC updates antimicrobial stewardship guidelines for hospitals. The US Centers for Disease Control and Prevention (CDC) updated its guidelines on antimicrobial stewardship from 2014, incorporating new evidence and lessons learned in the subsequent 5 years. Updates include: higher priority given to leadership of stewardship programs with more allocated time and resources; appointment of more stewardship leaders to improve accountability; better inclusion of pharmacists in leadership and nurses in stewardship action plans; more granular stratification of priorities to streamline higher priority interventions; emphasis on interventions targeting more common indications for hospital antibiotics; greater emphasis on prescription and impact monitoring as well as provider-level data reporting; and improved program auditing and feedback to stakeholders. [CDC]

Outpatient settings lack appropriate first-line antibiotic selection. Researchers from the Center for Disease Control and Prevention (CDC), collaborating with the University of Utah and Pew Trusts, investigated whether first-line antibiotics were prescribed appropriately to treat common respiratory infections in US outpatient settings. On average, only 50 percent of visits received recommended first-line antibiotics. First-line antibiotics were more likely to be prescribed to children and at retail clinics where stricter protocols were in place. Antibiotic stewardship and appropriate antibiotic prescription for common conditions are believed to be imperative at preventing antimicrobial resistance, and better care is necessary in outpatient settings. [AAC]

Measles vaccine linked to significant reduction in virus transmissibility. A cross-sectional study using US measles data from 2000 to 2017 found that measles transmissibility among those who were not vaccinated against the virus was 3-4 times higher than those who received one or two doses of the vaccine. The effective reproduction number of measles, which indicates the mean number of people a patient will transmit the virus to, was 0.76 among unvaccinated individuals, 0.17 among those who received one dose of the measles vaccine, and 0.27 among those who received at least 2 doses of the vaccine. The findings suggest the need for comprehensive measles vaccine coverage. [JAMA Pediatrics]

Disease outbreaks prompt the introduction of vaccine exemption bills across the US. Researchers at Drexel University found that vaccine-preventable disease outbreaks in children were associated with an increase in state bill proposals that restricted vaccine exemptions. The study found that vaccine-preventable diseases, including but not limited to diphtheria, influenza, pneumococcal disease, and measles, occurred at a rate of 25 per 100,000 population in the US between 2010 and 2016. Nearly 2oo vaccine exemption bills were introduced across states between 2011-2017, of which 53 percent were seeking easier vaccine exemptions and 47 percent were seeking restricted exemptions. Increases in outbreaks were positively associated with exemption restriction bills specifically. [JAMA Pediatrics]

PCV10 decreases invasive disease potential of S. pneumoniae in Mozambique. Researchers compiled invasive pneumococcal disease (IPD) data among children <5 years old in Manhiҫa, Mozambique and found a decrease in serotypes with high invasive disease potential following the introduction of the 10-valent pneumococcal conjugate vaccine(PCV10) in 2013. Before the introduction of PCV10 in southern Mozambique, serotypes 1, 6B, and 14 were associated with high invasive disease potential (OR= 22.3, 3.1, 3.4, respectively). After PCV10 introduction, only serotype 6A, which is not included in the vaccine, was associated with high invasive disease potential (OR=6.1). [Vaccine]

Locally transmitted yellow fever reported in Venezuela for the first time in 15 years. Venezuela has confirmed the first case of locally transmitted yellow fever reported in the country since 2005. A 46-year-old male resident was located in Gran Sabana, Bolivar State 19 days prior to symptom onset. The patient is currently hospitalized with renal failure and anemia. UNICEF donated 571,000 doses of the yellow fever vaccine to the country last month, and health authorities are strengthening epidemiological surveillance as part of public health response. [WHO]

Prenatal Zika exposure linked to lower receptive language scores in Puerto Rican infants. Researchers conducted a cross-sectional study including 65 infants (3 to 12 months old) in Puerto Rico and found that prenatal Zika virus exposure was associated with lower receptive language scores. Although there was not a significant difference in general cognitive or domain-specific scores between infants born to mothers with and without Zika virus, receptive language scores were significantly lower among prenatally Zika-positive infants (mean difference=5.52, p=0.04). [JAMA Network Open]

Prevalence of resistant E. coli is common across poultry farms in Punjab, India. [CDDEP]