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Center For Disease Dynamics, Economics & Policy

Weekly Digest: Drivers of non-prescription purchase of antibiotics; Vaccine side-effects and SARS-CoV-2 infection after vaccination; Income inequality in the US as a risk factor for COVID-19 cases and deaths; Shortening treatment time for tuberculosis.

Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics. Researchers from CDDEP and the University of Delhi examine knowledge, behavior, and consumer practice towards antibiotics and antimicrobial resistance (AMR) to identify factors driving the purchasing of non-prescription antibiotics. Findings from 72 in-depth consumer interviews conducted in all 11 districts of Delhi reveal that retail pharmacies are the first point of consultation for common ailments and that saving time and money are the main drivers for self-medication. Consumers’ knowledge of antibiotic use and AMR is low, emphasizing the need for ongoing community awareness campaigns. [PharmPract]

Shortening treatment time for tuberculosis. In an open-label, phase 3, randomized, controlled trial spanning 13 countries, researchers tested the noninferiority of two 4-month Rifapentine-based regimens to the standard 6-month rifampin-based regimen. The study included 2343 participants newly diagnosed with pulmonary tuberculosis, and the primary outcome was TB-free survival at 12 months. Rifapentine with moxifloxacin was noninferior to the standard treatment (11.6% vs. 9.6%; difference, 2.0 percentage points; 95% CI, −1.1 to 5.1) and adverse events of grade 3 or higher occurred at similar rates in both groups. The findings from this study provide evidence that the standard 6-months treatment can be replaced by shorter and effective regimens, reducing both treatment time and cost [NEJM]

Substantial gap between drug approval in the United States and availability in nations that contributed to research. A cross-sectional study conducted by Yale researchers monitored the availability of 34 FDA-approved novel drugs to different parts of the world, including countries that collaborated on research and participated in the drug clinical trials. The study revealed that five years after their approval in the US, only five of the 34 novel drugs were approved in all countries where they were tested. Furthermore, among 70 countries contributing research participants, 7% (5 countries) received market access to the drugs they helped test within one year of US approval, and 31% (22 countries) did so within five years. Approvals were faster in high-income countries, and access was lowest in African countries. The significant gap in the approval of drugs and their availability to patients globally undermines the fair bargain that countries consider when collaborating on drug trials. [JAMA]

Income inequality in the US as a risk factor for COVID-19 cases and deaths. Researchers assessed the relationship between the Gini coefficient, a measure of income distribution and economic equality, and the number of COVID-19 cases and deaths recorded between March 1, 2020, and February 28, 2021, in US counties in all 50 states, the District of Columbia, and Puerto Rico. US counties with higher economic disparities were more likely to record a higher number of per capita COVID-19 cases (Spearman’s rank correlation coefficient: 0.052, p<0.001) and deaths (0.134, p<0.001) when accounting for factors such as poverty, age, race/ethnicity, mask use, and education of residents and urbanicity and rurality and physician density. The association between Gini coefficients and COVID-19 cases and deaths varied over time, being more pronounced during the summer months and declining into the fall and winter of 2020. [JAMA]

Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK. Researchers from King’s College London assess the safety and side effects of the Pfizer-BioNTech and the Oxford-AstraZeneca vaccines using responses from the COVID Symptom Study app. Between December 8 and March 10, 2021, 627,383 individuals were vaccinated with one or two doses of either vaccine. Within eight days of vaccination, 13.5% and 33.7% reported systemic side effects after the first dose of the Pfizer and the Astra Zeneca vaccine, respectively. Side-effects were more common among individuals with previous SARS-CoV-2 infection (1.6 times after the first dose of AstraZeneca and 2.9 times after the first dose of Pfizer). There was a reduction in infection risk in the weeks following the first dose of the vaccine, reaching 60% about 12 days after the first AstraZeneca first dose and 69% about 21-44 days after the first Pfizer vaccine dose. [The Lancet Infectious Diseases

 Maternal SARS-CoV-2 IgG may provide limited protection in infants. Research on perinatal infection of infants born to mothers infected with SARS-CoV-2 is mixed. Researchers at Zhongnan Hospital of Wuhan University in China analyze the seroconversion of 27 newborns born to 26 women diagnosed with SARS-CoV-2 infection and show that the SARS-CoV-2 IgG antibody rate among mothers was 80.8% before birth and that half of the newborns obtained maternal IgG antibodies. The IgG transfer rate was 18.8% for infants whose mothers were infected less than two weeks before delivery and 81.8% for infants whose mothers were infected more than two weeks before delivery. However, their levels dropped to one-tenth of that at birth after two months, suggesting that maternal antibodies provide limited protection for infants. [Nature Scientific Reports

 Procalcitonin-guided algorithms can improve treatment and reduce costs. Sepsis and bacterial lower respiratory tract infections are linked to antimicrobial resistance (AMR), a major global health threat. To reduce the inappropriate use of antibiotics, biomarkers such as procalcitonin can distinguish between bacterial and non-bacterial infections and predict responses to antimicrobial treatments. Researchers used a decision tree model to estimate the impact of procalcitonin-guided algorithms on therapy for ICU patients with suspected sepsis or lower respiratory tract infections in all Argentinian hospitals. They found that using such algorithms could avert 734.5 antibiotic treatment days, 7,900 antibiotic-resistant infections, and 5,100 Clostridioides difficile cases per year, reducing costs substantially by $422.40 US dollars per patient per year. [PLOS ONE]

 Analysis of antimicrobial stewardship in the Western Cape, South Africa, finds gaps in antimicrobial stewardship. Antimicrobial stewardship (AMS) programs have gained prominence as a valuable tool in combating the threat of antimicrobial resistance, but they vary widely in their structure and implementation. A survey of 35 facilities in the six health districts of the Western Cape in South Africa found that 54.3% of the facilities had AMS committees, with a higher proportion of these in urban than rural facilities. Over a third of the hospitals (36.1%) did not regularly review their antimicrobial consumption data, and 51.4% did not review antimicrobial resistance patterns in their facilities. Additionally, ten rural and three metropolitan facilities reported not receiving support from or providing outreach to other facilities. Better integration of AMS across local and regional bodies can provide valuable assistance and support to health care providers at all levels and promote better-prescribing practices. [The South African Medical Journal]

CDC predicts a decline in COVID-19 hospitalization and deaths in the United States by July 2021. The US Centers for Disease Control and Prevention published revised COVID-19 incidence and mortality trends for the remainder of 2021. Six different models generated predictions under four scenarios: low vaccine uptake and low adherence to non-pharmaceutical interventions (NPI), low vaccine uptake with moderate NPI, high vaccine uptake with low NPI, and high vaccine uptake with moderate NPI adherence. All scenarios predicted an increase of COVID-19 cases, hospitalizations, and deaths through May 2021, with a sharp decline by July. Lifting or relaxing adherence to non-pharmaceutical interventions such as social distancing and mask-wearing were predicted to undermine vaccination-related reductions in cases and deaths. [MMWR]

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