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Weekly Digest: Improved testing strategies for tuberculosis diagnosis in young children; Wastewater-based epidemiology helps measure the effectiveness of interventions; Treatment with convalescent plasma did not improve survival in hospitalized COVID-19 patients

Improved testing strategies for tuberculosis diagnosis in young children. Researchers conducted a prospective cross-sectional diagnostic study to identify combinations of minimally invasive specimens and assays for bacteriologic diagnosis of tuberculosis in young children. The study recruited 300 children from inpatient and outpatient settings in Kisumu County, Kenya, between October 2013 and August 2015. Two nasopharyngeal aspirate (NPA) samples (74%), a combination of one NPA sample and one stool sample (71%), and a combination of one NPA sample and one urine sample (69%) had similar diagnostic performances as the reference-standard samples (gastric aspirate and induced sputum) which are more difficult to collect. These minimally invasive sample collection strategies promise to facilitate TB diagnosis among children younger than five years in resource-limited settings. [JAMA Pediatrics].

Antimicrobial use positively associated with hospital-onset Clostridioides difficile infections. Clostridioides difficile infections (CDIs), previously associated with increased antibiotic use, have been declared an urgent public health threat by the CDC. Researchers from CDC used hospital discharge and inpatient charge records from the Premier Healthcare Database to reassess this association. Among the 921 participating hospitals, 50 additional days of antibiotic therapy (particularly, carbapenems, cephalosporins, and piperacillin-tazobactam) per 1,000 patient days were associated with a 2.8% increase in the rate of hospital-onset CDIs. In contrast, hospitals that decreased total antibiotic use by at least 30% demonstrated a 40% decrease in their infection rates. Reductions in the combined use of cephalosporins, fluoroquinolones, and carbapenems could decrease hospital-onset CDIs. [Infection Control & Hospital Epidemiology]

Wastewater-based epidemiology (WBE) of human viruses helps measure the effectiveness of interventions. Researchers in the UK analyzed wastewater in six major municipal centers to assess the detection of SARS-CoV-2 RNA. Virus detection in wastewater may be more cost-effective and accurate in measuring the prevalence of human viruses in densely populated areas than seroprevalence testing, which requires a lot of effort, resources, and time. Overall, SARS-CoV-2 RNA levels detected in wastewater through WBE correlated well with the abundance of COVID-19 cases in the area and reflected the success of lockdown measures. [Water Research]

Treatment with convalescent plasma did not improve survival in hospitalized COVID-19 patients. Researchers in the United Kingdom conducted a randomized, controlled, open-label trial (RECOVERY, NCT04381936) in 177 NHS hospitals between May 2020 and January 2021 to investigate the effect of convalescent plasma therapy on mortality among hospitalized COVID-19 patients. Eligible participants were randomly assigned to receive either usual care alone or usual care plus high-titer convalescent plasma. The study showed that 28-day mortality was 24% for the control and convalescent plasma groups (rate ratio 1.00, 95% CI 0.93–1.07; p=0.95). Similarly, there was no difference in hospital discharge or progression to mechanical ventilation, suggesting that high-titer convalescent plasma therapy did not improve survival or other clinical outcomes in hospitalized patients with COVID-19.  

Post-exposure prophylaxis and household confinement best at mitigating infectious respiratory disease outbreaks. Researchers in Europe and the UK conducted a systematic review of econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks between 2003 and 2019 in OECD countries. Of the seventeen studies that met the inclusion criteria, six were comparative cost analyses of influenza outbreaks, and 11 were cost-effectiveness studies focusing on preventative and response measures to influenza outbreaks. The findings indicated that compared to no intervention, mask-wearing and screening were both effective and cost-saving. Additionally, community contact reduction was effective with mixed results for cost-saving, and school closures were effective but not cost-saving in the long-term. Post-exposure prophylaxis combined with household confinement were identified as the most cost-saving and effective mitigation measures compared to no interventions. [BMJ Open

CDC reports low vaccine coverage among US adults. Coverage for vaccines received during adulthood, including HPV, hepatitis, and influenza among Americans aged 19 years and older, was low in 2018, according to the US Centers for Disease Control and Prevention. Coverage rates were 23.3% for the pneumococcus vaccine, 62.9% for tetanus, and 24.1% for herpes zoster (for those aged 50 and older). Influenza vaccination for the 2017-18 season was 46.1% and was higher among white adults (49.3%) compared to blacks (39.0%) and Hispanics (37.5%). Overall, coverage was significantly higher among US-born adults compared to those born in foreign countries. [MMWR]

Reductions in the number of vaccine doses improve adherence but not overall vaccination rates. In August 2015, the German Standing Committee on Vaccination recommended changing the PCV vaccination schedule from 2, 3, 4, and 11-14 months of age (MoA) to 2, 4, and 11-14 MoA, with the hope that fewer doses might lead to higher rates of vaccine acceptance. Researchers conducted a retrospective claims analysis using data from about 60 health insurance companies in Germany. Completion of PCV vaccination (defined by three doses and a booster in 2013 and by two doses and a booster in 2016) increased from 68.3% in 2013 to 75.6% in 2016; however, the number of mature non-vaccinated infants remained stable at 9% between 2013 and 2016. [Vaccine]

Need for improvements in polio surveillance efforts. Analysis of 2019-2020 poliomyelitis transmission surveillance data, consisting of clinically confirmed or suspected acute flaccid paralysis (AFP) cases from 42 countries, revealed that national and subnational nonpolio AFP rates and stool specimen adequacy are declining. The WHO Global Polio Laboratory Network tested 219,049 stool specimens in 2019 and 147,582 in 2020. Although the total number of wild poliovirus type 1 (WPV1) cases decreased globally from 2019 to 2020, the increase in orphan WPV1 isolates between 2019 and 2020 in both countries suggests gaps in AFP surveillance. [MMWR]

No significant reduction in antibiotic use in the US in the decade ending in 2018. Antibiotic stewardship represents a key strategy to reduce antibiotic resistance. Researchers at Johns Hopkins University School of Medicine conducted a cross-sectional study using the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2018. The NHANES, completed by a large sample of the population in the United States, can assess for non-topical antibiotics prescribed in the last 30 days. The study showed a significant decline in antibiotics from 1999 to 2018. However, from 2007 to 2018, there was no significant change, indicating slow progress and warranting more regional level research to identify factors that can improve the reduction. [Open Forum for Infectious Disease]

Group B Streptococcus disease associated with increased childhood mortality and neurodevelopmental impairmentsWhile Group B Streptococcus (GBS) disease is a leading cause of neonatal death, little is known about its long-term effects after early childhood. Researchers in Denmark and the Netherlands assess the long-term mortality, neurodevelopmental impairments (NDIs), and economic outcomes of invasive GBS (iGBS) from infancy to adolescence. The study included 2,258 children born between 2000 and 2017 diagnosed with iGBS and 22,462 children with no history of iGBS. Meningitis was associated with increased mortality at age 5 (adjusted HR 4.08 [95%CI 1.78 to 9.35] for Denmark and 6.73 [3.76to 12.06] for the Netherlands), and any iGBS disease was associated with increased risk of NDIs at age 10 (risk ratio 1.77 [1.44 ro 2.18] in Denmark and 2.28 [1.64 to 3.17] in the Netherlands), highlighting the importance of maternal GBS vaccines and the need to follow up with iGBS disease survivors throughout childhood. [The Lancet Child & Adolescent Health