OFFICES IN Washington D.C. & New Delhi

The Center For Disease Dynamics, Economics & Policy

Weekly Digest: Childhood vaccines reduce antibiotic consumption in LMICs; Modeling the burden of COVID-19 across countries in Africa; Researchers estimate district-level COVID-19 risk scores across India.

Weekly Digest: Childhood vaccines reduce antibiotic consumption in LMICs; Modeling the burden of COVID-19 across countries in Africa; Researchers estimate district-level COVID-19 risk scores across India.

Childhood vaccines reduce antibiotic consumption in LMICs. Researchers at CDDEP, Berkeley, UC San Francisco, and Imperial College London assessed the impact of vaccines on antibiotic consumption among children under five in low- and middle-income countries (LMICs). The study found that among children 24-59 months old, pneumococcal conjugate (PCVs) and rotavirus vaccines reduce cases of antibiotic-treated acute respiratory infection (ARI) and diarrhea, 19.7 percent (95% confidence interval, 3.4–43.4 percent) and 11.4 percent (4.0–18.6 percent), respectively. These vaccines therefore prevent an estimated 23.8 million and 13.6 million cases of antibiotic-treated ARI and diarrhea per year among children in LMICs under current vaccination coverage levels. Universal coverage of these vaccines could prevent an additional 40 million cases of antibiotic-treated illnesses. Results of this study support vaccination as a global strategy to combat AMR. [Nature]

Modeling the burden of COVID-19 across countries in Africa. Researchers at CDDEP and Johns Hopkins University estimated the potential COVID-19 case burdens in each African nation considering various interventions, such as curfews, lockdowns, and social distancing. Given current trends in case burden, the model estimates the potential resource needs that would be required under four different scenarios: no intervention, moderate lockdown, hard lockdown, and hard lockdown with continued social distancing/isolating. The model found that nationwide 60-day lockdowns in African countries should be effective at buying time to prepare health facilities for a surge of cases, preparing for/teaching social distancing, and reducing new cases if social distancing is strictly enforced and good contact tracing continues during the course of the lockdown. [CDDEP]

Researchers estimate district-level COVID-19 risk scores across India. Researchers at CDDEP used data from large nationally representative surveys, administrative sources, and published studies to estimate district-level risks of COVID-19 in India based on health, healthcare access, and socioeconomic indicators. The study found that districts in northern, southern, and western Indian states such as Punjab, Tamil Nadu, Kerala, and Maharashtra were at the highest health risk for COVID-19 infection, while districts in eastern and central states, such as Uttar Pradesh, Bihar, and Madhya Pradesh had higher socioeconomic and healthcare access risks for COVID-19. [MedRxiv]

More research needed to assess remdesivir as a treatment for COVID-19. In the first randomized controlled trial of remdesivir, an experimental drug being tested to treat severe COVID-19, researchers did not find significant evidence that the drug produces clinical benefits. In the trial of 237 patients with severe COVID-19 in Hubei, China, researchers found that remdesivir was not significantly associated with a faster time to clinical improvement (hazard ratio: 1.23 [95% CI 0.87, 1.75]) or improved 28-day mortality (14 percent in remdesivir group vs. 13 percent in placebo). In the intention-to-treat analysis, patients in the remdesivir group had a numerically faster median time to improvement than the placebo group (18 vs. 23 days, respectively), although results were not statistically significant. The trial was stopped before reaching its predetermined sample size due to the COVID-19 outbreak coming under control in China. Larger studies are therefore needed to support these findings. [The Lancet]

Study finds lack of evidence to support hydroxychloroquine as effective treatment for COVID-19. In a pre-print article analyzing 368 COVID-19 patients at US Veterans Health Administration hospitals, researchers reported no evidence that hydroxychloroquine, administered with or without azithromycin, reduced a patient’s risk of mortality or progression to ventilator therapy. The overall risk of death was 2.61 times higher among patients who received hydroxychloroquine alone compared to those who did not receive the drug (p=0.03), and the risk of ventilation did not differ significantly across treatment groups (p>0.05). The lack of evidence supporting the use of hydroxychloroquine as a treatment for COVID-19 emphasizes the need for randomized controlled trials prior to widely adopting new drugs. [MedRxiv]

High prevalence of COVID-19 detected in homeless shelters with clusters of cases. Researchers identified a high prevalence of COVID-19 cases among residents and staff at homeless shelters that reported a cluster of cases (two or more in the previous two weeks) in Seattle (17 and 17 percent of residents and staff tested positive, respectively), Boston (36, 30 percent), and San Francisco (66, 16 percent). The prevalence of COVID-19 cases in shelters in Seattle with only one reported case was lower, with five percent of residents and one percent of staff members testing positive. At shelters in Atlanta where no cases were reported in the preceding two weeks, four percent of residents and two percent of staff tested positive for the virus. The study authors note the importance of implementing infection control measures in homeless shelters and providing comprehensive testing to all residents and staff regardless of symptoms when a cluster of COVID-19 cases is identified. [CDC MMWR]

Overly broad antibiotic treatment linked to higher mortality in sepsis patients. In a US cohort study including 17,430 hospital patients with community-onset sepsis, researchers found that both undertreatment and overtreatment with broad-spectrum antibiotics was associated with an increased risk of mortality (adjusted OR: 1.19 [95% CI 1.03-1.37], 1.22 [95% CI 1.06, 1.40], respectively). Common causal pathogens were Escherichia coli, Staphylococcus aureus, and Streptococcus species (33.7, 21.3, and 13.5 percent, respectively). Over two-thirds of patients received antibiotics that target drug-resistant pathogens, although only 13.6 and 13.2 percent had resistant gram-positive or gram-negative organisms, respectively. The study authors note that better diagnostic tests for resistant organisms are needed to reduce overly broad antibiotic treatment. [JAMA Network Open, CIDRAP]

Flu vaccine averts 1 in 25 antibiotic prescriptions. In a study of nearly 37,500 US outpatients with acute respiratory illness, researchers found that influenza vaccination averted 1 in 25 antibiotic prescriptions (3.8 percent) during 2013-2018 flu seasons. Approximately 36 percent of patients with acute respiratory illness and 26 percent of patients with the flu were prescribed antibiotics during these flu seasons, and the vaccine efficacy was estimated to be 35 percent against flu-associated acute respiratory illnesses. The study authors note that increased vaccination coverage and accurate flu diagnoses may prevent inappropriate antibiotic use. [Clinical Infectious Diseases]

CDDEP to undertake cutting edge research as part of a global consortium aimed at preparing for future pandemics. Researchers at CDDEP working with the University of Virginia’s Biocomplexity Institute (US) have received a $10 million, five-year collaborative “Expeditions in Computing” grant from the National Science Foundation. The purpose of the grant is to use innovative technological and scientific advancements to plan for and respond to epidemics and pandemics, including outbreaks of deadly novel viruses and even the common flu, which sickens and kills millions of people each year. This study aims to develop transformative and scalable computing and data science technologies to revolutionize real-time epidemiology for controlling disease outbreaks. The consortium includes teams of researchers at 14 academic institutions, working with renowned international partners who are determined to find ways to stop or mitigate outbreaks before they spread across the globe. [Global Pervasive Computational Epidemiology]

Survey platform launched to collect information about the impacts of COVID-19. COVIDsurveys.org hosts web- and SMS-based mass surveys aimed at rapidly collecting information about the ongoing COVID-19 pandemic to assist public health officials to better address the needs of communities and healthcare workers. The platform is operated by CDDEP, funded by a Bill & Melinda Gates Foundation Grand Challenges Exploration Grant, and powered by Harvard Humanitarian Initiative’s KoBo Toolbox. COVIDsurveys.org is an interactive platform that allows the public to provide insights and thoughts on the current situation as well as watch COVID-19 related content. Information provided through these surveys will also inform, support, and improve public health campaigns around the globe now and in the future. [COVIDsurveys]