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Center For Disease Dynamics, Economics & Policy

Weekly Digest: Targeted surveillance can reduce uncertainty in AMR trends in China; Non-pharmaceutical interventions delayed in countries with better health preparedness measures

Non-pharmaceutical interventions delayed in countries with better health preparedness measures. In a recent article CDDEP researchers analyzed factors associated with delay in the implementation of non-pharmaceutical interventions (NPIs) such as national school closure, global travel ban, and country-wide lockdowns, between January 1st, 2020 and April 29th, 2020. Countries with larger populations and better health preparedness measures had greater delays in implementation. Implementation of lockdowns, but not national school closures, led to significant reductions in mobility. [The European Journal of Economics]

Targeted surveillance can reduce uncertainty in AMR trends in China. Researchers from ETH Zurich and CDDEP used point-prevalence surveys from event-based surveillance for foodborne bacteria in China to map AMR trends in animals. The analysis showed a high proportion of antimicrobial compounds with a resistance of greater than 50% in eastern, central, and northwestern regions of China. Furthermore, researchers identified optimal locations for additional surveillance to minimize uncertainty on the current AMR map based on this data. This approach could help optimize the use of limited resources for event-based surveillance. [Nature]

High and low pre-infection glucose levels are associated with increased risk for COVID-19. A population-based, historical cohort study in Israel investigated the effects of pre-COVID-19 infection glucose levels on the risk for severe illness in patients with and without diabetes. In a cohort of 37,121 patients with COVID-19, 1.9% had severe disease. For patients without diabetes, elevated fasting blood glucose (FBG) level of 106 mg/dl and above was associated with severe COVID-19. For patients with diabetes, the lowest risk was for patients with FBG levels of 106-125 mg/dl, and the risk increased with both higher and lower glucose levels (<100mg/dl). [PLOS One]

Non-pharmaceutical interventions are essential during vaccination campaigns.  A matched test-negative-case-control study among healthcare workers in Brazil showed that vaccination with at least one dose of the CoronaVac vaccine was associated with a 0.51-fold reduction in the odds of symptomatic COVID-19 infection more than 14 days after vaccination. Surprisingly, researchers estimated the two-dose schedule to have low effectiveness (36.8%, 95% CI 11.3 to 71.4) during the two weeks or more following the second dose, emphasizing the role of non-pharmaceutical interventions during vaccination campaigns. [The Lancet]

WHO calls for investment towards TB vaccine development. The Bacillus Calmette–Guérin (BCG) vaccine against tuberculosis (TB), introduced one century ago, provides moderate protection against severe disease in infants and children. However, an effective vaccine to prevent TB in adults is lacking, and while many vaccine candidates are currently in clinical trials, it could take years before they are available. The COVID-19 pandemic demonstrated what political and financial backing could contribute to the rapid development of life-saving vaccines. The World Health Organization calls for increased and sustained investments in TB vaccine development to address the spread of multi-drug resistant TB. [WHO]

Long-term cognitive deficits in people who have recovered from COVID-19. A study in the UK sought to identify cognitive consequences of COVID-19 following reports of ‘Long COVID’ symptoms. The findings revealed cognitive deficits compared to controls among those who had recovered from COVID-19, including those with asymptomatic disease. While deficits were substantial in both hospitalized and non-hospitalized persons, the most significant deficit was among hospitalized patients who experienced a reduction of 0.47 standard deviations in a global composite score, the equivalent of seven points in a classic intelligence test. [The Lancet]

MDRO colonization lowers overall survival in hepatocellular carcinoma patients. A German study assessing the impact of multidrug-resistant organisms (MDRO) colonization among 964 hepatocellular carcinoma (HCC) patients, revealed that Enterobacterales with extended-spectrum β-lactamase-like phenotype with or without resistance to fluoroquinolones (59%) and vancomycin-resistant Enterococcus faecium (37%) were the most frequently identified organisms among colonized patients (n=59). Colonized patients had more severe cirrhosis, advanced HCC, impaired liver function, and lower overall survival (189 days vs. 1001 days), indicating that MDRO-colonization is an independent risk factor for survival in HCC patients. [Journal of Cancer Research and Clinical Oncology]

Ambulance transport is associated with an increased risk of acquiring MRSA and VRE. A retrospective cohort study estimated the relative risk of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection during ambulance transport. In a cohort of 11,324 patients treated in the emergency room, 3,903 were transported via ambulance. Of the entire cohort, nine patients acquired MRSA, and three acquired VRE. The 30-day prevalence of MRSA or VRE was 0.20% in the ambulance group compared to 0.05% in the unexposed group, indicating ambulance transport has four times the risk of acquiring MRSA or VRE than non-ambulance transport. [Infection Control and Hospital Epidemiology]

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