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The Center For Disease Dynamics, Economics & Policy

Weekly Digest: Travel-related antimicrobial resistance; Surveying the public’s likelihood of getting a COVID-19 vaccine; Impact of COVID-19 pandemic on routine immunization services in Lebanon; Reduction in mobility and COVID-19 transmission.

 COVID-19

National trends in the US public’s likelihood of getting a COVID-19 vaccine—April 1 to December 8, 2020. As vaccines against COVID-19 are being distributed across the United States, vaccine hesitancy remains an obstacle to achieving high vaccination levels. The Understanding America Study (UAS) is an internet panel survey of approximately 9,000 U.S. adults. Respondents recruited from this panel have participated in biweekly tracking surveys about COVID-19 since March 10, 2020. From the April 1-14 survey through November 25-December 8, researchers asked respondents whether they would get vaccinated against COVID-19 once a vaccine is available to the public. During this period, the respondents reporting to somewhat, or very likely get vaccinated decreased from 74% to 56%, and the decline occurred in all demographic groups. In the November 25-December 8 survey, women, Black individuals, the elderly, and those with at least a bachelor’s degree were more likely to say they will get vaccinated than their counterparts. [JAMA]

Factors associated with non-adherence to social distancing rules during the COVID-19 pandemic. Researchers conducted a cross-sectional survey to assess social distancing (SD) behaviours in North London. They revealed that a vast majority (92.8%) of the participants did not adhere to all SD rules, and nearly half (48.6%) engaged in intentional non-adherence of rules. Non-adherence to all SD rules had a stronger association with not being vulnerable to COVID-19 and having lower control over others’ SD, whereas intentional non-adherence had a stronger association with intention and anti-social psychological factors. The authors recommended that people living in high-risk environments, such as those living in multiple occupancy houses, should be specially supported when asked to stay at home, and public health messaging should emphasize shared responsibility and public consciousness. [BMC Public Health]

Reduction in mobility and COVID-19 transmission. An analysis of the relationship between individual mobility and the transmission rate of COVID-19, similar to a study done at CDDEP on mobility in the United States, but expanded to include 52 countries and using mobility data provided from both Apple and Google, revealed findings similar to those reported earlier. There was a strong relationship between the mobility metric used and COVID-19 transmission early on in the pandemic when broad lockdown measures were employed (March 2020 through May 2020), but that relationship deteriorated after that initial period. There may be utility in measuring the correlation between mobility and COVID-19 transmission; however, without expanding the analysis to include other control measures, such as commercial closures and mask mandates, it is difficult to quantify it reliably. [Nature Communications]

Modelling safe protocols for reopening schools during the COVID-19 pandemic in France. Researchers in France explored partial, progressive, or full school reopening scenarios through a stochastic age-structured transmission model. They reported that reopening schools after lockdown might increase COVID-19 cases, yet protocols exist to keep the epidemic controlled. They stressed that priority should be given to pre- and primary schools allowing younger children to resume learning, whereas full attendance in middle and high schools was not recommended for stable or increasing epidemic activity. Under a scenario with stable epidemic activity, reopening pre-schools and primary schools alone would lead to up to 76% occupation of ICU beds. Immediately reopening all school levels may overwhelm the ICU system. Large-scale test and trace were recommended to keep the epidemic under control. After the initial submission, data that became available showed that progressive reopening of schools, limited attendance, and strong adoption of preventive measures contributed to a decreasing epidemic after lifting the first lockdown. [Nature]

 Tuberculosis preventive therapy for children and adolescents: an emergency response to the COVID-19 pandemic. COVID-19 is predicted to have a severe impact on tuberculosis (TB) disease dynamics. Shelter in place orders can increase TB transmission among family members, and the most effective infection control measures (rapid diagnosis and prompt initiation of therapy) have been hampered. The effects of COVID-19 on TB may be especially devastating among children and adolescents, given the disease’s biology and difficulties with diagnosing among these age groups. The provision of TB preventative therapy for at-risk children is one approach to address this problem. The authors provide an example from Khayelitsha, South Africa, where there has been a decrease in the use of healthcare services during the pandemic. Children considered high-risk were screened and initiated on preventative therapy at home if they had a negative test for rifampicin-resistant forms of tuberculosis (RR-TB). The medication was delivered at home or during routine medical visits, and most follow-ups were conducted over the phone. Partner organizations provided food parcels to families with food insecurities. These community-based services were led by a mobile team of healthcare workers, including a general medical practitioner, a nurse, a social worker, a counsellor, and a peer support worker. The provision of TB preventative therapy as an emergency response could greatly reduce morbidity and mortality and decrease the burden on healthcare systems. [The Lancet, Child & Adolescent Health]

 Drug Resistance and Global Health

 Travel-related antimicrobial resistance. Researchers conducted a systematic review of literature on the impact of travel on the dissemination of AMR. They revealed that high-income countries were more likely to be recipient nations for AMR originating from middle- and low-income countries. The most common origin of travellers with resistant bacteria was Asia, covering 36% of the total isolates. Of the recorded AMR movements associated with travel, 91.83% were of enteric bacteria. Beta-lactams and quinolones were the most documented drug-resistant organisms, accounting for 35% and 31% of the overall drug resistance, respectively. Medical tourism was twice as likely to be associated with multidrug-resistant organisms than general travel. The authors concluded that international travel is a vehicle for the transmission of antimicrobial resistance globally, and health systems should identify recent travellers to ensure that adequate precautions are taken. [Tropical medicine and infectious diseases]

Impact of COVID-19 pandemic on the utilization of routine immunization services in Lebanon. Researchers in Lebanon conducted a cross-sectional study to assess the pandemic’s impact on utilizing routine immunization services. They found that the utilization of immunization services decreased by 31% at the national level. In the private sector, immunization services provision diminished by 46.9%, mainly between February and April 2020. The highest decrease rates were observed for oral poliovirus vaccine (OPV) and hepatitis A, followed by measles and pneumococcal conjugate vaccines. The number of vaccine doses administered in the public sector decreased by 20%. The most prominent reductions were detected for the OPV and measles vaccines and during October 2019 and March 2020. The authors concluded that there was a substantial decrease in the utilization of routine immunization due to the pandemic and that public health interventions were required to prevent future outbreaks of vaccine-preventable diseases. [Plos One]

 A cost-effectiveness analysis of South Africa’s seasonal influenza vaccination programme. South Africa’s seasonal influenza vaccination strategy includes vaccinating vulnerable populations (people over 65 years old, pregnant women, people living with HIV/AIDS, people with underlying medical conditions, and children aged 6-59 months). In a study published in Vaccine, researchers used the World Health Organization’s Cost-Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV) to estimate influenza cases, outpatient visits, hospitalizations, and deaths averted in these vulnerable groups. They found that the vaccination program was cost-effective for all vulnerable populations except children aged 6-59 months, with incremental cost-effectiveness ratios (ICER) ranging from $1750/QALY in people living with HIV/AIDS to $7500/QALY in children. The higher cost of vaccinating children, who require two doses rather than one, together with the vaccine’s limited efficacy in the age group contributed to higher ICER. This analysis demonstrates the usefulness of CETSIV, although the tool may underestimate the indirect benefits of vaccination. [Vaccine]

Cost-effectiveness and budget impact analyses for the prioritisation of the four available rotavirus vaccines in the national immunisation programme in Thailand. Rotavirus is a major cause of diarrhea in children <5 years old in Thailand, however, vaccination has yet to be included in the national vaccination program. Researchers conducted a cost-utility analysis to estimate costs and outcomes of four WHO-prequalified rotavirus vaccines (Rotarix®, RotaTeq®, ROTAVAC®, and ROTASIIL®) using a societal perspective. Programs were considered cost-effective if they had an incremental cost-effectiveness ration (ICER) less than USD 5,110 per quality-adjusted life-year (QUALY) gained. The transmission dynamic model simulated introducing the vaccine among children <1 years old versus no vaccine. Without a vaccine, the model predicted 312,118 cases compared to 144,299 cases with 95% coverage. All vaccines were cost-saving with average cost-savings estimates ranging from USD 22 to 32 million per year and 999 QUALYs gained. The healthcare system’s net savings using any of the four vaccines ranged between USD 12 and 33 million per year. Researchers concluded that rotavirus vaccines should be implemented in the national vaccination program as any of the four WHO-prequalified vaccines would reduce healthcare spending and benefit population health. [Vaccine]

Nonnutritive sweeteners can promote the dissemination of antibiotic resistance through conjugative gene transfer. Researchers conducted an in vitro study on the effect that four commonly used artificial sweeteners (saccharin, sucralose, aspartame, and acesulfame potassium) have on the horizontal transmission dynamics of antibiotic resistant genes (ARGs) in bacteria. Nonnutritive sweeteners can exist in concentrations of up to hundreds of mg/L in the human body because they are not generally metabolized and can also be found in sub-surface water and the effluent of wastewater treatment plants. The researchers demonstrated for the first time that the four sweeteners could promote ARG transfer by conjugation at environmentally and clinically relevant concentrations. This finding can have an enormous impact on the food industry; however, more research and in vivo assays are necessary to determine how much this can occur in the human gut and urinary systems. [ISME]

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