OFFICES IN Washington D.C. & New Delhi

Center For Disease Dynamics, Economics & Policy

Weekly Digest: Vaccination slows down emergence of antimicrobial resistance in Ethiopia; Risk factors for pediatric COVID-19 deaths in Brazil.

Vaccination slows down the emergence of antimicrobial resistance in Ethiopia. Researchers at the University of North Carolina at Chapel Hill and Addis Ababa University developed an agent-based model to evaluate the economic value of childhood vaccination with the pneumococcal conjugate (PCV) in the context of antimicrobial resistance (AMR) in Ethiopia. The study estimated a 14.77% and 0.59% decline in the growth of AMR to amoxicillin and ceftriaxone since 2011, translating to approximately 718,000 treatment failures avoided; a 27.8% reduction in AMR related deaths between 2011 and 2017; and, $32.7 million in savings. [Vaccine]

Repeat BCG vaccination not associated with protection from TB in a 30-year follow-up. A 30-year follow-up of 47,000 individuals participating in a double-blind, randomized, placebo-controlled trial of repeat BCG vaccination in Malawi between 1986 and 1989 revealed no overall effects of the second BCG vaccination on tuberculosis incidence (TB) (OR 0.92; 95%CI 0.80 to 1.05). However, the second vaccine dose was associated with lower odds of a TB infection among known HIV-negative persons, those vaccinated as children, and cases arising 20 years after the vaccine. [The Lancet]

Risk factors for pediatric COVID-19 deaths in Brazil. Data analysis from a nationwide database in Brazil revealed that among 11,613 hospitalized patients with COVID-19 younger than 20 years, 86.5% were discharged, 3.2% were still admitted at the time of analysis, and 7.6% had died the hospital. Factors associated with increased risk of hospital death were age, ethnicity, geopolitical region, and comorbidities. [The Lancet]

High vaccine hesitancy among subgroups of healthcare personnel. Healthcare personnel (HCP) in two academic hospitals in Philadelphia were surveyed about their intention to receive the COVID-19 vaccine. Among the 5,929 HCP surveyed, 47.3% of nurses were vaccine-hesitant, compared to 30% of nurse practitioners and physician assistants and 13.1% of the doctors. Common concerns were potential side effects, vaccine newness, and lack of knowledge, while risk factors were race and sex. Despite hesitancy among certain groups, 67.8% of HCP planned to receive the COVID-19 vaccine, and 78.5% intended to receive it as soon as possible. [Infection Control & Hospital Epidemiology]

Immune response to PEG linked to allergic reactions to COVID-19 mRNA vaccine.  A recent US study assessed the mechanisms behind allergic reactions to the mRNA COVID-19 vaccines. The findings indicated that a history of allergic reactions was associated increased risk of vaccine allergy. In a sample of 22 patients with suspected allergic reactions to the COVID-19 vaccines, 15 had clinical allergy history, and 17 met the Brighton anaphylaxis criteria. Additionally, there we indications that immune responses to polyethylene glycol might be responsible for the reaction in most individuals. [JAMA Network Open]

Enteropathogens linked to diarrhoeal disease in a systematic review and meta-analysis. Identification of enteropathogens responsible for diarrhoeal disease represents a critical step in the vaccine development process. A recent systematic review and meta-analysis synthesized data from 130 case-control and cohort studies examining at least one enteropathogen of interest and the outcome of diarrhoea. The odd ratio for pathogen identification varied across strains, age groups, and child mortality settings, ranging from 0.4 (95% CI 0.2 to 0.6) for Giardia lamblia to 54.1 (95% CI 7.4 to 393.5) for Vibrio cholerae; and, from 4.4 (95% CI 2.6 to 7.7) for rotavirus in children aged 0-1 in low child mortality settings to 12.5 (95% CI 7.8 to 20.1) in children in high child mortality settings. [Lancet Global Health]

Misconceptions related to antibiotic use among Singaporean population. The general population of Singapore was surveyed on knowledge, attitudes, and practices related to antibiotics, their use, and antibiotic resistance. Among 706 respondents, 35.6% answered correctly when asked whether antibiotics were effective against bacterial or viral infections. Common misconceptions were that antibiotic resistance occurs when our bodies become resistant (62.5%), or antibiotics become less powerful (48.5%). People with better knowledge scores were less likely to expect (OR 0.84, 95% CI 0.72 to 0.99) or be prescribed antibiotics (OR 0.76, 95% CI 0.63 to 0.90). [BMJ Open]

COVID-19 pandemic could have long-term effects on hepatitis C care and diagnoses. A US modeling study simulated the 10-year impact of pandemic-related disruptions in healthcare delivery on hepatitis C (HCV) outcomes. In a scenario of no return to pre-pandemic levels of administered HCV care, the simulation predicted 1,060 fewer identified cases, 21 more cases of cirrhosis, and 16 more liver-related deaths per 100,000 people, compared to the ‘no pandemic’ scenario. However, doubling treatment initiation and completion following a realistic 18-month disruption was predicted to overcome pandemic-related consequences. [Clinical Infectious Diseases]

Global Point Prevalence Survey data on antimicrobial use in four African countries. Data from the Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance at 17 hospitals in Ghana, Uganda, Zambia, and Tanzania, revealed an overall prevalence of antimicrobial use of 50% (30-57%), with most antibiotics used belonging to the WHO ‘Access’ and ‘Watch’ categories. Indications for prescriptions were well-documented in most countries; however, the proportion of prescriptions compliant to guidelines varied considerably, ranging from 55% in Zambia to 88% in Tanzania, highlighting the need for antimicrobial stewardship programs. [Antibiotics]

Photo: shutterstock