September 24, 2021
What is the cost of vaccinating 90% of children in India? A study led by CDDEP researchers estimated the cost of raising childhood vaccination coverage to 90% in each district in India using vaccine price data from India’s comprehensive multi-year strategic plan for immunization and vaccine delivery costs for 24 districts from a 2018 field study. The estimated costs of delivering one dose each of Bacillus Calmette-Guerin (BCG) and measles vaccines, and three doses each of oral polio (OPV) and diphtheria, pertussis, and tetanus vaccine were US 784.91 million. When considering all childhood vaccines, the estimated national cost was $1.73 billion, 32% higher than the estimated 2018 budget for vaccinating the adult and pediatric population. [Health Policy and Planning]
Ebola vaccine is safe for administration in children. The safety and immunogenicity of a two-dose heterologous Ebola virus vaccine regimen were assessed in children under 18 years old at three clinics in Kambia district, Sierra Leone, in a randomized, double-blind, controlled trial (NCT02509494). The week after administration, local and systemic adverse effects included injection site pain, headache, and fever and differed across the age groups. However, antibody responses to the Ebola virus glycoprotein 21 days after the second dose were seen in 98% – 99% of the children across the different age groups, indicating the suitability of this vaccine in children. [The Lancet Infectious Diseases].
Shorter antibiotic course as effective for the treatment of Enterobacterales bloodstream infection. A randomized controlled trial in five Spanish hospitals investigated whether a 7-day course of antibiotics for Enterobacterales bloodstream infection could achieve similar outcomes as 14-day treatments. In a study of 248 patients where 119 and 129 patients were assigned the 7-day and 14-day treatment, respectively, the non-inferiority margin was met for clinical outcomes, suggesting that the shorter course may be the preferred treatment strategy. [Clinical Microbiology and Infection]
Genomic analysis of AMR in Streptococcus suis. Researchers recently used a large-scale genomic approach to characterize antimicrobial resistance (AMR) in Streptococcus suis, a commensal found in pigs that can also cause severe disease in humans. Differences in minimum inhibitory concentrations (MICs) were found between countries, depending on their antimicrobial usage. AMR levels were high for many antimicrobials, including those not used to treat S. suis. Additionally, genome sequencing detected 22 novel candidate resistance determinants, which explained most of the variation in MIC, highlighting the contribution of genomic data to address AMR. [BMC Biology]
COVID-19 vaccines are effective against infection that requires hospitalization, ICU admission, or ambulatory care visit. Researchers investigated the effectiveness of COVID-19 vaccines against ambulatory care, hospitalization, or access to an intensive care unit. The effectiveness of full vaccination against hospitalization and ICU admission was 89% and 90%, respectively. In addition, full vaccination was 91% effective against infections leading to an emergency department or urgent care visit. For high-risk groups, vaccine effectiveness against hospitalization and ambulatory care ranged from 81% to 95%. [NEJM]
Considerations for COVID-19 booster vaccine administration. The new rise in COVID-19 cases has prompted concern about the need for vaccine booster doses. However, many observational studies on the effects of booster doses are hard to interpret because of potential confounding and selective reporting. Considering the evidence showing that COVID-19 vaccines are more effective against severe disease than infections (including those caused by the delta variants), any available doses may be better utilized by vaccinating the previously unvaccinated population. Any consideration of boosting should be based on careful analysis of adequately controlled clinical data. [The Lancet]
Multiple barriers to physical distancing. A study in Ireland qualitatively explored barriers and facilitators to physical distancing to reduce transmission of COVID-19. Barriers included difficulties maintaining and negotiating close relationships, getting used to COVID-19-related threats, taking risks to protect overall wellbeing and uncertainty around government guidelines. However, barriers and facilitators varied according to context and life stage, which should be considered when designing interventions. [HRB Open Research]
Treatment with Rituximab may hinder COVID-19 antibody responses in patients with hematologic malignancies. A prospective observational study in Italy monitored immune responses in COVID-19 patients with hematological malignancies (HM). Antibody levels were measured one, three, and six months after PCR tests came back negative. On average, serological responses to SARS-CoV-2 in HM patients were comparable to those of controls; however, the responses varied greatly. The study identified a subgroup of HM patients who had recently received Rituximab, with lower seroconversion rates, warranting careful consideration of vaccination strategies for this subgroup. [Nature]
A study in Gabon records demographic and clinical characteristics associated with severity, outcomes, and mortality of COVID-19. A retrospective cross-sectional study in Gabon assessed medical records from 837 COVID-19 patients hospitalized between March and June 2020 in the Armed Forces Hospital in Libreville. The mortality rate was 1.4%; 3.7% experienced severe disease; 33.7% presented mild symptoms, while 62.6% were asymptomatic. Disease severity was associated with age and a history of diabetes. [JAMA Network]
More deaths are assigned to causes other than COVID-19 in counties with reduced access to healthcare. A US cross-sectional study examined health care factors associated with excess county-level deaths not assigned to COVID-19. The study included 2096 counties and 319.1 million residents, 11.0% of whom did not have health insurance. Excess deaths not assigned to COVID-19 were higher in counties with more uninsured people (27% vs. -5%) and counties with fewer primary care physicians per capita (20% vs. 0%). [JAMA Network]
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