Antibiotic prescribing during the covid-19 pandemic

Reduction in overall antibiotic prescribing in the US in 2020.

One Health Trust researchers conducted an observational, ecological study to evaluate the impact of the COVID-19 pandemic on antibiotic prescribing in the United States between February and December 2020. The total number of antibiotic prescriptions dropped by 26 percent as compared to the same period in the previous three years, with the most significant decline being prescriptions in children. While COVID-19 prevention measures such as facemasks and school closures were associated with lower prescribing among children, there was a positive correlation between COVID-19 cases and antibiotic prescribing in adults, implicating behavioral norms as drivers of prescribing practices. [Oxford Open Forum Infectious Diseases]

Low-income households in India face greater out-of-pocket expenditures for childhood infections.

National survey data in India was used to estimate out-of-pocket expenditures (OOPE) incurred by Indian households for the treatment of childhood infections in children five years of age or younger. Viral hepatitis and tuberculosis were linked to markedly high OOPE per episode (INR 1478 and INR 1031, respectively), and overall OOPE for childhood infections for outpatient care and hospitalization constituted 4.8 percent and 6.7 percent of total household consumption expenditure respectively. Poorer households reported a higher burden of OOPE and less access to health services, highlighting the need for implementation of health policies to address this health inequity.  [PLOS ONE]

World Health Organization renames monkeypox in the face of discrimination against certain groups.

Since the start of the monkeypox outbreak in May 2022, public health experts and researchers have called for the use of an alternate name for the disease. The stigma associated with monkeypox has resulted in discrimination against African people and members of the LGTBQ+ community, as well as needless killings of monkeys around the world. On November 28, 2022, WHO announced monkeypox’s new name: Mpox. While this change is a step forward in the fight against discrimination based on diseases, action is needed to address underlying issues that lead to such discrimination. [The Lancet Regional Health – Americas]

Wastewater surveillance is an effective, low-cost alternative to mass population COVID-19 testing.

Researchers estimated the financial costs of conducting wastewater surveillance of SARS-CoV-2, to inform decision-making on whether it is more cost-effective than routine mass population testing. Researchers studied surveillance sites in Blantyre, Malawi and Kathmandu, Nepal and accounted for consumables, equipment, and human resource time costs. Costs ranged from USD 6,175 to USD 8,272 per month for the Blantyre site and USD 16,756 to USD 30,050 for the Kathmandu site, which was dedicated solely to SARS-CoV-2 surveillance, resulting in higher costs of human resources and equipment. The cost per person in the catchment area per year for both sites ranged between USD 0.07 to USD 0.13, making wastewater surveillance an economical way to support other monitoring activities. [PLOS Global Public Health]

Antibiotic resistomes in marine environments are exacerbated by wastewater treatment plants.

Wastewater treatment plants (WWTPs) play an important role in protecting natural environments from pollution, but they also serve as reservoirs and transmitters of antibiotic resistance genes (ARGs). Researchers studied two WWTPs in the Hangzhou Bay, China to assess the prevalence and distribution of ARGs in the WWTP effluent. Compared to the coastal sediment, wastewater samples contained a greater diversity of ARG subtypes, indicating that WWTPs contribute significantly to the antibiotic resistome risk to marine environments. [Environmental International]

Researchers classify bacterial vaccine candidates against WHO-priority pathogens.

Vaccines constitute critical and effective tools for fighting antimicrobial resistance. A recent review mapped bacterial vaccines in the pipeline against priority bacterial pathogens to outline the current development landscape. Vaccines in different development stages were grouped according to their feasibility from the biological, developmental, access, and implementation perspectives. The authors provide recommendations for each vaccine group, including for increased coverage of authorized existing vaccines to reduce antimicrobial resistance. [The Lancet Microbe]

Variations in COVID-19 mortality rates based on state-specific vaccination coverage in the United States.

In 2020, the United States saw high COVID-19 death rates and more excess all-cause mortalities than other peer countries. Researchers investigated state-by-state differences in mortality in 2021 and 2022 after COVID-19 vaccines became available and new variants developed and spread across the country. The top ten states with the highest vaccination coverage experienced markedly fewer COVID-19 fatalities (75 deaths per 100,000) compared to the ten least vaccinated states (146 deaths per 100,000). While the researchers note their estimates were not adjusted by age or comorbidities, they point out that the U.S. would have prevented over 100,000 deaths between June 2021 and March 2022 if COVID-19 mortality rates matched those of the ten most vaccinated states. [JAMA]

India’s growing population and low vaccination coverage contributed to a measles outbreak in 2022.

Despite India’s goal of eliminating measles by 2023, the country faced its largest recent outbreak of measles in November 2022 when the number of cases recorded surpassed 12,000. In addition to persistently low vaccination coverage among newborns, COVID-19 disruptions in measles vaccine uptake resulted in millions of children being more susceptible to the disease. Between 2019 and 2021, just over half of Indian children received the recommended two measles vaccine doses before the age of three. Furthermore, India’s expanding population of 27 million births yearly poses a challenge to infection tracking and routine vaccination efforts. [Nature]

COVID-19 prevention methods indirectly worsened depression and anxiety in children and adolescents globally.

Researchers summarized the indirect effects of COVID-19 mitigation strategies on the mental health of children and adolescents around the world. Meta-analysis revealed a pooled prevalence of 32 percent for depression and anxiety in children and adolescents with no pre-existing mental health conditions. After adjusting for the region of residence, significant differences between the pooled prevalence of depression were identified, with respondents living in the Eastern Mediterranean region having a prevalence of depression of nearly three-fourths compared to that of one-third in the Americas. Researchers note significant limitations to the review, including the low quality and number of the included studies, but highlight the importance of addressing and investing in child and adolescent mental health in the face of future public health crises. [BMJ Global Health]


Image from Canva.