March 14, 2022
The social determinants of sanitation must be recognized. The lack of access to safe drinking water in one-third of the world’s population leads to 360,000 diarrheal-associated deaths among children under five each year. More than four billion people lack access to toilets, resulting in open defecation among 700 million. Besides biological and medical factors, gender differences, culture, education access, and employment are all social determinants of health that are related to sanitation. Sociocultural aspects of sanitation should be treated as equal to or more impactful than the relationship of health and materials (like infrastructure and technology) to sanitation. [The Sanitation Triangle]
WHO handbook for national action plans (NAP) on AMR provides guidance for the human health sector. For most countries, it is challenging to achieve NAP implementation that is evidence-based and demonstrates sustained action. The handbook provides a practical, stepwise approach to NAP on AMR implementation within the human health sector and a process and collation of tools to prioritize, cost, implement, monitor, and evaluate NAP activities. The process begins with establishing multisectoral and sectoral coordination and governance mechanisms, prioritization of activities, and development of costed and budgeted operational plans. Finally, the handbook provides guidance for resource mobilization, implementation, and monitoring and evaluating. [WHO]
Evidence-based travel policies are needed for SARS-CoV-2 variants and future pandemic preparedness. The rapid global spread of SARS-CoV-2 variants despite travel restrictions revealed flaws in common strategies and a need to reassess them. Weak evidence has been used to justify strategies like vaccine passports, reactive flight bans, and blanket quarantines. Many governments adopt diverse combinations of international travel policies and scale them back without communicating clear objectives or the evidence supporting them. As population immunity to SARS-CoV-2 increases, it is important to reassess earlier pandemic mitigation objectives, while establishing transparent and well-aligned strategies to deal with health and economic consequences. [The Lancet]
Survivors of the acute phase of covid-19 face increased risk of mental health disorders. Researchers conducted a cohort study to estimate the risks of incident mental health disorders in survivors of the acute phase of covid-19. In a cohort comprised of 153 848 people who survived the first 30 days of SARS-CoV-2 infection, and two control groups (contemporary and historical), the COVID-19 group showed an increased risk of incident anxiety disorders, depressive disorders, stress and adjustment disorders, and use of antidepressants. The risk of incident opioid prescriptions, opioid use disorders, and other substance use disorders also increased. There was also a greater risk for neurocognitive decline and sleep disorders. The findings from the study warrant prioritization of mental health disorders among survivors of acute COVID-19. [BMJ]
Non-pharmaceutical interventions during the COVID-19 pandemic prompted a decrease in respiratory tract infections. The application of non-pharmaceutical interventions (NPIs) like universal masking, hand washing, and social distancing not only caused a decline in reported COVID-19 cases but also led to a decrease in non-COVID-19 respiratory tract infection-related hospital use. It also prompted a decline in incidence of previously common respiratory pathogens, like influenza and Streptococcus pneumoniae. While antimicrobial agents are necessary to treat patients with COVID-19 co-infections, antibiotic prescription was significantly higher than the estimated prevalence of bacterial co-infection, indicating the overuse of antibiotics during the COVID-19 pandemic. Epidemiological surveillance is needed to establish antimicrobial stewardship programs to prevent AMR from overuse of antibiotics during the COVID-19 pandemic. [Antibiotics]
Standardized, thorough research on contact tracing is needed to support policy. In a systematic literature review to determine the effectiveness of contact tracing in communicable disease control, only 47 out of 9,050 unique citations met the review’s inclusion criteria. Most eligible studies (72.5%) evaluating the effect of provider-initiated contact tracing, including 66·7% of COVID-19 studies, found contact tracing interventions were associated with improvements in communicable disease control. While contact tracing can be an effective tool in communicable disease control, heterogeneous methodological approaches, a lack of quantitative evidence on its effectiveness, and a dearth in the specificity of vital tracing parameters limit authorities’ ability to make informed choices on its utility. [The Lancet]
Vaccine-derived polio outbreaks affected almost two dozen African countries in 2020 and 2021. The emergence of vaccine-derived polio occurs when live, weakened poliovirus from oral vaccines circulates and mutates into the neurovirulent form among unimmunized or under-immunized, children. Outbreaks can often be controlled but may worsen when countries don’t see vaccine-derived outbreaks as an emergency or vaccination programs become lax, waiting for a more genetically stable vaccine. As an example, once among countries with the best polio program, last year Nigeria had more than half of all vaccine-derived polio cases globally and exported the virus to 18 countries. [Science News]
Baricitinib reduces the number of deaths from severe COVID-19 by 20%. Patients receiving this anti-inflammatory medication had a reduced risk of invasive mechanical ventilation or death and were more likely to be discharged alive within 28 days. Baricitinib was granted emergency use authorization in the USA in November 2020, when its use was recommended in combination with remdesivir. In January 2022, the WHO recommended baricitinib’s use with cortiocosteroids. In February 2022, the US NIH guidelines advised its use in combination with dexamethasone. It now seems baricitinib has benefits regardless of the treatments it’s combined with and can benefit both vaccinated and unvaccinated individuals. [BMJ]
Approximately 8 percent of antibiotics in Rwanda fail to meet quality requirements. An analysis of 232 batches of antibiotics from randomly selected private pharmacies across Rwanda revealed. more than 90% of analyzed antibiotics did not include the recommended dosage information on their labels, and 20% did not state a complete ingredients list. The active pharmaceutical ingredient was found in 100% of analyzed batches, but moderate deviations from acceptable ranges were found, with 3.9% containing more and 4.3% containing less of the active ingredient than the label listed. Antibiotics had been manufactured across 10 countries, with 49.6% manufactured in Kenya. The most represented antibiotics were amoxicillin, co-trimoxazole, and cloxacillin. [Antibiotics]
The COVID-19 pandemic disrupted dengue cycles and reduced dengue risk. The incidence of dengue in 2020 across 23 countries was compared with the predicted incidence based on the monthly incidence, climatic, and population variables in each country between 2014–2019. Deviations in incidences were then linked to specific pandemic-related public health and societal measures and their resulting effects on human movement. School closures and reduced time in non-residential areas had the strongest association with reduced risk of dengue, highlighting the influence human movement has on disease transmission. [The Lancet Infectious Diseases]
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