COVID-19 self-tests could partially relieve the over-burdened health system in Indonesia; Inappropriate antibiotic use causes substantial economic costs in LMICs.

COVID-19 hospitalizations and deaths were decoupled from infections while omicron circulated in South Africa. A seroepidemiologic survey conducted between October 22 and December 9, 2021, in Gauteng, South Africa revealed widespread SARS-CoV-2 seropositivity (73%) in the population before the omicron-dominant wave of Covid-19. The incidence of SARS-CoV-2 infection increased and subsequently declined more rapidly during the fourth wave than it had during previous waves. When compared to data from previous waves, the infection incidence rate was decoupled from hospitalizations, recorded death, and excess death, and researchers believe that cell-mediated immunity from vaccines and natural infections may have contributed to this lower degree of disease severity. [NEJM]

COVID-19 self-tests could partially relieve the over-burdened health system in Indonesia. Bivariate and multivariate regression analyses were applied to quantitative survey data collected in mid-2021 in Indonesia to assess the likelihood of use of SARS-CoV-2 self-test, willingness to pay for a self-test device, and likely actions following a positive self-test result. Among 630 respondents, 15.53% knew about COVID-19 self-testing, and 62.7% agreed that people should be able to self-test at home. If available, more than 60% of respondents would use self-tests when necessary and would do regular self-testing when recommended. Upon receiving a positive self-test result, most respondents would communicate it (86.03%), seek counseling (80.79%), self-isolate (97.46%), or inform their close contacts (90.48%). [Tropical Medicine & International Health]

Antibiotic prescribing and use are locally impacted social processes. Although most research on antimicrobial resistance (AMR) is focused on drug development, more attention is needed to address the socio-cultural and socio-economic determinants of infections and antibiotic use. Context-specific solutions co-developed with end-users are vital to improving the use of existing and new antibiotics. Because AMR is a global problem, interventions must be able to be scaled to diverse contexts. Disparities between the global North and South in funding, research, and resources must be addressed, to bolster in-country capacity building, deliver sustainable research, and support researchers to generate locally owned knowledge. [Journal of Antimicrobial Chemotherapy ]

One Health antibiotic stewards could mitigate AMR in highly impacted regions. The translation of knowledge on AMR into effective design and implementation of action plans is stifled by gaps in understanding, attitudes, and practices in human health, agriculture, and environmental sectors. In areas where AMR burden is heaviest, One Health Stewards, trained to translate and use both global and local evidence for knowledge dissemination, may facilitate context-specific interventions. [One Health ]

Modelling the future economic burden of AMR is complex. The precision of models predicting the future economic burden of AMR depends on the accuracy of future resistance rate predictions. The overuse and inappropriate use of antimicrobials, and their effects on AMR prevalence spread beyond the individual user of the antimicrobials, but the full impact is tough to estimate. Examining the cost-effectiveness of interventions to combat AMR must take a One Health perspective and include the costs and benefits to all sectors, including human healthcare, animal healthcare, and environmental health. Methods used to model future AMR rates should be transparently and consistently communicated to aid in the application of research by policymakers. [Applied Health Economics and Health Policy ]

Study of antimicrobial growth promoter use in chickens contributes to microbiome engineering research. Researchers investigated the functional footprint of microbial communities in the cecum of chickens fed four distinct antimicrobial growth promoters (AGPs). Growth promotion caused by different AGPs is associated with common and unique cecal microbiome differences at the taxonomic, metagenomic, and metabolomic levels compared to untreated birds. Many of these differences bolster hypotheses regarding how microbial activities contribute to bird health and performance. Thus, mapping microbiome functional changes associated with antibiotics and other nutritional interventions, along with a detailed description of how the physiology of individual microbes contributes to the processes, could allow for precision microbiome engineering for both animal and human health. [Nature Communications ]

Inappropriate antibiotic use causes substantial economic costs in LMICs. A top-down, retrospective economic impact analysis of inappropriate antibiotic use for upper respiratory tract infections (URIs) was conducted using data from 2300 exit interviews and 1100 household visits in the Kintampo North and South districts in Ghana. Data were drawn from cases for both URIs treated with antibiotics against recommendations from clinical guidelines, and URIs that should have been treated with antibiotics according to clinical guidelines but were not. Health care costs related to inappropriate antibiotic use for URIs were estimated to be around 20 million USD annually. Travel costs and lost income due to travel, together, were estimated to be around 62 million USD. [Antimicrobial Resistance & Infection Control volume ]

Political manipulation negatively impacts Brazil’s childhood vaccination rates. The consequences of the dissemination of misinformation and the political polarization of COVID-19 vaccines instigated distrust in public vaccination campaigns in Brazil. While the country has one of the most comprehensive immunization policies worldwide integrated into its national health system, overall child vaccination coverage has dropped. This coincides with Brazil’s lack of political support for health policies translating into budget cuts and science denialism. This manufactured atmosphere of distrust and uncertainty has been coined State Denialism, which through scientific disinformation, frames vaccination as an “individual choice” as opposed to a collective perspective based on solidarity and the common good. [Lancet ]

Pediatric pesticide poisoning is an urgent public health issue in India. Pesticide poisoning in the pediatric population in India is a significant cause of morbidity and mortality today. This primarily includes intentional pesticide poisoning by adolescents to commit suicide, young children that are poisoned by accidental ingestion, unintentional dermal, or inhalational exposure. A scarcity of data complicates policy design and implementation. To address pediatric poisonings, access to pesticides must be limited and farmers and the public should be educated about the proper storage and use of pesticides. Strategies are needed to address the dearth of data on poisoning, the management of acute poisoning, and emerging toxicological threats. This can be accomplished in part with the establishment of more poison centers. [Global Pediatric Health]

Should China end its zero-COVID policy? Mainland China impeded many COVID-19 outbreaks while maintaining its zero-COVID policy for more than 20 months. Researchers suggest mainland China should change its zero-case policy to one of living with SARS-CoV-2 considering the low case fatality rate (CFR) of 0.008% from COVID-19 in the country from May 2020 to February 2022; a high vaccination rate in the region (85% with a 2.2 inoculation dose average); and the low pathogenicity of the current variant, Omicron. The change could assuage some socioeconomic problems and liberate funding to address other public health issues. However, the greatest challenge in the policy change is a possible rapid surge in SARS-CoV-2 cases, which could overwhelm the healthcare system and increase the COVID-19 CFR. [Nature]

Photo: Shutterstock