March 07, 2022
Urban-centric COVID-19 research and policy left rural populations vulnerable. Limited healthcare infrastructure, lower rates of vaccination, and opposition to government policies worsened the COVID-19 pandemic in rural areas. Despite significant negative impacts on unemployment and mental health in rural regions, policymakers and researchers have focused on urban areas, translating to insufficient funding and investigation for rural populations. Financial resources are needed for health education, medical equipment, and infrastructure, to make drugs available, to attract and retain senior managers and professional nurses, and to build accessible health centers for rural communities. [BMJ]
WHO global survey on infection prevention and control in health facilities reveals the need for investment. The World Health Organization (WHO) core components for infection prevention and control (IPC) are critical for effective IPC programs. In the first WHO global survey to assess the implementation of these programs in healthcare facilities, researchers used a cross-sectional survey of global IPC professionals. Low-income and middle-income countries remain the most vulnerable to infection but core components across income levels hinder IPC progress. Increased support for more effective and sustainable IPC training programs and implementation is crucial to reduce risks posed by outbreaks to global health security and to ensure patient and health worker safety. [The Lancet Infectious Diseases]
Research with mystery shoppers reveals the distribution of unprescribed antibiotics. Inappropriate use of antimicrobials is a key driver for antimicrobial resistance in South Africa, caused in part by the selling of unprescribed antibiotics. To determine the accessibility of antibiotics without a prescription in pharmacies in South Africa, researchers executed an observational study, using simulated patients presenting with upper respiratory tract infections and urinary tract infections. Antibiotics were sold in privately owned pharmacies without a prescription in 80% of cases, while no antibiotics were dispensed in corporate (franchised) pharmacies. To limit selling unprescribed antibiotics, community pharmacists and assistants should be educated on appropriate patient care and legal requirements, with dispensing electronically monitored. [JAC – Antimicrobial Resistance]
Diagnostic testing is a crucial tool in targeting vaccines. Timely and reliable diagnostic testing is fundamental to understanding where vaccine-preventable diseases are occurring so that the appropriate vaccines can be used in the correct places, at the ideal times, and targeting the right people. Although some vaccines are recommended by WHO for inclusion in routine immunization systems everywhere, others can be used more flexibly to adapt to geographic and time-specific contexts. Diagnostic testing can also identify populations at risk for diseases despite previous vaccination efforts, allowing programs to focus on reaching these groups. [The Lancet Microbe]
Policies regarding COVID-19 vaccines during pregnancy vary globally. Gaps in data regarding the safety and efficacy of COVID-19 vaccines during pregnancy led to global differences in public health guidance on the use of the vaccines during pregnancy throughout the pandemic. Researchers conducted systematic screenings of public health authorities’ websites in diverse countries and territories, tracking policies on COVID-19 vaccine use in pregnancy throughout the pandemic. In September 2021, 38% of observed authorities recommended use, 28% permitted it, 15% permitted use with qualifications. In contrast2% were against use but allowed exceptions, and 17% were against any use. These findings suggest a policy shift from May 2021, when only 6% of studied countries and territories recommended the use of vaccines during pregnancy. Policy positions also varied by vaccine product, with Pfizer/BioNTech and Moderna vaccines being most recommended or permitted. [BMJ Global Health]
Doubt cast on the relation of COVID-19 vaccine for children to MIS-C cases. Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 is a rare condition that can potentially result in fatal outcomes. Concerns about post-vaccination MIS-C have been publicized regarding uncertainties surrounding MIS-C’s immunopathogenesis. However, researchers found that only 1 per 1 million individuals aged 12–20 years who received one or more doses of a COVID-19 vaccine developed MIS-C. Among 21 individuals diagnosed with MIS-C after COVID-19 vaccination, 15 of them had laboratory evidence of prior SARS-CoV-2 infection, casting doubt about attribution of cause to the vaccine. [The Lancet Child & Adolescent Health]
Omicron BA.2 is up to 40% more infectious but no more severe than original Omicron strain BA.1. Subvariant BA.2 is now the dominant Omicron strain across Denmark, India, and other countries, representing about 21% of sequenced cases worldwide. There was initially concern that BA.2, which has an approximately 40-mutation difference from BA.1, caused more severe COVID-19 in animal studies. However, there is no evidence showing that this subvariant increases the risk of severe disease in humans. Both Omicron BA.1 and BA.2 tend to cause less severe cases of COVID-19 compared to Delta and other variants of concern. [Science Insider]
Current mRNA COVID-19 vaccines have an upper limit of effectiveness, restricting booster usefulness. Fourth vaccines can raise neutralizing antibody levels but provide limited additional protection against symptomatic disease and infection. Booster doses may be beneficial for people at higher risk of severe illness and can be used to recover immunity lost over time. However, continuous administration of the same boosters will have limited effectiveness for most of the population, highlighting the need for new vaccines that can prevent infection from emerging variants and the importance of defining times between doses when administering existing vaccines. [Nature News]
Oral tetracyclines can increase AMR in subgingival, gastrointestinal, and upper respiratory tract flora. A systematic review examined antimicrobial resistance (AMR) following the administration of doxycycline, tetracycline, oxytetracycline, or minocycline over a period of 2-18 weeks. Limited data showed that most studies reported increased tetracycline resistance in adults, with subgingival flora most commonly affected, followed by gastrointestinal and upper respiratory tract flora. There were no reports of skin flora being affected. Given the potential risk for increased AMR, caution should be used when administering these antibiotics prophylactically for disease prevention purposes. [JAC – Antimicrobial Resistance]
Despite no evidence that COVID-19 vaccination causes infertility, misinformation persists, fueling vaccine hesitancy. Infertility rumors state that vaccines cause permanent menstrual cycle changes, infertility, and increase miscarriage risks in women, as well as negatively affect men’s testicles, prostate, and testosterone levels. Studies from the US Centers for Disease Control and Prevention (CDC) show that the age-adjusted miscarriage rate of vaccinated individuals is 12.8% compared to the 11%-16% average. The US CDC has consequently recommended vaccination for people who are pregnant, breastfeeding, or trying to conceive. Addressing this misinformation is essential as pregnant individuals are at greater risk of adverse outcomes from COVID-19 infection. [JAMA]
Photo: Shutterstock
