Polluted river water in India compromises the health of millions of people.

OHT’s founder and president, Dr. Ramanan Laxminarayan, shared his views on the impact that river pollution in India has on the health and well-being of hundreds of millions of residents surrounding the bodies of water. Nearly half of sewage generated in the country is left untreated and is directly discharged into waterways. This problem is compounded by high rates of urbanization, inadequate surveillance, and corruption surrounding the enforcement of policies meant to promote clean water supplies. Studies demonstrate that extended exposure to heavy metals in drinking water, such as arsenic or cadmium, greatly increases the risk of cancer. Additionally, it increases the likelihood of liver and renal illness, miscarriage, or birth defects. [The Telegraph]

Templated microbiology comments may reduce antifungal prescribing.

A retrospective study assessing antifungal prescribing before and after adding a templated microbiology comment to 297 hospital urine cultures growing Candida was conducted between June 2018 and January 2020. Compared to prescriptions before the implementation of the comments, there was a 14.1% drop in antifungal prescribing for patients with candiduria in the post-implementation cohort. The findings of this study indicated that this low-resource intervention might effectively improve antimicrobial stewardship and reduce antifungal exposure. [Antimicrobial Stewardship & Healthcare Epidemiology]

Community health workers in low-resource settings face complex challenges.

Community health workers (CHWs) in low- and middle-income countries (LMICs) are essential to bridging the gap between health systems and community members and ensuring universal health coverage in these countries. In a pioneering study, researchers conducted interviews and group discussions with CHWs from five LMICs working in maternal and newborn health to understand the challenges they face in their work. Their major challenges were insufficient knowledge, inadequate infrastructure, and low social acceptance of CHW services, suggesting that CHWs in LMICs are rejected both by the health systems in which they work and by their own community members. [PLOS ONE]

Despite heavy funding and high hopes, the U.K.’s antimicrobial subscription pilot program may not foster new drug discoveries.

An antimicrobial subscription model, rolled out in the United Kingdom in April 2022, entails paying a flat annual rate to a pharmaceutical company for an antibiotic commonly distributed by the country’s health system. Proponents view the pilot program as an effective way to distribute high-value, low-use antibiotics and reduce antibiotic overuse. Critics believe that the subscription model does not incentivize molecular innovation, but instead supports the sale of existing antibiotics. Funding awarded to the pharmaceutical companies involved in the model is not equivalent to promoting new drug discoveries. [The Lancet Microbe]

Severe maternal and neonatal outcomes decreased in Malawi’s omicron wave.

A national maternal surveillance software, MATSurvey, was used to compare severe maternal and neonatal outcomes during the COVID-19 omicron wave in Malawi to those during the previous beta and delta waves. Severe maternal outcomes occurred in 9% of patients during the omicron wave, 42% during the beta wave, and 30% in the delta wave. All neonates born in the omicron wave survived compared to 98% in the delta wave and 96% in the beta wave. While this survey provides critical insight into maternal and neonatal health outcomes in Malawi during the COVID-19 pandemic, study limitations include the lack of key patient-centric variables, such as vaccination status or therapeutic regimens. [The Lancet Global Health]

Researchers investigated trends in antimicrobial dispensing.

Researchers conducted a systematic review of 35 studies investigating antimicrobial dispensing practices with and without a prescription in diverse countries, including India, Canada, and Syria. Analysis revealed that penicillin was the most dispensed/studied antimicrobial class, followed by macrolides and cephalosporins. The most common intervention performed by community pharmacists while dispensing antimicrobials was asking questions, particularly about drug allergies and patient symptoms. None of the included studies reported assessing antimicrobial dispensing quality. The researchers call for an increased focus on training pharmacists in LMICs to counsel patients and raise awareness about proper antibiotic use. [Antimicrobial Resistance & Infection Control]

Mass Drug Administration needs long-term investments rather than magic bullets

Researchers conducted a qualitative bioethics survey to weigh the cost and benefits of global Mass Drug Administration (MDA) for treating infectious diseases. From 35 semi-structured interviews, investigators determined that WHO guidance, ethics and data safety monitoring committees, and community health workers played a key role in developing ethical MDA frameworks. While MDA can save lives in low-and middle-income countries (LMICs), social and political concerns surround this “magic bullet” approach that can potentially increase bacterial AMR and disrupt otherwise healthy populations. Future directions in MDA management point to strengthening community-based health programs and local, autonomous decision-making to increase ethical guidance on MDAs. [Infectious Diseases of Poverty]

Collective immunization against smallpox may not be enough to contain monkeypox.

A team of researchers in Austria used mixed-modeling methods to predict whether monkeypox cross-protective effectiveness can be inferred from smallpox vaccination in Vienna. The study revealed that there was age-related protection against monkeypox by previous compulsory smallpox vaccination in about half of the population (1.9 million people) and that the probability of infecting another person after exposure exceeded normal threshold values. Understanding the complexities of monkeypox dissemination beyond sexual transmission can also assist researchers with better modeling of monkeypox dynamics in the future. [International Journal of Infectious Diseases]

A behavior-based AMR approach may assist with vaccination efforts.

To address AMR in multiple global contexts, the WHO has released the Tailoring Antimicrobial Resistance Program (TAP) to assist Member States to achieve higher levels of vaccination uptake. The TAP is an in-depth, stepwise guide that public health officials can use to develop context-appropriate public health plans to tackle AMR. This behavior insights approach may also help to provide more actionable methods for AMR containment, as guidance measures at the national level are often well-structured but poorly implemented. Officials are hopeful that the ease of access to the TAP will motivate countries to invest additional time, human resources, and funding to adjust AMR-prevention strategies to meet their needs. [WHO]

The demographics of COVID-19 reinfections warrant scaled-up surveillance efforts.

Researchers in Clark County, Nevada, conducted a population-level analysis to assess the burden of COVID-19 reinfections from 2020-2022. Reinfection rates rose from ~3% to 11% following the introduction of the Omicron variant in December 2021, with an elevated incidence in adults 18-50 years of age, women, and minority groups. The study suggests that identifying other drivers of reinfection risk, such as occupational and social exposures, may offer insights into why some groups are more disproportionately affected by COVID-19, beyond the usual disparities of ethnicity and race. Increased surveillance efforts are recommended to boost data collection to address the disease burden of repeated infections in communities. [Centers for Disease Control and Prevention]

COVID-19 mathematical modeling requires better data.

COVID-19 modeling efforts in the US deserve a second chance, as inaccuracies in state-level dissemination of data and poor public health messaging systems have reduced public trust. To build back credibility, experts suggest ways that go beyond broadening the range of prediction targets (for example, incident cases and deaths). These include data standardization, increased genomic surveillance for future COVID-19 variants, and communicating a range of plausible outcomes to enhance public interpretation and increase model transparency. Accurate COVID-19 forecasting can ultimately serve to guide public health policy towards more positive outcomes which can help reduce widespread fears surrounding the progression of COVID-19. [The Lancet]

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