March 22, 2022
Improved quality of health facilities can improve vaccination outcomes. OHT researchers examined the association between the quality of public health facilities and child vaccination outcomes in rural India. With data from the nationally representative Integrated Child Health and Immunization Survey (2015–2016), researchers used multiple correspondence analyses to evaluate the relationship between vaccination outcomes in children under two and health facility quality, controlling for household socioeconomic characteristics. Infrastructure quality was positively associated with positive vaccination outcomes. The distribution of infrastructure quality contributed to increased gaps in full immunization and on-time vaccination between rich and poor households, while closer proximity to vaccination sites for poorer households reduced these gaps. [Vaccine]
Maternal immunization against the respiratory syncytial virus (RSV) could lower antimicrobial prescribing among infants. RSV is a leading cause of severe acute lower respiratory tract infections (LRTIs) among infants globally, and a prominent contributor to common non-severe infections that account for high volumes of antibiotic consumption. Using data from a blinded, multi-country trial, researchers from OHT, Novavax, and the University of California, Berkeley found that infants of mothers the assigned RSV fusion (F) vaccine experienced fewer antimicrobial prescription courses over the first 90 days of life than infants of mothers assigned a placebo. The estimated efficacy of the RSV F vaccine used in the trial analyzed against RSV-associated, medically significant LRTI did not meet the pre-specified criterion for success, but future RSV vaccine candidates with higher efficacy may achieve greater reductions in antimicrobial consumption. [PNAS]
Combinations therapies can treat Pseudomonas aeruginosa more effectively than monotherapies. Pseudomonas aeruginosa is a Gram-negative bacterium, primarily associated with hospital-acquired infections. Due to the pathogen’s high levels of antibiotic resistance, resulting infections are difficult to treat effectively, often resulting in treatment with antibiotic combination regimens. In a systematic search with screening criteria, researchers found that in many cases combination therapies were able to match or outperform monotherapies with none performing noticeably worse than monotherapies. Although most clinical studies were small and lacked statistical significance and only few were prospective randomized clinical trials, the review suggests combination therapies have a place in the treatment of these infections and, in some cases, they could be more effective than monotherapies. [Antibiotics]
Antibiotic therapy choice affects low-frequency resistance mutations short-term. Acute bacterial infections are often treated empirically, with antibiotic therapies altered mid-treatment. Low-frequency antibiotic resistance mutations emerge, contract, and even go to extinction in days following alterations in therapy. An analysis of Pseudomonas aeruginosa populations in sputum samples from patients at the onset of respiratory infection reveals that resistance mutations can emerge at low frequencies within days of therapy. In studying select resistance mutations, rare mutations can increase by nearly 40-fold over five to twelve days in response to antibiotic changes but mutations showing resistance to antibiotics not administered decline and even go to extinction. Patient-specific antibiotic cycling strategies informed by deep genomic surveillance could drive resistance mutations to extinction during early stages of infection. [Nature]
Data-driven modeling frameworks can support clinical decisions about infection control measures in ICUs. Using electronic healthcare record data and a multi-drug resistant organisms (MDRO) universal screening program, researchers from OHT and US institutions developed a data-driven modeling framework to predict different MDRO colonizations upon intensive care unit (ICU) admission and identified associated socio-demographic and clinical factors. Among the ICU admissions examined, the MDRO colonization rate was 17.59%, with models performing sensitivity and specificity values as high as 80% and 66% respectively. Multiple predictors of MDRO colonization were identified, including long-term care facility stay, current disease diagnosis, and recent isolation precaution procedures before ICU admission. [Frontiers in Public Health]
Behavior change interventions must address the public’s misunderstandings about vaccines’ purpose, development, and safety. Members of the general public, including healthcare providers and individuals who had recovered from or lost a family member to COVID-19, were interviewed or attended focus groups in Abidjan, Côte d’Ivoire to understand the public’s perceptions of the virus, infection, preventative behaviors, infection-related stigma, and vaccines. Vaccine safety concerns, rumored side effects, affordability, low perceived risk of infection, and distrust of the government and vaccine manufacturers and promoters were cited as reasons for vaccine hesitancy. [Vaccine]
Children infected with SARS-CoV-2 may be less likely to produce antibodies due to a robust innate immune response. While this allows children to clear COVID-19 infections quickly, they have lower levels of antibody-producing memory B cells and memory T cells compared to adults. These findings suggest that there’s less of an adaptive immune response in children and that they are less likely than adults to produce antibodies, despite having similar viral loads in their bodies during infection. How protected they are from reinfection or following infection from different variants remains uncertain. [Nature News]
Face mask use should be maintained for two to ten weeks after desired vaccination coverage is achieved. A computational simulation-model study found that even when vaccine coverage exceeds herd immunity thresholds, face mask use should not immediately end as virus transmission does not immediately cease. Maintaining face mask use was also found to be cost-effective or cost-saving when face mask cost per person was equivalent to US$1.25 per day or less, even when 100% of symptomatic, infectious individuals were isolated. Increased transmissibility, increased social interactions, and reduced vaccine effectiveness increased the cost-effectiveness and cost-savings of mask-wearing. [The Lancet Public Health]
Wastewater analysis can help identify outbreaks early on, along with the pathogens at work. While this monitoring technique involving genomic sequencing of pathogen fragments shed in feces has become popular during the COVID-19 pandemic, it can also be used for other pathogens, including influenza, rotavirus, norovirus, adenoviruses, respiratory syncytial virus, and antibiotic-resistant bacteria. It can be used to monitor infections in thousands to millions of individuals and monitor pathogen evolution. However, despite its potential, this technique still has major logistical and technical challenges and has little impact on national and public health policies. [Science News]
High levels of antimicrobial resistance among Vibrio and Aeromonas bacterial species in Sicilian seawater. An analysis of seawater samples from Sicily’s Tyrrhenian coast identified a total of 29 bacterial strains from five different genera, along with genes mainly conferring resistance to β-lactamic and sulfonamide antibiotics. Most isolates (89.6%), were resistant to cefalozin, however, 37.9% of isolates were resistant to amoxicillin/clavulanic acid, 31% to streptomycin, 17.2% to sulfamethoxazole/trimethoprim, 13.7% to ceftriaxone, 6.8% to colistin, 6.8% to tetracycline, and 3.4% to enrofloxacin. Approximately 41% of bacteria were resistant to one antibiotic, while 59% were resistant to two to five antibiotics. [Antibiotics]
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