August 21, 2023
Minimizing patient safety gaps caused by the COVID-19 pandemic requires a multisectoral approach.
The fifth Global Ministerial Summit on Patient Safety, which took place in February 2023 centered around the impact of the COVID-19 pandemic on patient safety. Experts, including OHT’s Dr. Ramanan Laxminarayan, summarized key takeaways from the summit. The pandemic exposed and exacerbated safety gaps in health systems worldwide, including insufficient infection prevention and control measures, inappropriate antibiotic prescribing, interruption of essential medical services, and healthcare staff shortages. The effects of the pandemic on existing healthcare insufficiencies posed significant safety risks to patients, increasing and introducing new sources of harm in clinical practice. Multisectoral engagement and an integrated health systems approach can be instrumental in providing safe healthcare and minimizing patient harm. [The Lancet Infectious Diseases]
Integrated surveillance and data systems are needed to mitigate the effects of climate-sensitive infectious disease transmission.
A transdisciplinary approach to creating tools that support climate policies and increase health system resilience is needed to combat climate-sensitive infectious disease transmission risk across One Health Sectors. The proposed “Integrated Knowledge-to-Action” framework includes a comprehensive surveillance system that draws from several data sources, four major research streams, and user-oriented outcomes. Future work to validate the effectiveness of this approach should entail testing using case studies across varying social and political contexts. [The Lancet Regional Health – Europe]
Drivers of antibiotic prescriptions in rural China
Researchers investigated antibiotic prescribing and dispensing trends, the prevalence of community antibiotic resistance, and the drivers of antibiotic use for common infections in rural health facilities in Anhui Province, China. Using a mixed-methods approach, they found that more than 80 percent of participating patients diagnosed with urinary tract infections or respiratory tract infections (RTIs) at four rural sites were prescribed antibiotics; nearly half of these patients received intravenous antibiotics. Antibiotic prescribing for RTIs was correlated with a longer duration of infection (OR = 3.33) and the presence of sore throat (OR = 1.64), but not the presence of bacterial pathogens. Fever strongly predicted the prescription of intravenous antibiotics (OR = 2.87). More than half of physicians interviewed at participating facilities reported diagnostic uncertainty as a key driver of antibiotic prescribing, as well as the common perception of antibiotics as “anti-inflammatory” among patients. [PLOS Global Public Health]
The Americas endure more than 10 percent of global AMR fatalities.
A systematic analysis of data from 2019 shows that 141,000 deaths or 11.1 percent of total global fatalities attributable to antimicrobial resistance (AMR) occur in the World Health Organization (WHO) Region of the Americas. Pathogens contributing to the majority of AMR burden in the Americas included Staphylococcus aureus and Escherichia coli, each being responsible for over 100,000 AMR-associated deaths. While 14 countries in the Americas have published national action plans (NAPs) to combat AMR, 15 countries have plans in the development or approval stage and 6 have yet to develop a NAP. Strengthened surveillance infrastructure and data reporting practices can help track the regional and national progress of the Americas toward mitigating the effects of AMR. [The Lancet Regional Health – Americas]
Women in the Global South face a disparately high burden of climate-specific health harms.
While extreme heat and associated climate events are becoming more prevalent around the world, the Global South shoulders most of the economic and health burden of increasing temperatures and heat-related hazards. Women in the Global South face the greatest risk of climate-specific health harms, as demonstrated in an extreme heat event in 2010 in Ahmedabad, India where women made up the majority of the 1,344 recorded excess deaths. Greater attention to the negative effects of extreme heat on women’s health in the Global South and further analysis of the health-related financial costs of global warming can help mount an equitable climate change response and justify investment in protective and adaptive health tools. [PLOS Climate]
Ceftriaxone prescription rates among children in Israel decreased after the introduction of the pneumococcal conjugate vaccine.
Researchers assessed the dynamics of outpatient parenteral ceftriaxone dispensed prescription rates (DPR) among pediatric patients following the introduction of the pneumococcal conjugate vaccine (PCV), which preceded reduced respiratory tract infection (RTI) rates, in southern Israel. During the 13-year study period (2005-2018), ceftriaxone DPR in Jewish and Bedouin children under the age of 5 significantly decreased shortly after the implementation of PCV. The annual mean ceftriaxone prescription reduction per 1,000 child-years in children under age 5 ranged between 18.4 and 13.9 in the post-PCV period. The declining trends in ceftriaxone DPR among Jewish children after the provision of PCV point to a causative relationship between vaccine distribution and reduced rates of RTI in pediatric populations. [International Journal of Infectious Diseases]
Analysis of ESBL-producing E. coli in Madagascar revealed multiple transmission events across One Health interfaces.
A health policy brief examined the benefits and risks of an intergovernmental panel for One Health (IPOH) in relation to pandemic prevention, preparedness, and response (PPR). The IPOH would aim to facilitate knowledge uptake in policy-making to address the emergence and re-emergence of infectious diseases at the human-animal-environment interface. Some of the values of the IPOH would include the provision of a unified voice from the scientific community, identification of knowledge gaps, promotion of data sharing across borders, and coordination across One Health platforms. Conversely, risks of the panel could include subjugation to governments’ priorities, slower delivery of PPR outcomes, and complex coordination efforts with a number of institutions, governments, and other stakeholders. [The Lancet Global Health]
Cyclones are associated with increases in cases of waterborne infectious diseases in the United States.
A review of 23 years of data on cyclone exposure and effects on waterborne infectious disease in the US found a 52 percent increase in cases of cryptosporidiosis, a 48 percent increase in cases of Shiga toxin-producing E. coli infections, and a 42 percent increase in cases of Legionnaires’ disease associated with major rainfall-producing storms. Around 7.15 million cases of waterborne illness are diagnosed annually in the US and these infections can be life-threatening for children, the elderly, and the immunocompromised. Flooding due to major storms contaminates environmental, recreational, and drinking water sources and poses threats to public health. Flooding is likely to increase as storms become more severe and water infrastructure systems age and deteriorate. [Emerging Infectious Diseases]
Mobile games show promise in fighting antimicrobial resistance.
A review of two mobile games that engage the player in the fight against antimicrobial resistance (AMR) demonstrated the motivational and educational possibilities of the genre. Leveraging learning through playing games, known as gamification, has proven effective in education on AMR for target audiences. Two free mobile games were successful in imparting scientific information as well as stirring emotions to act for AMR mitigation. However, there is a need for more multilingual games that depict the reality of AMR in low-and-middle-income countries which face the greatest AMR burden.[JAC-Antimicrobial Resistance]
Fruit bats pose a high risk of Nipah virus transmission in south and southeast Asia.
Nipah virus (NiV) is a highly transmissible and virulent zoonotic infection threatening south and southeast Asia. In humans, NiV can cause severe respiratory illness and/or deadly encephalitis and has a 40-75 percent fatality rate. The primary reservoir hosts are several species of fruit bats that can transmit the disease via saliva, excrement, or when consumed. Increasing human populations and encroachment into bat habitats augment the risk of an NiV epidemic. A One Health approach must be employed to combat this threat through surveillance, vaccine and antiviral drug development, and exploration of medicinal plants for therapeutic agents against NiV. [Tropical Medicine and Health]
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