New research presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress suggests that indirect predictors, including sociodemographic and healthcare indicators, could help bolster antimicrobial resistance (AMR) surveillance in parts of the world where laboratory-based surveillance methods are lacking.

To estimate global AMR prevalence in priority gram-negative bacterial pathogens (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) in countries lacking surveillance data, researchers with the Amsterdam Institute for Global Health and Development at Amsterdam University Medical Center used data obtained from the Vivli AMR Register and ResistanceMap. They then supplemented that with sociodemographic, healthcare, environmental, and governance-related data from the World Health Organization Health Inequality Data Repository and the World Bank's Development Indicators.

"While the use and overuse of antibiotics are key drivers of AMR, many other factors contribute to its increased prevalence, including poor water quality and sanitation, poor governance (or corruption), and inadequate public spending on health," lead author Sneha Kotian, MBBS, said in an ESCMID press release emailed to reporters. "Although many countries fall short in surveillance of clinical AMR, they collect detailed socioeconomic data."

Shedding light on AMR blind spots

The ensemble model enabled the researchers to estimate AMR rates for nine pathogen-drug combinations in countries without data from 2004 to 2021, improving coverage from 24% to 85%. While the model worked better for certain pathogen-drug combinations than for others, it showed that rates of third-generation cephalosporin-resistant E coli and carbapenem-resistant A baumannii rose sharply in sub-Saharan Africa and South Asia over the period.

Kotian said studies like this can shed light on AMR blind spots.

"Our results show that sociodemographic and health-related indirect predictors of AMR can complement national surveillance data to help guide prioritisation of surveillance in regions currently lacking surveillance data," she said.

The United Nations Food and Agriculture Organization (UN FAO) last week announced the launch of a new initiative aimed at reducing the need for antimicrobials in the food and agriculture sector.

The initiative, dubbed RENOFARM (Reduce the Need for Antimicrobials on Farms for Sustainable Agrifood Systems Transformation), will work with governments, farmers, the private sector, and civil society organizations to provide countries with policy support, technical assistance, capacity building, and knowledge sharing to help reduce the use of antimicrobials in livestock production and prioritize animal health and welfare. In 2017, antimicrobial use in animals represented 73% of all antimicrobials used worldwide.

Exploring 'innovative pathways'

"The persistent use of antimicrobials in livestock production is concerning for human health, animal welfare, and environmental sustainability," FAO Director-General QU Dongyu said in a video message announcing the launch of the initiative. "We must explore innovative pathways to curb the use of antimicrobials and promote sustainable practices that safeguard public health and our planet's well-being, while improving livestock productivity."

Reducing the use of antimicrobials and animal and plant agriculture has been a significant part of the One Health antimicrobial resistance strategy promoted by the Quadripartite, which comprises the FAO, World Health Organization, World Organization for Animal Health, and the UN Environment Programme. 

RENOFARM is currently being piloted in the poultry sector in Indonesia. The FAO plans to implement it in more than 100 countries. 

Negativity about vaccines surged 27% on Twitter after COVID-19 vaccines first became available, according to a new study presented this week at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress.

In the years prior to COVID-19, there were more negative statements about vaccines than positive ones, but the introduction of vaccines and news about mandating vaccines caused negative statements to spike on Twitter, now called X. 

The study used data from an open-source software (the Snscrape library in Python). The program downloaded tweets with the hashtag "vaccine" published on Twitter from January 1, 2018, to December 31, 2022.

A total of 567,915 tweets were extracted and analyzed, with 458,045 classified as negative and 109,870 as positive by a machine-learning algorithm. After the introduction of COVID-19 vaccines at the end of 2020, there were on average 10,201 more vaccine-related tweets per month.

Negative tweets peaked in April 2021

The program identified 310,508 tweets (12,420 a month on average) with negative sentiment after December 11, 2020. This represents a 27% increase in negative tweets than would be expected had the COVID-19 vaccines not been introduced (9,785 a month, 95% confidence interval, 9,282 to 10,249).

April 2021, the month the White House announced that all people aged 16 and older would be eligible for the COVID-19, had the highest number of negative tweets.

"Vaccines can prevent complications from diseases for which we have limited treatment options, such as influenza and COVID-19, but there has been growing opposition to their use in recent years," said first study author Guillermo Rodriguez-Nava, MD, of Stanford University, in an ESCMID press release.

The damage caused by negative voices is already apparent.

"The damage caused by negative voices is already apparent, with clusters of measles re-emerging in countries where it was previously considered eradicated."

A University of California at Los Angeles (UCLA) study late last week in JAMA Network Open finds that, despite less access to healthcare, undocumented Latino workers who visited the emergency department (ED) received COVID-19 vaccines at the same rate as US citizens.

The researchers interviewed a sample of adult non-Latino patients, legal Latino residents or citizens, and undocumented Latino patients at two California healthcare centers from September 2021 to March 2022.

The median age of the 306 participants was 51 years, 48% were women, 68% were Latino, 14% were White, 11% were Black, and 7% were of other race. Of undocumented Latinos, 25% were uninsured, and 30% usually visited the ED for healthcare.

Undocumented workers much more likely to report infection

Among all participants, 87% said they had received one or more doses of COVID-19 vaccine, and 13% reported declining the vaccine. Concern about potential adverse effects of the vaccine was the most common reason (37%) for not getting vaccinated. 

Undocumented Latino workers were much more likely to report a previous COVID-19 infection than non-Latinos and legal Latino residents.

Relative to undocumented Latinos, non-Latino patients were much less likely to believe that undocumented workers could receive the COVID-19 vaccine in the United States (odds ratio [OR], 0.09). Thirteen percent of interviewees said they knew undocumented people who didn't get vaccinated because they worried about deportation. Of those who had declined the vaccine, 22% said they were interested in receiving a dose in the ED.

Undocumented Latino workers were much more likely to report a previous COVID-19 infection than non-Latinos (OR, 3.42) and legal Latino residents (OR, 2.73).

"We would have expected Latinx patients to have lower rates of vaccination, considering higher rates of infection, hospitalizations, and death," lead author Jesus Torres, MD, MPH, said in a UCLA news release. Torres noted that EDs are one of the main healthcare access points for undocumented workers, who make up about 3% of the US population but are not often included in research.

From a public health perspective, he added, it's important to identify disadvantaged groups for research, policy work, resource allocation, and targeted vaccine campaigns.