News Scan for Jan 28, 2021

News brief

COVID-19 tied to markedly higher mortality in pregnant women

Pregnant women with COVID-19 had a case-fatality rate 13.6 times higher than similarly aged people with COVID, according to a study published this week in the American Journal of Obstetrics & Gynecology. The study's 3 maternal deaths (1.3% of the 240-person cohort) result in only an absolute rate difference of 1.2%, but the researchers point out that they also represent 9.4% of Washington State's COVID deaths in 20- to 39-year-olds.

The researchers drew their data from Mar 1 to Jun 30, 2020, across 35 sites in Washington that represented 61% of the state's annual deliveries. In addition to the increased mortality rate, which had a 95% confidence interval (CI) of 2.7 to 43.6, the results also revealed that pregnant women with COVID-19 were 3.5 times more likely to be hospitalized for the infection compared with people of a similar age who had COVID but were not pregnant (95% CI, 2.3 to 5.3).

Of the study's participants, 1 in 10 were hospitalized for COVID, 1 in 11 developed a severe or critical infection, and 1 in 30 had to be admitted to the intensive care unit (ICU) at least once. The three women who died all had at least one comorbidity, were between the ages of 35 and 39, and were of minority ethnicity or race. Of the 45 known SARS-CoV-2 tests given to neonates, none were positive.

COVID severity during delivery was positively associated with the likelihood of preterm birth, low birthweight, and admission to the neonatal ICU, as well as maternal conditions such as gestational diabetes and new onset hypertensive disorders. For instance, 45.4% of women with severe or critical COVID infections delivered early, as opposed to 5.2% of mild cases and 9.0% of recovered cases.

"These results suggest that the exclusion of pregnant patients from COVID-19 vaccine trials was a mistake," said Kristina Adams Waldorf, MD, senior author, in a press release. "Here is an important group that is typically highly vulnerable to influenza infections and, yet they were excluded from COVID-19 vaccine trials."
Jan 26 Am J Obstet Gynecol study
Jan 27 University of Washington Health Sciences press release

COVID outcomes not different in hospitalized healthcare workers

Healthcare workers (HCWs) hospitalized for COVID-19 did not have significantly different mortality and mechanical ventilation outcomes compared with hospitalized non-healthcare workers, according to a matched cohort study published today in JAMA Network Open.

The researchers matched 122 hospitalized HCWs with 366 hospitalized non-HCWs in North America from Apr 15 to Jun 5, 2020. Using multivariable logistic regression, the adjusted odds ratio (aOR) for mortality was 0.47 (95% CI, 0.18 to 1.27) and 0.66 for mechanical ventilation (95% CI, 0.37 to 1.17).

HCWs were also less likely to need intensive care unit admission (aOR 0.56; 95% CI, 0.34 to 0.92) and less likely to stay at the hospital 7 days or longer (aOR 0.53; 95% CI, 0.34 to 0.83).

While the researchers suggest that the "equivalent or slightly better outcomes" among hospitalized HCWs may be partially explained by personal protective equipment use or adherence to workplace protocols, they add that their data could also be biased to the healthy worker effect. Age, smoking and alcohol use, body mass index, and comorbidities all had standardized mean differences of 0.10 or higher even after matching, such as 0.14 for the Charlson Comorbidity Index.

"Given the inability within large data sets (including our own) to distinguish where COVID-19 exposures occurred among HCWs, alternative approaches are necessary to study how exposure intensity in HCWs may affect outcomes, ideally prospectively selecting only HCWs that were confirmed to be exposed through their workplace," the researchers write.
Jan 28 JAMA Netw Open study

WHO releases 10-year plan to tackle neglected tropical diseases

The World Health Organization (WHO) today unveiled a new roadmap for battling neglected tropical diseases (NTDs), which includes new targets and new approaches to 20 diseases that affects more than 1 billion people, mainly in lower income countries.

Though the world has made progress against NTDs, the WHO said significant challenges remain, such as climate change, conflict, emerging zoonotic and environmental health threats, and inequities in health services and sanitation.

Key goals of the plan include reducing by 90% the number of people who need treatment for NTDs and reducing by 75% the disability-adjusted life years linked to the diseases. It also highlighted the need to eradicate dracunculiasis (Guinea worm) and yaws.

Overall, the roadmap tracks 10 targets, which include cutting deaths from vectorborne NTDs, such as dengue, by more than 75%. The WHO said the plan was developed through a broad consultative process and endorsed by the World Health Assembly in November.

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in a statement that ending the scourge of NTDs urgently requires a different approach. "This means injecting new energy into our efforts and working together in new ways to get prevention and treatment for all these diseases, to everyone who needs it."
Jan 28 WHO statement

H5N8 avian flu hits more poultry farms in Europe and Japan

Two European countries and Japan reported more outbreaks in poultry involving highly pathogenic H5N8, according to the latest notifications from the World Organization for Animal Health (OIE).

In Europe, Germany reported an outbreak at a turkey farm in Mecklenburg-Vorpommern state, which started on Jan 26, killing 35 of 7,350 birds. Also, Poland reported events on farms in two provinces. An outbreak at a commercial farm in Kujawsko-Pomorskie province began on Jan 24, and one at a layer farm in Wielkopolskie province started on Jan 22. Between the two outbreaks, the virus killed 979 of 347,326 birds. Countries in Europe also continue to report more H5N8 outbreaks in wild birds.

Elsewhere, Japan reported two more outbreaks, one at a layer hen farm in Chiba prefecture that began on Jan 10 and one at a broiler farm in Kagoshima prefecture that started on Jan 12. Taken together, the virus killed 1,011 of 1,184,000 birds.
Jan 27 OIE report on H5N8 in Germany
Jan 27 OIE report on H5N8 in Poland's Kujawsko-Pomorskie province
Jan 27 OIE report on H5N8 in Poland's Wielkopolskie province
Jan 28 OIE report on H5N8 in Japan

In outbreaks involving other strains, France reported a highly pathogenic H5N3 outbreaks in wild birds in Manche department in the west and a low-pathogenic H5N3 outbreak at a foie gras production farm in Pyrenees-Atlantiques department in the southwest, a region hit hard by recent H5N8 outbreaks. The outbreak began on Jan 18 at a facility housing 10,200 birds.
Jan 28 OIE report on H5N3 in French wild birds
Jan 28 OIE report on low-path H5N3 in France

Stewardship / Resistance Scan for Jan 28, 2021

News brief

Study finds most outpatient antibiotics in China are inappropriate

More than half of outpatient antibiotic prescriptions at Chinese hospitals over a 3.5-year period were inappropriate, Chinese researchers reported yesterday in The Lancet Infectious Diseases.

Using data from the Beijing Data Center for Rational Use of Drugs, a national database that collects prescription data from hospitals from all provincial-level regions in mainland China, the researchers analyzed antibiotic prescriptions linked to visits to outpatient clinics and emergency departments from Oct 1, 2014, through April 30, 2018.

A total of nearly 173 million outpatient visits to 139 secondary and tertiary hospitals were evaluated in the study. ICD-10 diagnostic codes were used to classify outpatient antibiotic prescriptions issued on the same day as diagnosis as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use.

Over the study period, 18,848,864 outpatient visits (10.9%) ended with an antibiotic prescription, with prescribing rates of 9.3% for outpatient clinics and 26.9% for emergency departments. Of the antibiotic prescriptions, 51.4% were classified as inappropriate, 28.4% as potentially appropriate, and 15.3% as appropriate, and 4.8% could not be linked to any diagnosis.

Children younger than 6 years had the highest proportion of inappropriate prescriptions, at 71.1%. A substantial amount of antibiotic overuse was driven by respiratory conditions, mainly viral upper respiratory tract infections and bronchitis.

Of the more than 23 million individual antibiotics prescribed, 80% were broad-spectrum. The top four most prescribed antibiotics were third-generation cephalosporins (21.7%), second-generation cephalosporins (16.4%), macrolides (15.3%), and fluoroquinolones (14.1%).

The authors say the findings of the study—the first of its kind conducted in China—suggest China's efforts to curb antibiotic overuse over the past decade have had little effect. Promoting appropriate use of antibiotics and establishing antibiotic stewardship programs in secondary and tertiary hospitals are two of the targets of China's 5-year national action plan (NAP) to contain antimicrobial resistance, which was launched in 2016.

"In conclusion, our findings indicate that inappropriate antibiotic prescribing was highly prevalent nationwide in China," the authors wrote. "More in-depth antibiotic stewardship programmes focusing on optimising antibiotic prescribing need to be implemented in China to achieve the goals set in the NAP."
Jan 27 Lancet Infect Dis abstract

European biotech firms urge support for antibiotic development measures

A coalition of European biotech companies is voicing its support for the European Commission's efforts to boost antibiotic development.

In a statement posted on its website, the BEAM (Biotech companies from Europe innovating in Anti-Microbial resistance research) Alliance said it welcomes the European Commission's Pharmaceutical Strategy, which aims to ensure that Europe has the supply of safe, effective, and affordable medicines to meet its needs. Adopted on Nov 25, 2020, the strategy recognizes the development of novel antibiotics as a prime example of addressing unmet medical needs—one of the strategy's four pillars—and calls for new economic incentives and reimbursement models to boost antibiotic development.

The Alliance also said that while new incentives and reimbursement reforms are needed to maintain a sustainable pipeline of new antibiotics over the long-term, faster solutions are needed. And it argues that innovative approaches to boost antibiotic research and development should embrace a broad definition of antibiotics, including nontraditional approaches, and take into account the needs of small- to medium-sized companies, which are struggling to advance their antibiotic-development programs because of the financial challenges.

"The BEAM Alliance stands ready to provide all necessary input to support the Commission in finding innovative solutions that can be deployed in the short term, and to contribute to the debates on systemic, long-term reforms," the group wrote.
Jan 26 BEAM Alliance statement