Over the weekend, the World Health Organization (WHO) confirmed it began a Jynneos vaccination campaign in the Democratic Republic of the Congo (DRC) in an effort to stem an ongoing mpox outbreak.

The DRC has reported more than 30,000 suspected and laboratory-confirmed mpox cases this year, including 990 deaths. The outbreak has spread to 15 other African nations.

A total of 265,000 doses of Jynneos, donated by the European Union, were distributed in the DRC. According to the WHO, the vaccination campaign will be rolled out in 11 of the most affected health zones in Equateur, North Kivu, Sankuru, South Kivu, Sud-Ubangi, and Tshopo provinces.

Our top priority is to secure safe and effective vaccines for children in the next phase of vaccination

"Africa CDC remains committed to working closely with the DRC to ensure vaccines reach those who need them the most, while also working to strengthen health systems to prevent future outbreaks. Our top priority is to secure safe and effective vaccines for children in the next phase of vaccination," the Africa Centres for Disease Control and Prevention (Africa CDC) said in a press release announcing the start of the vaccine campaign. 

North Kivu province is first target 

Health workers in North Kivi province are among the first to receive the vaccines. North Kivi has been a hotspot for the current outbreak: 34% of the reported confirmed cases are individuals living in camps for internally displaced people, and approximately 75% of mpox cases in the province are among children 0 to 17, according to the latest situation report on the outbreak. 

Case investigations have shown mpox transmission in North Kivu is exclusively human-to-human, with about a third (34%) of the cases reporting sexual contact as the mode of transmission. Among those cases, over half are reported to occur in sex workers (52%).

The rate of oral antibiotic prescriptions dispensed in US outpatient pharmacies fell by 13% from 2011 to 2019, with the biggest declines observed in children, researchers reported last week in the American Journal of Epidemiology.

Using the IQVIA Xponent database and US Census bureau population estimates, researchers from the Centers for Disease Control and Prevention found that a total of 2.4 billion oral antibiotic prescriptions were dispensed from 2011 to 2019, with adults aged 65 and older, women, and the South region consistently accounting for the highest prescription rates. Penicillins, macrolides, and cephalosporins were the antibiotic classes with the highest prescription rates.

The prescription rate fell from 877 prescriptions per 1,000 persons in 2011 to 765 prescriptions/1,000 persons in 2018 and 2019 (–13%). The greatest overall decreases in prescribing rates were among children younger than 20 years (–25%), followed by adults aged 20 to 64 years (–10%), and the smallest decrease was among adults aged 65 and older (–1%).

Shifting trends in antibiotic classes

Among antibiotic classes, the largest annual decrease (measured as average annual percent change [AAPC]) across all age-groups for the entire study period was for macrolides (AAPC, aged 20 years and younger, –8%; aged 2o to 64 years, –3.8%; aged 65 and older, –5.1%). 

From 2016 to 2019, the largest annual decrease occurred in fluoroquinolones across all age-groups (AAPC, aged 20 years and younger, –14.8%; aged 20 to 64 years, –12.7%;  aged 65 and older, –11.2%). Among adults, during the study period, prescribing rates increased for beta-lactams (AAPC, aged 20 to 64 years, 6.4%; aged 65 and older, 5.6%), while cephalosporin use increased among adults 65 and older (AAPC, 2.4%).

The study authors say the small decline in antibiotic prescribing among older adults highlights the need to further evaluate prescribing practices in this population.

"Monitoring antibiotic prescribing trends nationally and by patient characteristics and antibiotic class is important for tracking progress toward goals to reduce unnecessary prescribing, optimize the treatment of infections, and mitigate antimicrobial resistance," they wrote.

The effectiveness of the long-acting monoclonal antibody nirsevimab (Beyfortus) against primary care visits for lower respiratory tract infections (LRTIs) caused by the respiratory syncytial virus (RSV) was 76% in 160 infants younger than 10 months old from November 2023 to February 2024, researchers in Murcia and Valencia, Spain, reported late last week in Pediatrics.

In September 2023, the Spanish national immunization program targeted three groups at high risk for severe RSV based on their birth date and underlying conditions: those born during the vaccination campaign (seasonal group), those younger than 6 months at the start of the campaign (catch-up group), and those aged 6 to 24 months with high-risk conditions at the campaign start.

RSV is the main cause of LRTIs in children younger than 5 years, the authors noted. 

Role of catch-up vaccination

Investigators with the MEDiterranean Infectious diseases PRIMary care (MEDIPRIM) network of primary care centers used a test-negative study design to estimate the effectiveness of nirsevimab against medically attended RSV-LRTIs among all infants born after April 1, 2023. In total, 141 babies (88%) received the drug, 29 of them at birth and 112 through the catch-up program.

This study underscores the effectiveness of nirsevimab in preventing medically attended LRTI in infants in outpatient settings and emphasizes the importance of a catch-up immunization program to reduce the disease burden in primary care.

Forty-four infants overall (27.5%) tested positive for RSV, and 116 served as controls. Three-quarters (75%) of infected infants had been vaccinated against RSV, as were 93% of controls. Seven children were hospitalized, three of whom were 3 months or older. Of those children, three tested positive for RSV and were younger than 3 months old; two of the three had been vaccinated, as was one control. 

The estimated effectiveness of the RSV vaccine was 75.8% (95% credible interval [CI], 40.4% to 92.7%) overall and 80.2% (95% CI, 44.3% to 95.4%) in infants in the catch-up group.

"This study underscores the effectiveness of nirsevimab in preventing medically attended LRTI in infants in outpatient settings and emphasizes the importance of a catch-up immunization program to reduce the disease burden in primary care," the researchers wrote.