A study conducted in the Cleveland Clinic Health System found that antibiotic prescriptions for respiratory tract infections (RTIs) were 64% more common for virtual vs in-person urgent care settings, researchers reported today in Clinical Infectious Diseases.

Using electronic health record data and ICD-10 diagnostic codes, Cleveland Clinic researchers identified RTI patients who were treated through traditional in-person urgent care or the virtual urgent care platform from 2018 through 2022 and assessed whether the encounter resulted in an antibiotic prescription. COVID-19 encounters were excluded. They then used mixed effect logistics regression to model the odds of a patient receiving an antibiotic prescription by urgent care setting.

There were 69,189 visits to in-person urgent care and 19,003 visits to virtual urgent care during the study period, with 58% of virtual visits resulting in an antibiotic prescription compared with 43% of in-person visits. Sinusitis diagnoses were more than twice as common in virtual care versus in-person visits (34% vs 13%) and in both settings were associated with high rates of antibiotic prescribing (95% in-person, 91% virtual).

Multivariable analysis found that, compared with in-person urgent care, antibiotic prescribing was significantly more common in virtual urgent care visits (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.53 to 1.75). The results were similar in an analysis conducted among the 36 clinicians who saw patients in both settings (aOR, 1.71; 95% CI, 1.53 to 1.90). 

The platform may be the issue

The study authors say that the higher volume of antibiotic prescribing in virtual urgent care was likely driven by a higher rate of sinusitis diagnoses. But that may have more to do with the platform than the clinicians, they conclude.

"To our knowledge, this is the first to attempt to isolate the role of the platform in antibiotic prescribing," they wrote. "That we found higher prescribing in virtual care suggests that it is the limitations of the platform, and not the clinicians or the health system, that drive higher antibiotic prescribing."

They add that, given its rapid expansion, antibiotic stewardship interventions are needed in virtual urgent care settings.

That we found higher prescribing in virtual care suggests that it is the limitations of the platform, and not the clinicians or the health system, that drive higher antibiotic prescribing.

Biological E, a vaccine and pharmaceutical company based in India, announced today that the World Health Organization has prequalified its novel oral poliovirus type 2 (nOPV2) vaccine, a next-generation vaccine for battling circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks.

The company said the live attenuated oral vaccine has improved genetic stability and has a decreased chance of seeding new outbreaks in low-immunity settings compared to the Sabin poliovirus type 2 vaccine. It added that real-world deployment in outbreak regions suggests that it can successfully reduce the incidence of cVDPV2 outbreaks. 

Ability to produce 500 million doses a year

Biological E is making the vaccine in collaboration with Indonesia-based PT Bio Farma, which is the first manufacturer of the nOPV2 vaccine, which the WHO prequalified in January. The collaboration and support for production came from the Bill and Melinda Gates Foundation.

Biological E said its manufacturing facilities can produce more than 500 million doses of the vaccine each year.  Indian regulators have already cleared the vaccine for export purposes.

Infections involving circulating vaccine-derived polioviruses are rare, resulting from mutations that can occur when the virus spreads among unvaccinated groups. Cases have increased in recent years owing to low immunization rates in certain settings. 

Lung ultrasounds (LUS) can help clinicians quickly and accurately decide if a COVID-19 patient needs respiratory help, according to findings of a new international study reported in The Journal of Infectious Diseases.

The study took place from June 2020 to June 2023 at two major US military hospitals, a homeless shelter, emergency room, and in a referral hospital in rural Uganda. COVID-19 patients were given a 12-zone LUS at the time of enrollment as a point-of-care tool. 

LUS, the authors found, was a useful way to assess the top predictors of worsening disease, measured as cross-validated area under the curve (cvAUC). The top predictor was B-lines (cvAUC, 0.88; 95% confidence interval [CI], 0.87 to 0.90), discrete B-lines (0.87; 95% CI, 0.85 to 0.88), oxygen saturation (0.82; 95% CI, 0.81 to 0.84), and A-lines (0.80; 95% CI, 0.78 to 0.81).

Our results demonstrate that among individuals with COVID-19, point-of-care ultrasound is useful for triage decisions across a broad array of clinical settings

"Despite differences in patient populations, ultrasound clinical settings, and COVID era, B-lines in 25 to 50% of lung fields was consistently sensitive for identifying those at risk of progression and confluent B-lines in ≥25% of lung fields were specific," the authors wrote. "Our results demonstrate that among individuals with COVID-19, point-of-care ultrasound is useful for triage decisions across a broad array of clinical settings." 

US teens who received recommended vaccines at public healthcare centers in 2020 were less likely to initiate and complete the human papillomavirus (HPV) vaccine series than those at private facilities, finds a study published yesterday in JAMA Pediatrics.

Led by researchers at the Henry Ford Health System, the study also found that teens at public centers had lower odds of receiving a clinician recommendation for the vaccine.

The team sampled data from the 2020 National Immunization Survey–Teen on 20,162 patients aged 13 to 17 years. Initiation was defined as receipt of at least one dose of HPV vaccine, and completion was considered at least two or three doses.

About 31,000 HPV-related cancers are diagnosed annually in the United States. "The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion," the authors wrote.

Importance of public healthcare centers

A total of 81.4% of teens received a recommendation for the vaccine, while 75.1% started and 58.6% completed the series. Public-facility patients were 38% less likely to receive a clinician recommendation than those at private centers (aOR, 0.62).

Public health centers play a crucial role in serving minority communities and in mitigating racial and ethnic disparities in health care.

HPV vaccine initiation differed significantly between public (71%) and private (77%) facilities, as did series completion (50% vs 61%, respectively). In adjusted analyses, teens at public centers had 29% lower chances of starting (adjusted odds ratio [aOR], 0.71) and 38% lower odds of completing (aOR, 0.62) the series than those at private facilities. 

"Public health centers play a crucial role in serving minority communities and in mitigating racial and ethnic disparities in health care," the researchers said. "Urgent actions are needed to enhance clinician participation in the promotion of HPV vaccination, especially in public facilities," they concluded.

The Advisory Committee on Immunization Practices recommends the HPV vaccine for adolescents aged 11 to 12 years and catch-up vaccination for those 13 to 26.