COVID vaccine lotteries tied to increased uptake in most, not all, states

Programs that reward the newly vaccinated with an entry in a lottery were associated with an increase in COVID-19 vaccinations in most—but not all—US states offering the incentive and may have spurred almost 2 million people to get immunized, according to research published yesterday in JAMA Network Open.

From Mar 17 to Jul 5, 2021, researchers from Drexel University and the University of Georgia polled 403,714 adult participants in the Household Pulse Survey and analyzed daily vaccination rates for the 11 states with a vaccine lottery and 28 states without such a program. Of all survey participants, 71.9% were vaccinated against COVID-19 and 28.1% were not.

A pooled analysis of both a difference-in-difference (DiD) analysis and an augmented synthetic control (ASC) analysis showed that the lottery programs were tied to a 2.1% increase in vaccination rates. In the ASC analysis, the programs were linked with an increase of 0.208 log points, implying an average 23.1% increment in the daily vaccination rate.

State-specific DiD and ASC analyses suggested that vaccine lotteries increased vaccination rates in Ohio (0.09 log points), Maryland (0.26), Oregon (0.15), and Washington (0.37) but not in Arkansas, Kentucky, or West Virginia. The ASC analysis showed that the lotteries were positively associated with vaccinations in New Mexico (0.32 log points) and New York (0.33).

The trend of daily state-specific first COVID-19 vaccination rate per 100,000 people (7-day moving average) over the study period seemed to decline after leveling off in mid-April.

"Given that the adult population in 11 treated states is approximately 85 million, a 2.1% estimate from the DiD result implies that the lottery programs may have expanded the vaccine coverage to approximately 1.78 million additional adults," the researchers wrote. "Similarly, our ASC estimate of 53 doses per day per 100 000 people translates into approximately 1.67 million additional adults getting vaccinated for an average of 37 posttreatment days in 11 treated states."

State-level variation in success of the vaccine lottery "should inform governments when adopting similar policies in the future," the authors concluded. "The findings may also be relevant to the ongoing debate on how to persuade the millions of US residents who are not yet vaccinated against COVID-19."
Dec 9 JAMA Netw Open study

Study suggests heart damage may last up to 1 year in COVID-19 patients

A small study of 66 COVID-19 patients suggests that those who continue to be short of breath during physical activity 1 year after recovery may have suffered heart damage, according to new data presented at EuroEcho 2021, a meeting of the European Society of Cardiology.

The 66 patients were hospitalized for COVID-19 in March and April of 2020 at the University Hospital in Brussels, Belgium. None had previous heart or lung disease. The average patient age was 50 years, and 67% were men.

One year after their discharge date, the patients' lung and heart function was tested via spirometry together with chest computed tomography.

Twenty-three patients (35%) had shortness of breath during the spirometry. Cardiac ultrasound showed those patients were more likely to display abnormal heart function.

"Our study shows that more than a third of COVID-19 patients with no history of heart or lung disease had persistent dyspnoea on effort a year after discharge from hospital. When looking in detail at heart function by cardiac ultrasound, we observed subtle abnormalities that might explain the continued breathlessness," said study author Maria-Luiza Luchian, MD, of University Hospital Brussels, Belgium, in a press release.
Dec 9 European Society of Cardiology press release

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Saudi funding aims to boost national antimicrobial resistance plans

The World Health Organization (WHO) announced yesterday that it has received more than $21 million from Saudi Arabia to support implementation of national antimicrobial resistance (AMR) action plans in several low- and middle-income countries.

The WHO says it will use the $21.6 million voluntary contribution to provide technical support to seven countries—Egypt, Ethiopia, Jordan, Indonesia, Nigeria, Pakistan, and Sudan—to help them implement action plans based on their specific needs. The agency will focus on helping the countries build capacity for multisectoral governance, AMR awareness, surveillance, laboratory detection, antimicrobial stewardship, infection prevention and control, and monitoring and evaluation.

In addition, the support will enable the WHO to appoint a dedicated senior AMR technical advisor in each of the countries' WHO country office. Lessons learned from the seven countries will be used to update and scale the approach globally

"Having a bigger pool of flexible funds has allowed us to advance our work innovatively and provide the much-needed support to WHO country offices to ensure impact in low- and middle-income countries," WHO Assistant Director-General, Hanan Balkhy, MD, said in a press release. "This funding model allows WHO to be strategic and agile in efforts to address antimicrobial resistance—a threat to each of WHO's Triple Billion Targets—and to drive public health impact in countries."
Dec 9 WHO press release

Study finds high level of inappropriate testing for fungal disease

Originally published by CIDRAP News Dec 7

A study conducted at a large teaching hospital in Tokyo found that most tests used to diagnose invasive fungal disease were inappropriate, Japanese researchers reported yesterday in Open Forum Infectious Diseases.

The retrospective study, conducted at University of Tokyo Hospital, looked at data on patients who underwent testing with three different types of non–culture-based fungal assays (NCBFAs): beta-D glucan (BDG), galactomannan antigen (GMA), or cryptococcal antigen (CRAG). Testing was deemed appropriate if the clinical presentation was compatible with a fungal infection and there was a predisposing host factor at the time of ordering. The researchers also examined factors that increased risk of inappropriate NCBFA use.

A total of 1,159 patients underwent testing with either serum BDG, GMA, or CRAG tests during the study period. Among the 470 patients included in the analysis, roughly 80% of NCBFAs conducted were deemed inappropriate. Nearly 17% of patients underwent three separate unnecessary NCBFAs simultaneously.

Ordering by transplant medicine physicians, repetitions of the test, the absence of predisposing factors for fungal infections, and the absence of recommendations from infectious diseases (ID) consultants were associated with an increased risk of inappropriate NCBFA use.

The study authors say that while avoidable fungal testing doesn't get as much attention as inappropriate urine cultures or Clostridioides difficile testing, the results suggest fungal diagnostic stewardship is needed to prevent unnecessary cascades of care in patients at low risk of fungal infection.

"Our findings suggest that stewardship efforts engaging transplant physicians, clinical decision support tools to guide ordering practices, and involvement of ID physicians as stewards may be important strategies to improve fungal testing practices," they wrote.
Dec 6 Open Forum Infect Dis abstract