News Scan for Oct 13, 2021

News brief

New online tool aims to help countries calculate cost of fighting AMR

The World Health Organization (WHO) today released a new tool to help countries calculate the costs of implementing multisectoral national action plans (NAPs) for antimicrobial resistance (AMR).

The modular online tool enables countries to prioritize activities included in their NAPs, which in many cases exist only on paper, and then calculates what those activities may cost, based on key parameters that are relevant to those countries. Users can also input existing national funds that will be used to cover the costs, which helps identify funding gaps and additional resources that might be needed to pay for AMR activities.

Funding for activities to address AMR, or lack thereof, remains a key issue for many countries. As of July 2021, 145 countries have developed AMR NAPs and an additional 41 are in the process of developing one. But according to a recent survey by the WHO, the World Organization for Animal Health, and the United Nations Food and Agriculture Organization, only 20% of these plans are fully funded and 40% have a budgeted operational plan.

"Leaders making funding decisions need to understand how much the activities included in the NAP will cost, how many activities are already being funded and how the budget can be increased," the WHO states in the user guide for the cost and budgeting tool. "A clear approach to costing and budgeting AMR NAPs is therefore a critical first step in ensuring that efforts are practical and can be implemented sustainably."
Oct 13 WHO AMR costing and budgeting tool and user guide

Ebola vaccine campaign launches in DRC outbreak area

Health officials in the Democratic Republic of the Congo (DRC) today launched an Ebola vaccination campaign in a part of North Kivu province where a confirmed case, plus three related suspected deaths, were recently reported.

In a statement, the WHO regional office for Africa said about 1,000 doses of VSV-EBOV—Merck's Ebola vaccine—and medical supplies were sent from Kinshasa to Goma, the capital of North Kivu province. About 200 of the doses were sent to the outbreak area near Beni, where a ring vaccination campaign is targeting contacts, contacts of contacts, and first responders.

The confirmed case involves a 2-year-old boy who died on Oct 6 at a local health facility. The suspected cases are three of his neighbors who are members of the same family. The three were sick in the latter part of September, and all died after experiencing symptoms similar to Ebola.

So far, 170 contacts have been identified and are being monitored.

The WHO said sporadic cases can arise after major outbreaks. The area around North Kivu province experienced a major outbreak from 2018 to 2020, and earlier this year a flare-up occurred near the city of Butembo in North Kivu. In survivors, the virus can persist in immune-protected parts of the body, and the virus is also present in the DRC's animal populations.

The WHO said genetic sequencing is under way to determine if the new case is linked to the earlier outbreaks, with results expected this week.
Oct 13 WHO African regional office statement
Oct 11 CIDRAP News story

COVID-19 Scan for Oct 13, 2021

News brief

Hospital-acquired COVID-19 affects patients, workers, study says

While the absolute risk of acquiring COVID-19 in the hospital was low—up to 0.75% risk per day of exposure pre-Delta (B1617.2) variant—patients or healthcare workers (HCWs) with COVID-19 nonetheless can be factors in the spread of COVID-19, a study published yesterday in PLOS One says.

The researchers looked at four UK teaching hospitals, where 66,184 patients were hospitalized and 5,569 HCWs were on the job from Jan 12 to Oct 2, 2020. Of the patients, 1.4% had a positive test within the same period, and 10.5% of those (97) had their first positive test post-hospitalization at least 7 days after admission, wherein they were considered a nosocomial case. Patients who likely acquired COVID-19 infections while in the hospital were older, had longer lengths of stay, and had more readmission, the researchers note.

Among the HCWs, 11.0% were positive during the study period.

For susceptible patients, 1 day in the same ward with a patient with hospital-acquired COVID-19 infection was associated with an additional 7.5 infections per 1,000 susceptible patients per day (95% credible interval [CrI], 5.5 to 9.5). Exposure to an infectious patient with community-acquired COVID-19 or to an infectious HCW, on the other hand, was associated with an additional 2.0 infections per 1,000 susceptible patients per day (95% CrI, 1.6 to 2.2).

HCW infections acquired from patients or from another HCW were both associated with an additional 0.8 infection per 1,000 susceptible HCWs per day (95% CrI, 0.3 to 1.6 and 0.6 to 1.0, respectively). Exposure to an infectious patient with community-acquired COVID-19 infection was associated with an additional 0.2 infection per 1,000 susceptible HCWs per day (95% CrI, 0.2 to 0.2).

"In this study, we observed that exposure to patients with hospital-acquired SARS-CoV-2 is associated with a substantial infection risk to both HCWs and other hospitalised patients. Infection control measures to limit nosocomial transmission must be optimised to protect both staff and patients from SARS-CoV-2 infection," the researchers write, noting that increased mitigations from Apr 25, 2020, onward were associated with 75% reduced odds of infection in susceptible patients.
Oct 12 PLOS One study

About 3 in 20 Midwest healthcare workers COVID vaccine hesitant

In a 1,971-person survey conducted from March to May, about 3 in 20 Midwest HCWs were hesitant about the COVID-19 vaccine, according to a study published yesterday in the American Journal of Infection Control.

Respondents were from a 465-bed University of Illinois at Chicago hospital, a 664-bed Rush University Medical Center hospital, and a 26-hospital system in Wisconsin and Illinois run by Advocate Aurora. The survey, which was based off the Health Belief Model framework, showed that 15% of HCWs had not received or were not planning to receive a COVID-19 vaccine.

Overall, vaccinated HCWs were more likely than unvaccinated HCWs to be influenced by having close contacts who wanted them to be vaccinated (odds ratio [OR], 5.52 to 18.83, depending on the relation). They were also more likely to believe that the vaccination would decrease the spread of COVID-19 (OR, 51.49) and decrease the likelihood of themselves, their patients, and their family from getting infected (ORs, 28.22, 22.45, and 27.19, respectively).

Unvaccinated people, in comparison, were 93% more likely to believe that the vaccine had insufficient evidence. They were also more likely to be Black (OR, 0.34), Republican (OR, 0.54), allergic to any vaccine component (OR, 0.27), or believe it would negatively affect pregnancy or pregnancy planning (OR, 0.09), according to multivariable logistic regression that led to a 95%–accurate vaccine hesitancy model.

The researchers noted that those who were vaccinated were more likely to be persuaded toward acceptance by external stimuli (eg, media, personal healthcare provider; OR, 1.83 and 4.77, respectively) than unvaccinated HCWs.

"Rather than focusing on generalized, impersonal outreach advertisements from a hospital administration or the mainstream media," they conclude, "hospitals should work internally to foster relationships and trust building among employees across departments and job roles, especially among nurses and physicians who remain highly trusted in their communities."
Oct 12 Am J Infect Control study