News Scan for Oct 26, 2021

News brief

Urinary antigen testing may help target antibiotics for pneumonia

Positive pneumococcal urinary antigen testing (PUAT) results among patients hospitalized with community-acquired pneumonia (CAP) was associated with earlier time to de-escalation of antibiotics, according to a single-center study published last week in Open Forum Infectious Diseases.

In the retrospective study, conducted at New York University Langone Health, researchers analyzed hospitalized CAP patients who had PUAT performed in 2019, comparing antibiotic de-escalation and outcomes in those who tested positive and negative. PUAT is a rapid, non-invasive assay that can aid in the diagnosis of CAP caused by Streptococcus pneumoniae. It has also been viewed as a potential antibiotic stewardship tool that might improve time to targeted, narrow-spectrum antibiotics and reduce use of broad-spectrum agents.

Of the 910 patients included in the analysis, 121 (13.3%) had a positive PUAT result and 789 (86.7%) had a negative result. Initial antibiotic de-escalation from a broad-spectrum antibiotic to a narrow-spectrum agent was similar in the PUAT-positive and -negative groups (82.9% vs 81.2%), but median time to de-escalation (interquartile range [IQR]) was similar in the PUAT-positive group (1 [IQR, 0 to 2] day vs 1 [IQR, 1 to 2] day). Within 24 hours of PUAT, more patients in the PUAT-positive group had atypical coverage discontinued (61.3% vs 47.2%). Patients with positive PUAT results were also less likely to have antibiotics escalated.

Among the PUAT-positive group, unadjusted analysis showed a shorter length of stay in patients who were de-escalated compared to those who were not de-escalated or required escalation (6 [IQR 4-10] days vs 8 [IQR 7-12]) days), with no difference in the incidence of Clostridioides difficile, in-hospital mortality, or 30-day infection-related readmission.   

The authors say the findings support the use of PUAT in conjunction with additional stewardship interventions.

"In order to have the greatest impact, testing should be considered on all patients admitted with a diagnosis of CAP, and coordinated efforts should be made with microbiology personnel to ensure appropriate workflows are established for timely PUAT results," they wrote.
Oct 22 Open Forum Infect Dis abstract

H3N2 strain makes early mark on Europe's flu season

Though flu cases are still low in Europe, an unusually early spike in Croatia is a sign that the 2021-22 flu season could be severe for older people, the European Centre for Disease Prevention and Control (ECDC) said today.

The ECDC said the main subtype detected in the region over the past month is influenza A H3N2, which is known for disproportionately affecting older people and has been linked to lower vaccine effectiveness. It said the early signals suggest the season could be severe for older people but noted the timing of flu circulation may vary among countries.

In a statement, Pasi Penttinen, MD, PhD, MPH, who leads the ECDC's flu program, said it's impossible to predict what the flu season will look like. He emphasized, however, that a steep increase in flu in the current COVID-19 pandemic setting could have serious consequences for people with weakened immune systems and place an extra burden on healthcare systems.

"It is therefore important that we take the necessary precautions and protect those that are most at risk," he said, adding that nonpharmaceutical interventions that worked against COVID-19 are also effective against flu. Penttinen also urged health and nursing home workers to get vaccinated against both diseases ahead of winter.
Oct 26 ECDC statement

Globally, flu activity is still at lower-than-expected levels, the World Health Organization (WHO) said today in an update that roughly covers the first half of October. Influenza A and B detections were reported from some regions, with both reported in North America. Influenza B was predominant in Caribbean and Central American countries, as well as in South Asia. Influenza A was the main virus in African countries that reported flu cases.

Of the respiratory specimens that tested positive for flu at national labs, 65.6% were influenza B, slightly lower than the WHO last global flu update. Of subtyped influenza A viruses, 66% were H3N2.

Also, countries in both hemispheres reported increased respiratory syncytial virus activity.
Oct 25 WHO global flu update

COVID-19 Scan for Oct 26, 2021

News brief

Guaranteed cash worked as a COVID vaccine incentive, study says

A guaranteed $25 cash card for both vaccine recipients and drivers of vaccine recipients lessened slowing COVID-19 vaccine uptake at participating sites in North Carolina, according to a research letter in JAMA Internal Medicine yesterday.

This contrasts with a JAMA study in July that showed no increased vaccine uptake from Ohio's million-dollar lottery.

In total, the North Carolina program gave out 2,890 cash cards to vaccine recipients and 1,374 cash cards to drivers. Compared with a baseline period of May 12 to 25, during the intervention period (considered Jun 2 to 8 in the study), participating clinics had less of a decline in vaccinations when compared with other sites in the same four counties and the whole state, at –26.4%, –51.1%, and –48.6%, respectively. A first baseline period from Apr 28 to May 11 suggested that these participating sites may have had greater traffic compared with other sites, as well.

Of 401 vaccine recipients surveyed, 41% said the cash card was an important reason for getting vaccinated, and they were more likely to say so if they weren't White (odds ratios [ORs], 2.00 to 4.68) or if they had less than $40,000 in annual income (ORs, 1.94 to 2.36). Nine percent said they would not have been vaccinated if there were no cash incentive, and 15% said they waited or searched for an opportunity for vaccination incentives.

"Someone driving me here today" was an important reason for 49% of respondents, with greater likelihood among Black people (OR, 1.74), Hispanic people (OR, 2.51), or lower-income respondents (OR, 2.77 to 6.09). Furthermore, those with lower income (OR, 2.10 to 3.97) and those 50 years and older (OR, 2.30) were more likely to have been brought by a driver who received a cash card.

"In this pilot program in North Carolina, incentives slowed the decline in vaccination and promoted more equitable distribution by alleviating barriers to vaccination, particularly for low-income, Black, and Hispanic individuals," the researchers conclude.
Oct 25 JAMA Intern Med study

Non-COVID research projects may be affected most during pandemic

Researchers who did not conduct COVID-related projects initiated 36% fewer new projects in 2020 versus 2019, according to a commentary published in Nature Communications today. The reductions were seen across all fields, particularly affecting women and those taking care of children.

The study was a follow-up to an April 2020 study that surveyed about 4,500 random US and European scientists and found that scientists who relied on laboratories and equipment had a greater reduction in research hours compared with those who didn't as much. In addition, researchers with children 5 years or younger also saw a 17% decline in research hours.

In this current survey, conducted in January 2021 and involving 6,982 scientists, overall work hours were closer to pre-pandemic levels, with only a 2.2-hour deficit per week compared with the 7.1-hour deficit reported in April 202020. Those pursuing COVID-related work had about the same levels as pre-pandemic productivity; however, those that didn't dropped from three new projects to two, and new co-authorships for non-COVID papers declined by 5%. The researchers say the decline is likely due to factors affecting all fields.

"The finding that researchers pursued fewer new projects in 2020 suggests that these trends may reflect scientists working on established topics, writing up existing research, submitting drafts earlier than they would have otherwise, writing more grant proposals than typical, or revisiting old data and reviving legacy projects that they would not have pursued otherwise," the researchers write.

"During the early phase of the pandemic, scientists reported a sharp decline in time spent on research," said Dashun Wang, PhD, one of the study's authors, in a Northwestern University press release. "These productivity levels have recovered, which suggests some optimism. However, given the long gestation time for new research ideas to mature and be published, the decline in new projects suggests that the impact of the pandemic may not manifest in the publication record for years."
Oct 26 Nature Communications study
Oct 26 Northwestern University press release