Gavi, the Vaccine Alliance, and Bavarian Nordic today announced an advanced purchase agreement to secure 500,000 doses of Jynneos mpox vaccine for African countries, which will be delivered this year.

In a statement, Gavi said it will buy the vaccine with a new response fund created in June, which is designed to free up cash to rapidly buy vaccines in health emergencies. Africa is facing a complex and quickly escalating mpox outbreak, with a novel clade 1b clade spreading in parts of the Democratic Republic of the Congo and a handful of neighboring countries. The endemic clade 1 strain and the global clade 2 virus are fueling cases in several countries. 

Today's announcement follows the World Health Organization's recent prequalification of Bavarian Nordic's mpox vaccine.

Sania Nishtar, MD, PhD, Gavi's chief executive officer, thanked the response fund donors and said, "We are committed to working with affected governments and our partners to turn these vaccines into vaccinations as quickly and effectively as possible and, over time, to build a global vaccine stockpile if sufficient funding is secured for Gavi's work through 2030." 

Incorporating COVID-19–specific elements into an existing antimicrobial stewardship program (ASP) framework was associated with reduced antibiotic use and resistance at a safety-net hospital in Chicago, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

COVID-19 posed a significant diagnostic challenge for clinicians in the early months of the pandemic, because symptoms often appeared indistinguishable from lower respiratory tract infections caused by bacteria or other viruses. That, along with a lack of specific treatments, resulted in a surge of antibiotic use (AU) in hospitals, which in turn led to an increase in antimicrobial resistance (AMR). To address this issue, clinicians and pharmacists at Saint Anthony Hospital in Chicago added guidelines that discouraged the routine use of antibiotics for COVID-19 and advised against broad-spectrum antipseudomonal use to a previously established syndrome-based ASP.

To assess the impact of the guidelines, researchers from Saint Anthony and the University of Illinois at Chicago examined data on AU and AMR from 2018 through 2021. They found that the average quarterly antibiotic days of therapy (DOT) per 1,000 patient-days increased by 8.7% (from 359 to 391 DOT) from 2019 to 2020, but then declined by 18.6% (from 391 to 318 DOT) in 2021. Quarterly antibiotic DOT peaked at 440 DOT during the initial COVID-19 surge, but the peaks were smaller with each subsequent surge, falling by 29% from the initial surge to the Omicron surge.

Potential strategy for future pandemics

Meanwhile, the incidence rate per 1,000 patient-days for extended-spectrum beta-lactamase (ESBL)-producing organisms increased from 2.13 in 2019 to 3.58 in 2020, before decreasing to 1.84 in 2021. For carbapenem-resistant Enterobacterales, the incidence increased from 0 in 2018 to .43 in 2019 and further to 1.79 in 2020, before returning to 0 in 2021.

"This suggests that ASP not only guided AU but also may have contributed to the mitigation of AMR," the study authors wrote. "By adapting this intervention to include COVID-19-specific elements, we successfully managed the challenges posed by the pandemic."

They add that leveraging ASP interventions and infrastructure could be a crucial strategy for future pandemics.

Analysis of Campylobacter isolates in East Africa found that multidrug resistance (MDR) was significantly higher in poultry than in people, researchers reported yesterday in Emerging Infectious Diseases.

For the study, an international team of researchers collected and explored the population structure of 178 Campylobacter isolates from Kenya and Tanzania, including 81 from patients with diarrhea and 97 from poultry samples. Africa has the world's highest incidence of campylobacteriosis, and previous studies have found a high prevalence of antimicrobial resistance (AMR) in Campylobacter isolated from humans and poultry in Africa. The researchers conducted antimicrobial susceptibility testing and used whole genome sequencing (WGS) to explore the differences and similarities between the human and poultry isolates.

MDR Campylobacter identified in 41% of poultry isolates

AMR was detected in 75.3% and MDR (defined as resistance to three or more antibiotic classes) in 2.5% of the 81 patient isolates. In the 97 poultry isolates, the estimated AMR prevalence was 85.7%, but MDR prevalence was 40.9%. Five poultry isolates were resistant to five of the six antibiotics tested. WGS identified 57 Campylobacter sequence types (STs) from patients and 29 STs in poultry samples, including many previously unreported STs. Common STs included Campylobacter jejuni ST353 (4 human and 10 poultry isolates from 6 farms), ST2122 (10 poultry isolates from 4 farms), and ST1932 (9 poultry isolates from 5 farms) and Campylobacter coli ST8043 (11 poultry isolates from 5 farms).

The researchers say the study, which is one of the largest using WGS to characterize Campylobacter in East Africa, provides several valuable insights.

"The high prevalence of MDR and the identification of previously undescribed STs highlights the need for ongoing investigation of enteric pathogens, such as Campylobacter spp., in low-resource settings," they wrote. "That effort would require genomic tools to be embedded within formal and transparent surveillance systems, in addition to a greater understanding of the role of antimicrobial use and biosecurity measures as drivers of the emergence of resistance in human health and food production and improved governance of antimicrobial use in both sectors."