Vaccination linked to COVID-19 decline in healthcare workers

In Orange County, California, COVID-19 vaccination in healthcare personnel (HCP) was connected with a 94% reduction in HCP cases 3 weeks after second doses of mRNA-based vaccines were administered, according to a JAMA Network Open research letter yesterday.

The researchers included 10,188 HCP from the University of California Irvine Health, the only academic medical center in the county, and tracked COVID-19 infections from Nov 1, 2020, to Mar 31, 2021. Participants were screened daily for COVID symptoms and fever and were tested if positive. In addition, about 250 asymptomatic HCP were tested per week up to Dec 13, after which 500 per week were tested. COVID-19 vaccinations began Dec 16.

Data showed that HCP COVID-19 case rates were parallel to the county's surge in winter 2020-21 but began diverging a week after second vaccine doses began. One week after second doses started, weekly HCP cases fell from 18 to 8 (55% reduction), then to 3 at 2 weeks (84% reduction 2 weeks post-second dose), and finally to 1 at 3 weeks (94% reduction).

Median age of HCP was 38 years, and 61% were women. Almost one in five (19%) were Latino, and 32% lived in the top five cities with the highest COVID-19 burden in Orange County. The researchers note that, once vaccination programs began, 58% of HCPs received a first dose within 2 weeks and 70% received one within 4 weeks.

"This study found a rapid and sustained decline in both COVID-19 symptomatic and asymptomatic infections following HCP vaccination in a region experiencing high rates of COVID-19 disease nationally in the 2020 to 2021 winter season," concluded the researchers, adding that the difference was likely underestimated, as some HCP would have influenced the county's rates.
Jul 8 JAMA Netw Open study

Engaging Black faith leaders, pharmacists to boost vaccine acceptance

A community-based COVID-19 vaccine campaign partnering with Black faith leaders and pharmacists led to 351 Black people getting vaccinated in 1 day, or 78% the number of Black people who had been vaccinated in the county the prior month, reports a research abstract yesterday from the European Society of Clinical Microbiology and Infectious Diseases (ECSMID).

The results were presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID), held online this year.

Loma Linda University (LLU) is the largest vaccination center in San Bernardino County, California, of which 7.8% of residents are Black. Prior to this outreach effort, LLU administered first doses to only 451 Black people, or 3.2% of 14,157 vaccinees, from Jan 5 to Feb 5.

For its outreach, the LLU School of Pharmacy first met with 20 churches, shared COVID-19 information, and garnered support from Black faith leaders. Then LLU had a Black pharmacist host COVID-19 education webinars that were advertised and coordinated by pastors. The effort culminated in a mobile vaccine clinic at a church on Feb 6. The researchers add that, because pastors were the ones who managed the appointment lists, the mobile clinic eliminated internet-related barriers.

At the 1-day mobile clinic, 420 people were vaccinated, 351 (84%) of whom were Black. The week following the mobile vaccination clinics, Black attendance also increased at LLU mass vaccination sites—4.3% of 9,373 first doses were given to Black people—which the researchers say could be because of their outreach efforts.

"Black churches have long been more than places of worship to their communities," said lead author Jacinda Abdul-Mutakabbir, PharmD, MPH, of LLU, in an ESCMID press release. "They serve as strongholds for disseminating trusted information and have been integral in our initiative to help achieve racial equity in the COVID-19 vaccine rollout."

Abdul-Mutakabbir said they are also expanding efforts to connect with the Latino community, another group that has been disproportionately hit by the pandemic.
Jul 8 ESCMID abstract and press release

Three countries report more vaccine-derived polio cases

Three countries—Afghanistan, the Democratic Republic of the Congo (DRC), and Yemen—reported more polio cases this week, all involving vaccine-derived types, the Global Polio Eradication Initiative (GPEI) said in its latest update.

Afghanistan reported 1 more circulating vaccine-derived poliovirus type 2 (cVDPV2) case, which involves a patient from Badghis, lifting its total for 2021 to 42.

The DRC reported one more cVDPV2 case, bringing its number so far this year to nine. The report did not note a location for the latest illness.

Meanwhile, Yemen reported a circulating vaccine-derived poliovirus type 1 (cVDPV1) case, in a patient from Saadah, putting its total at three for the year.
Jul 8 GPEI update

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

New center will focus on antimicrobial resistance, TB treatments

The London School of Hygiene and Tropical Medicine (LSHTM) announced today that it is partnering with Johnson & Johnson (J&J) to launch a center focused on research into antimicrobial resistance and tuberculosis (TB).

According to an LSHTM press release, the J&J Center for Global Health Discovery will "advance the critical, early-stage discovery and exploratory science needed to develop potentially lifesaving innovations to address diseases that disproportionately impact the world's poorest and most vulnerable people."

The center will focus specifically on research into next-generation drug regimens needed to treat all forms of TB.

"By bringing together the excellent science of institutions like LSHTM with Johnson and Johnson’s expertise in translational research, I believe we can not only bridge but fill the gaps in innovation needed to tackle the world’s urgent health issues," said Anil Koul, PhD, vice president and head for Global Health Discovery and Partnerships at J&J, and a professor of translational research at LSHTM.

The center will be part of a larger and decentralized scientific network being developed by J&J to drive pharmaceutical research and development in parts of the world where the need is greatest.
Jul 9 LSHTM press release

Real-world, in vitro data show promise for cefiderocol against gram-negs

Japanese drug maker Shionogi & Co. is presenting what it calls key new data on the antibiotic cefiderocol at the annual European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), which begins today.

In a company press release, Shionogi, of Osaka, said an overview of susceptibility and clinical outcomes found that the overall clinical response was positive in 141 patients who received the novel cephalosporin antibiotic in a global compassionate use program. The patients had infections caused by gram-negative pathogens resistant to all alternative antibiotics, mainly Pseudomonas aeruginosa(50%) and Acinetobacter baumannii complex (24%).

Initial data from the cefiderocol Early Access Programme for patients with gram-negative infections showed that of 237 patients treated with the antibiotic, 40.5% had carbapenem-resistant A baumannii infections, 32.9% had carbapenem-resistant P aeruginosa infections, and 37.1% were also co-infected with COVID-19.

"Shionogi is excited to share these real-world data at ECCMID, providing initial evidence that cefiderocol is addressing the high unmet need for new antimicrobials effective against important resistant pathogens, such as carbapenem-resistant Acinetobacter or Pseudomonas," said Mark Hill, MBBS, Shionogi's global head of market access.

The company also cited studies showing that cefiderocol demonstrated extensive in vitro activity against carbapenem-resistant gram-negative isolates collected from Europe and the United States as part of the SENTRY Antimicrobial Surveillance Program.

Cefiderocol, sold under the brand name Fetroja, was approved for treating complicated urinary tract infections by the Food and Drug Administration in 2019, then for treatment of hospital-acquired and ventilator-associated pneumonia the following year. It's one of two antibiotics that England's National Health Service has selected for purchase under its pilot subscription-style payment model, which aims to pay developers of innovative antibiotics annually for access to their products, rather than reimbursing them based on the quantity of antibiotics sold.
Jul 8 Shionogi press release

Urine culture stewardship linked to reduced catheter infections

Originally published by CIDRAP News Jul 8

A urine culture stewardship initiative at a teaching hospital in Michigan reduced overuse of urine cultures and was associated with a significant decline in catheter-associated urinary tract infections (CAUTIs), researchers reported today in Infection Control & Hospital Epidemiology.

The analysis by researchers with the Henry Ford Health System in Detroit looked at the impact of a urine culture stewardship program implemented at the hospital in 2015 to complement a urinary catheter best-practice bundle that emphasized appropriate use of urinary catheters and optimization of catheter-insertion and maintenance protocols. The stewardship program emphasized obtaining urine cultures from intensive care unit (ICU) patients only if a urinary source of sepsis was suspected.

Previous research has shown that minimizing use of urinary catheters has been one of the most effective interventions for reducing CAUTIs, while inappropriate urine culture testing in catheterized patients can lead to overdiagnosis of CAUTIs and result in antibiotic overuse.

To assess the impact of the complementary programs, the researchers reviewed the urine culture utilization rate (UCUR), the catheter utilization ratio (CUR), and CAUTI incidence in the hospital's ICU from 2015 through 2017.

They found that UCUR decreased from 3,081 in 2015 to 2,158 in 2016 and 1,218 in 2017, while CAUTIs decreased from 78 in 2015 to 60 in 2016 to 28 in 2017. Regression analysis over time showed statistically significant decreases in UCUR and CAUTI rates, a modest decline in CUR, and a correlation between declines in UCUR and the CAUTI rate. No cases of unrecognized pyelonephritis or CAUTI were identified.

"Urine-culture stewardship programs in combination with standard best practices could significantly influence CAUTI rates in ICUs," the study authors concluded.
Jul 8 Infect Control Hosp Epidemiol abstract

WHO recommends new rapid molecular tests for TB

Originally published by CIDRAP News Jul 7

The World Health Organization (WHO) today issued an update to its consolidated guidelines on the detection of TB and drug-resistant TB.

The update includes three new classes of rapid molecular tests recommended by the WHO: moderate-complexity automated NAATs (nucleic acid amplification tests) for the initial detection of TB and resistance to rifampicin and isoniazid, low-complexity automated NAATs for detection of resistance to isoniazid and second-line anti-TB agents, and high-complexity hybridization-based NAATs for the detection of pyrazinamide resistance. An accompanying operational handbook aims to help facilitate implementation and roll-out of the tests by national TB programs.

The WHO estimates that more than a third of TB patients and two-thirds of those with drug-resistant TB go undetected. The agency hopes that the high diagnostic accuracy of rapid molecular tests, along with quick turnaround times, will lead to major improvements in the early detection of TB and drug-resistant TB.

"Ensuring that everyone can obtain a rapid and accurate diagnosis, followed by treatment according to the latest WHO guidelines, will save lives and reduce suffering," Tereza Kasaeva, director of the WHO Global TB Programme, said in a press release. "We call for rapid action and stakeholder support in ensuring these updates are rapidly implemented to enable access to the latest technologies and innovations."
Jul 7 WHO press release

Antibiotic stewardship interventions affect hospital in Oman

Originally published by CIDRAP News Jul 7

A series of antimicrobial stewardship (AMS) interventions by clinical pharmacists at a hospital in Oman had a significant clinical impact and helped reduce costs, researchers reported yesterday in the International Journal of Infectious Diseases.

The retrospective analysis of clinical pharmacists' (CPs') interventions at the 500-bed tertiary care hospital found that of the 828 interventions related to antimicrobial use in 2018, 62% involved intensive care unit patients, followed by patients admitted under medicine specialties (16%) and hematology/oncology patients (7%). The most common type of intervention was adjustment of the dosing regimen (42%), followed by deletion of the antimicrobial order (34%). The three antibiotics that most commonly required modification were meropenem, piperacillin/tazobactam, and vancomycin.

The most common type of clinical impact associated with the intervention was improving the efficacy of the treatment, which was reported in 45% of cases. Preventing unnecessary antimicrobial exposures was reported with 30%. Most of the interventions (64%) were graded as major. The projected net annual cost savings from the interventions, including cost reduction and cost avoidance, was US $193,320.

"We believe that our study not only demonstrates the important value of CPs in ID [infectious diseases] treatment, but also provides powerful evidence for policy/decision makers to consider the establishment of a formal AMS program at our institution," the study authors wrote.
Jul 6 Int J Infect Dis study