In a clinical cohort study, only 31.9% of high-risk adult COVID-19 outpatients were prescribed an antiviral drug, which the researchers said underscores the need to identify and reduce treatment barriers.

A team led by scientists from the California genomics firm Helix analyzed electronic health records from two healthcare systems in Minnesota and Nevada to determine prescribing patterns of nirmatrelvir-ritonavir (Paxlovid), molnupiravir, and remdesivir among 3,247 high-risk COVID-19 patients from April 2022 to June 2023.

The findings were published yesterday in Clinical Infectious Diseases.

Prescribing rose slightly in 2023

In total, 31.9% of patients were prescribed a COVID-19 antiviral, the most common of which was Paxlovid (87.6%), followed by molnupiravir (11.9%) and remdesivir (0.5%). The vast majority of patients were given their prescription on either the day they tested positive (30.3%) or the day after (56.3%).

The prescribing rate rose slightly over time, from 28.0% in 2022 to 34.6% in 2023. The proportion of patients with underlying conditions prescribed an antiviral was 32.2% to 42.6%. The percentage of patients with Charlson Comorbidity Index (CCI) scores of 1, 2, 3-4, and greater than 5 was 26.2% to 45.5%.

There is a need to identify and address treatment barriers and raise awareness and understanding among providers and patients around oral antiviral eligibility, prescribing considerations, and proven benefits.

Antiviral prescribing rates were similar for adults aged 65 and older (39.6%), including those with chronic lung disease (39.8%) or a weakened immune system (43.0%). Of the 1,732 patients (53.3%) with symptoms, prescribing was not meaningfully different overall (35.4% vs 27.9%) among asymptomatic patients or those 65 and older (42.6%).

Ages 50 to 64 years and 65 and older (vs 18 to 49); asthma, diabetes, obesity; and CCI values of 1, 2, or 3-4 (vs 0) were significantly tied to a higher likelihood of prescription. Conversely, unvaccinated status (vs vaccinated 0 to 5 months earlier) and having an emergency department or laboratory-only (vs outpatient) visit or chronic kidney disease were significantly linked to lower chances of prescription.

"There is a need to identify and address treatment barriers and raise awareness and understanding among providers and patients around oral antiviral eligibility, prescribing considerations, and proven benefits," the authors wrote.

New Jersey meat processor Fratelli Beretta USA has recalled about 11,000 pounds of its Busseto Food brand ready-to-eat charcuterie products after the Minnesota Department of Agriculture detected Salmonella in a product sample.

In a recall notice, the US Department of Agriculture (USDA) Food Safety Inspection Service (FSIS) said it is working with the Centers for Disease Control and Prevention and state health partners to investigate a multistate Salmonella outbreak. The positive sample that Minnesota officials found came from an unopened product sample as part of an illness investigation.

More cases likely

On January 2, the Minnesota Department of Health (MDH) said one Minnesotan got sick in December after eating a Busseto brand charcuterie sample bought at Sam's Club. The patient wasn't hospitalized. The MDH said that, since many patients infected with Salmonella don't seek medical care, the number of affected people is likely to be higher.

The FSIS recall notice said the sampler pack was produced on October 30, 2023, and was sold as a twin-pack containing two 9-ounce trays containing prosciutto, sweet sopressata, and dry coppa with the lot code L075330300 and best-if-used-by date of April 27, 2024.

Products subject to the recall were shipped to Sam's Club distribution centers in eight states: Georgia, Illinois, Indiana, Minnesota, North Carolina, Ohio, Oklahoma, and Texas. The FSIS said it is concerned that the products may still be in customer's refrigerators. It urged people not to consume them and to throw the products away or return them to the place of purchase.

The city of Dourados in Brazil's Mato Grosso del Sul state yesterday became the country's first to launch a mass dengue vaccination campaign.

In a prefecture statement today, officials said 537 doses were given on the first day of the campaign, which was developed by the municipal health department in a partnership with Takeda, which produces the Qdenga vaccine.

Targeting 150,000 people between ages 4 and 59 years old, the dengue vaccine will be administered in two doses, 3 months apart.

Prefecture health secretary Waldno Lucena, MD, said, "Dourados has been an example for the entire country, vaccination strengthens individual defenses and also contributes to building a collective barrier against the spread of dengue."

Newly approved vaccine

Brazilian drug regulators approved the Takeda vaccine in March 2023. The live attenuated vaccine, given subcutaneously, is built on a serotype 2 backbone and targets all four dengue serotypes.

The Americas region experienced record dengue activity in 2023, with Brazil the hardest-hit country, with more than 2.9 million cases. The World Health Organization last month noted a marked rise in dengue activity over the past two decades and warned that multiple factors could fuel further rises, including vector distribution changes, climate change, El Nino weather pattern consequences, and fragile healthcare systems.

A new report by British members of parliament (MPs) is calling on the UK government to address issues hampering research and development of bacteriophage therapy.

Interest in phages, which are viruses that target and kill bacteria, has grown in recent years amid the global rise in antimicrobial resistance (AMR) and the weak pipeline for new antibiotics. But the report from the House of Commons Science, Innovation and Technology Committee says their potential as a treatment for drug-resistant infections in the United Kingdom can't be fully realized, because most UK and imported phages have not been manufactured to meet the required Good Manufacturing Process (GMP) standards and therefore can't be used in clinical trials or compassionate use cases.

The committee says this issue has hindered attempts to conduct research of phage safety and efficacy, develop phage infrastructure, and integrate phage therapy into the UK health system.

To address the problem, the report says the UK Department for Health and Social Care (DHSC) should bring together funders and innovation centers to build a GMP facility that can be used by phage researchers and developers.

"Such research could harness the UK's genomic research prowess and artificial intelligence to match phages to bacteria and allow manipulation to increase effectiveness," the committee wrote.

Until then, the committee argues that the government should allow compassionate use of non-GMP phages produced in the UK for last-resort medical cases.

Defining the role of phage therapy

The report, which is based on interviews and written evidence submitted by phage researchers and AMR experts, also calls for a dialogue between phage researchers, DHSC, and other UK health agencies on what specific evidence is needed to fully assess the safety and efficacy of phages; identification of bottlenecks for phage transitional research; an annual report on the progress made in all phage-related technologies; inclusion of information about the clinical use of phages within medical training; and guidance on how phages will be regulated.

"More broadly, the Government should produce a clear statement on the role that phages could play in fighting AMR and how they will be supported," the report states.