News Scan for Jan 06, 2021

News brief

Policy brief shows support for antibiotic development incentives

Interviews with policymakers and antimicrobial resistance (AMR) experts from 13 countries indicate broad support for financial incentives to boost antibiotic development, despite uncertainty over which incentives are appropriate and how much they'll cost, according to a policy brief released yesterday by the European Union Joint Action Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI) and the Global AMR Research and Development Hub.

In the interviews, which were conducted to better understand perceptions of antibiotic development incentives and barriers to implementing them, 11 of 13 interviewees expressed high-level, general support for incentive programs. But before selecting a type of incentive, they said they prefer to wait for evidence from the three countries—United Kingdom, Germany, and Sweden—currently testing "pull incentives" models that aim to increase revenues for antibiotics while also ensuring access to them.

Experts from 9 of the 10 European countries said they would prefer a common, European or multinational incentive that's independent of national drug pricing and reimbursement plans.

Policymakers were also clear that incentives should apply only to antibiotics that meet public health needs, and that the public heath value must be demonstrated in clinical trials that test those antibiotics against multidrug-resistant infections.

In addition, 12 of 13 interviewees indicated that shortages of existing antibiotics is a problem in their countries, and 8 of 13 said shortages have resulted in greater use of broad-spectrum antibiotics.

"The results of these interviews point to a clear need for specific, detailed incentives that national policymakers can assess, tailor, and implement," the policy brief said. "These incentives must be designed with the aim of ensuring national access to important antibiotics that meet public health need."
Jan 5 EU-JAMRAI and Global AMR R&D Hub policy brief

Cell-derived flu vaccines offer higher efficacy than egg-derived, data show

The cell-derived inactivated quadrivalent (four-strain) influenza vaccine (ccIIV4) was 7.6% more effective than its egg-derived counterpart (eIIV4) during the 2018-19 US flu season, according to a study published yesterday in Clinical Infectious Diseases.

The researchers used primary medical records and medical claims data to create a retrospective cohort consisting of 2,125,430 people who received ccIV4 and 8,000,903 people who received eIIV4. Patients were 4 years and older. Overall, 1.6% of ccIIV4 recipients had a flu-related medical encounter, compared with 2.4% of those who received eIIV4.

After stratifying the data for age and adjusting for sex, race, ethnicity, geographic region, vaccination week, and health status, the investigators determined that ccIIV4 was 7.6% more effective than eIIV4 overall (adjusted value, post hoc, 95% confidence interval [CI], 6.5% to 8.6%). They also found that ccIIV4 was 3.9% to 7.5% more effective than eIIV4 in every age-group except those 65 and older. In that group, ccIV4 relative vaccine effectiveness was -2.2% (95% CI, -5.4 to 0.9), but the researchers noted that the results were not statistically significant and that this group is already prone to declining immunity with age.

"The propagation of influenza vaccine viruses in mammalian cells rather than embryonated chicken eggs eliminates the opportunities for adaptive viral mutations to occur [owing to the egg environment] and maintains viral antigenicity, which supports the improved effectiveness of ccIIV4 observed in this study," the researchers write.
Jan 5 Clin Infect Dis study

Study finds adjuvanted flu vaccine helps lower nursing home outbreaks

US nursing homes that gave their residents the adjuvanted trivalent (three-strain) influenza vaccine (aTIV) versus the standard trivalent influenza vaccine (TIV) had a 17% reduction in suspected or lab-confirmed flu outbreaks, according to a separate study published yesterday in Clinical Infectious Diseases. When covariates were accounted for, this reduction increased to 21% and 22% for suspected or lab-confirmed flu outbreaks, respectively.

Adjuvants are substances added to vaccines to boost the immune response.

The researchers randomized nursing home vaccinations during the 2016-17 flu season, with 387 facilities receiving aTIV and 390 receiving TIV. From November through March, residents who received aTIVs had a 6% reduction in hospitalization due to any cause and a 20% reduction in hospitalization due to pneumonia or influenza compared with those who received TIVs.

Overall, nursing homes that received aTIVS reported 148 suspected or confirmed flu outbreaks, whereas 302 suspected or confirmed outbreaks occurred in nursing homes that received TIVs. (The study did not look at outbreak scope.)

The researchers also found that flu outbreaks occurred more in facilities with cognitive impairment and dementia wards as well as those who used contracted staffing.

Because the 2016-17 flu season had a low vaccine effectiveness (20%), the researchers write, "The adjuvanted (MF59) vaccine may achieve a more robust immunogenic response through induced cellular or heterologous immunity. This may explain the superiority of aTIV versus TIV when vaccine effectiveness is low."
Jan 5 Clin Infect Dis study

COVID-19 Scan for Jan 06, 2021

News brief

Recovered COVID patients may have immune memory for up to 8 months

In a US study published today in Science, researchers detected immune memory to SARS-CoV-2 across all immune cell types studied for as long as 8 months after patients became ill with COVID-19.

In the study, a team led by researchers from the La Jolla Institute for Immunology in California analyzed levels of antibodies and other cells involved in immune response to the novel coronavirus in 254 specimens from 188 recovered adult COVID-19 patients, including 43 samples taken 6 months or more after infection.

Recruited from sites across the United States, study participants had a range of COVID-19 illness severity, from asymptomatic to severe, although most had mild cases. Of all participants, 93% were never hospitalized; of the 7% who were hospitalized, some required intensive care.

Concentrations of anti-spike protein immunoglobulin G (IgG), anti-nucleocapsid IgG, RBD IgG, and PSV neutralizing antibodies decayed slightly but remained relatively stable for more than 6 months, and spike-specific B cells were more abundant at 6 months than at 1 month after illness onset.

Concentrations of SARS-CoV-2–specific CD4+ and CD8+ T cells, which have been linked to more mild disease, waned to half their original concentrations by 3 to 5 months.

The authors noted that understanding immune memory of SARS-CoV-2 is important to improving diagnostic tests and vaccines and for predicting future pandemic activity. Noting that immune memory varies among recovered COVID-19 patients, they called for long-term studies to better understand these variations and what they mean in terms of immunity.

"Nevertheless, our data show immune memory in at least three immunological compartments was measurable in ~95% of subjects 5 to 8 months [after infection], indicating that durable immunity against secondary COVID-19 disease is a possibility in most individuals," the authors wrote.
Jan 6 Science study

Smoking tied to worsen COVID-19 symptoms, more hospitalization

Yesterday in Thorax, researchers used data collected from the British ZOE COVID Symptom Study App to show that smoking is tied to a worsening of COVID-19 symptoms and that smokers were more likely to be hospitalized for treatment.

Eleven percent of the 2.4 million participants of the symptom study self-identified as smokers, and 35% said they felt unwell in March and April of 2020. Those who said they were current smokers were 14% more likely to report three main symptoms of COVID-19—fever, persistent cough and shortness of breath—than were non-smokers.

Smokers were also twice as likely to be hospitalized for their infections. The trend for worsening disease in smokers follows other respiratory diseases, the authors said: Smokers are five times as likely to develop influenza and twice as likely to have pneumonia as non-smokers.

Overall, about 15% of the UK's population describe themselves as smokers.

"The present data suggest that smoking cessation should be considered as an element in strategies to address COVID-19, as smoking increases both the likelihood of symptomatic disease defined according to the presence of 'classic' symptoms of fever, cough and breathlessness and the severity of disease, defined based on the number of symptoms," the authors concluded.

In a King's College London news release today, senior author Dr. Mario Falchi said, "Some reports have suggested a protective effect of smoking on COVID-19 risk. However, studies in this area can easily be affected by biases in sampling, participation and response. Our results clearly show that smokers are at increased risk of suffering from a wider range of COVID-19 symptoms than non-smokers."
Jan 5 Thorax study
Jan 6 King's College news release