Study finds mass azithromycin distribution reduces childhood mortality in Africa

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Young African children — poco_bw / iStock

A review and meta-analysis of five randomized controlled trials (RCTs) indicates that mass biannual azithromycin distribution significantly reduces mortality in children ages 1 to 5 years in high-mortality settings, researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.

The five RCTs were conducted in five countries in sub-Saharan Africa (Burkina Faso, Ethiopia, Malawi, Niger, and Tanzania) and included a total of 691,235 children who were randomized to receive biannual single-dose mass distribution of azithromycin (MDA-azithromycin) or placebo.

MDA-azithromycin was recommended by the World Health Organization for children ages 1 to 11 months in high-mortality settings in sub-Saharan Africa in 2020 based in part on the results of one of the RCTs (the 2018 MORDOR trial), but subsequent RCTs have found the impact on mortality is bigger when all children under 5 in such settings receive the antibiotic.

In the analysis of mortality among children ages 1 and younger in the RCTs, researchers from the All India Institute of Medical Sciences found that MDA-azithromycin group had a mortality rate of 2.20%, compared with 2.51% in the placebo group, representing a non-significant mortality reduction of 10% (relative risk [RR], 0.90; 95% confidence interval [CI], 0.78 to 1.04). Trial sequential analysis (TSA) indicated inconclusive evidence.

Significant mortality reduction in older children

But in the four studies that provided data on children ages 12 to 59 months, the analysis found a mortality rate of 1.72% in the MDA-azithromycin group, versus 2.04% in the placebo group, for a statistically significant 15% reduction in mortality (RR, 0.85; 95% CI, 0.79 to 0.91), with TSA confirming sufficient evidence.

Although adverse events were rare, data on antimicrobial resistance, which has been one of the concerns with MDA-azithromycin, were limited.

"The significant mortality reduction observed in children aged 12–59 months positions MDA-azithromycin as a potentially valuable tool in high-mortality settings, especially in sub-Saharan Africa," the study authors wrote. "However, the findings raise critical considerations, particularly regarding age-specific targeting, as the greater efficacy observed in older children suggests prioritizing this group for MDA campaigns while continuing research into interventions for younger infants."

UK’s first annual infectious disease trend report shows RSV vaccination benefits

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Lisa Schnirring

The United Kingdom’s Health Security Agency (HSA) yesterday published it first annual report on infectious disease trends, which weaves together data from 2023 through early 2025 and reveals that infectious diseases were responsible for 20% of hospital bed usage and had an annual cost of 6 billion pounds ($7.7 billion).

vaccinated senior — *EvgeniyShkolenko/iStock*

They said a number of infectious diseases rose, especially endemic and vaccine-preventable ones, but they acknowledged that social mixing and a return to international travel following the pandemic period contributed to the patterns.

The UK just had an intense flu and respiratory syncytial virus (RSV) season for the second year in a row, but health officials saw promising signs from the introduction of RSV vaccine in seniors and pregnant women, which is easing some of the winter pressure on health systems. Officials also presented new information on the impact of RSV vaccination in seniors, which showed a 30% drop in hospitalizations this winter in people ages 75 to 79 years old.

COVID transmission remained at baseline during the winter, with the vaccine about 45% effective against hospitalization and uptake in the older age-group at 60% to 70%. “Vaccination of priority groups, in particular the elderly, remained an important intervention to protect against severe disease,” the HSA said.

Worrisome rises in TB, measles, and pertussis

Tuberculosis cases increased 11% in 2023 compared to the previous year, and initial data for 2024 show an additional increase of 13%, a pattern it says puts the UK at risk of losing its low-incidence status as defined by the World Health Organization.

Officials also noted a surge in measles cases in children younger than 10 years and pertussis (whooping cough) outbreaks, both in 2024. There were 433 pertussis cases in infants younger than 3 months old, 10 of them fatal.

Meta-analysis adds to emerging evidence tying HPV to cardiovascular disease

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Mary Van Beusekom, MS

Illustration of heart in body — *Rasi Bhadramani / iStock*

Human papillomavirus (HPV) is most often associated with causing different types of cancer, but a meta-analysis being presented on March 31 at the American College of Cardiology’s (ACC's) Annual Scientific Session in Chicago suggests that it also poses a significant risk of cardiovascular disease.

For the UConn-led review, researchers analyzed 7 studies conducted from 2011 to 2024 that included the HPV status and cardiovascular outcomes of 249,366 patients over follow-up times of 3 to 17 years. Most were retrospective and longitudinal cohort studies, 3 each were from the United States and South Korea, and 1 each was from Brazil and Australia.

The researchers examined the relationship between HPV and cardiovascular disease, coronary artery disease, and high blood pressure in pooled study cohorts. Some analyses adjusted for potential confounding factors such as smoking and diabetes.

HPV is a sexually transmitted infection that can cause genital warts and cancers of the cervix, other reproductive organs, and the throat.

40% higher risk of cardiovascular disease

Relative to HPV-negative participants, HPV patients had a 40% higher risk of cardiovascular disease and twice the risk of coronary artery disease, but no increased rate of high blood pressure. After adjusting for factors such as sociodemographics, medical history, lifestyle, family history, and use of blood pressure–lowering drugs, HPV patients had a 33% higher risk of cardiovascular disease.

We always talk about cardiovascular risk factors like smoking, high blood pressure and so on, but we know that about 20% of cardiovascular disease cannot be explained by these conventional risk factors.

Stephen Akinfenwa, MD

"The biological mechanism has not been determined but is hypothesized to be related to chronic inflammation," lead author Stephen Akinfenwa, MD, of UConn, said in the ACC press release. "We would ultimately like to see if reducing HPV via vaccination could reduce cardiovascular risk."

Akinfenwa said clinicians should closely monitor HPV patients' hearts. "We always talk about cardiovascular risk factors like smoking, high blood pressure and so on, but we know that about 20% of cardiovascular disease cannot be explained by these conventional risk factors," he said.

The US Centers for Disease Control and Prevention recommends the HPV vaccine for all children, but many adults haven't been vaccinated because they were past the age to receive it when it debuted in 2006.