A Scottish study finds no link between COVID-19 vaccination or infection of pregnant women and major congenital anomalies in their babies.

The nationwide study, led by University of Edinburgh and Public Health Scotland researchers, was published late last week in Nature Communications.

The team analyzed the electronic health records of babies whose mothers had received the Pfizer/BioNTech (73.7%) or Moderna (7.9%) mRNA COVID-19 vaccine after Dec 8, 2020.

The May 2020 to April 2022 study aimed to identify any association between congenital anomalies (structural or functional abnormalities at birth) and maternal vaccination or SARS-CoV-2 infection from 6 weeks before conception to 20 weeks' gestation. All fetuses or babies had reached at least 12 weeks' gestation by the time of live birth, miscarriage, stillbirth, or abortion.

Findings provide reassurance

Among the 6,731 babies of vaccinated mothers, 153 (2.3%) had any anomaly, and 120 (1.8%) had a nongenetic anomaly. Of the 20,193 babies of unvaccinated women, 467 had any anomaly (2.3%), and 375 (1.9%) had a nongenetic anomaly.

Of the 1,574 babies of infected mothers, 32 (2.0%) had any anomaly, and 26 (1.7%) had a nongenetic anomaly. Of the 4,722 babies of uninfected mothers, 85 (1.8%) had any anomaly, and 72 (1.5%) had a nongenetic anomaly.

Vaccination remains the best way for women to protect themselves and their babies from the known risks of SARS-CoV-2.

Primary analyses identified no link between vaccination and any anomaly (adjusted odds ratio [aOR], 1.01) or nongenetic anomaly (aOR, 1.00) or between infection and any anomaly (aOR, 1.02) or nongenetic anomaly (aOR, 0.94).

When the exposure window was narrowed from conception to 10 weeks' gestation, there was still no link between vaccination or infection and anomalies.

"This supports current policy and clinical advice that vaccination can be given at any stage of pregnancy and to women planning to become pregnant, and that vaccination remains the best way for women to protect themselves and their babies from the known risks of SARS-CoV-2 infection in late pregnancy," the researchers wrote.

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) recently reported 12 more highly pathogenic H5N1 avian flu detections in mammals, including skunks, bears, a raccoon, and a red fox.

Most of the animals that tested positive were from West Coast states, including Oregon, Washington, and Alaska. Oregon reported the virus in six skunks and a raccoon. Washington reported the virus in a racoon, and Alaska confirmed H5N1 in a Kodiak bear on Kodiak Island.

Elsewhere, Nebraska reported the H5N1 strain in a grizzly bear from Scotts Bluff County. A Jan 5 report from the Scottsbluff Star Herald said a bear was among four animals at the Riverside Discovery Center that died from avian flu. The others were a cougar and two tigers. The report said the animals ate local geese that had been donated to the zoo.

Also, Montana reported the virus in a grizzly bear from Teton County and a red fox from Madison County. The reports lift the number of H5N1 detections in US mammals since April 2022 to 110.

Also, APHIS has reported a few more outbreaks in poultry in the first days of 2023, in Kansas, Missouri, and Oregon. The outbreaks in Missouri and Oregon involve backyard birds, while the Kansas outbreak affected a commercial game bird farm in Anderson County that houses 8,900 birds.

Since the H5N1 Eurasian virus was first detected in US poultry in February 2022, the virus has led to the loss of a record 57.8 million poultry across 47 states.

A point-prevalence study (PPS) found a high rate of antibiotic use in hospitals in Thailand, with more than a quarter of antibiotics used for infection prevention, researchers reported last week in JAC-Antimicrobial Resistance.

The cross-sectional survey, using the standardized World Health Organization PPS protocol, was conducted from March to May 2021 at 41 primary (11), secondary (19), and tertiary (11) hospitals in Thailand. Out of 8,958 inpatients, 4,745 (53%) received antibiotics on the survey date. The prevalence of antibiotic use ranged from 14.3% to 74.3% and increased according to the level of hospital (primary 49.4%, secondary 51.9%, and tertiary 55.0%). Antibiotic use was highest among inpatients aged 65 years and older (57.1%), followed by children (54.9%) and newborns (32.5%).

Overall, the top three commonly used antibiotics were third-generation cephalosporins (30.1%), first-generation cephalosporins (11.1%), and carbapenems (10.6%). Of the 6,619 antibiotics prescribed, 68.6% were used to treat infections (most commonly respiratory tract infections), 26.7% were used for surgical prophylaxis (infection prevention), and 4.7% for other or unknown indications. Of the patients who received antibiotics for prophylaxis, 70.3% received them for more than 1 day after surgery, which is considered inappropriate.

"In the context of uncertainties, evidence and practice guidelines can improve such inappropriate practices," the study authors wrote. "Prolonged surgical prophylaxis is not only ineffective for postoperative infections but it increases the risk of side effects and AMR [antimicrobial resistance]."

Prolonged surgical prophylaxis is not only ineffective for postoperative infections but it increases the risk of side effects and AMR.

The study authors note that the 53% prevalence rate is slightly higher than that found in a prior study conducted in Thailand in 2018 (51.5) and significantly higher than recent PPS studies reported in Eastern Europe (28%), North America (39%), and East and South Asia (39%).

"The findings from the study could be used as benchmarks for improving antibiotic prescription in the future," they concluded. 

An analysis of primary care antibiotic use in Burkina Faso and the Democratic Republic of the Congo (DRC) suggests that a high proportion of broad-spectrum antibiotic use could be replaced by narrower-spectrum or no antibiotic use, researchers reported late last week in The Lancet Infectious Diseases.

In a letter to the journal, researchers from Burkina Faso, the DRC, and Belgium said they conducted the study to evaluate whether the antibiotic use targets identified in the World Health Organization's (WHO's) AWaRE (Access, Watch, and Reserve) Antibiotic Book are realistic and achievable for low- and middle-income countries. The book recommends that 90% of infections requiring an antibiotic in primary healthcare can be treated with oral Access antibiotics rather than broad-spectrum Watch antibiotics, and that more than 50% of minor infections can be treated without antibiotics.

The WHO AWaRe Antibiotic Book has great potential to optimise antibiotic use in primary care.

Analyzing data from patient surveys after visits to primary healthcare centers and over-the-counter medicine stores, the researchers found that 638 (60%) of 1,062 patients in Burkina Faso and 297 (80%) of 371 patients in the DRC used antibiotics, of which 8% and 30% were Watch antibiotics. Of the Watch antibiotic prescriptions, 8% were for gastrointestinal complaints without diarrhea, 8% were for skin infections, and 6% were for bronchitis—conditions for which Watch antibiotics are not indicated.

If the AWaRE Antibiotic Book were adhered to, the researchers estimate that 69% of Watch antibiotic use in Burkina Faso and 75% of Watch antibiotic use in the DRC could be replaced by Access antibiotics or no antibiotics, which suggests that the 90% Access target is "theoretically attainable in both countries," they wrote.

"The WHO AWaRe Antibiotic Book has great potential to optimise antibiotic use in primary care, foremost when at once regulating or guiding over-the-counter dispensing of Watch antibiotics, and facilitating follow-up of patients' clinical evolution," the researchers concluded.