COVID-19 Scan for Jul 13, 2021

News brief

Public health groups support mandatory COVID vaccines in healthcare

Today a consensus statement by several leading public health organizations and a commentary in the Annals of Internal Medicine voiced support for mandating COVID-19 vaccinations in US healthcare workers (HCWs).

The consensus statement, published in Infection Control & Hospital Epidemiology, was submitted by seven associations and societies, including the Society for Healthcare Epidemiology of America (SHEA), the Association for Professionals in Epidemiology and Infection Control (APIC), and the Infectious Diseases Society of America (IDSA), and it covered US COVID vaccines' real-world effectiveness data, clinical trial findings, and safety results.

The three COVID-19 vaccines under US emergency use authorization (EUA) have a high efficacy to prevent COVID-19 infection, an even higher efficacy against serious infection, and high effectiveness against COVID infection, the authors write. They also note that the vaccines (Moderna, Pfizer/BioNTech, and Johnson & Johnson) have good profiles.

"Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law," write the authors. "The consensus statement also supports COVID-19 vaccination of non-employees functioning at a healthcare facility (for example, students, contract workers, volunteers, etc.)."
Jul 13 Infect Control Hosp Epidemiol statement

The commentary frames the issue in the context of mandating flu vaccines, which some healthcare centers have been doing for almost 15 years. Not only is COVID-19 deadlier than the flu, it causes greater workplace and labor force disruptions and affected far more people in 2020 than the average yearly flu impact. Additionally, the authors add, all three COVID-19 vaccines under EUA in the United States have a higher vaccination effectiveness than the typical flu vaccine (70% to 95% vs 30% to 50%).

While healthcare organizations have taken care to protect workers, vaccines would provide continual protection without needing workplace or behavioral changes, the authors write.

They add, "We cannot rely on patients being vaccinated to prevent nosocomial transmission because some patients cannot get the vaccine, some will decline, and vaccine may not be effective in immunocompromised patients."
Jul 13 Ann Intern Med commentary

COVID-19 seroprevalence less than 20% in US dialysis patients

COVID seroprevalence at the beginning of 2021 was 18.9% in 21,464 US patients who received dialysis, or roughly a rise of 15 percentage points compared with July 2020, according to a study yesterday in JAMA Network Open.

The researchers looked at 21,464 patients who received dialysis from US Renal Care facilities in January, excluding people who had received COVID vaccinations. Less than one in five (18.4%) had COVID-19 antibodies, which translated to an 18.7% seroprevalence across the US dialysis population and 21.3% across the US adult population (95% confidence intervals, 18.1% to 19.2% and 20.3% to 22.3%, respectively).

Comparatively, in July 2020, unweighted seroprevalence was 4.4%, which translated to 4.7% in the US dialysis population and 5.4% in the general US population. The researchers also noted that in July seroprevalence was less uniformly spread across geographic areas and between urban and rural areas.

January 2021 dialysis patients were an average age of 63.1 years, with more than 49% 65 or older. More than half (57%) were men, and a disproportionate amount were of racial or ethnic minority (Hispanic, 18%; Black, 29%). In the unweighted sample, those who were 18 to 44 years old (25.9%), were Hispanic or lived in Hispanic neighborhoods (25.1%), or had the lowest income bracket (24.8%) had higher seroprevalence.

"The results suggest that, because these subpopulations overlap with people who express high levels of vaccine hesitancy in the US, vaccination campaigns may need to engage these high-risk groups to achieve sufficient penetration and reach community-level protection against SARS-CoV-2," the researchers write.
Jul 12 JAMA Netw Open study

News Scan for Jul 13, 2021

News brief

Study highlights limited access, financial challenges for new antibiotics

Patients in several high-income countries still have limited access to most of the new antibacterials approved since 2010, and as a result sales revenue for these drugs has been insufficient—findings that highlight the poor commercial prospects for new antibiotics, researchers reported yesterday in Clinical Infectious Diseases.

To better understand barriers to effective antibacterial therapy in high-income countries, the researchers examined patient access to new antibacterials in G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) and seven other high-income countries in Europe, looking at the commercial launch dates, the lag time between regulatory approval and commercial launch, and sales data. They included all new molecular entity antibiotics approved by either the US Food and Drug Administration, the European Medicines Agency (EMA), Health Canada, or the Japanese Pharmaceuticals and Medical Devices Agency from Jan 1, 2010, through Dec 31, 2019.

Of the 18 antibacterials identified (16 antibiotics and 2 products for Clostridioides difficile), the majority were accessible in only three countries (the United States, United Kingdom, and Sweden), and the remaining countries had access to less than half of them. Only 4 antibacterials were launched in the European countries studied, and only 2 were launched in all 14 countries. European marketing authorization did not lead to automatic European access, as only a few of the 14 antibacterials approved by the EMA were commercially launched. No significant difference in access between innovative and non-innovative products was observed.

Median annual sales in the first approval market (generally the United States) for all 18 drugs were $16.2 million. Sponsors of four of the antibacterials filed for bankruptcy following regulatory approval, and sponsors for three other drugs had market capitalizations less than $300 million.

"Mean sales of $16.2 million are insufficient to cover ongoing commercialization costs, including manufacturing, regulatory, medical affairs, and post-approval commitments, with no opportunity to recover sunk R&D [research and development] costs," the study authors wrote. "This economic situation explains why sponsors for seven of the eighteen products suffered either bankruptcy or market capitalizations below the sunk cost of R&D, with the bulk of this economic damage coming since April 2019."

The authors say the findings reinforce calls for new economic incentives that will delink profits for new antibiotics from unit sales.
Jul 12 Clin Infect Dis abstract

Point-prevalence study reveals high antibiotic use in Ghanaian hospitals

Point-prevalence surveys conducted in antimicrobial resistance (AMR) surveillance sentinel hospitals in Ghana found high levels of antibiotic use and empiric prescribing, researchers reported yesterday in JAC-Antimicrobial Resistance.

Overall prevalence of antibiotic use across the sentinel sites from September through December 2019 was 54.9% (1,591 out of 2,897 patients), ranging from 48.7% to 67.2%. The highest prevalence of antibiotic use was observed in adult intensive care units (89.3%). The average number of antibiotics per patient was 1.7, with 66% administered via the parenteral route, and 53.9% of patients received at least one antibiotic on the day of the survey.

Most antibiotics (52.2%) were used to treat infections, while 26.1% were for surgical prophylaxis and 13.7% had no documented indication. Of the 1,367 antibiotic prescriptions for treatment of infections, approximately 96% were prescribed empirically. Only 48.2% of the antibiotic prescriptions had a documented reason in the notes.

There were 35 different antibiotics prescribed across all hospitals. The five most commonly used antibiotics were metronidazole (20.6%), cefuroxime (12.9%), ceftriaxone (11.8%), amoxicillin/clavulanic acid (8.8%), and ciprofloxacin (7.8%).

"Such high antibiotic prescription rates in hospitals are fuelled by factors such as inadequate diagnostic microbiology services and differences in the organizational structures of hospitals," the study authors wrote. "Given the association between antimicrobial use and the selection of resistant pathogens, the high frequency of antimicrobial use in Ghana is a reflection of the AMR problem in the country."

The authors say the findings could be used as benchmarks for improving antibiotic prescribing.
Jul 12 JAC-Antimicrob Resist study