Increased COVID vaccination in nursing home staff cut cases, deaths

News brief

A study of 15,042 US nursing homes found that before the Omicron variant wave, an increase in staff COVID-19 vaccination with the primary series resulted in fewer cases among residents and staff and fewer deaths in residents. Researchers from the University of Chicago detailed their findings today in JAMA Network Open.

They note that so far, 2.16 million cases have been reported in nursing home residents and staff, with nearly 155,000 of them fatal. Though nursing home settings were prioritized for the first doses of the vaccine, uptake was lower in staff than in residents. Data on the effectiveness of a federal mandate has been weak, and the researchers note that more information is needed to guide ongoing policies on staff vaccination.

For their longitudinal cohort study, the team looked at data on COVID-19 outcomes in Medicare- and Medicaid-certified nursing homes between May 30, 2021, and Jan 30, 2022. The facilities covered in the study report COVID-19 data to the Centers for Disease Control and Prevention and passed data quality checks as part of the National Healthcare Safety Network.

Their analysis revealed that before the Omicron period, increasing weekly staff vaccination rates by 10 percentage points was associated with 0.13 fewer weekly COVID-19 cases per 1,000 residents, 0.02 fewer weekly deaths per 1,000 residents, and 0.03 fewer weekly staff cases. However, when they looked at just the period that included the Omicron wave, they didn't see a link between increasing staff vaccination rates and fewer adverse outcomes.

Though the original vaccine campaign in nursing homes brought down cases and deaths, and the vaccine mandate lifted vaccination levels, policies going forward cannot remain stagnant and should evolve to include additional booster doses, the group said. "As the pandemic evolves, staff vaccination mandates need to evolve as well," they wrote.

China publishes new national action plan to combat antimicrobial resistance

News brief

Amid high levels of resistance to priority pathogens and limited treatment options in China's hospitals, the Chinese government has published its new plan to fight antimicrobial resistance (AMR).

Announced in October, the National Action Plan for Combating Antimicrobial Resistance (2022-2025) was developed by China's National Health Commission and focuses on "the need to effectively control major pathogens of human and animal origin and gives new annual targets and more detailed indicators for combating AMR," officials with China's Ministry of Health wrote yesterday in the Journal of Antimicrobial Chemotherapy.

Ever since the MCR-1 gene, which confers resistance to the last-resort antibiotic colistin, emerged from China in 2016, public health experts have been concerned about widespread antibiotic use and high levels of AMR in China. That concern is underscored by 2021 data from the China Antimicrobial Surveillance Network, which show the resistance rates of meropenem-resistant Klebsiella pneumoniae, meropenem-resistant Pseudomonas aeruginosa, and meropenem-resistant Acinetobacter baumannii were 24.4%, 18.9%, and 72.3%, respectively.

"In China, few antimicrobial agents are available for treating infections caused by a carbapenem-resistant organism," the officials wrote.

Key objectives

The five key objectives of the plan, which build on targeted efforts developed under China's first national action plan, include slowing the emergence of resistant organisms and preventing the spread of resistant infections; strengthening the national health surveillance network that monitors AMR; accelerating basic and applied research and development for new antibiotics, vaccines, and diagnostics; establishing national reference laboratory performance standards for antimicrobial susceptibility; and improving international collaboration and capacities for AMR prevention, surveillance, and control.

The creation of national AMR action plans was an important element of the global action plan put forward by the World Health Organization (WHO) in 2015 to address the emerging AMR crisis. A 2021 survey from the WHO showed that 86% of responding countries had developed multisectoral national AMR action plans, but only 20% were actively monitoring implementation of those plans.

Study details SARS-CoV-2 seroprevalence patterns in children

News brief

A meta-analysis of SARS-CoV-2 seroprevalence studies in kids found that at that start of the Omicron surge, 50% to 70% of children were still susceptible and that levels of earlier infection were higher in lower-income countries and in ethnic minority groups. An international research team published their findings yesterday in eClinicalMedicine.

The researchers wrote that it's important to look at patterns of seroprevalence in kids, which are the most undervaccinated group, with greater numbers needing critical care in the wake of the Omicron variant. For their study, they included 247 studies that included 757,075 children across 70 countries. They pointed out that only two of the studies included samples from early 2022, which doesn't adequately cover Omicron waves.

The team found that seroprevalence increased over time and varied by geographic region. Their seroprevalence estimate averaged 7.3% for the first COVID-19 wave, 37.6% for the fifth wave, and 56.6% for the sixth wave. They found no sex difference in the risk of contracting the virus.

The highest seroprevalence levels were among children in South East Asia and Africa regions, with the lowest in the Western Pacific region. Estimates were higher in older children, those in lower-income countries, and those in ethnic minority groups. For example, Hispanic children had a higher risk of infection than White children.

"Considering the highly contagious nature of the new SARS-CoV-2 variants, developing a new generation of vaccines that is effective against a wide range of variants and expanding vaccine coverage for children and adolescents must be a priority, particularly for those in underprivileged settings and those with minority ethnic backgrounds," the group wrote.

This week's top reads