Lower- income nations lacked adequate protection for health workers during COVID-19

News brief

A survey study across seven low- and middle-income countries (LMICs) from late 2020 through 2021 reveals that that only 43% of healthcare facilities had sufficient personal protective equipment (PPE) stock to comply with the COVID-19 pandemic safety guidelines as defined by the World Health Organization (WHO). The study was published yesterday in PLOS One.

The phone-based survey included 1,554 health facilities in Bangladesh, Burkina Faso, Guinea, Nigeria, Guatemala, Liberia, and Malawi, conducted from August 2020 to December 2021. Participating facilities were asked to take stock of PPE on the survey date. Overall 21% of healthcare facilities were in urban locations, 7% were peri-urban, and 72% were rural.

Forty-six percent of facilities did not have respirators, and 16% did not have any gloves, the authors said. "PPE availability was notably low in Guinea, Bangladesh, and Nigeria, where fewer than 70% of health facilities have all the recommended PPE," the authors said. "The shortage was particularly severe for respirators and masks."

The WHO recommends six pieces of PPE to protect against COVID-19, including a medical mask, eye protection (goggles) or facial protection (face shield) to avoid contamination of mucous membranes; a clean, non-sterile, long-sleeved gown; and gloves. Those performing aerosolizing procedures should also wear respirators, such as N95 or FFP2s.

Only 61% had enough PPE for COVID treatment

However, in the LMICs surveyed the complete PPE set was available in only 64% of the health facilities, but, when the items were available, stocks were usually too low to supply all workers, the authors said. "Even when all items were available, healthcare workers treating COVID-19 suspected patients were reported to wear all the recommended equipment in only 61% of health facilities," they wrote.

The shortage was particularly severe for respirators and masks.

"While efforts were made to accelerate and enhance the production and dissemination of PPE globally, the availability of the equipment continued to require critical attention in many LMICs," the authors concluded.

Experts offer tips to combat rampant online COVID, other health misinformation

News brief

Mary Van Beusekom, MS

Information overload The US medical and public health communities should work together to combat online health misinformation through sustainable investments in media monitoring and counter messaging, according to a Harvard Medical School–led research team.

Their report, published today in the Annals of Internal Medicine, describes how to address untruths such as the social media rumors that undermined trust in science during the COVID-19 pandemic.

"Understanding the information ecosystem, social media networks, and the scope of incentives that drive users and social media platforms can provide critical insights for strong coordination between stakeholders and funders to address this challenge," the study authors wrote.

Much work, new challenges ahead

Early in the pandemic, one of the researchers helped develop the ThisIsOurShot and VacunateYa (TIOS-VY) national response to disinformation by educating medical professionals on sharing accurate health information and hosting digital events on social media.

After the COVID-19 vaccine rollout began in December 2020, more than 25,000 healthcare professionals hosted more than 500 digital events and shared vaccine-related selfies or videos on social media, generating more than 1.5 billion impressions.

"This jump-started their digital networks to engage in conversations about the COVID-19 vaccine experience and discuss the COVID-19 news of the day," the authors wrote.

This jump-started their digital networks to engage in conversations about the COVID-19 vaccine experience and discuss the COVID-19 news of the day.

TIOS-VY built a coalition of 60 healthcare professional and community organizations with more than 1 million member doctors, nurses, and pharmacists. By training more than 6,500 professionals during 52 training sessions over 18 months, TIOS-VY increased participants' average self-reported confidence in having effective COVID-19 conversations to 80%, up from 50% before training.

But the efforts weren't without challenges, including limited funding, scarce data on digital audiences, and online attacks on public health experts. And much work remains. Nearly 2 years after the pandemic began, 78% of adults said they either still believed or were unsure about one or more of eight untruths about COVID-19 or vaccines.

"Trust challenges will continue to increase as generative artificial intelligence tools are leveraged to create viral content that audiences will have trouble distinguishing from reality," the authors wrote.

ECDC reports spread of multidrug-resistant Shigella

News brief

Chris Dall, MA

Shigella illustration The European Centre for Disease Prevention and Control (ECDC) said today that more than 300 cases of shigellosis have been reported since April in Europe and the United States, most of them multidrug-resistant (MDR), with transmission seen primarily among men who have sex with men (MSM).

The cases are linked to seven national and international distinct microbiologic clusters of Shigella strains that show resistance to first- and second-line antibiotics, such as third-generation cephalosporins, fluoroquinolones, sulfamethoxazole, and trimethoprim. The ECDC says it's particularly concerned about strains with additional resistance to azithromycin, which are considered extensively drug-resistant (XDR) and difficult to treat.

Shigellosis is a gastrointestinal condition caused by Shigella bacteria. While the infection is commonly associated with exposure to contaminated food and water, oral and anal sex has become a major route of transmission, particularly among MSM. In February, the ECDC reported on an increase in XDR Shigella sonnei cases among networks of MSM in Europe.

Most of the cases have been recorded in 2022 and 2023, with cases reported in Belgium (26), Denmark (13), Germany (23), Ireland (50), the Netherlands (21), Spain (>60), and the United States (106).

The ECDC recommends that MSM practice safe sex, ensure good personal hygiene, and refrain from sexual activity if they develop gastrointestinal symptoms. The agency is also calling for increased awareness among clinicians and microbiologic laboratories of the international spread of MDR Shigella strains.

Chinese study finds high levels of resistance in gonorrhea

News brief

Chris Dall, MA

Gonorrhea bacteria in petri dish Gonorrhea infections in China are showing decreasing susceptibility to ceftriaxone along with high levels of resistance to other antibiotics, according to a study today in the Journal of Infectious Diseases.

To evaluate resistance trends in Neisseria gonorrhoeae infections in China, a team of Chinese researchers analyzed 463 isolates collected from Chinese men and women in 2021. They tested susceptibility to azithromycin, spectinomycin, penicillin, tetracycline, ciprofloxacin, ceftriaxone, and cefixime and conducted whole-genome sequencing (WGS) to assess resistance markers and sequence types.

High resistance to penicillin (75.2%), tetracycline (89.7%), and ciprofloxacin (98.3%) and decreased susceptibility to ceftriaxone (8.9%), cefixime (14.3%), and azithromycin (8.6%) were observed among the isolates. WGS revealed that sustained transmission of clones of a global N gonorrhoeae strain (FC428) that harbors mutations in the penA-60.001 gene appears to be driving resistance to ceftriaxone, which is the last remaining recommended first-line gonorrhea treatment in China and many other countries.

The sustained dissemination of multidrug-resistant penA-60.001 subclones in China in 2021 possibly threatens the effectiveness of ceftriaxone.

The study authors say the decreased susceptibility to ceftriaxone and cefixime (an oral antibiotic with similar in vitro activity to ceftriaxone) far exceeds what's been observed in other countries. Furthermore, they note, the high-level resistance to penicillin, tetracycline, and ciprofloxacin suggests those antibiotics should no longer be considered for first-line treatment.

"The sustained dissemination of multidrug-resistant penA-60.001 subclones in China in 2021 possibly threatens the effectiveness of ceftriaxone monotherapy," they write. "The strengthening of gonococcal surveillance in China would help quantify the true burden of the penA-60.001 mosaic strain, which also plays an important role in the development of prevention and control measures."

Florida reports more cases of malaria and dengue

News brief

Lisa Schnirring

In its latest weekly arbovirus report, the Florida Department of Health confirmed one more local malaria case as well as one more local dengue infection. The report covers mosquito-borne illness activity for the week ending July 15.

The malaria case involves a resident of Sarasota County, where the earlier locally acquired cases occurred. The new case lifts the number of local cases for the year to seven. Texas also reported a local malaria case this year, which involved someone from Cameron County.

Dengue cases rise to 3

Meanwhile, the dengue illness was in Miami-Dade County, raising the state's total for the year to three. The earlier two cases this year were in the same county.

Florida eliminated local dengue transmission in the 1930s but has reported sporadic infections, often from Miami-Dade County. Localized outbreaks in Key West occurred in 2009 and 2010.