News Scan for Oct 14, 2020

News brief

Study finds no increased COVID-19 risk for childcare workers

In one of the first large-scale studies of COVID-19 transmission in US childcare programs, no association was found between day care exposure and COVID-19 transmission risk for providers.

The Pediatrics study analyzed online survey data from 57,335 childcare workers—identified through a variety of national childcare organization contact lists—who reported activity from Apr 1 to May 27. Participants indicated whether they tested positive or were hospitalized for COVID-19 as well as their level of exposure to childcare settings. The analysis included county-level COVID-19 data, median household income, and participants' personal health precautions.

In both unmatched and matched case-control analyses, no association was shown between COVID-19 outcome and exposure to care (unmatched odds ratio [OR], 1.06, 95% confidence interval [CI], 0.82 to 1.38, P = 0.66; matched OR, 0.94, 95% CI, 0.73 to 1.21, P = 0.64). Disease risk for childcare workers was associated with high levels of county-level cumulative per capita COVID-19 deaths (OR, 1.60, 95% CI, 1.19 to 2.15, P = 0.00).

Higher COVID-19 rates were reported for providers who identified as American Indian/Alaskan Native, African American/black, or Hispanic, but avoiding high-risk situations and travel was shown to be a protective factor. These factors were not associated with exposure to childcare, "suggesting a lack of association between child care exposure and COVID-19 outcomes regardless of these other factors," the authors conclude.

The authors recognize that increased infection mitigation practices—such as smaller groups, cohorting, distancing, symptom screening, handwashing, and disinfecting—early in the pandemic may have played a role in reducing transmission, and they caution that these findings should not be generalized to other educational settings with different environments and age-groups.

"Even after adjusting for other variables, community-level transmission remained a significant predictor of child care providers testing positive or being hospitalized for COVID-19, highlighting the importance of reopening child care programs only when background transmission rates are low and decreasing," the authors wrote.
Oct 1 Pediatrics study


COVID-19 conspiracies increase vaccine hesitancy, study shows

A Royal Society Open Science study yesterday found that small increases in receptivity to conspiracy theories equate to large increases in vaccine hesitancy, demonstrating a powerful effect of misinformation on pandemic health behaviors.

Scientists from the University of Cambridge conducted large, national surveys in the United Kingdom, United States, Ireland, Mexico, and Spain in April, asking participants to rate the reliability of statements and popular myths about COVID-19 on a seven-point scale from "very unreliable" to "very reliable," and to provide demographic data, information about political ideology, and other related information.

The scientists found that a one-unit increase in perceived reliability of misinformation was associated with a 23% drop in the participant's likelihood to get vaccinated (OR, 0.77; 95% confidence interval [CI], 0.72 to 0.83) and a 28% decrease in the odds that they would recommend vaccination for vulnerable friends and family (OR, 0.72; 95% CI, 0.67 to 0.78).

Notably, a large majority of people in all countries judged misinformation statements as unreliable, with a median score across all countries of 2.46 (standard deviation, 1.32), although certain conspiracy theories were rated as reliable by a significant percentage of participants in all nations.

The claim that the coronavirus was engineered in a Wuhan laboratory was embraced as reliable by 22% to 23% of participants in Britain and United States, 26% in Ireland, 33% in Mexico, and 37% in Spain. Conspiracy statements involving global vaccination plots were also rated as reliable by significant numbers of participants across all five nations.

Factors that increased the likelihood of susceptibility to misinformation included identification as more right-wing or politically conservative, younger age (except in Mexico), and trust in politicians to effectively tackle the crisis. Factors that reduced susceptibility to misinformation included scoring high on numeracy tasks and a declared high level of trust in scientists.

"Numeracy skills are the most significant predictor of resistance to misinformation that we found," said lead author Jon Roozenbeek, PhD, in a Cambridge University news release. "The fostering of numerical skills for sifting through online information could well be vital for curbing the 'infodemic' and promoting good public health behaviour."
Oct 14 R Soc Open Sci study
Oct 13 University of Cambridge news release


Plant-derived flu vaccine is non-inferior, studies show

A quadrivalent (four-strain) flu vaccine derived from the Nicotiana benthamiana plant, a relative of the tobacco plant, produces "non-inferior" results at minimum, according to the results of two phase 3 vaccine efficacy (VE) trials published in a Lancet study yesterday.

The first study found a 35.1% absolute VE (95% CI, 17.9% to 48.7%) for respiratory illness caused by matched strains in adults 16 to 64 years of age, and the second reported an 8.8% relative VE (95% CI, -16.7% to 28.7%) across all strains in adults 65 and older compared with a chicken egg–derived quadrivalent inactivated vaccine.

The researchers conducted their randomized, observer-blind studies in Northern Hemisphere locations across Europe, Asia, and North America. In the 18-to-64 study, researchers administered either the plant-derived vaccine or a placebo to 10,160 people during the 2017-18 flu season. Serious adverse events were comparable between the two groups, with 55 (1.1%) of the 5,064 who received the plant-derived vaccine experiencing a severe effect and 51 (1.0%) of the 5,072 in the placebo group experiencing one. While the 18-to-64 study produced suboptimal results—the target was 70%—the flu VE for that year in the United Kingdom was 15%.

As for the older-adult study, 12,794 adults 65 years of age or older either received the plant-derived vaccine or an egg-based vaccine during the 2018-19 flu season. Of this group, 263 (4.1%) and 266 (4.2%) experienced serious adverse events, respectively. In a Lancet commentary, John Tregoning, PhD, of Imperial College London, adds, "Notably, although the plant-derived vaccine was equally protective, it induced a lower antibody response, measured by haemagglutination inhibition and microneutralisation."
Oct 13 Lancet study
Oct 13 Lancet commentary


WHO: Some parts of world report slight flu upticks

It its latest update on the global flu situation, the World Health Organization (WHO) said some countries are reporting rising flu activity, but it added the caveat that current data should be interpreted with caution, owing to impacts on circulation and surveillance due to the COVID-19 pandemic.

Overall, flu is still at lower levels than expected for this time of the year in both hemispheres, but slight increases have been reported in Cambodia, Laos, a few Pacific islands, Afghanistan, and southern China.

Testing of respiratory samples at national labs that are part of the WHO surveillance network during the last half of September are still finding few samples that are positive for flu: only 99 positive tests of 50,521 specimens. Of the positive samples, 60.6% were influenza A, and of the subtyped influenza A viruses, all were H3N2.
Oct 12 WHO global flu update


LymeX, a $25 million public-private initiative, focuses on diagnoses

On Oct 10, the US Department of Health and Human Services (HHS) and the Steven & Alexandra Cohen Foundation announced the launch of LymeX, an initiative to improve diagnostics and patient care for tick-borne diseases such as Lyme disease. The $25 million partnership is the largest Lyme disease public-private partnership in history.

Inspired by Alexandra Cohen's personal experience with Lyme disease and the format of KidneyX—which includes innovation competitions—LymeX hopes to tackle tick-borne diseases by facilitating and supporting stakeholder engagement, education and awareness, and next-generation diagnostics.

The initiative does not replace or take away from other government programs focused on ticks or tick-borne disease, but it is the latest act that the federal government has taken in this area.

The Lyme Innovation Initiative, which LymeX is now a part of, was launched by HHS in 2018. Since then, other notable actions have included the Kay Hagan Tick Act and its $150 million in funding over 5 years, as well as President Donald Trump's request for an additional $58 million in funding for issues related to tick-borne diseases in the 2021 budget.
Oct 12 HHS press release

Stewardship / Resistance Scan for Oct 14, 2020

News brief

CARB-X taps Swiss company to develop antibiotic for Enterobacteriaceae

CARB-X announced today that it is awarding up to $2.62 million to Swiss biopharmaceutical company Polyphor AG to develop a new antibiotic to treat infections caused by Enterobacteriaceae, including carbapenem-resistant Enterobacteriaceae (CRE).

The antibiotic being developed by Polyphor is a thanatin-derivative peptide that targets the lipopolysaccharide transport protein in gram-negative bacteria to break down their outer membrane. The company says antibiotics in this class have shown potent and specific activity against Enterobacteriacea, including extremely drug-resistant strains like CRE.

"Polyphor's project enriches the pool of novel approaches to deliver a therapeutic that can treat infections caused by multidrug-resistant Gram-negative pathogens, for which only one new class since 1962 has been approved for use in patients," CARB-X research and development director Erin Duffy, PhD, said in a press release. "It is in the early stages of development, and if successful and approved, it could potentially change the way these life-threatening infections are treated and save lives."

This is the second CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) award for Polyphor. For today's award, the company will be eligible for an additional $15.82 million in funding if certain project milestones are met.

Since its launch in 2016, CARB-X has awarded more than $252 million to support early development of 70 antibacterial products.
Oct 14 CARB-X press release


Quality improvement program linked to reduce antibiotics in NICU

An initiative aimed at addressing gaps in antibiotic stewardship was associated with decreased antibiotic use and exposure in the neonatal intensive care unit (NICO) of a New York children's hospital, researchers reported today in Pediatrics.

The quality improvement (QI) initiative begun in 2016 at the Golisano Children's Hospital set out to decrease the antibiotic use rate (AUR) by 20% in the NICU by focusing on addressing gaps in the core elements of antibiotic stewardship programs outlined by the Centers for Disease Control and Prevention.

Strategies for reducing antibiotic use included data collection and analysis, audit and feedback on prescribing patterns, development of written guidelines for common infections, implementation of a sepsis risk calculator (SRC) to determine if evaluation for sepsis was warranted, and a focus on antibiotic use in preterm infants. The primary outcome measure was AUR, and the secondary outcome measure was the percentage of infants discharged without receiving antibiotics while in the NICU.

The monthly AUR decreased from 27.6% at baseline to 15.5%, a 43.8% reduction, and has been sustained for more than 18 months. The authors of the study attribute the decline to implementation of the SRC, adopting a 36-hour rule-out period for sepsis evaluations, a 36-hour antibiotic hard stop, and novel guidelines for early-onset sepsis (EOS) evaluation among infants  younger than 35 weeks.

The percentage of infants discharged without antibiotic exposure increased from 15.8% to 35.1%. The percent of infants younger than 36 weeks undergoing evaluation for EOS decreased by 42.3% and for those under 35 weeks by 26.0%.

"We believe our methods for achieving improvement, which involved a rich understanding of our current system, rigorous testing, standardization of practices, and analyzing data over time, are applicable to all teams focused on QI," the authors wrote.
Oct 14 Pediatrics abstract

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