Moderna today reported positive interim results from a phase 1/2 trial of its mRNA combination vaccine against COVID and flu and said it would advance the vaccine, called mRNA 1083, to a phase 3 trial.

In a statement, the company said researchers evaluated the vaccine's safety and immunogenicity compared to a standard dose of Fluarix flu vaccine in adults ages 50 to 64 and to a the high-dose Fluzone vaccine in adults ages 65 to 79. For both age-groups, they compared mRNA 1083 to its Spikevax COVID booster.

Antibody titer levels for mRNA 1083 were similar to or greater than both of the flu vaccines. Also, neutralizing antibody titers were similar to the bivalent Spikevax booster. Local and systemic effects for mRNA 1083 were similar to Moderna's standalone COVID booster. No new safety concerns were noted compared to the COVID vaccine.

Moderna said it plans to start the phase 3 trial in 2023, with a goal of submitting the vaccine for regulatory approval in 2025.

Stephane Bancel, Moderna's chief executive officer, said combination vaccines offer an opportunity to streamline the experience for consumers and health providers and increase compliance with public health recommendations. "We are excited to move combination respiratory vaccines into Phase 3 development and look forward to partnering with public health officials to address the significant seasonal threat posed to people by these viruses," he said.

The European Centre for Disease Prevention and Control (ECDC) and the Public Health Agency of Sweden today released a 36-page after-action report on how decisions were made whether to keep schools open during the earlier pandemic months. According to an ECDC press release, the reviewers looked at how the policies were made, gauged their impact, and assembled detailed lessons on good practices and areas for improvement in future health emergencies.

The report focuses on the period of November 2020 to January 2021, a time when Sweden experienced a second wave that was much larger than its first. Sweden's policy was distance learning for secondary-school students and keeping in-person learning in place—alongside infection control measures for younger students, except when local outbreaks occurred.

Multiple stakeholders working with the national education agency and regional health officers collaborated on the advice for schools. Decisions were influenced by health outcomes and the broader impact on the public, the well-being of students, families, and school staff, and socioeconomic inequalities. The advice changed as new evidence emerged.

The review also identified data missing during guidance development, including data on children's perspectives and aggregated data on student absenteeism. It also identified guiding principles, including a focus on what was best for children, that adults are responsible for cutting the burden of disease spread, equal access for all students, and a priority to keep schools open.

Andrea Ammon, MD, MPH, ECDC's director, said the after-action report shows the complexity of decision-making around public health measures such as school closures that were designed to cut SARS-CoV-2 transmission but affected children, especially those from vulnerable groups.

"Pandemic preparedness plans everywhere should be updated to account for such complexities, through activities such as enhancing cross-sectoral coordination, developing strategies for communicating the rationale behind recommended measures and establishing approaches for listening to the affected stakeholders," she said.

A wastewater study in Australia suggests nursing homes could be a significant contributor to antimicrobial resistance (AMR), researchers reported yesterday in Microbiology Spectrum.

In the study, researchers from the University of South Australia collected wastewater samples from two residential aged care facilities (RACFs) and one retirement village in Adelaide. One of the RACFs had implemented an antimicrobial stewardship program 3 years prior to the study. The samples were collected at five different time points over 18 months (October 2019 to February 2021), and Escherichia coli were isolated and assessed for phenotypic and genotypic resistance. Whole-genome sequencing was conducted to identify resistance genes.

Higher incidence of AMR at one facility

Of the 93 antibiotic-resistant E coli isolates analyzed (58 from RACF 1, 27 from RACF 2, and 8 from the retirement village), 66.7% and 97.6% were resistant to ceftazidime and ciprofloxacin, respectively. In addition, high levels of resistance to trimethoprim-sulfamethoxazole (54.8%) and gentamicin (50.5%) were observed. A much higher incidence of resistance to cefepime (84.5%) and ceftazidime (98.3%) was found in RACF 1, while RACF 2 had higher levels of gentamicin resistance (66.7%).

Although all isolates analyzed in the study were resistant to at least one antibiotic, RACF 1— which did not have an antimicrobial stewardship program—also harbored a greater number of multidrug-resistant (MDR) E coli isolates, with 93.1% of isolates recovered from the facility shown to be resistant to at least three antibiotics, compared with 18.5% in RACF 2. Further analysis revealed the presence of the international high-risk E coli clone, ST131, and a higher prevalence of mobile resistance genes in RACF 1, as well.

The researchers say that while the study was limited to three sites and 300 residents, the findings suggest a wider problem, as inappropriate antibiotic use is known to be common in nursing homes.

"The results of this study highlight the need for ongoing surveillance of residential aged care facilities when it comes to medication use," lead study author Henrietta Venter, PhD, said in a university press release. "Given our ageing population, there is a crucial need to regularly monitor these facilities and mitigate the threat of AMR."