Study shows limitations of Jynneos vaccination centers during mpox outbreak

News brief

A new study in JAMA Network Open shows that availability of the two-dose Jynneos vaccine to protect against mpox was not widespread during last summer's outbreak, with only 17.1% of the US population living within 15 minutes of a vaccination site and 50% living more than an hour away.

During the first week of August 2022, the US Food and Drug Administration authorized emergency use of the smallpox/mpox vaccine Jynneos (made by Bavarian Nordic) in an effort to contain a growing international outbreak. To understand distribution patterns of the vaccine, the study authors reviewed individual state government websites about vaccination sites and contacted each state's department of public health to confirm the vaccination sites.

The authors found that by Aug 5, 2022, there were 247 designated vaccination sites in the 26 states and Washington, DC. Twenty-four states distributed vaccines on a case-by-case basis.

California had the most sites (28), but only Connecticut, Rhode Island, and Washington, DC, had sites within 45 minutes of all residents.

We found that there were significant racial disparities.

White people were also more likely than Black residents to live near vaccination sites: 46.5% of White people lived within 30 minutes of the nearest vaccination site, compared with 16.3% of Black people and 24.0% of Hispanic people.

"In the 5 states with the highest number of mpox cases, Black people consistently had worse geographic access compared with White and Hispanic people," the authors wrote. "We found that there were significant racial disparities in mpox vaccine access across the US."

White House to launch $5 billion program to improve COVID vaccines

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Vaccine vial in front of virusThe Biden administration is launching a $5 billion plan to speed the development of new COVID-19 vaccines and treatments, the Washington Post reported yesterday, citing top federal health officials. Called "Project Next Gen," the effort follows on the heels of "Operation Warp Speed," a Trump-era program that streamlined the development of COVID vaccines.

For vaccines, the goals include versions that can induce mucosal immunity, which could cut transmission risk, and a universal coronavirus vaccine that could help protect against SARS-CoV-2 variants or new coronavirus threats.

Several scientists are pushing for better coronavirus vaccines. In February, a group led by the Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, published a roadmap for advancing better coronavirus vaccines.

Biden signs bill ending national emergency

In other developments, President Joe Biden yesterday signed a bill to end the national emergency for COVID, which was first declared in March 2020, according to NBC News.

The Republican-led measure passed the House and Senate in January and March, respectively. Biden had signaled that he would end both the national emergency and a separate public health emergency on May 11 in an effort to wind down certain pandemic programs in an orderly fashion but said he wouldn't veto legislation.

The two actions have given the government more regulatory power and flexibility in its pandemic response. Examples of programs impacted by the national emergency are mortgage forbearance and Veterans Administration homecare visit evaluations for caregivers. Meanwhile, the public health emergency, for example, affects Medicare rules for keeping vulnerable people covered during the pandemic and has Southwest-border policy implications.

Kids' screen use rose amid COVID school closures, then fell but stayed elevated

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Teen boy asleep on bed with laptopCanadian researchers find that children's average weekday screen time rose an average of 1.35 hours during the first COVID-19 wave but then dropped during the second and third waves—although it remained higher than prepandemic levels.

For the study, researchers in Quebec, Alberta, and Ontario modeled mother-reported All Our Families survey results on children's screen time from 2018 and reports from mothers and children from the first three pandemic waves in spring 2020, winter 2021, and fall 2021.

Screen time was defined as the recreational use of a smart phone, tablet, or gaming or computer device outside of schoolwork on weekdays and weekends. Canadian schools were closed only during wave 1.

Participants included 2,123 mothers and 1,288 children with an average age of 7.9, 9.7, 10.4, and 11.1 years prepandemic and during waves 1, 2, and 3, respectively.

Weekend screen use didn't change much

According to mothers, children used screens for 1.35 more hours on weekdays during the pandemic wave 1 than before. During wave 2, mothers and children reported fewer average hours of screen time than during wave 1, with mothers reporting a larger drop than children (-1.06 vs -0.55 hours). Screen use didn't differ significantly between waves 2 and 3 but remained higher than prepandemic.

Weekend daily screen time didn't change significantly among waves, but the rise reported by both mothers and children, when averaged, was significant (0.14 and 0.18, respectively). Relative to weekdays, weekend screen time didn't differ significantly from prepandemic to the first wave, and reports didn't differ significantly between mothers and children.

The researchers noted that screen-time reports differed significantly between mothers and children once schools reopened. "If children are the best informants of their screen time, as they often are for their mental health, mothers may have underestimated daily weekday screen time or schools may have allowed more screen time when in-person learning resumed," they wrote.

Highly resistant Pseudomonas strains found in Nigerian hospitals

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Multidrug-resistant Pseudomonas aeruginosaA study conducted in three Nigerian hospitals found that nearly half of Pseudomonas aeruginosa isolates were resistant to all antibiotics tested, researchers reported yesterday in JAC-Antimicrobial Resistance.

In the study, a team of researchers from Nigeria and Germany conducted whole-genome sequencing and antibiotic susceptibility testing on strains of P aeruginosa isolated from wounds (88 isolates), urine/catheter tips (25), sputum/tracheotomy aspirates (5), ear swabs (4), and vaginal swabs (1). The aim of the study was to determine the antibiotic susceptibility patterns of P aeruginosa, which is typically resistant to multiple antibiotics, and identify antimicrobial resistance genes. The researchers were particularly interested in carbapenemase genes, since carbapenem resistance can severely limit the treatment options for P aeruginosa infections.

Of the 123 isolates analyzed, 43% were resistant to all five antibiotic classes tested (penicillins, cephalosporins, carbapenems, aminoglycosides, and fluoroquinolones), 44% were resistant to imipenem, and 39% were resistant to imipenem. Among the meropenem-resistant isolates, 89% carried at least on carbapenemase gene. The most prominent carbapenemase gene was blaNDM-1, which conferred resistance to all five antibiotic classes and increased the minimum inhibitory concentrations from meropenem and imipenem.

The exceptional prevalence of carbapenemases, particularly blaNDM-1, in Nigerian hospitals highlights the global rise in carbapenem resistance mediated by carbapenemases.

The study authors note that the isolate were from secondary and tertiary hospitals, which tend to have a larger proportion of patients with severe infections that require increased carbapenem use, resulting in increased selection for carbapenem-resistant bacteria. Nonetheless, they say the results suggest antibiotic resistance in hospitals in western Africa is increasing and needs to be addressed.

"The exceptional prevalence of carbapenemases, particularly blaNDM-1, in Nigerian hospitals highlights the global rise in carbapenem resistance mediated by carbapenemases and emphasizes the necessity of limiting the continuing spread of antimicrobial resistance," they wrote. "This can be achieved by controlling and reducing antibiotic use in agriculture, by adequate wastewater treatment, and by implementing routine susceptibility testing, antibiotic stewardship programmes, and improved hygiene measures in hospitals to limit the application of last-resort antibiotics and the spread of highly resistant bacteria."

Equatorial Guinea reports another Marburg virus case

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Equatorial Guinea's health ministry today on Twitter reported 1 more Marburg virus case, raising the outbreak total to 15 confirmed cases. Officials also reported 1 more death, putting the fatality count at 11.

Currently, no patients are hospitalized, and health officials are monitoring 385 contacts, down from 604 a week ago.

The outbreak—the country's first—began in January. In the early part of the outbreak, 20 probable cases were reported, all of them fatal.

Confirmed cases have been reported from four districts, raising concerns about more widespread transmission. At least eight cases are from the city of Bata, a port city with a population of roughly 173,000.

Tanzania is also battling its first Marburg virus outbreak. Marburg virus is a close cousin of Ebola virus. Like Ebola, Marburg spreads through the body fluids of infected patients. It has a case-fatality rate as high as 88%. So far, there are no approved vaccines or treatments.

Quick takes: H3N8 avian flu risk, meningitis in Togo, Michigan blastomycosis outbreak

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  • The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) have both weighed in on a human H3N8 avian flu case reported in late March by Chinese health officials. The case is China's third involving the strain, and earlier reports had said the 56-year-old woman from Guangdong province had contact with poultry. The WHO said she became ill on Feb 22 and died on Mar 16. The WHO said risk of spread is low, but more information is needed on the source of the virus and how it is related to other H3N8 viruses in animals. The CDC added that H3N8 viruses from another lineage have been detected in US wild birds and mammals in the past, including an 2011 outbreak in New England harbor seals.
  • Togo is grappling with its first pneumococcal meningitis outbreak, which began in mid-December and has resulted in 141 cases, 12 fatal, the WHO said today. Nearly half the cases are in children and young adults. The WHO said the risk to Togo, which is in Africa's meningitis belt, is high, especially amid the country's security crisis and lack of a strong surveillance system.
  • County health officials in Michigan's Upper Peninsula recently announced that they are investigating a blastomycosis outbreak linked to a paper mill in Escanaba, with 19 cases of the fungal illness confirmed so far, along with 74 probable cases. So far, the source of the fungus hasn't been identified. The fungus that causes blastomycosis grows in moist soil and decomposing matter such as wood and leaves. People contract the fungus by inhaling spores. It does not spread from person to person.

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