News Scan for Jul 23, 2020

Primary care antibiotic stewardship in UK
;
High parental HPV vaccine hesitancy

Survey shows increase in stewardship programs in English primary care

A 2019 survey of clinical commissioning groups in England showed an increase in antimicrobial stewardship (AMS) programs compared with the previous survey, according to a report yesterday from UK nonprofit The Patients Association.

The group sent freedom-of-information requests with a range of questions about AMS programs to all clinical commissioning groups, which are groups of primary care practices in an area that come together to commission the best services for their population, in England. A previous survey had been conducted in 2016, and progress was judged by comparing the results. Out of 191 clinical commissioning groups that received the survey, a total of 107 responded.

About 79% reported having an AMS program for more than a year, an increase of 19% from the 2016 survey, and only 17% said they did not have a named individual responsible for implementation of their program, down from 33% in 2016. In addition, 64% of respondents said they were currently achieving their antibiotics reduction target, and the number of respondents who reported implementing the full TARGET (Treating Antibiotics Responsibly, Guidance, Education, Tools) toolkit more than doubled compared with 2016.

But only 5% said they had a protected budget for AMS programs, only 15% reported using point-of-care diagnostic tests to determine whether antibiotics were necessary, and 73% said that they could do more to achieve the aims of their AMS programs.

"While good progress has been made, more needs to be done," the report said.

Recommendations include improved metrics and targets, more research into geographic disparities in antibiotic prescribing rates, establishment of dedicated funding, and a better understanding of barriers to point-of-care testing.
Jul 22 Patients Association report

 

Nearly 60% of US parents say they won't vaccinate their kids against HPV

Nearly 60% of the parents of about 4.3 million US children don't intend to have them vaccinated against the highly infectious and sexually transmitted human papillomavirus (HPV), according to survey results published earlier this week in The Lancet Public Health.

Researchers at the University of Texas at Houston analyzed the data of parents of 82,297 children 13 to 17 years old from the 2017-18 National Immunization Study. They found even higher vaccine hesitancy rates (higher than 65%) in Idaho, Kansas, Michigan, Montana, Nebraska, North Dakota, Oklahoma, and Utah.

The authors said that the vaccine hesitancy is troubling because improving HPV vaccination coverage is the only way to stem rising numbers of certain preventable cancers. HPV, which is associated with 34,800 new cancer cases a year, causes more than 90% of all cervical and anal cancers, 60% of penile cancers, and about 70% of all oral cancers.

The HPV vaccine is given in a Centers for Disease Control and Prevention–recommended series of two doses for children who received the first dose before age 15 years or three doses for those starting the regimen at ages 16 to 26. But only about 51.1% of teens are fully vaccinated.

The investigators also found that parents of one in four teens who received their first HPV vaccine dose said they would not complete the series, including more than 30% of parents in Arkansas, Florida, Georgia, Hawaii, Idaho, Utah, and West Virginia. The reason given by 18% of parents was that their healthcare provider didn't tell them a second dose was needed, while about 15% cited safety concerns.

In a commentary in the same journal, Robert Bednarczyk, PhD, of Emory University, said it's important for providers to educate and to anticipate issues that parents might bring up and be ready to debunk any misinformation.

"These direct steps could potentially increase intention to vaccinate for parents of approximately 2 million adolescents in the USA, which would translate to a 10% increase in vaccine coverage for adolescents aged 13–17 years," he said. "The tools are available, they just need to be widely accepted and implemented by health-care providers."
Jul 21 Lancet Public Health study and commentary

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