UK study finds CRP tests tied to lower antibiotic prescribing for cough
The use of point-of-care C-reactive protein (CRP) tests in primary care practices reduced the odds of prescribing antibiotics for cough by 21%, a non-significant but clinically relevant reduction, researchers reported yesterday in Eurosurveillance.
Using a pragmatic randomized controlled trial design, researchers from Public Health England allocated the top 19 antibiotic prescribing general practices in Northern England to an intervention group that used CRP point-of-care tests (POCTs) for patients who had symptoms of acute cough, and a control group using standard practice. The eight practices allocated to the intervention arm, with a patient population of 47,000, were given a CRP-POCT machine and 100 CRP tests to use over 6 months.
The primary objective of the study was to determine if the intervention practices had reduced odds of prescribing for lower respiratory tract infection, acute cough, bronchitis, and chest infection. The researchers also evaluated patient satisfaction questionnaires.
The eight practices undertook 268 CRP tests over 6 months. A strong majority of CRP results (78%; 209 of 268) indicated no infection, and management of these patients mainly followed National Institute for Health and Care Excellence (NICE) guidance for self-care and no antibiotics (90%; 188/209). But only 12 (22%) of 54 CRP results that indicated a delayed antibiotic should be considered were managed in line with NICE guidance.
Patients reported that CRP testing was comfortable (88%), convenient (84%), useful (92%), and explained well (85%). Patients believed CRP POCT aided clinical diagnosis, provided quick results, and reduced unnecessary antibiotic use. In consultations for which the diagnosis mentioned cough, intervention practices had an estimated 21% reduction (95% confidence interval: 0.46 to 1.35) in the odds of prescribing an antibiotic compared with the controls.
"In routine general practice, CRP POCT use was variable," the authors wrote. "Non-significant reductions in antibiotic prescribing may reflect small sample size due to non-use of tests. While CRP POCT may be useful, primary care staff need clearer CRP guidance and action planning according to NICE guidance."
Nov 5 Eurosurveill study
Vaccine education increases parents' measles concern, survey finds
After 493 Minnesota parents learned that uptake of the measles, mumps, and rubella (MMR) vaccine in their county was below herd immunity levels, 133 (27.0%) had a raised level of concern around measles risk, University of Minnesota researchers reported in Vaccine.
The results come at a time when MMR coverage remains low in some US regions. The study also found that 40.2% of respondents learned that their county's MMR vaccine, while higher than they thought, was below the herd immunity threshold.
The study's data collection took place via onsite electronic surveys at the 2016 Minnesota State Fair, and participants were parents of children from 6 to 18 years old. (Survey advertising did not directly allude to vaccines: "Have you heard about the herd?") Participants were asked about herd immunity, their estimations of their county's MMR vaccination coverage, what herd immunity threshold they thought measles required, and their concern for their children regarding measles. Then, after receiving a short educational intervention about these topics, including their county's coverage, their levels of concern were re-evaluated.
Of the respondents, 334 (67.8%) knew what herd immunity was, with white participants being 3.1 times more likely, metropolitan residents being 2.0 times more likely, and those having at least an associate's degree being 1.7 times more likely. Before the educational intervention, 373 (76%) said they were at least somewhat concerned their child would contract measles without the vaccine. After learning about the MMR vaccine and herd immunity, 354 (72%) said they were at least somewhat concerned, and 304 (62%) said they were at least somewhat concerned about a potential county outbreak.
"Overall, a significant proportion of parents learned that MMR vaccination rates were higher than they expected," the researchers write, "which may have reassured them that measles risk was low in their areas, even though none of the counties had vaccination rates that met the herd immunity threshold."
Of note, the year after the survey was conducted, in 2017, Minnesota officials grappled with a 79-case measles outbreak, the largest in the state since 1990.
Nov 4 Vaccine study
China reports another H9N2 avian flu infection
China has reported its seventh H9N2 avian flu case of the year, which involves a 3-year-old girl from Guangdong province who had contact with domestic poultry, the European Centre for Disease Prevention and Control (ECDC) said in its latest weekly communicable disease threat report.
The girl became ill with mild symptoms on Oct 12 and was hospitalized the same day, and she has fully recovered. Investigators found no other related cases among her contacts.
The country reported its last case in August, also involving a young child with mild symptoms from Guangdong province.
Sporadic H9N2 cases have been reported in countries such as China where H9N2 is endemic in poultry. So far children are the most affected group, and the virus in humans has not been linked to sustained transmission.
Nov 6 ECDC weekly communicable disease threat report
Eight countries report more polio, including first in Republic of Congo
Eight countries reported new polio cases this week, including the first from the Republic of Congo. Most involved circulating vaccine-derived poliovirus type 2 (cVDPV2), but Pakistan reported one more wild poliovirus type 1 (WPV1) case, according to the latest update from the Global Polio Eradication Initiative (GPEI).
Pakistan's WPV1 case was in Punjab province, raising its total for the year to 80. Elsewhere in the Middle East, Afghanistan reported 20 more cVDPV2 cases in eight different provinces, bringing its total for 2020 to 121.
Six African nations reported cVDPV2 cases. The Republic of Congo case was in Kouilou and is linked to an outbreak in Angola.
Burkina Faso reported 3 cases in two different locations, lifting its number from two different outbreaks to 40 for the year so far. The Central African Republic reported 1 more case from RS5 province, putting its 2020 total so far at 3.
Chad added 2 cases to its total, one each in Tandjile and Logone Oriental provinces, for 79 cases for the year from two different outbreaks. Ivory Coast reported 1 more case, in Poro, raising its number for the year to 52. And finally, South Sudan reported 3 more in different locations, pushing its number for 2020 to 15, all linked to an outbreak in Chad.
Nov 5 GPEI update
