News Scan for Jan 06, 2021

Incentives for new antibiotics
Cell-derived flu vaccine protection
Flu vaccine in nursing homes

Policy brief shows support for antibiotic development incentives

Interviews with policymakers and antimicrobial resistance (AMR) experts from 13 countries indicate broad support for financial incentives to boost antibiotic development, despite uncertainty over which incentives are appropriate and how much they'll cost, according to a policy brief released yesterday by the European Union Joint Action Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI) and the Global AMR Research and Development Hub.

In the interviews, which were conducted to better understand perceptions of antibiotic development incentives and barriers to implementing them, 11 of 13 interviewees expressed high-level, general support for incentive programs.  But before selecting a type of incentive, they said they prefer to wait for evidence from the three countries—United Kingdom, Germany, and Sweden—currently testing "pull incentives" models that aim to increase revenues for antibiotics while also ensuring access to them.

Experts from 9 of the 10 European countries said they would prefer a common, European or multinational incentive that's independent of national drug pricing and reimbursement plans.

Policymakers were also clear that incentives should apply only to antibiotics that meet public health needs, and that the public heath value must be demonstrated in clinical trials that test those antibiotics against multidrug-resistant infections.

In addition, 12 of 13 interviewees indicated that shortages of existing antibiotics is a problem in their countries, and 8 of 13 said shortages have resulted in greater use of broad-spectrum antibiotics.

"The results of these interviews point to a clear need for specific, detailed incentives that national policymakers can assess, tailor, and implement," the policy brief said. "These incentives must be designed with the aim of ensuring national access to important antibiotics that meet public health need."
Jan 5 EU-JAMRAI and Global AMR R&D Hub policy brief


Cell-derived flu vaccines offer higher efficacy than egg-derived, data show

The cell-derived inactivated quadrivalent (four-strain) influenza vaccine (ccIIV4) was 7.6% more effective than its egg-derived counterpart (eIIV4) during the 2018-19 US flu season, according to a study published yesterday in Clinical Infectious Diseases.

The researchers used primary medical records and medical claims data to create a retrospective cohort consisting of 2,125,430 people who received ccIV4 and 8,000,903 people who received eIIV4. Patients were 4 years and older. Overall, 1.6% of ccIIV4 recipients had a flu-related medical encounter, compared with 2.4% of those who received eIIV4.

After stratifying the data for age and adjusting for sex, race, ethnicity, geographic region, vaccination week, and health status, the investigators determined that ccIIV4 was 7.6% more effective than eIIV4 overall (adjusted value, post hoc, 95% confidence interval [CI], 6.5% to 8.6%). They also found that ccIIV4 was 3.9% to 7.5% more effective than eIIV4 in every age-group except those 65 and older. In that group, ccIV4 relative vaccine effectiveness was -2.2% (95% CI, -5.4 to 0.9), but the researchers noted that the results were not statistically significant and that this group is already prone to declining immunity with age.

"The propagation of influenza vaccine viruses in mammalian cells rather than embryonated chicken eggs eliminates the opportunities for adaptive viral mutations to occur [owing to the egg environment] and maintains viral antigenicity, which supports the improved effectiveness of ccIIV4 observed in this study," the researchers write.
Jan 5 Clin Infect Dis


Study finds adjuvanted flu vaccine helps lower nursing home outbreaks

US nursing homes that gave their residents the adjuvanted trivalent (three-strain) influenza vaccine (aTIV) versus the standard trivalent influenza vaccine (TIV) had a 17% reduction in suspected or lab-confirmed flu outbreaks, according to a separate study published yesterday in Clinical Infectious Diseases. When covariates were accounted for, this reduction increased to 21% and 22% for suspected or lab-confirmed flu outbreaks, respectively.

Adjuvants are substances added to vaccines to boost the immune response.

The researchers randomized nursing home vaccinations during the 2016-17 flu season, with 387 facilities receiving aTIV and 390 receiving TIV. From November through March, residents who received aTIVs had a 6% reduction in hospitalization due to any cause and a 20% reduction in hospitalization due to pneumonia or influenza compared with those who received TIVs.

Overall, nursing homes that received aTIVS reported 148 suspected or confirmed flu outbreaks, whereas 302 suspected or confirmed outbreaks occurred in nursing homes that received TIVs. (The study did not look at outbreak scope.)

The researchers also found that flu outbreaks occurred more in facilities with cognitive impairment and dementia wards as well as those who used contracted staffing.

Because the 2016-17 flu season had a low vaccine effectiveness (20%), the researchers write, "The adjuvanted (MF59) vaccine may achieve a more robust immunogenic response through induced cellular or heterologous immunity. This may explain the superiority of aTIV versus TIV when vaccine effectiveness is low."
Jan 5 Clin Infect Dis study

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