News Scan for Jul 20, 2022

News brief

Study spotlights overuse of broader-spectrum antibiotics in Saudi Arabia

An analysis of dental and pediatric primary care practices in Saudi Arabia found higher prescribing of broader-spectrum antibiotics and poor adherence to antibiotic prescribing guidelines, researchers reported yesterday in the American Journal of Infection Control.

The retrospective cross-sectional study, conducted from May through November 2020 at 24 primary healthcare centers in Saudi Arabia, assessed antibiotic prescribing patterns at family medicine and dental practices using the World Health Organization AWaRe (Access, Watch and Reserve) classification system and relevant clinical guidelines. The researchers also identified factors associated with the choice of Watch-group antibiotics, which are broader-spectrum agents with a higher resistance potential.

Of the 752 antibiotic prescriptions assessed, 84% were prescribed by general practitioners and 16% by dentists, most commonly for urinary tract (12.8%) and acute respiratory tract (12.2%) infections. Compared with Access-group antibiotics, Watch-group antibiotics such as second-generation cephalosporins and macrolides were more likely to be prescribed based on the number of prescriptions (51.1% vs 48.9%) and defined daily doses (DDDs) (52.2% vs 47.8%).

The percentages of Watch-group antibiotics for children and adults were 66.7% and 42.9%, respectively. The overall adherence to clinical prescribing guidelines for children, adults, and total prescribed antibiotics was 27.2%, 64%, and 49.5%, respectively, with dental clinics demonstrating better adherence than general practices.

Multivariable logistic regression analysis found that being a child (adjusted odds ratio, [aOR], 2.89; 95% confidence interval [CI], 1.46 to 5.78), diagnosis with acute respiratory tract infection (aOR, 2.62; 95% CI, 1.03 to 6.69), and urinary tract infection (aOR, 4.69; 95% CI, 2.09 to 10.56) were associated with higher prescribing of Watch-group antibiotics.

The study authors say the findings indicate national guidelines on antibiotic use are needed in Saudi Arabia, along with a surveillance system to track antibiotic use at the national level.

"The higher proportion of prescribing of Watch-group antibiotics in this study for both children and adults is a warning sign that may reflect inappropriate awareness of the optimum antibiotic selection as well as poor adherence to guidelines," they wrote. "This result may lead to a potential increase in bacterial resistance and overuse of broad-spectrum antibiotics, which consequently increases costs and the likelihood of adverse drug reactions or lowered therapy outcomes."
Jul 19 Am J Infect Control abstract

First local dengue case in Florida prompts health alert

The Florida Department of Health this week announced a mosquito-borne illness advisory after the first local dengue illness of 2022 was identified in a Miami-Dade County resident.

Officials urged people to take preventive steps, such as draining standing water from items such as buckets and flowerpots and wearing protective clothing and mosquito repellent. They also issued a reminder about symptoms, which can be asymptomatic or mild, but can also include fever, headache, eye pain, and musculoskeletal pain.

Dengue is spread by Aedes mosquitoes. Local dengue cases aren't uncommon in south Florida. Last year Florida didn't have any reported cases, but in 2020 officials recorded 71 locally acquired cases, according to the Centers for Disease Control and Prevention (CDC).
Jul 18 Florida Department of Health statement
CDC dengue background information

COVID-19 Scan for Jul 20, 2022

News brief

Unvaccinated police, firefighters report low trust in COVID-19 vaccines

Although unvaccinated police officers and firefighters are more likely to develop COVID-19, they are less likely to trust that the vaccines are effective and safe, according to a US study published yesterday in JAMA Network Open.

University of Miami researchers led the study of 1,415 police officers and firefighters from Arizona, Florida, Minnesota, Oregon, Texas, and Utah participating in two studies from January to September 2021. Participants worked at least 20 hours a week in roles requiring them to come within 3 feet of others.

Each week, participants collected nasal specimens and reported any COVID-like symptoms. They also contributed respiratory samples for polymerase chain reaction (PCR) testing and completed quarterly follow-up surveys.

Of the participants, 79% were men, 68% were firefighters, 17% were police officers, and 15% had other roles. The average age was 41.3 years, and 82% completed an attitude survey (363 of 586 [62%] of the unvaccinated and 800 of 829 [97%] of the fully vaccinated). About 41% were unvaccinated.

Of the fully vaccinated, 35% said they trusted the government in terms of COVID-19 vaccines, compared with 12% of the unvaccinated. Among the unvaccinated, 17% believed that the vaccines were effective, versus 54% of the vaccinated. Similarly proportions of each group believed the vaccines were safe (15% vs 54%).

Over the study period, 184 COVID-like illnesses were identified. Police were infected at a rate of 11.9 per 1,000 person-weeks (unvaccinated) and 0.6 per 1,000 (vaccinated). Among firefighters, the rate was 9.0 per 1,000 person-weeks (unvaccinated) and 1.8 (vaccinated).

The researchers noted that police officers and firefighters are at higher risk of COVID-19 infection than healthcare workers but have relatively low vaccine uptake. COVID-19 was the leading cause of work-associated deaths among police in 2021, causing 323 of 482 deaths (67%).

"Our findings suggest that state and local governments with large numbers of unvaccinated first responders may face major workforce disruptions due to COVID-19 illness," the authors wrote. "Governments should consider vaccine mandates with regular testing and alternative work assignments for unvaccinated workers."
Jul 19 JAMA Netw Open research letter

Influenza surveillance systems may have caught initial COVID-19 activity

An increased number of cases of influenza-like illness (ILI) that tested negative for influenza were present in global influenza surveillance networks early in the COVID-19 pandemic, an average of 13.3 weeks before the first reported COVID-19 peaks in 16 of the 28 countries included in a study published today in PLOS Medicine.

To conduct the study, researchers looked at outliers in influenza-negative ILI surveillance networks in 2020 compared to trends over the previous 5 years in 28 countries that have established ILI surveillance, using data from the World Health Organization Global Influenza Surveillance and Response System (GISRS).

During the week of Jan 13, 2020, Peru, the Philippines, Poland, and Spain all showed ILI outliers. During the week of Mar 9, 2020, the United States and the United Kingdom showed outliers, which was 4 to 6 weeks before the first recorded peak of COVID-19 activity.

Bolivia, Colombia, India, Mexico, Republic of Moldova, Nepal, and Peru demonstrated a lag between the first detected outlier and reported COVID-19 peak of greater than 12 weeks. Only in three countries—Germany, Madagascar, and Uganda—did the first detected outlier in 2020 occur after the first reported COVID-19 peak.

"In the first year of the COVID-19 pandemic, we found increases in cases of non-influenza respiratory illness before the first reported major outbreaks of COVID-19, suggesting COVID-19 may have spread much faster than initially reported globally," said Natalie Cobb, PhD, of University of Washington, first author of the study, in a press release.

The authors also said strengthening routine disease surveillance networks is important, as they may serve as predictive tools for future pandemics.
Jul 19 PLOS Med study
Jul 19 PLOS press release