News Scan for Jun 23, 2022

News brief

Data show moderate protection in infants born to COVID-vaccinated moms

Maternal COVID vaccination during pregnancy provides 52% protection against COVID-19 hospitalization in infants but only 38% protection against Omicron hospitalization, according to a study yesterday in the New England Journal of Medicine.

Protection against an intensive care unit (ICU) stay, however, was 70%.

The case-control study included 537 case infants (181 hospitalized for COVID-19 during the Delta period and 356 during Omicron) and 512 control infants who did not have COVID. The median age of both groups was 2 months, and 19% of the case infants and 24% of the control infants had at least one underlying health condition.

Among the case infants, 113 (21%) required intensive care, 64 of whom received mechanical ventilation or vasoactive infusions. Two infants born to unvaccinated mothers died from COVID-19.

The researchers determined that the effectiveness of maternal vaccination with two doses of mRNA vaccine against hospitalization for COVID-19 in infants overall was 52% (95% confidence interval [CI], 33% to 65%), but fell from 80% (95% CI, 60% to 90%) during Delta to 38% (95% CI, 8% to 58%) during Omicron. Effectiveness was 69% (95% CI, 50% to 80%) for vaccination after 20 weeks of pregnancy and 38% (95% CI, 3% to 60%) for earlier in the pregnancy.

Protection was 70% (95% CI, 42% to 85%) against admission to an ICU and 47% (95% CI, 25% to 62%) against non-ICU hospitalization.

In a related editorial, Sonja Rasmussen, MD, from the University of Florida, and Denise Jamieson, MD, MPH, from Emory University, said, "This evidence that Covid-19 vaccines help to protect infants as well as mothers is highly relevant for patient counseling: a 'two-for-one' deal may encourage more mothers to receive Covid-19 vaccination."

A letter in the same journal, meanwhile, details no increase in serious events among 45,232 pregnant women who had received one or two doses of a COVID vaccine immediately before or during pregnancy. The data are from eight US Vaccine Safety Datalink sites from women vaccinated from Dec 15, 2020, through Jul 1, 2021.
Jun 22 N Engl J Med study, editorial, and letter


1 in 5 US adults experience COVID-19 symptoms 3 months after infection

A new survey of US adults shows 1 in 5 have experienced lingering symptoms of COVID-19 that have persisted for at least 3 months, suggesting long COVID is a common phenomenon after acute infection.

The survey was conducted by the US Census Bureau this month, and results were analyzed by the Centers for Disease Control and Infection (CDC). Forty percent of those polled said they had been infected with COVID-19, with 1 in 13 of all US adults experiencing long COVID symptoms at the time they were surveyed. These symptoms can include brain fog, headache, and muscle pain.

The United States reported 184,074 new COVID-19 cases yesterday and 860 deaths, according to the Johns Hopkins COVID-19 tracker. The 7-day average of new daily cases is 97,069, with 298 daily deaths, according to the New York Times tracker.

As vaccines for the youngest Americans are now available, Tennessee lawmakers are urging Gov Bill Lee to delay the state's health department from distributing and promoting the COVID-19 vaccines to children under 5, the Associated Press (AP) reports.

The lawmakers argue that the pandemic is no longer an emergency in the state.
CDC long covid
Johns Hopkins University
New York Times
Jun 22 AP


CDC experts votes to recommend high-dose flu vaccines for seniors

Yesterday the CDC's Advisory Committee on Immunization Practices (ACIP) unanimously recommended the use of high-dose influenza seasonal vaccine for Americans 65 years and older, owing to the waning immunity seen in this age-group with standard-dose vaccines.

This is the first time the group has recommended a certain flu vaccine for those 65 and older.

Currently there are three such vaccines on the market, Fluzone High-Dose, Fluad with an immune booster, or Flublok, which is made with insect cells instead of chicken eggs, AP reports.

Sanofi, which makes Fluzone, released a new survey this week showing that 66% of US healthcare providers would recommend high-dose flu vaccines to senior patients

The CDC is expected to follow ACIP's recommendation with an endorsement of its own in the coming days.
Jun 22 AP
Jun 22 Sanofi
press release

Stewardship / Resistance Scan for Jun 23, 2022

News brief

VA study finds expectation of antibiotics colors patient satisfaction

A study of Veterans Affairs (VA) patients found that the expectation of an antibiotic had a bigger impact on patient satisfaction than did receipt of an antibiotic, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

For the cross-sectional study, researchers from the Veterans Health Administration and Vanderbilt University Medical Center evaluated electronic medical record data and patient satisfaction questionnaires completed by veterans who were treated for an upper respiratory infection (URI) in an 18-clinic ambulatory VA primary care system.

Previous research has shown that unnecessary antibiotic prescribing for URIs is common in VA patients, and one partial explanation is that many VA healthcare providers perceive that their patients expect antibiotics and will base their satisfaction with the visit on whether or not they get them. But that hypothesis has not previously been tested.

Of the 1,329 veterans eligible for the study, 432 completed the questionnaires, for a response rate of 33%. Of those patients, 228 (52.8%) received an antibiotic and 204 (47.2%) did not. Analysis of the questionnaires found no difference in mean total satisfaction for those who received an antibiotic (67.7 points) versus those who did not (66.9 points) (adjusted difference, 0.6 points; 95% confidence interval [CI], –2.1 to 3.3). But for those who expected an antibiotic compared with those who did not, the mean total satisfaction score was 4.4 points lower (95% CI, –7.3 to –1.6 points). And among the veterans who accurately remembered the visit and did not receive an antibiotic, those who expected an antibiotic had significantly lower satisfaction scores than those who did not (unadjusted score difference, –16.6; 95% CI, –24.6 to –8.6).

"In conclusion, antibiotic receipt alone does not determine Veteran satisfaction with URI visits," the study authors write. "Patient expectations of receiving or not receiving an antibiotic were an important factor that significantly affected satisfaction scores."

The authors add that while the findings may not be generalizable to populations outside the VA system, they suggest that working with patients to understand what drives their expectations could inform efforts to reduce unnecessary antibiotic prescribing for URIs.
Jun 23 Antimicrob Steward Healthc Epidemiol study


Study suggests MRSA nasal swabs could play bigger stewardship role

A study conducted in a West Virginia hospital found that implementation of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs was associated with reduced use of gram-negative antibiotics, researchers reported today in the Journal of Antimicrobial Chemotherapy.

In the study, researchers with West Virginia University Hospitals conducted a retrospective chart review to compare the duration of gram-negative antibiotic therapy for pneumonia before and after the implementation of MRSA polymerase chain reaction (PCR) nasal swabs, which have previously been shown to be very accurate in ruling out MRSA pneumonia and limiting the use and duration of broad-spectrum anti-MRSA antibiotics. Although MRSA is a gram-positive bacterium, the researchers wanted to see if use of MRSA PCR nasal swabs might also have an impact on broad-spectrum gram-negative antibiotics by prompting discussions about appropriate empiric therapy and antibiotic de-escalation.

Comparing antibiotic use in 120 community- and hospital-acquired pneumonia patients pre-implementation and 120 post-implementation, the researchers found that the median duration of gram-negative therapy was 154 hours in post-implementation group and 176.4 hours in the pre-implementation group. There were no significant differences in the secondary outcomes of time to de-escalation (52.7 hours vs 54.9 hours) or time to transition from intravenous to enteral therapy (53 hours vs 57.3 hours). The median cost of gram-negative regimens per patient was nearly $15 lower in the post-implementation group ($31.36 vs $45.90).

The authors say the findings are noteworthy because shorter antibiotic durations not only reduce patient exposure to antibiotics and their potential side effects but can also shorten hospital stays.

"This introduces an additional benefit of MRSA nasal swabs and further incentivizes their use as an antimicrobial stewardship tool," they write.
Jun 23 J Antimicrob Chemother abstract

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