News Scan for May 02, 2022

News brief

COVID vaccine uptake at Minnesota workplace rose after $1,000 incentive

The rate of full COVID-19 vaccination among employees of a private Minnesota medical device manufacturer rose 10.4 percentage points after the company began offering $1,000 incentives for immunization, finds a study published late last week in JAMA Network Open.

Researchers from Starkey Hearing Technologies and the University of Minnesota studied COVID-19 vaccination outcomes at Starkey from the incentive period of Aug 6 to Sep 30, 2021. Employees who agreed to watch and acknowledge an online educational program and show proof of two doses of an mRNA vaccine received $1,000 in October.

Data, including the vaccine brand and dates of each dose, were entered into a human resources database and combined with information on employee age, salary band, sex, and race.

By Sep 30, 2,055 of 2,099 (97.9%) workers eligible for the incentive reported their vaccination status. Of the 2,055 employees, 54.7% were women, 75.5% were White, 12.5% were Asian, and 6.8% were Hispanic.

Before the incentive was offered, 75.7% of employees were fully vaccinated against COVID-19, a figure that rose to 86.1% after, for a 10.4 percentage-point increase. Of 500 employees who had received one or no vaccine doses before, 42.8% were fully vaccinated by study end.

In the weeks leading up to the incentive announcement, rates of employees receiving their first and second vaccine doses were flat. But the week of the announcement, 54 more employees (95% confidence interval [CI], 29 to 79) received their first vaccine dose, and 70 more workers (95% CI, 30 to 110) received their second dose.

A higher proportion of women than men were vaccinated after the incentive was offered (45.3% vs 38.2%). Compared with their White and Black counterparts, Asian workers had higher levels of vaccine uptake (52.4% vs 43.6% vs 15.4%). Vaccination rates didn't differ significantly by age-group or salary range.

"Limitations of the study include absence of a control group, being limited to a single company, and possible confounding with full approval of the Pfizer vaccine by the FDA on August 23, 2021," the study authors wrote.
Apr 29 JAMA Netw Open research letter

Flu vaccination associated with 34% lower risk of cardiac events

A new meta-analysis of six randomized controlled trials finds that seasonal influenza vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and people with a recent acute coronary event had a 45% lower risk. The study also appeared in JAMA Network Open.

The studies took place from 2000 to 2021 and included participants who were randomized to receive either a flu vaccine or placebo. The studies included 9,001 patients at an average age of 65.5 years; 52.3% had a previous cardiac event.

The authors found that 3.6% of vaccinated patients developed a major adverse cardiovascular event within 12 months of flu vaccination, compared with 5.4% of those who received placebo or control. This means 56 people would have to be vaccinated to prevent 1 cardiac event.

All told, 1.7% of vaccine recipients died of cardiovascular causes, compared with 2.5% of placebo or control recipients, for a 26% lower risk (risk reduction, 0.74; 95% confidence interval, 0.42 to 1.30; P = .29).

"The effect sizes reported here for major adverse cardiovascular events and cardiovascular mortality (in patients with and without recent ACS [acute coronary syndrome]) are comparable with—if not greater than—those seen with guideline-recommended mainstays of cardiovascular therapy, such as aspirin, angiotensin-converting enzyme inhibitors, β-blockers, statins, and dual antiplatelet therapy," the authors concluded.
Apr 29 JAMA Netw Open study

WHO details Australia's recent Japanese encephalitis virus spike

Since March, when Australia declared a communicable disease incident of significance after a locally acquired case of Japanese encephalitis virus (JEV), the country has reported 35 cases—25 suspected and 12 probable—across four states, the World Health Organization (WHO) said in an outbreak notice last week.

Three deaths were reported, and the latest symptom onset was Mar 14.

The cases are the first on Australia's mainland since 1998. JEV is a mosquito-borne virus that mainly affects pigs and horses, but infectious pigs can amplify circulation in mosquitoes, which can transmit the disease to humans. The four affected states are New South Wales, Queensland, South Australia, and Victoria.

The cases this year are unusually high, given that Australia had reported only 15 JEV cases over the past decade. Of those, only 1 was acquired in Australia.

As of Apr 20, JEV has been detected on 73 pig farms across the same four states. Scientists are working to determine which mosquito species are most important in the spread of the disease in Australia. The WHO added that most cases are asymptomatic, but in those with clinical disease, the case-fatality rate can be as high as 30%, and some neurologic consequences can be permanent. There are no treatments, and vaccination is usually only advised for people in certain risk groups.

The onset of colder months in southern Australia could reduce mosquito populations and transmission, the WHO said, adding that the regional and global risk level is currently low.
Apr 28 WHO outbreak notice
Mar 4 CIDRAP News scan

Stewardship / Resistance Scan for May 02, 2022

News brief

Multimodal stewardship intervention linked to fewer outpatient antibiotics

A multimodal intervention at primary care practices in a large healthcare system in North Carolina was associated with significant decreases in inappropriate outpatient antibiotic prescribing for upper respiratory tract infections, researchers reported today in Infection Control & Hospital Epidemiology.

The interventions included in the Carolinas Healthcare Outpatient Antimicrobial Stewardship Outpatient Network (CHOSEN) included an antimicrobial stewardship health education campaign for patients and providers, and an interactive reporting dashboard for comparing antibiotic prescribing among providers, practices, and organizational groupings. In the study, researchers evaluated the impact of the initiative before (April 2016 to October 2017) and after (May 2018 to March 2020) it was implanted at 162 ambulatory family medicine, internal medicine, pediatric medicine, and urgent care facilities. The primary outcome of interest was inappropriate antibiotic prescribing for upper respiratory infections by primary-care service line.

Overall, the proportion of encounters with antibiotics inappropriately prescribed fell from 47.5% in the pre-intervention period (286,580 antibiotic prescriptions in 404,248 encounters) to 38.7% during the intervention period (277,177 prescriptions in 832,200 encounters). The relative difference in prescribing rates was –18.5%. Comparison of monthly antibiotic prescribing rates showed that after CHOSEN was implemented, encounters in family medicine showed the largest relative decrease in the proportion of visits with inappropriate antibiotic prescribing (–20.4%), followed by internal medicine (–19.5%), pediatric medicine (–17.2%), and urgent care (–16.6%).

The study authors say the key factors in the success of the CHOSEN intervention included diverse stakeholder engagement in design and implementation, unified messaging and tools across all service lines and practices, senior leadership support, and timely performance feedback and data transparency. The intervention has since been expanded to the emergency division, school-based care practices, and virtual visits.

"Detailed evaluations of changes in prescribing by indications, provider characteristics, practice type, and antibiotic classes, along with their interactions, are planned for future analysis," they wrote.
May 2 Infect Control Hosp Epidemiol study

Follow-up blood cultures tied to longer hospital stays, antibiotic duration

In a study published late last week in the same journal, researchers found that follow-up blood culture (FUBC) practices for gram-negative bacilli (GNB) bacteremia were associated with prolonged length of hospital stay and duration of antibiotic treatment.

To evaluate the value of routine FUBC for GNB bacteremia, which has been questioned because of the increased risk of false-positive results, researchers conducted a retrospective observational study at four acute-care hospitals in New York City, comparing length of hospital stay, antibiotic duration, and in-hospital mortality in patients with GNB bacteremia who had FUBCs performed and those who didn't. Of the 376 hospitalized patients with GNB bacteremia who met eligibility, 271 (72%) had FUBCs performed.

After propensity score matching, the researcher analyzed 87 pairs of patients with and without FUBCs. The median length of stay was longer among patients with FUBCs than patients without FUBCs (9 days vs 7 days; P = .017). The median duration of antibiotic treatment was also longer among patients with FUBCs than patients without (8 vs 6 days; P = .007). No statistically significant difference was observed in in-hospital mortality between patients with and without an FUBC (odds ratio, 0.37; 95% confidence interval [CI], 0.08 to 1.36).

"In conclusion, current clinical practices of obtaining FUBCs in patients with GNB bacteremia may be associated with prolonged length of stay and duration of in-hospital antimicrobial therapy," the study authors wrote. "Thus, the development of validated selection criteria for identifying subgroups in which FUBCs are likely to have a higher or lower yield is essential to optimizing clinical outcomes and resource utilization."
Apr 29 Infect Control Hosp Epidemiol study