COVID-19 deaths and hospitalizations averted by rapid vaccination rollout in the United States

Importance: Randomized clinical trials have shown that the COVID-19 vaccines currently approved in the US are highly efficacious. However, more evidence is needed to understand the population-level impact of the US vaccination rollout in the face of the changing landscape of COVID-19 pandemic in the US, including variants with higher transmissibility and immune escape. Objective: To quantify the population-level impact of the US vaccination campaign in averting cases, hospitalizations and deaths from December 12, 2020 to June 28, 2021. Design: Age-stratified agent-based model which included transmission dynamics of the Alpha, Gamma and Delta variants in addition to the original Wuhan-1 variant. Setting: Our model was calibrated to COVID-19 outbreak and vaccine rollout in the US. Model predictions were made at the country level. Participants: Simulated age-stratified population representing US demographics. Main Outcomes and Measures: Cases, hospitalizations and deaths averted by vaccination against COVID-19 in the US, compared to the counterfactuals of no vaccination and vaccination administered at half the actual pace. Results: The swift vaccine rollout in the US curbed a potential resurgence of cases in April 2021, which would have been otherwise fuelled by the Alpha variant. Compared to the scenario without vaccines, we estimated that the actual vaccination program averted more than 26 million cases, 1.2 million hospitalizations and saved 279,000 lives. A vaccination campaign with half the actual rollout rate would have led to an additional 460,000 hospitalizations and 121,000 deaths. Conclusions and Relevance: The COVID-19 vaccination campaign in the US has had an extraordinary impact on reducing disease burden despite the emergence of highly transmissible variants. These findings highlight that the pace of vaccination was essential for mitigating COVID-19 in the US, and underscore the urgent need to close the vaccine coverage gaps in communities across the country.

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Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.87 ◽

2021 ◽

pp. 1-8

Author(s):

Wendy Thompson ◽

Leanne Teoh ◽

Colin C. Hubbard ◽

Fawziah Marra ◽

David M. Patrick ◽

...

Keyword(s):

United States ◽

British Columbia ◽

Broad Spectrum ◽

Antibiotic Prescription ◽

Population Level ◽

The United States ◽

Antibiotic Prescribing ◽

Prescribing Behavior ◽

The Us ◽

Amoxicillin Clavulanic Acid

Abstract Objective: Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). Design: Population-level analysis of antibiotic prescription. Setting: Outpatient prescribing by dentists in 2017. Participants: Patients receiving an antibiotic dispensed by an outpatient pharmacy. Methods: Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. Results: In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. Conclusion: Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.

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The carbon footprint of dietary guidelines around the world: a seven country modeling study

Nutrition Journal ◽

10.1186/s12937-021-00669-6 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Brittany Kovacs ◽

Lindsey Miller ◽

Martin C. Heller ◽

Donald Rose

Keyword(s):

The Netherlands ◽

Carbon Footprint ◽

The United States ◽

Dietary Guidelines ◽

Consumption Patterns ◽

Consumption Pattern ◽

Carbon Footprints ◽

Country Level ◽

The Us ◽

The World

Abstract Background Do the environmental impacts inherent in national food-based dietary guidelines (FBDG) vary around the world, and, if so, how? Most previous studies that consider this question focus on a single country or compare countries’ guidelines without controlling for differences in country-level consumption patterns. To address this gap, we model the carbon footprint of the dietary guidelines from seven different countries, examine the key contributors to this, and control for consumption differences between countries. Methods In this purposive sample, we obtained FBDG from national sources for Germany, India, the Netherlands, Oman, Thailand, Uruguay, and the United States. These were used to structure recommended diets using 6 food groups: protein foods, dairy, grains, fruits, vegetables, and oils/fats. To determine specific quantities of individual foods within these groups, we used data on food supplies available for human consumption for each country from the UN Food and Agriculture Organization’s food balance sheets. The greenhouse gas emissions (GHGE) used to produce the foods in these consumption patterns were linked from our own database, constructed from an exhaustive review of the life cycle assessment literature. All guidelines were scaled to a 2000-kcal diet. Results Daily recommended amounts of dairy foods ranged from a low of 118 ml/d for Oman to a high of 710 ml/d for the US. The GHGE associated with these two recommendations were 0.17 and 1.10 kg CO2-eq/d, respectively. The GHGE associated with the protein food recommendations ranged from 0.03 kg CO2-eq/d in India to 1.84 kg CO2-eq/d in the US, for recommended amounts of 75 g/d and 156 g/d, respectively. Overall, US recommendations had the highest carbon footprint at 3.83 kg CO2-eq/d, 4.5 times that of the recommended diet for India, which had the smallest footprint. After controlling for country-level consumption patterns by applying the US consumption pattern to all countries, US recommendations were still the highest, 19% and 47% higher than those of the Netherlands and Germany, respectively. Conclusions Despite our common human biology, FBDG vary tremendously from one country to the next, as do the associated carbon footprints of these guidelines. Understanding the carbon footprints of different recommendations can assist in future decision-making to incorporate environmental sustainability in dietary guidance.

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Population-level analysis of antibiotic use and death rates in beef feedlots over ten years in three cattle-feeding regions of the United States

Journal of the American Veterinary Medical Association ◽

10.2460/javma.20.10.0560 ◽

2021 ◽

pp. 1-7

Author(s):

Stephanie C. Rutten-Ramos ◽

Shabbir Simjee ◽

Michelle S. Calvo-Lorenzo ◽

Jason L. Bargen

Keyword(s):

Death Rate ◽

Live Weight ◽

Population Level ◽

Antibiotic Use ◽

The United States ◽

Death Rates ◽

Cattle Feeding ◽

The Us ◽

Rate Ratios ◽

Beef Feedlots

Abstract OBJECTIVE To assess antibiotic use and other factors associated with death rates in beef feedlots in 3 regions of the US over a 10-year period. SAMPLE Data for 186,297 lots (groups) of finished cattle marketed between 2010 and 2019 were obtained from a database representing feedlots in the central, high, and north plains of the US. PROCEDURES Descriptive statistics were generated. Generalized linear mixed models were used to estimate lot death rates for each region, sex (steer or heifer), and cattle origin (Mexico or the US) combination. Death rate was calculated as the (number of deaths/number of cattle placed in the lot) × 100. Lot antibiotic use (TotalActiveMG/KGOut) was calculated as the total milligrams of active antibiotics assigned to the lot per live weight (in kilograms) of cattle marketed from the lot. Rate ratios were calculated to evaluate the respective associations between lot death rate and characteristics of cattle and antibiotic use. RESULTS Mean death rate increased during the 10-year period, peaking in 2018. Mean number of days on feed also increased over time. Mean TotalActiveMG/KGOut was greatest in 2014 and 2015, lowest in 2017, and moderated in 2018 and 2019. Death rate was positively associated with the number of days on feed and had a nonlinear association with TotalActiveMG/KGOut. Feeding medicated feed articles mitigated death rate. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested a balance between disease prevention and control in feedlots for cattle with various risk profiles. Additional data sources are needed to assess TotalActiveMG/KGOut across the cattle lifetime.

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Projected resurgence of COVID-19 in the United States in July-December 2021 resulting from the increased transmissibility of the Delta variant and faltering vaccination

10.1101/2021.08.28.21262748 ◽

2021 ◽

Author(s):

Shaun Truelove ◽

Claire P. Smith ◽

Michelle Qin ◽

Luke C. Mullany ◽

Rebecca K. Borchering ◽

...

Keyword(s):

United States ◽

Vaccination Coverage ◽

Vaccine Coverage ◽

Public Health Practice ◽

The United States ◽

Social Contacts ◽

Vaccination Uptake ◽

The Us ◽

Novel Variant ◽

Report Data

What is already known about this topic? The highly transmissible SARS-CoV-2 Delta variant has begun to cause increases in cases, hospitalizations, and deaths in parts of the United States. With slowed vaccination uptake, this novel variant is expected to increase the risk of pandemic resurgence in the US in July-December 2021. What is added by this report? Data from nine mechanistic models project substantial resurgences of COVID-19 across the US resulting from the more transmissible Delta variant. These resurgences, which have now been observed in most states, were projected to occur across most of the US, coinciding with school and business reopening. Reaching higher vaccine coverage in July-December 2021 reduces the size and duration of the projected resurgence substantially. The expected impact of the outbreak is largely concentrated in a subset of states with lower vaccination coverage. What are the implications for public health practice? Renewed efforts to increase vaccination uptake are critical to limiting transmission and disease, particularly in states with lower current vaccination coverage. Reaching higher vaccination goals in the coming months can potentially avert 1.5 million cases and 21,000 deaths and improve the ability to safely resume social contacts, and educational and business activities. Continued or renewed non-pharmaceutical interventions, including masking, can also help limit transmission, particularly as schools and businesses reopen.

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779. Impact of updated IDSA practice guidelines on the treatment of Clostridium difficile infections in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.847 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S346-S346 ◽

Cited By ~ 1

Author(s):

Cornelius J Clancy ◽

Minh-Hong Nguyen

Keyword(s):

United States ◽

Practice Guidelines ◽

Randomized Clinical Trials ◽

The United States ◽

Prescription Data ◽

Recommended Treatment ◽

The Us ◽

Before And After ◽

Dosing Regimens ◽

National Pact

Abstract Background IDSA published updated practice guidelines for C. difficile infections (CDI) in February 2018. Since publication of previous CDI guidelines in2010, randomized clinical trials (RCTs) have demonstrated benefit of oral (po) vancomycin or fidaxomicin over metronidazole in at least some types of CDI. Updated guidelines endorsed vancomycin or fidaxomicin as recommended treatment for initial and recurrent nonfulminant CDI episodes, and vancomycin as treatment for fulminant CDI. We studied the use of po vancomycin, fidaxomicin and metronidazole in the United States before and after publication of updated guidelines. Methods We obtained US antibiotic prescription data (IQVIA, Durham, NC) since 2013, and used standard dosing regimens for treatment of initial CDI to estimate numbers of infections treated with different agents. Po vancomycin and fidaxomicin are used exclusively against known or suspected CDI. Metronidazole is used to treat CDI and other infections. IQVIA data do not capture indications for prescriptions. Results Treatment courses of po vancomycin and fidaxomicin increased by 45% (n = 126,729 increase) and 44% (n = 11,243 increase), respectively, over the 12 months after publication of the updated CDI guidelines compared with 12 months before publication (Figure, second arrow; Table). Increased use of both agents was evident in the first month after guidelines were published. Over the same 12 month periods, treatment courses of po metronidazole decreased by 3% (190,430 decrease). In comparison, treatment courses of po vancomycin increased by 24% (n = 47,219 increase) over the 12 months after publication of the multi-national PACT study in August 2014 (Figure, first arrow), which demonstrated superiority of vancomycin over metronidazole. Since 2013, there were no significant increases in the use of fidaxomicin until publication of the updated guidelines. Conclusion Updated IDSA guidelines have had a major impact on treatment of CDI in the US. RCT data used for guideline updates have been available since 2007–14 and 2011–12 for po vancomycin and fidaxomicin, respectively. IDSA should provide more timely updates to practice guidelines as new data emerge. Annual or bi-annual updates posted in electronic or other nontraditional formats may be more efficient than publishing long-form articles. Disclosures All authors: No reported disclosures.

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Ukraine

10.1093/wentk/9780197532102.001.0001 ◽

2020 ◽

Author(s):

Serhy Yekelchyk

Keyword(s):

The United States ◽

Political Conflict ◽

Linguistic Differences ◽

Political Crises ◽

Contemporary Politics ◽

The Us ◽

American Media ◽

The Face ◽

Crony Capitalism ◽

Us Presidential Election

Conventional wisdom dictates that Ukraine’s political crises can be traced to the linguistic differences and divided political loyalties that have long fractured the country. However, this theory obscures the true significance of Ukraine’s recent civic revolution and the conflict’s crucial international dimension. The 2013-14 Ukrainian revolution presented authoritarian powers in Russia with both a democratic and a geopolitical challenge. In reality, political conflict in Ukraine is reflective of global discord, stemming from differing views on state power, civil society, and democracy. Ukraine’s sudden prominence in American politics has compounded an already-widespread misunderstanding of what is actually happening in the nation. In the American media, Ukraine has come to signify an inherently corrupt place, rather than a real country struggling in the face of great challenges. Ukraine: What Everyone Needs to Know® is an updated edition of Serhy Yekelchyk’s 2015 publication, The Conflict in Ukraine. It addresses Ukraine’s relations with the West, particularly the United States, from the perspective of Ukrainians. The book explains how independent Ukraine fell victim to crony capitalism, how its people rebelled twice in the last two decades in the name of democracy and against corruption, and why Russia reacted so aggressively to the strivings of Ukrainians. Additionally, it looks at what we know about alleged Ukrainian interference in the 2016 US presidential election, the factors behind the stunning electoral victory of the political novice Volodymyr Zelensky, and the ways in which the events leading to the impeachment proceedings against President Donald Trump have changed the Russia-Ukraine-US relationship. This volume is essential reading for anyone who wants to understand the forces that have shaped contemporary politics in this increasingly important part of Europe, as well as the international background of the impeachment proceedings in the US

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A Missed Partnership: Russia and the US at the Pacific

Outlines of global transformations politics economics law ◽

10.23932/2542-0240-2019-12-1-159-184 ◽

2019 ◽

Vol 12 (1) ◽

pp. 159-184

Author(s):

D. V. Suslov

Keyword(s):

United States ◽

The United States ◽

Asia Pacific ◽

Asia Pacific Region ◽

The Pacific ◽

The Us ◽

The Face ◽

Soviet Space ◽

Favorable Conditions ◽

Post Soviet Space

Both Russia and the United States consider the Asia-Pacific as the center of the world economy and politics and assume the active presence in the region crucial for their security and economic development. They did not have such sharp contradictions there as in Europe or in the post-Soviet space. Moreover, some of their interests in the Asia-Pacific Region coincide – such as preventing Chinese hegemony. In this regard, the Russian-American dialogue and cooperation in the Asia-Pacific could be an important pillar of the positive agenda of their relations and a factor in their sustainability. Due to foreign policy inertia, the inflexibility of the agenda of Russian-American relations and the inability of the parties to go beyond the usual pattern, such a dialogue has not even begun. Both sides demonstrated strategic myopia. This weakened the resilience of US-Russian relations in the face of new challenges and accelerated their deterioration and disruption to a new confrontation. The Asia-Pacific has become another theater of the US-Russian systemic confrontation. However, it is in the interest of bothRussia and the United States to separate relations in this region from their general confrontation. This will create favorable conditions for Russia to build a balanced partnership system in the Asia-Pacific, which is necessary to consolidate its role as an independent global great power. In addition, the Russian-American dialogue on the Asia-Pacific, or at least the weakening of their confrontation in this region, will reduce its polarization and prevent tensions between the US and its Asian allies and partners.

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Convalescent plasma use in the United States was inversely correlated with COVID-19 mortality

eLife ◽

10.7554/elife.69866 ◽

2021 ◽

Vol 10 ◽

Author(s):

Arturo Casadevall ◽

Quigly Dragotakes ◽

Patrick W Johnson ◽

Jonathon W Senefeld ◽

Stephen A Klassen ◽

...

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Inverse Correlation ◽

Population Level ◽

The United States ◽

Mortality Data ◽

The Us ◽

The Usa ◽

Excess Deaths ◽

Strong Inverse Correlation

Background. The US Food and Drug Administration authorized Convalescent Plasma (CCP) therapy for hospitalized COVID-19 patients via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to use in about 500,000 patients during the first year of the pandemic for the US.Methods. We tracked the number of CCP units dispensed to hospitals by blood banking organizations and correlated that usage with hospital admission and mortality data.Results. CCP usage per admission peaked in Fall 2020, with more than 40% of inpatients estimated to have received CCP between late September and early November 2020. However, after randomized controlled trials failed to show a reduction in mortality, CCP usage per admission declined steadily to a nadir of less than 10% in March 2021. We found a strong inverse correlation (r = -0.52, P = 0.002) between CCP usage per hospital admission and deaths occurring two weeks after admission, and this finding was robust to examination of deaths taking place one, two or three weeks after admission. Changes in the number of hospital admissions, SARS-CoV-2 variants, and age of patients could not explain these findings. The retreat from CCP usage might have resulted in as many as 29,000 excess deaths from mid-November 2020 to February 2021.Conclusions. A strong inverse correlation between CCP use and mortality per admission in the USA provides population level evidence consistent with the notion that CCP reduces mortality in COVID-19 and suggests that the recent decline in usage could have resulted in excess deaths.Funding. There was no specific funding for this study. AC was supported in part by RO1 HL059842 and R01 AI1520789; MJJ was supported in part by 5R35HL139854. This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services; Office of the Assistant Secretary for Preparedness and Response; Biomedical Advanced Research and Development Authority under Contract No. 75A50120C00096.

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Estimating wildlife vaccination coverage using genetic methods

10.1101/129064 ◽

2017 ◽

Author(s):

Freya Smith ◽

Andrew Robertson ◽

Graham C. Smith ◽

Peter Gill ◽

Robbie A. McDonald ◽

...

Keyword(s):

Bovine Tuberculosis ◽

Vaccine Coverage ◽

Vaccination Campaign ◽

Total Duration ◽

Vaccine Dose ◽

Population Level ◽

Tuberculosis Control ◽

Animal Populations ◽

Hair Samples ◽

Wildlife Vaccination

AbstractVaccination is a potentially useful approach for the control of disease in wildlife populations. The effectiveness of vaccination is contingent in part on obtaining adequate vaccine coverage at the population level. However, measuring vaccine coverage in wild animal populations is challenging and so there is a need to develop robust approaches to estimate coverage and so contribute to understanding the likely efficacy of vaccination.We used a modified capture mark recapture technique to estimate vaccine coverage in a wild population of European badgers (Meles meles) vaccinated by live-trapping and injecting with Bacillus Calmette-Guérin as part of a bovine tuberculosis control initiative in Wales, United Kingdom. Our approach used genetic matching of vaccinated animals to a sample of the wider population to estimate the percentage of badgers that had been vaccinated. Individual-specific genetic profiles were obtained using microsatellite genotyping of hair samples which were collected both directly from trapped and vaccinated badgers and non-invasively from the wider population using hair traps deployed at badger burrows.We estimated the percentage of badgers vaccinated in a single year and applied this to a simple model to estimate cumulative vaccine coverage over a four year period, corresponding to the total duration of the vaccination campaign.In the year of study, we estimated that between 44-65% (95% confidence interval, mean 55%) of the badger population received a vaccine dose. Using the model, we estimated that 70-85% of the total population would have received at least one vaccine dose over the course of the four year vaccination campaign.This study represents the first application of this novel approach for measuring vaccine coverage in wildlife. This is also the first attempt at quantifying the level of vaccine coverage achieved by trapping and injecting badgers. The results therefore have specific application to bovine tuberculosis control policy, and the approach is of significance to the wider field of wildlife vaccination.

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Effect of Prophylactic Human Papillomavirus (HPV) Vaccination on Oral HPV Infections Among Young Adults in the United States

Journal of Clinical Oncology ◽

10.1200/jco.2017.75.0141 ◽

2018 ◽

Vol 36 (3) ◽

pp. 262-267 ◽

Cited By ~ 80

Author(s):

Anil K. Chaturvedi ◽

Barry I. Graubard ◽

Tatevik Broutian ◽

Robert K.L. Pickard ◽

Zhen-Yue Tong ◽

...

Keyword(s):

United States ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Population Level ◽

The United States ◽

Hpv Infection ◽

Vaccine Uptake ◽

The Us ◽

Oral Hpv ◽

Level Effect

Purpose The incidence of human papilloma virus (HPV)–positive oropharyngeal cancers has risen rapidly in recent decades among men in the United States. We investigated the US population–level effect of prophylactic HPV vaccination on the burden of oral HPV infection, the principal cause of HPV-positive oropharyngeal cancers. Methods We conducted a cross-sectional study of men and women 18 to 33 years of age (N = 2,627) within the National Health and Nutrition Examination Survey 2011 to 2014, a representative sample of the US population. Oral HPV infection with vaccine types 16, 18, 6, or 11 was compared by HPV vaccination status, as measured by self-reported receipt of at least one dose of the HPV vaccine. Analyses accounted for the complex sampling design and were adjusted for age, sex, and race. Statistical significance was assessed using a quasi-score test. Results Between 2011 and 2014, 18.3% of the US population 18 to 33 years of age reported receipt of at least one dose of the HPV vaccine before the age of 26 years (29.2% in women and 6.9% in men; P < .001). The prevalence of oral HPV16/18/6/11 infections was significantly reduced in vaccinated versus unvaccinated individuals (0.11% v 1.61%; Padj = .008), corresponding to an estimated 88.2% (95% CI, 5.7% to 98.5%) reduction in prevalence after model adjustment for age, sex, and race. Notably, the prevalence of oral HPV16/18/6/11 infections was significantly reduced in vaccinated versus unvaccinated men (0.0% v 2.13%; Padj = .007). Accounting for vaccine uptake, the population-level effect of HPV vaccination on the burden of oral HPV16/18/6/11 infections was 17.0% overall, 25.0% in women, and 6.9% in men. Conclusion HPV vaccination was associated with reduction in vaccine-type oral HPV prevalence among young US adults. However, because of low vaccine uptake, the population-level effect was modest overall and particularly low in men.

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