Pregnant women should get the COVID-19 vaccine, said CDC Director Rochelle Walensky, MD, noting that vaccination surveillance systems found “no safety concerns” for more than 35,000 women in their third trimester or for their babies.
She explained that initial vaccine trials did not include pregnant women, so data on possible issues were limited, and the guidance was cautious or even conflicting. “We know that this is a deeply personal decision,” she said. “I encourage people to talk to their doctors and their primary care providers to determine what is best for them and for their baby.”
Peer-reviewed data from national surveillance systems, which were published in a recent issue of the New England Journal of Medicine, back the new recommendation. Between December 14, 2020, and February 28, 2021, data on thousands of pregnant women were collected from CDC’s Safe App and the Safe Pregnancy Registry, as well as the vaccine adverse event reporting system. The data show that pregnant women experienced adverse effects similar to those observed in the rest of the population, primarily minor symptoms such as injection site pain, headache, chills, and fever.
Severe reactions were not more common among pregnant women compared with those who were not pregnant, except for nausea and vomiting, which were reported slightly more often among pregnant women following the second dose, according to the research. Early data showed no “obvious safety signals” for pregnancy or neonatal outcomes.
New guidelines recommend shorter courses of antibiotics
New clinical guidelines from the American College of Physicians promote shorter courses of antibiotics to treat uncomplicated cases of pneumonia, urinary tract infection, cellulitis, COPD exacerbations, and acute bronchitis.
The new guidelines point out that a 5-day course of antibiotics usually works just as well as longer regimens under these circumstances—with the added benefits of fewer adverse effects and reduced overall antibiotic exposure. The guideline authors emphasize the importance of accurately diagnosing patients to avoid prescribing antibiotics needlessly or for longer than necessary.
“If a patient is not improving with appropriate antibiotics, it is important for the clinician to reassess for other causes of symptoms rather than defaulting to a longer duration of antibiotic therapy,” the authors wrote, cautioning that a longer course of antibiotics should be “the exception and not the rule.”
STDs reach all-time high
Annual cases of sexually transmitted diseases (STDs) in the United States continued to increase in 2019, hitting an all-time high for the sixth consecutive year, according to new CDC data.
The 2019 STD Surveillance Report shows there were 2.5 million cases of chlamydia, gonorrhea, and syphilis—the three most commonly reported STDs in 2019. Between 2015 and 2019, cases of these STDs increased nearly 30%. The biggest increase was in cases of congenital syphilis, which almost quadrupled during that period.
“Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination, and advances in chlamydia diagnostics made it easier to detect infections,” said Raul Romaguera, acting director for CDC’s Division of STD Prevention.
“That progress has since unraveled, and our STD defenses are down. We must prioritize and focus our efforts to regain this lost ground and control the spread of STDs,” he said.
Early data for 2020 indicate that many of these worrying trends continued into that year.
The new data show that while the burden of STDs increased overall and in many groups in 2019, racial and ethnic minority groups, gay and bisexual men, and youth were affected the most.
“Focusing on hard-hit populations is critical to reducing disparities,” said Jo Valentine, associate director of the Office of Health Equity in CDC’s Division of STD Prevention.
“To effectively reduce these disparities, the social, cultural, and economic conditions that make it more difficult for some populations to stay healthy must be addressed. These include poverty, unstable housing, drug use, lack of medical insurance or regular medical provider, and high burden of STDs in some communities.”
CDC: Overdose deaths surged during pandemic
The U.S. drug overdose mortality rate increased last year, with more than 87,000 Americans dying from drug overdoses in the 12-month period that ended in September 2020, according to preliminary CDC data.
After falling slightly in 2018 for the first time in decades, overdose deaths began increasing again in the months just before the COVID-19 pandemic. The largest increase in overdose deaths occurred in April and May of 2020, when strict lockdown measures were in effect and job losses were growing. In addition, many drug treatment centers closed during that time, and drop-in centers that offer support, clean syringes, and naloxone cut back services, with many still not fully operational again.
The preliminary data show a 29% increase in overdose deaths from October 2019 through September 2020, compared with the previous 12-month period. The surge was fueled primarily by illicitly manufactured fentanyl and other synthetic opioids, though many fatal overdoses also involved stimulant drugs, especially methamphetamine. A number of organizations that work on addiction and other health issues recently called on HHS Secretary Xavier Becerra to “act with urgency” and end the rule that requires physicians to undergo a day of training before receiving federal permission to prescribe buprenorphine.
New NEJM article can serve as diabetes medication resource
The list of medication options to treat patients with diabetes grows continually longer and longer.
A clinical practice review article by Kalyani in the April 1, 2021, New England Journal of Medicine (NEJM) distills the newest trial results and guidelines into a systematic approach to treating patients with diabetes.
The article can serve as an up-to-date resource for health care practitioners on glucose-lowering therapies, particularly to reduce the risk of cardiovascular disease for patients with diabetes. People with type 2 diabetes are more than twice as likely to develop atherosclerotic cardiovascular disease and heart failure than people without the disease.
In the article, Kalyani includes comprehensive drug tables that detail A1C-lowering efficacy, route and frequency of administration, cost, effects on weight, risk of hypoglycemia, adverse effects, and clinical benefits—detailed information that can help health care providers choose the best glucose-lowering medication for patients with type 2 diabetes.
“Health care providers in primary care, endocrinology, cardiology, and nephrology are now prescribing these newer glucose-lowering drugs for their patients,” said Kalyani in a news release. “Diabetes care will need to be increasingly collaborative in the future and, at its core, remain patient-centered.”
In the article, Kalyani lists specific agents in two newer drug classes as beneficial for patients with diabetes who already show signs of cardiovascular disease.
“After metformin, which is widely considered the initial drug treatment for type 2 diabetes, specific drugs in the GLP-1 receptor agonist and SGLT2 inhibitor classes with demonstrated cardiovascular benefit should be considered as additional medications for patients who already have cardiovascular disease,” said Kalyani.
“This should be done irrespective of whether their A1C level is at target to reduce the risk of future cardiovascular events.”
Kalyani noted in the news release that the cardiovascular effects of older drugs remain uncertain because before 2008, FDA did not require large outcome trials for drugs after their introduction to the market.
The article also includes details about medications that offer additional benefits for patients with diabetes who have multiple cardiovascular disease risk factors, heart failure, and chronic kidney disease.