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Background US Centers for Disease Control and Prevention guidelines currently recommend triple-therapy antimicrobial treatment for anthrax meningitis. In the Kyrgyz Republic, a country with endemic anthrax, cutaneous anthrax patients are routinely hospitalized and treated successfully with only monotherapy or dual therapy. Clinical algorithms have been developed to identify patients with likely anthrax meningitis based on signs and symptoms alone. We sought to retrospectively identify likely meningitis patients in the Kyrgyz Republic using a clinical algorithm and evaluate risk factors and their outcomes by type of treatment. Methods We conducted a retrospective chart review of cutaneous anthrax patients in the Kyrgyz Republic from 2005 through 2012. Using previous methods, we developed a highly specific algorithm to categorize patients by meningitis status. We then evaluated patient risk factors, treatments, and outcomes by disease severity and meningitis status. Results We categorized 37 of 230 cutaneous anthrax patients as likely having meningitis. All 37 likely meningitis patients survived, receiving only mono- or dual-therapy antimicrobials. We identified underlying medical conditions, such as obesity, hypertension, and chronic obstructive pulmonary disease, and tobacco and alcohol use, as potential risk factors for severe anthrax and anthrax meningitis. Conclusions Based on our analyses, treatment of anthrax meningitis may not require 3 antimicrobials, which could impact future anthrax treatment recommendations. In addition, chronic comorbidities may increase risk for severe anthrax and anthrax meningitis. Future research should further investigate potential risk factors for severe anthrax and their impact on laboratory-confirmed meningitis and evaluate mono- and dual-therapy antimicrobial regimens for anthrax meningitis.

ObjectivesIn December 2020, an unprecedented vaccination programme to deal with the COVID-19 pandemic was initiated worldwide. However, the vaccine provision is currently insufficient for most countries to vaccinate their entire eligible population, so it is essential to develop the most efficient vaccination strategies. COVID-19 disease severity and mortality vary by age, therefore age-dependent vaccination strategies must be developed.Study design/MethodsHere, we use an age-dependent SIERS (susceptible–infected–exposed–recovered–susceptible) deterministic model to compare four hypothetical age-dependent vaccination strategies and their potential impact on the COVID-19 epidemic in Kyrgyzstan.ResultsOver the short-term (until March 2022), a vaccination rollout strategy focussed on high-risk groups (aged >50 years) with some vaccination among high-incidence groups (aged 20–49 years) may decrease symptomatic cases and COVID-19-attributable deaths. However, there will be limited impact on the estimated overall number of COVID-19 cases with the relatively low coverage of high-incidence groups (15–25% based on current vaccine availability). Vaccination plus non-pharmaceutical interventions (NPIs), such as mask wearing and social distancing, will further decrease COVID-19 incidence and mortality and may have an indirect impact on all-cause mortality.ConclusionsOur results and other evidence suggest that vaccination is most effective in flattening the epidemic curve and reducing mortality if supported by NPIs. In the short-term, focussing on high-risk groups may reduce the burden on the health system and result in fewer deaths. However, the herd effect from delaying another peak may only be achieved by greater vaccination coverage in high-incidence groups.

A Correction to this paper has been published: https://doi.org/10.1038/s41467-021-22038-x.