Study finds high rates of MIS-C in Latin American children

A Latin American study of children with COVID-19–related multisystem inflammatory syndrome (MIS-C) in The Pediatric Infectious Disease Journal found higher rates of the disease among Latin/Hispanic children compared with other global estimates.

The multicenter study evaluated 95 children (median age 7 years) diagnosed with MIS-C, a severe complication of COVID-19, from Jul 1 to Aug 11 in five Latin American countries—Mexico, Colombia, Peru, Costa Rica, and Brazil. Socioeconomic status was classified in a range from "very low status"—children from households earning less than each nation's minimum wage—to "high status" for children from families earning more than 16 times the minimum wage.  

Of a total of 409 children infected with SARS-CoV-2, the virus that causes COVID-19, 23% fulfilled the criteria for MIS-C. The death rate for Latin American children with MIS-C was significantly higher than that reported in a European study (4.2% vs 0.68%), suggesting that SARS-CoV-2 may have a stronger impact on children in Latin America. Low socioeconomic status was significantly associated with greater need for pediatric intensive care unit (PICU) admission (P < 0.009) and mechanical ventilation (P < 0.04).

"The higher number of severe disease and deaths reported in our series, however, is not completely unexpected, since acute COVID-19 has been reported to disproportionately affect Hispanics and Blacks," the study authors wrote. They note that the study provides further evidence of the unequal impact of COVID-19 on vulnerable people, including children.

"Long-standing inequities in the social determinants of health, such as housing, economic instability, insurance status, and work circumstances of patients and their family members have systematically placed social, racial, and ethnic minority populations at higher risk for COVID-19 and more severe illness, and our data further support this view," the study authors concluded.
Jan 2021 Pediatr Infect Dis J study

COVID-19 causes more severe disease, death rate 3 times higher than flu

A French study yesterday in The Lancet Respiratory Medicine confirms that COVID-19 causes more severe disease than seasonal influenza, with a death rate three times higher than flu, after two studies earlier this week provided similar results.

Flu epidemics have been used as a model for the COVID-19 pandemic, but data are accumulating—including a recent US Veterans Administration Health System study—showing longer hospital stays, a higher risk of complications, and up to five times the risk of death for COVID-19.

Researchers compared 89,530 patients hospitalized with COVID-19 from Mar 1 to Apr 31 with 45,819 patients hospitalized with flu from Dec 1, 2018, to Feb 29, 2019. COVID-19 resulted in nearly twice as many hospital admissions as influenza at the peak of the 2018-19 flu season—the worst French flu season for deaths in the past 5 years.

The death rate for COVID-19 patients was almost three times higher than that for flu (16.9% vs 5.8%). More COVID-19 patients required intensive care unit (ICU) admission (16.3% vs 10.8%) and ICU stays were nearly twice as long as those for flu patients (15 days vs 8 days). COVID-19 patients were also more likely to require invasive mechanical ventilation (9.7% vs 4.0%) and experience acute respiratory failure (27.2% vs 17.4%).

"Taken together, our findings clearly indicate that COVID-19 is much more serious than seasonal influenza," said co-lead researcher Pascale Tubert-Bitter, PhD, in a Lancet news release.  

The authors suggest that existing immunity to flu from previous exposure or vaccination could explain some of the observed differences, noting that very few people would be expected to have any immunity to the novel coronavirus that causes COVID-19.

"The large sample size is an important strength of the study and it is assumed that the indication for hospital admission in the two periods were the same and thus does not bias the results," Eskild Petersen, MD, wrote in a linked commentary. "The results clearly demonstrate that COVID-19 was more serious than seasonal influenza."
Dec 17 Lancet Respir Med study
Dec 17 Lancet Respir Med commentary
Dec 17 Lancet news release
Dec 16 CIDRAP news story on 2 recent similar studies

Afghanistan, African nations report more vaccine-derived polio cases

Five countries across Asia and Africa report new circulating vaccine-derived poliovirus type 2 (cVDPV2), according to Global Polio Eradication Initiative's weekly report.

In Afghanistan, 54 cases of cVDPV2 were reported across 12 provinces, with the most in Kandahar (19), Hilmand (14), and Uruzgan, Wardak, Zabul (each with 4). This brings the 2020 total to 214. Nearby in Pakistan, no new polio cases have been identified, but three wild poliovirus type 1 (WPV1) and two cVDPV2 positive environmental samples have been confirmed.

The Chad polio outbreak in Africa had two new cVDPV2 cases in Logone Oriental, and the risk of further cases across the Lake Chad subregion remains high. The multiple outbreaks occurring in Chad have been associated with new cVPDV2 cases in South Sudan (6) and Sudan (2) as well .

Also in Africa, the Democratic Republic of the Congo's Maindombe province and Nigeria's Zamfara province each had two new cVDPV2 cases, with Nigeria also finding one positive environmental sample of cVDPV2 in Lagos province.
Dec 16 GPEI report

UK health agency selects antibiotics for subscription payment model

England's National Health Service (NHS) announced today that it has selected the first antibiotics to be purchased through the United Kingdom's subscription-style payment model.

In collaboration with the National Institute for Health and Care Excellence (NICE) and the Department of Health and Social Care, NHS England selected the novel cephalosporin antibiotic cefiderocol, licensed for treating gram-negative bacterial infections in patients with limited options, and the beta-lactam/beta-lactamase inhibitor combination ceftazidime-avibactam, licensed for treating a number of infections, including pneumonia, intra-abdominal, and urinary tract infections.

Cefiderocol is manufactured by Shionogi and ceftazidime-avibactam by Pfizer. Over the next 12 months, NICE will evaluate the antibiotics to determine the annual subscription price the companies will receive.

The pilot program was launched by the NHS in 2019 to test a new model for paying for antibiotics that is based on their public health value. Under the program, NHS will pay companies on an annual basis for access to effective antibiotics, rather than reimbursing them based on the quantity of antibiotics sold. The aim of the payment model is to provide antibiotic developers with a predictable revenue stream and incentivize further investment in antibiotic development, while also promoting appropriate antibiotic use.

"Today is an important step in demonstrating that this payment model can be a 'win, win' for health systems and industry—NHS patients will be able to benefit from a secure supply of new antimicrobial drugs, while pharmaceutical companies will be able to reliably forecast their return on investment," project leads Mark Perkins and David Glover of NHS England wrote in a blog post.

NHS says the antibiotics will be made available to patients through the subscription model by early 2022.
Dec 18 NHS blog post

Swine H1N1 variant flu infects Dutch farmer

The Netherlands recently reported a variant H1N1 (H1N1v) case from 2019 involving a farmer who became sick after exposure to pigs, according to the latest zoonotic flu update from the World Health Organization (WHO).

The 43-year-old man began having symptoms on Sep 25, 2019, after which samples were collected from another symptomatic farm worker and symptomatic pigs. Influenza A was detected in samples from the farmer and the pigs, and further analysis found that the virus was related to avian-like H1N1 swine influenza viruses. Genomes from the farmer and the pigs were nearly identical.

The farmer saw his regular doctor and recovered after pneumonia treatment. The investigation found that he had no history of recent travel, didn't visit any trade fairs, and had not brought in new animals. Two of his contacts had flulike symptoms, but were not tested.

WHO's report also covered four other zoonotic flu cases that have already been publicly reported between Oct 24 and Dec 9 of this year: an H5N1 case from Laos, H9N2 and H5N6 cases from China, and an H1N2v case from Canada.
Dec 9 WHO zoonotic flu update