Demographics, underlying conditions tied to worse COVID in health workers

Today's Morbidity and Mortality Weekly Report (MMWR) provides updated information from voluntary reports on 100,570 healthcare personnel (HCP) with COVID-19 from February to July that shows variations in risk, including higher death rates in minority workers.

The authors analyzed data from standardized case report forms containing HCP demographic characteristics, including newly reported occupation type and job setting, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions and deaths.

The number of HCP with COVID-19 increased tenfold since first described in April, with 641 deaths. Demographic factors and preexisting conditions were predictive of poorer outcomes. Infected HCP who were older, male, Asian, or black—or had one or more underlying medical conditions—had higher death rates. 

"Long-standing inequities in social determinants of health can result in some groups being at increased risk for illness and death from COVID-19, and these factors must also be recognized and addressed when protecting essential workers in the workplace, at home, and in the community," the report states. 

The most commonly reported job settings for HCP COVID-19 cases were nursing homes and residential care facilities—67% of cases with reported job settings—with nurses representing the most common occupation—30% of cases with known occupation type.

The report does not identify the source of HCP exposure or infection but highlights the critical need for continued surveillance of HCP environments, personal protective equipment access and training, universal use of masks in work and community settings, and observing physical distancing guidelines to minimize the risk to HCPs and patients.
Sep 25 MMWR report

COVID-19 during pregnancy not associated with complications in infants

A Swedish study of pregnant COVID-19 patients giving birth at Karolinska University Hospital in Stockholm from Mar 25 to Jul 24 found a higher likelihood of labor complications, but no significant differences in outcomes in newborns compared with COVID-19–negative women.

Published in JAMA this week, the study tested women in labor using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs to identify COVID-19–positive patients. Among 2,682 women, 156 (5.8%) were SARS-CoV-2 positive and 65% of those who tested positive were asymptomatic—meaning they had no symptoms compatible with COVID-19.

COVID-19–positive laboring women were more likely to experience preeclampsia—a serious labor complication characterized by high blood pressure and protein in the urine—and less likely to undergo labor induction for reasons that are yet unclear. Lead author Mia Ahlberg, RNM, PhD, of Karolinska said in a university news release, "One possible reason for the latter is that both preeclampsia and COVID-19 impact several organs and can present similar symptoms."

No significant differences were noted for other maternal outcomes (mode of delivery, postpartum hemorrhage, and preterm birth) between COVID-19–positive and –negative groups. Neonatal outcomes, including 5-minute Apgar scores, birth weight for gestational age, prevalence of birth defects, and stillborn births, did not differ significantly between the groups.

The study authors write, "In light of other accumulating data, it is already clear that COVID-19 is less severe in pregnancy than the 2 previous coronavirus infections: severe acute respiratory syndrome–related coronavirus (SARS) and Middle East respiratory syndrome–related coronavirus (MERS). Nevertheless, there are reports of pregnant persons requiring critical care, and there have been other reports of both mother and infant deaths in association with COVID-19."

While encouraging, the study was limited by the number of laboring women presenting with COVID-19 symptoms, which restricts the ability to generalize to larger populations and different locations.

Ahlberg says, "Larger studies should be conducted to be able to identify if women with symptoms and different degrees of symptoms constitute a risk group for adverse outcomes such as preterm birth."
Sep 23 JAMA study
Sep 23 Karolinska Institutet news release

Children, adolescents less susceptible to COVID-19, meta-analysis finds

A systemic review and meta-analysis in JAMA Pediatrics today found that children and adolescents have a significantly lower susceptibility to COVID-19 than adults do. Previous studies have reached similar conclusions, but this study pools data from 32 studies to get a clearer overall picture.

Children and adolescents younger than 20 years were nearly half as likely to be infected than adults (odds ratio, 0.56; 95% confidence interval, 0.37 to 0.85) in the review of studies that involved contact tracing or population screening through Jul 28 and included a total of 41,640 children and adolescents and 268,945 adults. The decreased risk of infection was most pronounced in children younger than 10 to 14 years, "with adolescents appearing to have similar susceptibility to adults," the study authors write.

Infection and transmission rates in children have important implications for public health decisions regarding lockdowns and school closures. While available studies show evidence of transmission of SARS-CoV-2, the virus that causes, COVID-19, from children to other age-groups, the review contained relatively few data on transmission and was unable to elucidate a clear role.

The authors conclude, "Preliminary evidence suggests that children have a lower susceptibility to SARS-CoV-2 infection compared with adults, but the role that children and adolescents play in transmission of this virus remains unclear."

In a commentary in the same publication, Saul Faust, MD, writes, "In spite of everything we have known and understood about respiratory viral infections to date, it does now appear that children overall are relatively less susceptible to becoming infected as well [as] having less severe infection itself. How infectious children are once they have acquired the SARS-CoV-2 virus remains unclear. Studies have confirmed children carry viable virus in their nasopharynx, so children are almost certainly infectious."

Faust advocates for prioritizing the needs of children and young people in policy decisions around reopening of society, including ongoing studies of the role of transmission in schools, and making data-driven decisions that avoid politicization and take local community data, resources, and specific community needs into account.
Sep 25 JAMA Pediatrics study and commentary

Salmonella outbreak tied to dried mushrooms sickens 41 in 10 states

The US Centers for Disease Control and Prevention (CDC) yesterday announced a Salmonella Stanley outbreak linked to dried mushrooms in dishes served at ramen restaurants that has so far sickened 41 people in 10 states.

Illnesses began on Jan 21, with Aug 26 as the latest illness onset. Patient ages range from 2 to 74 years, and 62% of the patients are female. Of 32 cases with information available, 4 hospitalizations were reported. Health officials are using PulseNet, the national genetic subtyping network, to look for other cases. Tests on 26 samples from patients by the National Antimicrobial Resistance Monitoring System did not demonstrate any antibiotic resistance.

Epidemiologic and trace-back investigations suggest that wood ear mushrooms distributed by Wismettac Asian Foods, of Santa Fe Springs, California, sold only to restaurants, is the likely source of the outbreak. Interviews with 18 sick people found that 16 ate ramen at a restaurant in the weeks before their symptoms began, several from the same restaurants, a sign that they may be part of illness clusters.

Eight of the nine patients in the clusters reported eating wood ear mushrooms or ramen containing the item the week before they got sick. A review of records showed that Wismettac Asian Foods is the source of the mushrooms.

The California Department of Public Health tested the company's dried fungus from one of the restaurants and found Salmonella, and whole-genome sequencing is under way to see if the sample matches the strain that made patients sick.

Yesterday Wismettac recalled all Shirakiku imported dried fungus. It said the product was distributed to 31 states, Washington, DC, and British Columbia. The label on the package says the mushrooms are a product of China.
Sep 24 CDC outbreak notice
Sep 23 FDA recall notice

Report shows decline in Australian antibiotic use

A report this week from Australian health officials shows a consistent decline in the country's antibiotic use.

The report from the Australian Commission on Safety and Quality in Health Care looked at antibiotic prescriptions dispensed in all states and territories in the country from 2013-14 through 2017-18, with additional analysis of prescriptions for amoxicillin and amoxicillin-clavulanate. The results showed a downward trend in the number of prescriptions, the rate of prescriptions dispensed, and the volume of antibiotic use (number of defined daily doses dispensed per 1,000 people per day) compared with 2013-14.

Overall, 28.2 million prescriptions for antibiotics were dispensed in 2017-18, with a rate of 122,892 prescriptions per 100,000 people. That compares with 30.3 million prescriptions, and a rate of 126,864 prescriptions per 100,000 people, in 2013-14. Those trends were also observed for amoxicillin and amoxicillin-clavulanate, the second and third most prescribed antibiotics in Australia.

However, the report also notes that the volume of antibiotic use in 2017-18 (22.7 defined daily doses of antibiotics dispensed per 1,000 people per day) is more than twice the volume reported in the Netherlands (8.9) and Sweden (10.8), two countries with similar demographic profiles and standards of healthcare. In addition, socioeconomically disadvantaged areas of the country had higher antibiotic dispensing rates.

The authors of the report say that, to further optimize antibiotic prescribing in the country, efforts to educate the public and clinicians about appropriate antibiotic use need to continue.
Sep 23 Australian antibiotic dispensing report

Also this week, an organization representing Australian pharmaceutical and biotech companies announced the creation of the Australian Antimicrobial Resistance Network (AAMRNet).

The creation of AAMRNet was among the recommendations in a new "Fighting Superbugs" report from MTPConnect that came out of a meeting of stakeholders from the health, medical research, pharmaceutical, and government sectors held in November 2019 to develop an agenda for addressing AMR. Other recommendations from the report included the development of a national AMR research agenda, adoption of AMR-specific streamlined pathways for drug development, and creation of new regulatory incentives and reimbursement models to spur antibiotic development.
Sep 24 MTPConnect Fighting Superbugs report

Five nations report more polio; South Sudan has first vaccine-derived cases

Five countries reported more polio cases this week, two in the Middle East and three in Africa, including the first vaccine-derived cases in South Sudan, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

In the Middle East, Afghanistan reported 1 new wild poliovirus type 1 (WPV1) case, which involves a patient from Kandahar province, raising its total for the year to 47. It also reported 1 new circulating vaccine-derived poliovirus type 2 (cVDPV2) case in Kunar province, lifting that total for the year to 79. Pakistan reported 3 more WPV1 cases, 2 in Balochistan province and 1 in Punjab province, bringing its total for the year to 73. The country also reported 2 cVDPV2 cases in Sindh province, putting that total at 61 for 2020.

In Africa, Chad reported 3 cVDPV2 cases—2 in Logone Oriental province and 1 in Mayo Kebbi East province—raising its total so far this year to 66 from two different outbreaks. Guinea also reported 3 cVDPV2 cases, 2 in Kankan and 1 in N'zerekore, making 11 cases this year. And finally, South Sudan reported 3 cVDPV2 cases, its first such cases, 1 in Warrap province and the other 2 in Western Bahr El Ghazal province, which health officials have linked to Chad's outbreak.
Sep 24 GPEI weekly report