Group A strep infections climbing in Europe

News brief

At least five countries in Europe are reporting an increase in invasive group A Streptococcus (iGAS) disease and scarlet fever, according to a disease outbreak update today from the World Health Organization (WHO).

The WHO said that as of Dec 8, France, Ireland, the Netherlands, Sweden, and the United Kingdom have been observing an increase in iGAS cases stretching back to the spring in the Netherlands and summer months in the United Kingdom. Many of the cases have been in children under 10 years of age, and some have been fatal, with 13 deaths reported in England within 7 days of diagnosis.

Group A Streptococcus is most known for causing acute pharyngitis, also known as strep throat, but can also cause scarlet fever and other, more serious and life-threatening invasive infections. Transmission occurs through close contact with an infected person and is passed on through coughs, sneezes, or contact with a wound.

In all five countries, the number of iGAS cases reported in recent months has been higher than that observed during the same period in previous years.

Scarlet fever spikes in UK

Only France and the United Kingdom have reported scarlet fever cases, with the latter reporting 4,622 scarlet fever notifications from weeks 37 to 46 of the current season—more than three times the average number reported for the previous 5 years. UK health officials say several outbreaks have occurred in nurseries and schools.

The WHO says the increase could reflect an early group A Strep season coinciding with an increase in the circulation of other respiratory viruses. In response, enhanced surveillance has been implemented in the countries reporting iGAS increases, along with public health messages for the public and clinicians.

The WHO currently assesses the risk for the general population as low, with no observed increases in antibiotic resistance but says it will continue to closely monitor the epidemiologic situation throughout the European region.

Parents more open to child's COVID vaccination when given solid data

News brief

Parents in South Korea were three times more likely to have their child vaccinated against COVID-19 when they perceived the information they received on the vaccine to be sufficient and nearly eight times more likely to do so when they found the information credible, according to a study published yesterday in JAMA Network Open.

A team led by Seoul National University researchers surveyed 113,450 parents who had a child in grades 1 to 6 from Feb 7 to 10, 2022, 7 weeks before the COVID-19 vaccine rollout for children aged 5 to 11 years and during Omicron variant predominance. The team recruited parents through notices from their child's school. Median age of the 113,450 children was 10.1 years.

Clinicians' role in education

Only 6.5% of parents were willing to vaccinate their child as soon as possible. A total of 13.9% thought the vaccination information they received or accessed was sufficient, and 20.3% said it was credible.

Parents who thought the vaccination information they received was sufficient were 3.1 times more likely, and those who perceived the information to be credible were 7.6 times more likely, to say they would vaccinate their child against COVID-19 than those who found it insufficient or untrustworthy.

Higher levels of information sufficiency and credibility were tied to perceptions of greater vaccine safety (sufficiency, β=0.08; credibility, β=0.59) and effectiveness (sufficiency, β=0.05; credibility, β=0.60).

The researchers said that the results suggest "that communications and policies that provide sound information are essential to improve vaccination rates."

Perhaps vaccine hesitancy is not really hesitancy at all.

In a related commentary, Joanna Katzman, MD, MPH, of the University of New Mexico, and Ann Christiano, MPAP, of the University of Florida, said it's essential that healthcare providers be the main source of information about the vaccines, particularly new ones such as the COVID-19 vaccine.

"Perhaps vaccine hesitancy is not really hesitancy at all but the result of a lack of enough trained and trusted clinician messengers willing and able to patiently stay the course with their patients and families, listening without judgment to their fears and anxieties," they wrote.

Ebola vaccine strategies show safety and immune response

News brief

A pair of randomized, placebo-controlled clinical trials that examined three different Zaire Ebola vaccine strategies in four African nations found that all three prompted an antibody response at 14 days, persisting for 1 year in adults and children. An international group of researchers from the Partnership for Research on Ebola Vaccination (PREVAC) published their findings yesterday in the New England Journal of Medicine.

The trials began in 2017, enrolling 1,400 adults and 1,401 children in Guinea, Liberia, Sierra Leone, and Mali. The vaccine strategies tested were a dose of Johnson & Johnson Ad26.ZEBOV vaccine, with a booster dose of Bavarian Nordic's MVA-BN-Filo given 8 weeks later, two doses of Merck's VSV-EBOV given 8 weeks apart, or one dose of VSV-EBOV followed by a placebo injection 8 weeks later.

Antibody responses were seen by day 14 for all three strategies, which the team said is important, given that the vaccines are given in outbreak situations when rapid production of an antibody response is needed. However, so far, antibody correlates of protection aren't known. None of the volunteers got sick with Ebola during the trial, and researchers weren't able to assess protection.

No safety concerns were identified in the trial.

Second vaccine candidate heads for Uganda

Oxford University's Sudan Ebola vaccine candidate has been shipped to Uganda, just 80 days after the World Health Organization (WHO) declared an outbreak. The shipment includes more than 40,000 doses of the vaccine, which was made by the Serum Institute of India, the university said in a statement.

The Oxford vaccine is based on a modified chimpanzee adenovirus (ChAd1) vector platform. No vaccine has yet to be approved for the Sudan strain.

Ugandan officials and the WHO have prioritized three candidate Sudan Ebola vaccines for clinical trials in the outbreak area, however, a steep decline in cases will make evaluation difficult. The first doses—from the Sabin Vaccine Institute—arrived in the country last week.

Report describes mpox infections tied to tattoo parlor

News brief

Piercing or tattooing appears to be the vehicle that left 21 people infected with mpox virus (MPXV) after visiting the same tattoo parlor in Cadiz, Spain, during 2 weeks in July, according to a report yesterday in the New England Journal of Medicine.

From July 6 to July 19, the parlor served 58 customers, and 21 of them (36%) became infected with the virus. Of the mpox patients, 14 (67%) were female, and 9 (43%) were children. The median patient age was 26.

The first case was confirmed by polymerase chain reaction testing on July 19. The parlor was closed the next day after health authorities were notified. An outbreak probe revealed that 15 or 16 piercing- or tattoo-related items harbored MPXV. Contact tracing revealed a secondary case in one patient's mother. None of the tattoo parlor staff contracted the disease.

Clinical features were swollen lymph nodes a median of 7 days after piercing or tattooing. And around day 9, the patients started experiencing skin inflammation and rash. Fourteen patients had lesions spread to the trunk, head, and arms and legs.

Noting that much of mpox in the current outbreak has spread via male-to-male sexual contact, the authors conclude, "MPXV may develop new networks of transmission, with epidemiologic changes of the disease."

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