News Scan for Dec 10, 2020

News brief

First US case of gonorrhea with resistance-conferring mutation identified

A paper today in Morbidity and Mortality Weekly Reports (MMWR) describes the first US case of Neisseria gonorrhoeae harboring a genetic element that confers resistance to a first-line antibiotic.

The N gonorrhoeae isolate, collected from an HIV-negative heterosexual man in Nevada, was identified by investigators from the Southern Nevada Health District (SNHD) in November 2019, when testing revealed reduced susceptibility to ceftriaxone and cefixime, but not to azithromycin. An intramuscular shot of ceftriaxone and an oral dose of azithromycin is the current recommended regimen for gonorrhea.

Molecular testing of the isolate by the Centers for Disease Control and Prevention (CDC) revealed the emerging mosaic penA60 allele, which was first identified in Japan in 2016 and confers resistance to cephalosporins and increases the risk of treatment failure. Despite the reduced susceptibility to ceftriaxone, the patient reported at the end of November 2019 that his symptoms had resolved, and further testing returned negative results.

The CDC subsequently tested 257 N gonorrhoeae isolates collected from the Southern Nevada area by SNHD from September 2019 through November 2019 to look for the presence of the penA60 allele but found no additional isolates carrying it. Additional testing of 5,500 gonococcal isolates from the Gonococcal Isolate Surveillance Project (GISP) found none with reduced susceptibility to ceftriaxone or cefixime. The investigation was stopped in February.

The origin of the isolate remains unclear, the investigators said.

"This case highlights the utility and importance of surveillance programs like GISP as effective tools in identifying emerging antimicrobial-resistant pathogens that can negatively impact patient outcomes and threaten public health," they wrote.
Dec 10 MMWR Notes from the Field


Novel vaccines show good immune response against mutated polio strain

Data published yesterday in The Lancet demonstrate safety and a good immune response against a mutated (novel) poliovirus strain in adults and young children for two novel poliovirus type 2 vaccines (nOPV2-c1 and nOPV2-c2) that received an emergency use listing recommendation from the World Health Organization (WHO) last month.

The phase 2 trials compared the two vaccines to the monovalent oral polio vaccine (mOPV2) that was discontinued in 2016 over cases of circulating vaccine-derived poliovirus. The novel poliovirus strain targeted by the vaccine has been linked to the oral polio vaccine and threatens eradication, according to a Lancet news release.

The researchers recruited 200 healthy adults 18 to 50 years old in Belgium to receive dosages of the nOPV2 candidates either orally or as inactivated poliovirus vaccine (IPV), and in Panama, 100 children 1 to 4 years old as well as 574 infants 18 to 22 weeks old received the novel vaccines at varying dosages. Placebo controls were included in all trials, and the mOPV2 data were taken from 2016 trials.

By day 56 in the new trials, nOPV2 vaccine candidates all produced 100% seroprotection in children and 98% to 100% seroprotection in adults for oral vaccine or IPV, respectively. Infants had 98% seroprotection for either low-dose nOPV vaccine, the same level as the mOPV2 control group, and high doses of the nOPV vaccine candidates produced 100% seroprotection.

Because all study participants were immunized against polio previously, seroconversion was not always measurable. Still, after day 56, only the low-dose nOPV2-c2 infant group did not meet or exceed the 97% seroconversion rate that the infants who received mOPV2 had. The nOPV2 vaccine candidates produced 100% seroconversion for 40 children, whereas, among the 9 children who received mOPV2, only 6 seroconverted. Adults who received mOPV2 had 38% seroconversion, while those who received nOPV2 candidates had seroconversion rates ranging from 58% (nOPV2-c2 oral) to 82% (nOPV2-c2 IVP).

"For noPV2 candidates, [genetic] sequencing results remain promising and consistent with phase 1 study with no reverting modifications of the genetically stabilised domain V detected in any samples from any cohorts, while Sabin-2 reversino in domain V is common at day 7 after vaccination and beyond," add the researchers in the adult study.
Dec 9 The Lancet child/infant nOPV2 study
Dec 9 The Lancet
adult nOPV2 study
Dec 9 Lancet
press release
Dec 9 The Lancet


Global flu activity mainly sporadic, with both A and B circulating

The world's flu activity stayed at lower-than-expected levels, likely due to the impacts of COVID-19, though some countries reported sporadic or low-level activity, the WHO said in its latest update.

Caribbean and Central American countries reported sporadic influenza B, and some West African countries, including Burkina Faso and Ivory Coast, reported cocirculation of H3N2 and influenza B. In South Asia, India reported sporadic H3N2 and Afghanistan reported sporadic influenza B.

Southeast Asian countries continue to report mainly H3N2 at varying levels, decreasing in Cambodia, increasing in Laos, and remaining sporadic in Thailand.

Globally, of 192,375 samples tested at WHO-affiliated labs during roughly the first half of November, only 327 were positive for flu. Half were influenza A and half were influenza B. Of the subtyped influenza A samples, 80% were H3N2.
Dec 7 WHO global flu update

COVID-19 Scan for Dec 10, 2020

News brief

Study spotlights high COVID-19 death rate for US native populations

Data published today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report (MMWR) show nearly double the COVID-19 mortality rate among people of American Indian and Alaska Native (AI/AN) ethnicity compared with whites.

AI/AN populations suffered disproportionate mortality during the 2009 H1N1 flu pandemic, leading to concerns about a similar trend during COVID-19. The CDC has reported 2,689 COVID-19–associated deaths among non-Hispanic AI/AN people in the United States as of Dec 2, and an earlier MMWR study found more than three times the incidence of COVID-19 among AI/AN individuals compared to whites.

Researchers with the CDC, the Indian Health Service, and 14 state health departments—representing approximately 46.5% of the US AI/AN population—collected state health department data on COVID-19 cases and associated deaths in the AI/AN population. AI/AN race was defined as AI/AN either alone or in any racial/ethnic combination, while White race was defined as non-Hispanic White only.

The 14 states reported 1,134 deaths (55% men) among AI/AN populations from Jan 1 to Jun 30. The researchers found an age-adjusted mortality rate of 55.8 deaths per 100,000 for AI/AN people (95% confidence interval [CI], 52.5 to 59.3)—1.8 times that for whites (30.3 deaths per 100,000, 95% CI, 29.9 to 30.7).

The age of AI/AN people who died from COVID-19 was younger than that of whites—35.1% of AI/AN deaths were among people younger than age 60, compared with 6.3% of deaths among White people. Mortality rates among AI/AN young adults 20 to 29, 30 to 39, and 40 to 49 years of age were 10.5, 11.6, and 8.2 times higher than in whites in those age-groups.

The authors concluded, "Long-standing inequities in public funding; infrastructure; and access to health care, education, stable housing, healthy foods, and insurance coverage have contributed to health disparities (including higher prevalences of smoking, obesity, diabetes, and cardiovascular disease) that put indigenous peoples at higher risk for severe COVID-19–associated illness."
Dec 11 MMWR study


Most US parents agree about school reopening, with high concern levels

In a July survey of 858 parents with children in primary or secondary school, 84.9% were worried about education quality during the COVID-19 pandemic, with no significant differences across race, but non-white parents were more concerned about transmission-related issues if schools were to reopen in the fall, a separate MMWR report today finds.

CDC researchers found that 56.5% of parents at least somewhat agreed schools should open in the fall, with the most amount of agreement coming from white parents (62.3%) and the least from black parents (46.0%). Similarly, 67.6% of white parents said the experience of being in school was more important than COVID-related risks, whereas 53.9% of Hispanics, 53.4% of other races, and 56.5% of blacks felt this way.

Overall, 86.3% of parents were concerned about their child bringing home COVID-19 as a result of attending school, with 84.5% of white parents representing the least concerned subgroup and 92.7% of black parents representing the most concerned group. Parents of other racial backgrounds were the most concerned about student compliance with COVID mitigations (96.9%), followed by black parents (91.9%), white parents (85.6%), and then Hispanic parents (80.6%).

"Understanding racial/ethnic differences in parental attitudes and concerns about school reopening can inform communication and mitigation strategies and highlights the importance of considering risks for severe COVID-19 and family resource needs when developing options for school attendance during the COVID-19 pandemic," write the researchers. "The current school year is well underway; however, these findings remain relevant as the pandemic evolves and families and school districts continue to weigh the risks and benefits of in-person versus virtual instruction."

The authors caution against generalizing the results, adding that limitations include shifting opinions and the unknown variability of how parents with multiple children evaluated concerns that may have applied to one child more than another.
Dec 11 MMWR report

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