News Scan for Jun 04, 2020

News brief

WHO posts plan on drinking water, hygiene, wastewater to curb AMR

The World Health Organization (WHO) this week published a technical brief on water, sanitation, hygiene (WASH), and wastewater management to prevent infections and curb the spread of antimicrobial resistance (AMR).

The Global Action Plan to Combat AMR has identified WASH and wastewater management as crucial elements in the battle against AMR spread, but key participants and actions haven't been well represented in stakeholder platforms and national action plans, the WHO said.

The 32-page technical summary was compiled by the WHO, United National (UN) Food and Agriculture Organization (FAO), and World Organization for Animal Health (OIE), all UN agencies. It lays out the evidence and rationale within AMR national action plans and highlights sector-specific policies to fight AMR.

Evidence and suggested actions are grouped under six domains: coordination and leadership, households and communities, healthcare facilities, animal and plant production, manufacturing of antimicrobials, and surveillance and research.
Jun 1 WHO technical brief

Report: Wedding transmission fueled multistate mumps outbreak

A mumps outbreak that sickened 62 people in six states last year was triggered by transmission at a wedding in Nebraska attended by a fully vaccinated guest who had an asymptomatic infection, investigators from the US Centers for Disease Control and Prevention (CDC), Nebraska, and South Dakota reported today in Morbidity and Mortality Weekly Report (MMWR).

The 25-year-old index patient from Nebraska contracted the virus after taking care of a sick child who had returned from a vacation to Florida and Antigua. The patient's symptoms began a day after the wedding, which was attended by about 325 people from multiple states.

After the index patient's illness was found, health officials launched an investigation and identified 31 cases linked to wedding exposure. They also found 27 tertiary cases and 3 quaternary cases. Most (54) of the patients were from Nebraska, but five other states had patients: South Dakota, North Dakota, Minnesota, Idaho, and Wyoming. Two thirds of the patients had received two or more doses of measles, mumps, and rubella (MMR) vaccine.

Isolation and an MMR vaccine campaign helped end the outbreak. The authors noted that mumps is most infectious just before and during onset of parotitis (inflammation of the parotid gland) and that the timing of the wedding exposure probably contributed to transmission, with the event a conducive environment for droplet transmission, given close social interactions. Also, waning vaccine immunity probably contributed to the outbreak, they added.
Jun 4 MMWR report

COVID-19 Scan for Jun 04, 2020

News brief

Study: COVID-19 rate in US pediatric surgical patients low but varies by region

A study published today in JAMA Surgery has found a 0.93% overall incidence of COVID-19 among pediatric patients undergoing urgent surgery in three US hospitals, but with wide regional variations.

Overall, 1,295 patients younger than 19 years were tested for the novel coronavirus as part of universal preoperative screening at Children's Hospital of Philadelphia, Texas Children's Hospital in Houston, and Seattle Children's Hospital from Mar 26 to Apr 22.

Twelve of 1,295 (0.93%) tested positive, but the incidence ranged from 1 of 456 (0.22%) in Houston to 9 of 339 (2.65%) in Philadelphia. Incidence in Seattle was 2 of 500 (0.40%).

Mean age of all surgical patients was 7 years. The authors noted that five of the nine coronavirus-positive patients in Philadelphia were from a single township with a positive risk rate of 55.6%, versus 1.5% (5 of 330) in all other patients (risk ratio, 36.7; P = .001).

Of the 12 total patients with COVID-19, 6 had preoperative symptoms; 3 had fever, and 2 had nasal discharge. Because reported symptoms could have been attributed to unrelated conditions (eg, appendicitis), and many children are asymptomatic or only mildly ill, symptoms are unreliable indicators of infection, the authors said.

Accordingly, of 41 pediatric hospitals responding to a recent Pediatric Anesthesia Leadership Council survey, 56% reported implementing universal preoperative screening, they noted.

"The value of universal screening is greatest in areas with higher prevalence," the authors wrote. "As elective surgery resumes across the country, it is important to consider universal testing in the context of regional prevalence, local testing capability, and availability of personal protective equipment."
Jun 4 JAMA Surg research letter

Researchers: N95 respirators can be decontaminated successfully

A research letter yesterday in Emerging Infectious Diseases describes four methods of decontaminating N95 respirators and finds that, while all can be effective, the integrity of respirator fit and seal must be maintained.

Healthcare workers around the world rely on N95 respirators to protect themselves from aerosolized pathogens, and typically the respirators are discarded after a single use. But the COVID-19 pandemic has caused massive shortages and forced clinics and hospitals to reuse N95s for entire shifts. Decontaminating the respirators before reuse has become a new area of interest.

The authors looked at four methods to decontaminate N95s: ultraviolet (UV) light (260 to 285 nm), 70ºC (158ºF) dry heat, 70% ethanol, and vaporized hydrogen peroxide (VHP). For each decontamination method, the authors compared the normal inactivation rate of SARS-CoV-2 virus on N95 filter fabric to that on stainless steel. They also measured the filtration performance of N95 respirators after each decontamination run and 2 hours of wear, for 3 consecutive decontamination and wear sessions.

After a single decontamination method, filtration performance was not reduced. But, they write, "Subsequent rounds of decontamination caused sharp drops in filtration performance of the ethanol-treated masks and, to a slightly lesser degree, the heat-treated masks." They add, "Our results indicate that, in times of shortage, N95 respirators can be decontaminated and reused up to 3 times by using UV light and [VHP] and 1–2 times by using dry heat."
Jun 3 Emerg Infect Dis study