US hospital data show high death rate with Candida auris infections

News brief

An analysis of US hospitalizations linked to the multidrug-resistant fungal pathogen Candida auris found an estimated mortality rate of about one-third, researchers with the Centers for Disease Control and Prevention (CDC) reported yesterday in Emerging Infectious Diseases.

Using a large US hospital database, the CDC researchers reviewed 192 C auris–associated hospitalizations at 42 hospitals from 2017 through 2022, including 38 C auris bloodstream infections (20%). The hospitalizations occurred primarily among older adults (median age, 68 years) who were mostly male (54%) and non-Hispanic White patients (60%).

Underlying complications for patients with bloodstream and non-bloodstream C auris included sepsis (64%), diabetes (55%), chronic kidney disease (44%), and pneumonia (43%). Median hospitalization length was 13 days, and most hospitalizations (75.5%) involved an intensive care unit stay.

The in-hospital mortality rate was 21%, and discharge locations included hospice (13%), skilled nursing facility (28%), and long-term acute care (15%). The overall estimated crude mortality rate was 34% (47% for bloodstream infections and 31% for non-bloodstream infections).

These findings underscore the continued need for public health surveillance and C auris containment efforts.

The study authors say the findings support previous smaller studies showing that C auris infections occur most commonly in patients with complex medical conditions.

"These findings underscore the continued need for public health surveillance and C auris containment efforts," they wrote.

Recently published surveillance data from the CDC show that clinical C auris cases in the United States rose by 59% in 2020 and 95% and 2021, a spike that CDC officials say is partly linked to COVID-19 pandemic-related strains on the healthcare system.

Study shows pandemic tied to lower confidence in vaccines in sub-Saharan Africa

News brief

Stephanie Soucheray, MA

Man's arm with vaccine bandaid

Confidence in routine immunizations in eight sub-Saharan African countries has dropped during the past 2 years, along with the largest decline in vaccine uptake in the region in more than 30 years, according to new data published in Human Vaccines & Immunotherapeutics.

The study based vaccine confidence on 17,187 individual interviews conducted from 2020 to 2022 in the Democratic Republic of the Congo (DRC), Ivory Coast, Kenya, Niger, Nigeria, Senegal, South Africa, and Uganda. In addition to being queried on COVID-19 vaccines, participants were asked seven questions pertaining to vaccine confidence, including whether they agree with statements such as, "Vaccines are important for all ages," "Vaccines are important for children," and "Vaccines are safe."

The biggest declines in the belief "Vaccines are important for children" from 2020 to 2022 occurred in the DRC (20% decline), followed by Uganda (14%) and Nigeria (10.5%). Trust in the safety of COVID-19 vaccine did not fall during the study period, but in seven of the eight countries study participants said COVID-19 vaccines were less important in 2022 than in 2020.

Previously, declines in immunizations in Africa during the pandemic have been thought to be due to health service disruption. The interviews now also show that attitudes toward vaccines wavered.

'Worrying picture'

"Our study paints a worrying picture of declining vaccine confidence trends across many sub-national regions in sub-Saharan Africa, notably in the Democratic Republic of Congo, where confidence losses are particularly large," said lead author Alex De Figueiredo, PhD, a research fellow at the London School of Hygiene & Tropical Medicine, in a press release from Taylor & Francis Group, which publishes the journal.

Our study paints a worrying picture of declining vaccine confidence trends.

The authors said dropping vaccine uptake in sub-regions of African countries could lead to drops in herd immunity to a number of diseases.

Quick takes: FDA panel backs RSV preventive, Tpoxx trial enrollment, more polio cases

News brief

Lisa Schnirring

The US Food and Drug Administration (FDA) antimicrobial drugs advisory committee yesterday unanimously recommended approval of AstraZeneca and Sanofi's antibody treatment for preventing respiratory syncytial virus (RSV) in infants during their first RSV season. The committee also voted 19 to 2 to recommend the drug, called nirsevimab—given as a single-dose intramuscular injection—for children as old as 24 months who are at risk for RSV during the second season. If the FDA accepts the committee's recommendation, the drug will be available ahead of the United States' 2023-2024 RSV season, the company said in a statement.
Though tecovirimat (Tpoxx) has been used to treat mpox infections, including severe ones, its safety and efficacy haven't been fully fleshed out by clinical trials. To add more data, the National Institutes of Health has launched a study with a goal of enrolling more than 500 people worldwide. The Centers for Disease Control and Prevention (CDC) today in a Clinician Outreach and Communication Activity (COCA) email urged health providers to let mpox patients know that the drug is available through the trial and to encourage patients to participate.
Three countries reported new polio cases this week, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI). Afghanistan reported one more wild poliovirus type 1 (WPV1) case, bringing its total for the year to four, all in Nangarhar province. In Africa, the Democratic Republic of the Congo and Chad reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, lifting their totals for the year to 35 and 8, respectively.