Immunosuppressed patient populations, including cancer patients and those with HIV, have different rates of excess mortality attributed to COVID-19, according to an analysis of 99 studies published in the Journal of Infection.

The study, which attempted to standardize a method for categorizing the immunosuppressed as a clinical risk group, found that solid-organ transplant recipients and patients undergoing cancer treatment had a higher risk of mortality than COVID-19 patients with healthy immune systems.

The 99 studies included in the analysis were published between 2020 and 2022 and included 1,542,097 and 56,248,181 unique immunosuppressed and immunocompetent patients with COVID-19 infection, respectively.

Solid-organ transplant patients most at risk

The odds ratio (OR) for mortality for solid-organ transplant recipients compared to immunocompetent patients was 2.12 (95% confidence interval [CI], 1.50 to 2.99) and was 2.02 (95% CI, 1.69 to 2.42) for cancer patients.

People with rheumatologic autoimmune diseases and HIV had an only slightly elevated mortality risk compared to immunocompetent patients (ORs, 1.28 and 1.20, respectively).

The authors said the findings, "may prove beneficial for prioritising scarce medical resources including booster vaccine doses, novel therapeutics and passive forms of immunisation such as convalescent plasma and monoclonal antibody transfusion."

A cluster of nontuberculous mycobacteria (NTM) skin infections across nine states has been linked to cosmetic surgery procedures and gaps in infection control at a clinic in Florida, researchers with the Centers for Disease Control and Prevention (CDC) and the Florida Department of Health (FDOH) reported last week in Morbidity and Mortality Weekly Report.

After a non-Florida resident was identified with an NTM infection following a cosmetic procedure at a south Florida surgical clinic in February 2023, the CDC and FDOH issued a national Epidemic Information Exchange notice in March 2023 to identify additional cases. The subsequent investigation identified an additional 15 NTM infections in patients from nine states who underwent procedures at the same clinic (clinic A). An additional four patients experienced signs and symptoms of post-surgical infection but lacked confirmatory lab results.

The infections were caused by Mycbobacterium abscessus, a multidrug-resistant NTM known to cause skin and soft-tissue infections following cosmetic procedures. The 15 case-patients were all women in their early 30s whose symptoms began a median of 69 days after the procedure. Treatment required prolonged courses of oral and intravenous antibiotics.

Gaps in infection control

Clinic A was shut down, and although the source of the initial NTM infection was not identified, an infection control assessment at clinic B—which had the same surgeon, staff, and protocols as clinic A—by FDOH detected gaps in environmental cleaning practices, use of personal protective equipment, and surgical device disinfection.

"FDOH will use these findings to develop additional training for cosmetic surgery clinic staff members statewide to help prevent future outbreaks in this setting," the authors wrote, adding that healthcare providers should be on the lookout for extrapulmonary NTM when evaluating patients for postsurgical infection after cosmetic procedures.

The Wyoming Game and Fish Department (WGFD) reports that chronic wasting disease (CWD) has been identified in a buck mule deer in Deer Hunt Area 90 for the first time.

In a news release, WGFD said yesterday that the CWD case was confirmed in December.

Deer Hunt Area 90 is in the Lander region and borders Deer Hunt Areas 36, 89, 97, 157, and 160, all of which have had CWD cases.

CWD is a fatal neurodegenerative disease caused by infectious misfolded proteins called prions. While CWD is not yet known to infect humans, the Centers for Disease Control and Prevention advises hunters to not consume meat from any animal that is obviously ill or tests positive for the disease.

• The European Medicines Agency is reviewing GSK's respiratory syncytial virus (RSV) vaccine Arexvy for use in adults ages 50 to 59 who are at increased risk of complications from the disease. In a statement, GSK said its submission follows positive phase 3 trial findings that evaluated the vaccine in the expanded age-group. Arexvy is already approved in multiple countries for use in adults ages 60 and older. In December, Japan's health ministry accepted the company's submission for expanded use in adults ages 50 to 59.
• The Pan American Health Organization (PAHO) yesterday issued an epidemiologic alert for measles, warning about ongoing challenges with suboptimal vaccine coverage, a global increase in cases, and recent reports of imported cases in Americas region countries. According to World Health Organization (WHO) data, measles cases globally in 2023 rose 64% over the previous year. Nations in the Americas that have reported cases already this year, mostly imported, include Argentina, Brazil, Costa Rica, the United States, and Peru.
• Zimbabwe has been battling a cholera outbreak since February 2023, and yesterday the country launched a cholera vaccine campaign with a goal of immunizing 2 million people, according to a media report. The health ministry will receive a total of 2.3 million oral cholera vaccine doses from the WHO and UNICEF and has already more than 892,000 doses. The campaign will focus on 29 of Zimbabwe's hardest-hit districts.